The Code Stroke: medical evaluation by a pre-hospital attention service

In 1996, the NINDS (National Institute of Neurological Disorders and Treatment of Acute Stroke) published targets for the management of patients with acute cerebrovascular events, setting a time of 3 h or less for administration of thrombolytics, creating the Code Stroke. Objective: Evaluate the time between onset of symptoms and arrival at the emergency department of a hospital as prognostic factors in patients with cerebrovascular events attended by the prehospital emergency medical service in the metropolitan area of Monterrey, Nuevo Leon. Materials and methods: Calls received in the ED (EMME) between January and December 2012 were included in a retrospective cross-sectional study, with symptoms showing within the first 8 h or with an unknown onset. The Mann---Whitney test and Fisher’s exact test were used. Results: Thirty-six patients were included in the study. In 21, the final diagnosis was cerebral infarction, 5 patients were treated with thrombolysis (23.8%). They were divided into two groups: group 1 died or were left with severe neurological sequelae (n = 9) and Group 2 survived without sequelae or mild neurological sequelae (n = 12). The door hospital arrival time was 67 (29---116) min (Group 1) versus 54 (24---86) min (Group 2) (p = 0.110). The neurological status at the start of the event affected prognosis and mortality (p = 0.018). Conclusions: There are few studies analyzing the time between the inception of the symptomatology and the arrival to the emergency room. In our study 23.8% of this series were thrombolyzed, which puts us in the range of international statistics, compared to the series published by Geffner-Sclarsky et al. The population of this study is small so it is not able to show statistical differences, but the few studies that evaluate the Code Stroke in Mexico open the doors to future work with a larger population in Latin American society

The Effect of Stellar Rotation on Colour-Magnitude Diagrams: On the apparent presence of multiple populations in intermediate age stellar clusters

A significant number of intermediate age clusters (1-2 Gyr) in the Magellanic Clouds appear to have multiple stellar populations within them, derived from bi-modal or extended main sequence turn offs. If this is interpreted as an age spread, the multiple populations are separated by a few hundred Myr, which would call into question the long held notion that clusters are simple stellar populations. Here we show that stellar rotation in stars with masses between 1.2-1.7 Msun can mimic the effect of a double or multiple population, whereas in actuality only a single population exists. The two main causes of the spread near the turn-off are the effects of stellar rotation on the structure of the star and the inclination angle of the star relative to the observer. Both effects change the observed effective temperature, hence colour, and flux of the star. In order to match observations, the required rotation rates are 20-50% of the critical rotation, which are consistent with observed rotation rates of similar mass stars in the Galaxy. We provide scaling relations which can be applied to non-rotating isochrones in order to mimic the effects of rotation. Finally, we note that rotation is unlikely to be the cause of the multiple stellar populations observed in old globular clusters, as low mass stars (<1 Msun) are not expected to be rapid rotators.Comment: 5 pages, 1 figure, MNRAS letters, in pres

Graphene oxide: key to efficient charge extraction and suppression of polaronic transport in hybrids with poly (3-hexylthiophene) nanoparticles

Nanoparticles (NPs) of conjugated polymers in intimate contact with sheets of graphene oxide (GO) constitute a promising class of water-dispersible nanohybrid materials of increased interest for the design of sustainable and improved optoelectronic thin-film devices, revealing properties exclusively pre-established upon their liquid-phase synthesis. In this context, we report for the first time the preparation of a P3HTNPs–GO nanohybrid employing a miniemulsion synthesis approach, whereby GO sheets dispersed in the aqueous phase serve as a surfactant. We show that this process uniquely favors a quinoid-like conformation of the P3HT chains of the resulting NPs well located onto individual GO sheets. The accompanied change in the electronic behavior of these P3HTNPs, consistently confirmed by the photoluminescence and Raman response of the hybrid in the liquid and solid states, respectively, as well as by the properties of the surface potential of isolated individual P3HTNPs–GO nano-objects, facilitates unprecedented charge transfer interactions between the two constituents. While the electrochemical performance of nanohybrid films is featured by fast charge transfer processes, compared to those taking place in pure P3HTNPs films, the loss of electrochromic effects in P3HTNPs–GO films additionally indicates the unusual suppression of polaronic charge transport processes typically encountered in P3HT. Thus, the established interface interactions in the P3HTNPs–GO hybrid enable a direct and highly efficient charge extraction channel via GO sheets. These findings are of relevance for the sustainable design of novel high-performance optoelectronic device structures based on water-dispersible conjugated polymer nanoparticles

Zentyal Server, como proveedor de servicios de infraestructura TI

En el presente artículo se llevará acabo la migración y puesta en marcha de los sistemas de seguridad de la infraestructura de red, mediante el uso del GNU/LINUX basado en Ubuntu “Zentyal”, implementando servicios de infraestructura IT de mayor nivel para Intranet y Extranet en instituciones complejasIn this article the migration and implementation of the security systems of the network infrastructure will be carried out, through the use of the GNU / LINUX based on Ubuntu "Zentyal", implementing higher level IT infrastructure services for Intranet and Extranet in complex institutions

POLLUX : a database of synthetic stellar spectra

Synthetic spectra are needed to determine fundamental stellar and wind parameters of all types of stars. They are also used for the construction of theoretical spectral libraries helpful for stellar population synthesis. Therefore, a database of theoretical spectra is required to allow rapid and quantitative comparisons to spectroscopic data. We provide such a database offering an unprecedented coverage of the entire Hertzsprung-Russell diagram. We present the POLLUX database of synthetic stellar spectra. For objects with Teff < 6 000 K, MARCS atmosphere models are computed and the program TURBOSPECTRUM provides the synthetic spectra. ATLAS12 models are computed for stars with 7 000 K <Teff <15 000 K. SYNSPEC gives the corresponding spectra. Finally, the code CMFGEN provides atmosphere models for the hottest stars (Teff > 25 000 K). Their spectra are computed with CMF_FLUX. Both high resolution (R>150 000) optical spectra in the range 3 000 to 12 000 A and spectral energy distributions extending from the UV to near--IR ranges are presented. These spectra cover the HR diagram at solar metallicity. We propose a wide variety of synthetic spectra for various types of stars in a format that is compliant with the Virtual Observatory standards. A user--friendly web interface allows an easy selection of spectra and data retrieval. Upcoming developments will include an extension to a large range of metallicities and to the near--IR high resolution spectra, as well as a better coverage of the HR diagram, with the inclusion of models for Wolf-Rayet stars and large datasets for cool stars. The POLLUX database is accessible at http://pollux.graal.univ-montp2.fr/ and through the Virtual Observatory.Comment: 9 pages, 5 figures, accepted for publication in Astronomy ans Astrophysic

Hábitos de amamantamiento del ganado bovino Chinampo (Bos taurus) de México

RESUMENObjetivo. Conocer los hábitos de amamantamiento de becerros Chinampos (Bos taurus)en diferentes etapas de su lactancia. Materiales y métodos. Se utilizaron 20 vacas consu cría. A partir de los 30 hasta los 180 días de la lactancia los animales fueron observadosdurante 24 horas continuas cada mes registrando la frecuencia con la que los becerrosmamaron y la duración de cada amamantamiento. Resultados. Los becerros mamaroncon mayor frecuencia entre las 06:00 y las 07:00 hr, se observaron otros picos a las 10:00y a las 19:00 hr. La frecuencia promedio de amamantamiento en 24 horas fue de 4.9±0.21utilizando un total de 66.9 ± 3.1 minutos. Los becerros de 180 días de edad mamaronmenos veces comparados con los de edades inferiores a los 150 días; la duración delamamantamiento disminuyó a los 180 días de edad (p&lt;0.05). Las hembras mamaron conmás frecuencia que los machos (p&lt;0.05) pero el tiempo que utilizaron para esta actividadfue similar entre sexos (p&gt;0.05). Conclusiones. La frecuencia de amamantamientos esmayor durante las primeras horas de la mañana y al final de la tarde. Hasta los 5 mesesde edad la frecuencia y el tiempo de amamantamiento no variaron pero se redujeron a los180 días y las hembras mamaron con más periodicidad que los machos

Validation of miR-1228-3p as Housekeeping for MicroRNA Analysis in Liquid Biopsies from Colorectal Cancer Patients

BACKGROUND: Circulating microRNA (miRNA) analysis is a growing research field. However, it usually requires an endogenous control or housekeeping (HK) in order to normalize expression of specific miRNAs throughout different samples. Unfortunately, no adequate HK for circulating miRNA analysis is still known in the colorectal cancer (CRC) context whereas several have been suggested. Hence, our aims were to validate the previously suggested miR-1228-3p as HK for CRC studies, to compare its suitability with the widely used miR-16-5p, and to evaluate the influence of hemolysis on both miRNAs. METHODS: We analyzed by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) the expression of miR-1228-3p, miR-16-5p and the spike-in cel-miR-39 in a set of 297 plasmas (92 CRC, 101 advanced adenomas -AA-, and 100 controls) and 213 serum samples (59 CRC, 74 AA and 80 controls). We also analyzed both miRNAs depending on the hemolysis degree in 7 plasmas and 31 serums. RESULTS: Levels of miR-1228-3p and miR-16-5p did not show significant differences between groups although miR-16-5p exhibited more variability in plasma and serum samples. Importantly, the combination of cel-miR-39 and miR-1228-3p was the most stable one. Moreover, we observed that miR-16-5p was significantly influenced by hemolysis in contrast with miR-1228-3p that exhibited no correlation with this confounding factor in both biofluids. CONCLUSION: MiR-1228-3p has been validated as an adequate endogenous control for circulating miRNA analysis in CRC and AA liquid biopsies

Evaluating a multicomponent program to improve hypertension control in Guatemala: Study protocol for an effectiveness-implementation cluster randomized trial

Background: Hypertension is a major risk factor for cardiovascular disease (CVD). Despite advances in hypertension prevention and treatment, the proportion of patients who are aware, treated and controlled is low, particularly in low-income and middle-income countries (LMICs). We will evaluate an adapted version of a multilevel and multicomponent hypertension control program in Guatemala, previously proven effective and feasible in Argentina. The program components are: protocol-based hypertension treatment using a standardized algorithm; team-based collaborative care; health provider education; health coaching sessions; home blood pressure monitoring; blood pressure audit; and feedback.Methods: Using a hybrid type 2 effectiveness-implementation design, we will evaluate clinical and implementation outcomes of the multicomponent program in Guatemala over an 18-month period. Through a cluster randomized trial, we will randomly assign 18 health districts to the intervention arm and 18 to enhanced usual care across five departments, enrolling 44 participants per health district and 1584 participants in total. The clinical outcomes are (1) the difference in the proportion of patients with controlled hypertension (< 130/80 mmHg) between the intervention and control groups at 18 months and (2) the net change in systolic and diastolic blood pressure from baseline to 18 months. The context-enhanced Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM)/Practical Robust Implementation and Sustainability Model (PRISM) framework will guide the evaluation of the implementation at the level of the patient, provider, and health system. Using a mixed-methods approach, we will evaluate the following implementation outcomes: acceptability, adoption, feasibility, fidelity, adaptation, reach, sustainability, and cost-effectiveness.Discussion: We will disseminate the study findings, and promote scale up and scale out of the program, if proven effective. This study will generate urgently needed data on effective, adoptable, and sustainable interventions and implementation strategies to improve hypertension control in Guatemala and other LMICs.Fil: Paniagua Avila, Alejandra. Columbia University; Estados UnidosFil: Fort, Meredith P.. Institute Of Nutrition Of Central America And Panamá; GuatemalaFil: Glasgow, Russell E.. University of Colorado; Estados UnidosFil: Gulayin, Pablo Elías. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Hernández Galdamez, Diego. institute of Nutrition of Central America and Panamá; GuatemalaFil: Mansilla, Kristyne. institute of Nutrition of Central America and Panamá; GuatemalaFil: Palacios, Eduardo. Ministerio de Salud y Asistencia Social; GuatemalaFil: Peralta, Ana Lucia. Institute of Nutrition of Central America and Panamá ; GuatemalaFil: Roche, Dina. Institute of Nutrition of Central America and Panamá ; GuatemalaFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: He, Jiang. University Translational Science Institute; Estados UnidosFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panamá ; GuatemalaFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Effectiveness of new tools to define an up-to-date patient safety risk map: A primary care study protocol

Background: Reducing incidents related to health care interventions to improve patient safety is a health policy priority. To strengthen a culture of safety, reporting incidents is essential. This study aims to define a patient safety risk map using the description and analysis of incidents within a primary care region with a prior patient safety improvement strategy organisationally developed and promoted. Methods: The study will be conducted in two phases: (1) a cross-sectional descriptive observational study to describe reported incidents; and (2) a quasi-experimental study to compare reported incidents. The study will take place in the Camp de Tarragona Primary Care Management (Catalan Institute of Health). In Phase 1, all reactive notifications collected within one year (2018) will be analysed; during Phase 2, all proactive notifications of the second and third weeks of June 2019 will be analysed. Adverse events will also be assessed. Phases 1 and 2 will use a digital platform and the proactive tool proSP to notify and analyse incidents related to patient safety. Expected Results: To obtain an up-to-date, primary care patient safety risk map to prioritise strategies that result in safer practices. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Ventilación líquida. Metaanálisis y revisión sistemática de la literatura

Introducción: En 1990 con base en las propiedades de los pfc (perfluorocarbonos) se realizó el primer ensayo clínico de ventilación líquida en humanos, en seis recién nacidos prematuros con insuficiencia respiratoria grave observándose mejoría significativa en la oxigenación y en la distensibilidad pulmonar. ¿Qué son los pfc? Producidas en la Segunda Guerra Mundial, son sustancias químicas cuyas propiedades dependen de la unión de los átomos de Fluor-Carbono. Su utilidad para la ventilación mecánica depende de su capacidad de disolver 20 veces más O2 y 3 veces más CO2, que el plasma, evaporándose más rápidamente que el agua a temperatura corporal. Los pfc han sido aprobados para aplicaciones biomédicas como transportadores de oxigeno aplicados intravenosos en situaciones de desastres o en individuos que rechazan ser transfundidos, sin embargo, el interés se ha despertado para su uso en la ventilación mecánica y en el síndrome de insuficiencia respiratoria aguda (sira). Por ello, el objetivo de este metaanálisis y revisión sistemática es la valoración de su uso, en especial de la década de los 90 hasta 2020. Analizando lo que dice la literatura y cómo ha funcionado en pacientes con Covid-19 y sira que ameritaron internamiento en unidades de cuidados intensivos. Material y métodos: Se buscaron revisiones sistemáticas, metaanálisis y ensayos clínicos de las revistas The New England Journal of Medicine, The Lancet , Science, Journal of Apply Physiology, Crit Care Med, Chest, Lung, Journal of Pediatrics, American Journal of Respiratory and Critical Care Medicine, Medicina Intensiva, Revista de la Facultad de Medicina de la UNAM, utilizando las bases de datos de Pubmed, medline, y www.mdconsult.com. Se buscó que los artículos estuvieran enfocados en los resultados del uso de la Ventilación Líquida, tanto en recién nacidos, prematuros, en lactantes y en adultos. El estudio se llevó a cabo de agosto de 2021 a febrero de 2022 y se realizó en el Departamento de Neumología de la Facultad de Medicina de la Universidad Autónoma del Estado de México. Resultados y Discusión: Para el año 2000 existían 1104 publicaciones sobre ventilación líquida, y 564 de ellas eran ensayos clínicos en humanos (medline), que demostraban que la Ventilación Líquida Parcial resulta más ventajosa en neonatos. En adultos sólo ha habido pocos resultados buenos con la Ventilación Líquida Total que mantiene recirculando los pfc dentro de un sistema cerrado. En las revisiones de la Fundación Cochrane se ha demostrado en dos revisiones sistemáticas y en dos metaanálisis que no hay pruebas de efectos beneficiosos de la ventilación líquida parcial en adultos con lesión pulmonar aguda. Sin embargo, surge la pregunta del uso de los pfc asociados al surfactante artificial y de mayor número de estudios con grandes grupos comparativos. La pandemia ocasionada por el Covid-19 ha generalizado el uso de la ventilación mecánica en las unidades de cuidados intensivos. Conclusiones: La ventilación líquida con pfc es una realidad y constituye una nueva alternativa terapéutica para el manejo de los enfermos con síndrome de insuficiencia respiratoria aguda. Su uso con la ventilación líquida parcial no ha demostrado la utilidad esperada en adultos, que seguramente requerirán de la ventilación líquida total. En los neonatos con la ventilación líquida parcial existe ya suficiente evidencia para tenerla como una alternativa en los prematuros y el uso combinado con la administración de surfactante no se debe pasar por alto en los Hospitales de Perinatología a nivel mundial