Diabetic retinopathy as a predictor of cardiovascular morbidity and mortality in subjects with type 2 diabetes

This study aimed to evaluate the predictive value of diabetic retinopathy (DR) and its stages with the incidence of major cardiovascular events and all-cause mortality in type 2 diabetes mellitus (T2DM) persons in our large primary healthcare database from Catalonia (Spain). A retrospective cohort study with pseudo-anonymized routinely collected health data from SIDIAP was conducted from 2008 to 2016. We calculated incidence rates of major cardiovascular events [coronary heart disease (CHD), stroke, or both-macrovascular events] and all-cause mortality for subjects with and without DR and for different stages of DR. The proportional hazards regression analysis was done to assess the probability of occurrence between DR and the study events. About 22,402 T2DM subjects with DR were identified in the database and 196,983 subjects without DR. During the follow-up period among the subjects with DR, we observed the highest incidence of all-cause mortally. In the second place were the macrovascular events among the subjects with DR. In the multivariable analysis, fully adjusted for DR, sex, age, body mass index (BMI), tobacco, duration of T2DM, an antiplatelet or antihypertensive drug, and HbA1c, we observed that subjects with any stage of DR had higher risks for all of the study events, except for stroke. We observed the highest probability of all-cause death events (adjusted hazard ratios, AHRs: 1.34, 95% CI: 1.28; 1.41). In conclusion, our results show that DR is related to CHD, macrovascular events, and all-cause mortality among persons with T2DM

Glomerular Filtration Rate and/or Ratio of Urine Albumin to Creatinine as Markers for Diabetic Retinopathy : A Ten-Year Follow-Up Study

To determine the relationship between diabetic nephropathy and diabetic retinopathy on a population of type 2 diabetes mellitus patients. A prospective ten-year follow-up population-based study. We determined differences between estimated glomerular filtration rate (eGFR) using the chronic kidney disease epidemiology collaboration equation and urine albumin to creatinine ratio. Annual incidence of any-DR was 8.21 ± 0.60% (7.06%-8.92%), sight-threatening diabetic retinopathy (STDR) was 2.65 ± 0.14% (2.48%-2.88%), and diabetic macular edema (DME) was 2.21 ± 0.18% (2%-2.49%). Renal study results were as follows: UACR > 30 mg/g had an annual incidence of 7.02 ± 0.05% (6.97%-7.09%), eGFR < 60 ml/min/1.73 m 2 incidence was 5.89 ± 0.12% (5.70%-6.13%). Cox's proportional regression analysis of DR incidence shows that renal function studied by eGFR < 60 ml/min/1.73 m 2 was less significant (p = 0.04, HR 1.223, 1.098-1.201) than UACR ≥ 300 mg/g (p < 0.001, HR 1.485, 1.103-1.548). The study of STDR shows that eGFR < 60 ml/min/1.73 m 2 was significant (p = 0.02, HR 1.890, 1.267-2.820), UACR ≥ 300 mg/g (p < 0.001, HR 2.448, 1.595-3.757), and DME shows that eGFR < 60 ml/min/1.73 m 2 was significant (p = 0.02, HR 1.920, 1.287-2.864) and UACR ≥ 300 mg/g (p < 0.001, HR 2.432, 1.584-3.732). The UACR has a better association with diabetic retinopathy than the eGFR, although both are important risk factors for diabetic retinopathy

Ecuaciones de referencia de la capacidad aeróbica máxima ciclo-ergoespirometría para la población española adulta

[EN] Background: Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake ( ̇VO2 ) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. Methods: 182 men and women, 20–85 years old, were included and exercised on cycle-ergometer to exhaustion. ( ̇VO2 ) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. Results: Height, sex and age resulted predictive of both ̇VO2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas ̇VO2 peak = 0.017 · height (cm) − 0.023 · age (years) + 0.864 · sex (female = 0/male = 1) ± 179 l min−1 , and peak WR = 1.345 · height (cm) − 2.074 · age (years) + 76.54 · sex (female = 0/male = 1) ± 21.2 W were the best compromise between accuracy and parsimony. Conclusions: This study provides new and accurate ̇VO2 peak and WR rate reference values for individuals of European Spanish descent[ES] Antecedentes: Los valores de referencia utilizados con frecuencia para las pruebas de esfuerzo clínicas derivan de muestras no aleatorias y los criterios máximos para algunos de ellos están mal definidos. Nuestro objetivo fue obtener valores de referencia basados en la población general para el consumo máximo de oxígeno (VO 2 ) y la carga de trabajo (CT) para las pruebas de ejercicio cardiopulmonar a partir de una muestra representativa de varones y mujeres caucásicos españoles. Métodos: Se incluyeron 182 varones y mujeres, de entre 20 y 85 a ̃nos, que realizaron ejercicio en el cicloergómetro hasta el agotamiento. Se midieron el VO 2 y la CT. Las ecuaciones obtenidas de esta muestra se validaron en una cohorte independiente de 69 individuos, seleccionados aleatoriamente de la misma población. A continuación, se creó una ecuación final que fusionó las dos cohortes (n = 251). Resultados: La altura, el sexo y la edad resultaron predictivos tanto del ̇VO2 máximo como de la CT. El peso y la actividad física contribuyeron muy poco a la precisión de las ecuaciones. Las fórmulas ̇VO2 máximo = 0,017 × altura (cm) − 0,023 × edad (a ̃nos) + 0,864 × sexo (mujer = 0/varón = 1) ± 179 L × min−1 ; y CT máxima = 1,345 × altura (cm) − 2,074 × edad (a ̃nos) + 76,54 × sexo (mujer = 0/varón = 1) ± 21,2 W fueron el mejor equilibrio entre precisión y parsimonia. Conclusiones: Este estudio proporciona valores de referencia del ̇VO 2 máximo y la CT nuevos y precisos para personas de ascendencia espa ̃nola europea.This study was supported by a SEPAR (Sociedad Española de Neumología y Cirugía Torácica/Spanish society of Pulmonology and Thoracic Surgery) grant and NEUMOMADRD (Sociedad Madrileña de Neumología y Cirugía Torácica/Madrilenian Society of Pulmonology and Thoracic Surgery) research award

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Situacions d'anòxia en zones estuàriques sense forçament mareal: una aproximació als balanços producció/consum d'oxigen

[cat] En aquesta tesi doctoral s'han estudiat les causes de l'aparició de fenòmens hipòxics i anòxics en un sistema costaner estuarià micromareal com la badia dels Alfacs (Mediterrani NW), pel període comprès entre el final dels anys vuitanta i final dels anys noranta. La badia mostra esdeveniments hipòxics a finals d'estiu, els quals no ocorren cada any, i no semblen ser produïts per una sola causa. Es va trobar que, a finals dels anys noranta, el fons de la badia havia estat colonitzat per macroalgues, que no hi eren una dècada abans. Es va observar que aquestes macroalgues tenen una funció important per controlar els esdeveniments anòxics. Poden canviar d'uns quants dies a infinit el temps necessari per arribar a l'anòxia, depenent dels escenaris d'irradiància i biomassa. El balanç d'O2 sencer de tot l'ecosistema és lleugerament positiu en base anual: 26.5 mg O2 m-2 d-1; és molt positiu a l'estiu i l'hivern, molt negatiu a la primavera, i també negatiu, en un menor mesura, a la tardor. Per ordre d'importància, els productors principals d'O2 són el fitoplàncton i les macroalgues, i les principals sortides en són la respiració del sediment, l'intercanvi amb l'atmosfera, i l'exportació d'O2 del plàncton cap a l'aire i mar obert. Per tal d'analitzar el paper relatiu de cada procés ecològic en el balanç global, es va desenvolupar un model d'oxigen (OMMEL) aplicat a aquest tipus de badia per 1997, i l'ajust entre els valors observats i mesurats va ser bo en general. La producció biològica neta a la badia dels Alfacs és 326 g C m2 y-1. D'aquesta tesi es conclou que els esdeveniments hipòxics en badies com aquesta no són causats per un factor únic, aïllat i identificable, sinó per la coincidència en l'espai i temps d'un conjunt d'ells: alta temperatura, terbolesa de la columna d'aigua, alta biomassa macroalgal, respiració del sediment i absència de vent. Les situacions hipòxiques són mantingudes mentre aquestes condicions no canviïn substancialment i hi hagi poca renovació d'aigua profunda així com manca de flux advectiu per intrusió d'aigua marina externa, o per manca de flux no-advectiu amb la capa superior. Les hipòxies poden disminuir o fins i tot desaparèixer quan apareixen vents forts ocasionals, o vents més dèbils però més continuats, els quals trenquen o erosionen l'estratificació de la columna d'aigua. També poden disminuir quan hi ha renovació d'aigua profunda per entrada d'aigua marina exterior, causada, per exemple, per fluxos d'entrada d'aigua dolça a través dels canals de drenatge dels arrossars. El rang de maniobra per reduir el risc d'anòxia és baix. La principal possibilitat per reduir aquest risc és a través d'augmentar els fluxos d'entrada d'aigua dolça a la badia.[eng] Causes of hypoxic-anoxic situations in a coastal microtidal estuarine system called Alfacs Bay (NW Mediterranean) have been studied for the period between the end of the eighties and the end of the nineties. Alfacs bay shows occasional hipoxic events at the end of summer, which does not occur every year, and it does not seem to be due to a single cause alone. Macrophytes have an important role controlling anoxic events. They can shift from a few days to infinite the time needed to reach anoxia, depending on irradiance and biomass scenarios. Whole ecosystem O2 budget is slightly positive in annual basis: 26.5 mg O2 m-2 d-1, being very positive in Winter & Summer, very negative in Spring and also negative in a lesser extend in Autumn. In order of importance, main producers are phytoplankton and macroalgae, and main sinks are sediment respiration, exchange with athmosphere, and plankton O2 exportation to air and open sea. An oxygen model (OMMEL) was developed and applied to this type of bay for 1997, and model fit between observed and estimated values was good. Net biological production in Alfacs is 326 g C m2 y-1. Hypoxic events are not caused by an only factor, isolated and identifiable, but for the coincidence in space and time of a set of them: high temperature, water column turbidity, high macrophyte biomass and sediment respiration and wind absence. Hypoxic situations seems are kept while these conditions do not substantially change and there is little deep water renewal, lack of advective flow by intrusion of external salt water, or by lack of non-advective flow with the upper layer. Hypoxia decreases and can disappear when either occasional strong winds appear, or weaker winds but more continued, which break or erode water column stratification,. Or also when there is deep water renewal by external marine water entrance, caused by, for instance, freshwater inflow through the rice field drainage channels. Range of maneuver to reduce risk of anoxia is low. The main chance for management is through increasing freshwater inflows to the bay

Seguimiento del aprendizaje mediante análisis de trazas en una simulación de trampas ópticas

En este artículo se presenta una simulación de una trampa óptica, es decir, un haz de luz muy focalizado capaz de atrapar partículas dieléctricas alrededor de la zona focal. El programa ha sido diseñado para su utilización en la docencia a nivel de último año del grado de Física o Máster. La aplicación incluye un sistema de seguimiento que permite conocer (trazar) la interacción del estudiante con el programa. Esta herramienta permitirá al profesor analizar el trabajo realizado por el alumno así como también detectar la presencia de errores comunes

Estado biológico de la pradera de Posidonia oceanica de las Islas Medas. Informe de 1995

Podeu consultar l'Informe complet a: http://hdl.handle.net/2445/2466

Redaccio col·laborativa de treballs en la docència de les ciències experimentals. Comparació entre mètodes tradicionals i wikis

En aquest treball es presenta la recerca en docència que desenvolupen els autors, ique fa referència a l"ús de la redacció col·laborativa de documents i treballscooperatius en docència. Aquesta recerca es dedica principalment a l"anàlisi de l"ús de metodologies TIC, com és el wiki, per tal d"avaluar-ne els seus avantatges i inconvenients respecte als mètodes tradicionals de treball col·laboratiu. Entre d"altres aspectes, ens interessen la mesura de l"esforç en temps de dedicació de l"alumnat i també del professorat, i la possibilitat de fer una avaluació de cada alumne que inclogui la seva contribució individual al treball de grup. L"estudi s"està fent en diverses assignatures dels ensenyaments de Biologia, Ciències Ambientals i Infermeria. Es presenten algunes dades sobre els resultats obtinguts en aspectes com ara les dificultats tècniques, qüestions organitzatives i grau de satisfacció dels alumnes. S"aporten algunes dades preliminars sobre la valoració diferent de cada alumne segons el mètode