Comprehensive Cardiovascular and Renal Protection in Patients with Type 2 Diabetes

Cardiovascular; Diabetes; Glycated hemoglobinCardiovascular; Diabetes; Hemoglobina glicosiladaCardiovascular; Diabetis; Hemoglobina glicadaType 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. A particular focus is given to the global control of cardiovascular risk factors, the inclusion of weight within the therapeutic objectives, the education of patients, the deprescription of those drugs without cardiovascular benefit, and the inclusion of GLP-1 receptor agonists and SGLT2 inhibitors as cardiovascular protective drugs, at the same level as statins, acetylsalicylic acid, or renin angiotensin system inhibitors

Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies?

Cardiovascular disease (CVD) is the leading cause of death worldwide affecting both genders equally. However, in comparison to men, in women it often is underrecognized and undertreated in both the primary and secondary prevention settings. It is clear, that in the healthy population, there are profound differences both anatomically and biochemically between woman and men and this may impact how both groups present when they become ill. Therefore, there are some diseases that affect more frequently in women than in men such us myocardial ischemia or infarction without obstructive coronary disease, Tako-subo syndrome, some atrial arrhythmias or the appearance of heart failure with preserved ejection fraction. Therefore, the diagnostic and therapeutic strategies that have been established based largely on clinical studies with a predominant male population must be adapted before being applied to women. There is a paucity of data regarding cardiovascular disease in women. It is inadequate to only perform a subgroup analysis evaluating a specific treatment or invasive technique, when women constitute fifty percent of the population. In this regard, this may affect the time of clinical diagnosis and severity assessments of some valvulopathies. In this review, we will focus on the differences in the diagnosis, management, and outcomes of woman with the most frequent cardiovascular pathologies including coronary artery disease, arrythmias, heart failure and valvopathies. In addition, we will describe diseases that exclusively affect to women related with the pregnancy some of them are life treating. Although the lack of research in women plays a role in the poorer outcomes in women specially in ischemic heart disease the results of some techniques such as transcathether aortic valve implantation and transcatheter edge to edge therapy seem to have better outcome in women

Disposable electrochemical immunoplatform to shed light on the role of the multifunctional glycoprotein TIM-1 in cancer cells invasion

Detecting overexpression of cancer biomarkers is an excellent tool for diagnostic/prognostic and follow-up of patients with cancer or their response to treatment. This work illustrates the relevance of interrogating the levels of T-cell immunoglobulin and mucin domain 1 (TIM-1) protein as a diagnostic/prognostic biomarker of high-prevalence breast and lung cancers by using an amperometric disposable magnetic microparticles-assisted immunoplatform. The developed method integrates the inherent advantages of carboxylic acid-functionalized magnetic beads (HOOC-MBs) as pre-concentrator support and the amperometric transduction at screen-printed carbon electrodes (SPCEs). The immunoplatform involves a sandwich-type immunoassay assembled on HOOC-MBs through the specific capture/labeling of TIM-1 using capture antibodies and horseradish peroxidase (HRP)-conjugated biotinylated detection antibodies as biorecognition elements. The magnetic immunoconjugates were confined onto the working electrode (WE) surface of the SPCEs for amperometric detection using the hydroquinone/hydrogen peroxide/HRP (HQ/H2O2/HRP) redox system. The method allows the selective detection of TIM-1 protein over the 87-7500 pg mL-1 concentration range in only 45 min, with a limit of detection of 26 pg mL-1. The developed bioplatform was successfully applied to the analysis of breast and lung cancer cell extracts, providing the first quantitative results of the target glycoprotein in these types of samples.The financial support of PID2019-103899RB-I00 (Spanish Ministerio de Ciencia e Innovación) Research Projects and PI20CIII/00019 Grant from the AES-ISCIII Program co-founded by FEDER funds and the TRANSNANOAVANSENS-CM Program from the Comunidad de Madrid (Grant S2018/NMT-4349) are gratefully acknowledged. A.M-C. was supported by a FPU predoctoral contract supported by the Spanish Ministerio de Educación, Cultura y Deporte. J.Q. was founded by Minciencias, Mineducacion, MINCIT, and ICETEX through the Program Ecosistema Cientifico Cod. FP44842-211–2018, project number 58536. J.O. thanks support from the University of Antioquia and the Max Planck Society through the cooperation agreement 566–1, 2014.S

Implementación de la metodología flipped classroom en los laboratorios de Química Analítica

Adaptar el sistema tradicional de aprendizaje a las necesidades actuales del alumnado empleando la metodología flipped classroom en el laboratorio de Química Analítica I, con el objetivo de fomentar el aprendizaje utilizando herramientas digitales.Depto. de Química AnalíticaFac. de Ciencias QuímicasFALSEsubmitte

Diseño y preparación de un laboratorio virtual de Química Analítica: Técnicas instrumentales de análisis

La reciente pandemia del COVID-19 ha supuesto un cambio excepcional y drástico de la concepción tradicional del aprendizaje, tanto para los estudiantes como para los docentes. Ante esta situación se requiere no sólo acciones que faciliten la adaptación de los estudiantes y profesores a las plataformas educativas en línea, sino también a que éstas se conviertan en auténticas herramientas para potenciar y mejorar de forma significativa el aprendizaje del alumno. El presente proyecto de Innovación Educativa y Mejora de la Calidad Docente pretende mejorar la calidad del aprendizaje de varias asignaturas de los Grados de Química e Ingeniería Química que llevan asociado un Laboratorio de Técnicas Instrumentales. Tradicionalmente esa docencia práctica ha sido presencial, pero la situación excepcional surgida con la pandemia en el curso 2019/2020, ha demostrado que disponer de unas prácticas virtualizadas es de gran ayuda para facilitar el aprendizaje de los alumnos y facilitar una transferencia del conocimiento constructivo y colaborativo. Desde hace años, el personal docente e investigador (PDI), personal de administración y servicios (PAS) y los estudiantes de la UCM, disponemos de la plataforma de enseñanza online Moodle (Campus Virtual, CV). Sin embargo, la pandemia que vivimos ha evidenciado la brecha digital en lo referente a cómo usar Moodle y, por ende, la utilización de las Tecnologías de Información y Comunicación (TICs) como facilitadoras didácticas. A pesar de nuestras limitaciones, tanto profesores como estudiantes, hemos desarrollado una enorme capacidad resiliente, lo que permitió, durante el pasado mes de mayo, la puesta en marcha de los primeros laboratorios en línea en el Departamento de Química Analítica de la UCM. Fruto de esta experiencia, así como de la situación actual de incertidumbre para el curso próximo, algunos profesores, estudiantes y PAS del departamento hemos decidido adelantarnos a un escenario futuro en el que se contemple nuevamente la impartición de Docencia Experimental en línea y solicitar el presente proyecto de Innovación Educativa y Mejora de la Calidad Docente

Consensus document for lipid profile determination and reporting in Spanish clinical laboratories

Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio.Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Comprehensive management of risk factors in peripheral vascular disease. Expert consensus Manejo integral de los factores de riesgo en enfermedad arterial periférica. Consenso de expertos

Introduction: There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. Methodology: A multidisciplinary consensus following the Delphi methodology. Results: Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (< 55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. Conclusion: This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors

Determinación no invasiva del efecto de atorvastatina en la microvasculatura coronaria y la función endotelial periférica de pacientes dislipémicos

Introducción y objetivos. La monitorización del efecto de las estatinas se ha estudiado fundamentalmente en el ámbito arterial periférico. Es posible estudiar la microcirculación coronaria mediante la evaluación de la reserva coronaria (RC) con ecocardiografía transtorácica. El objetivo del estudio fue evaluar, de forma no invasiva, el efecto de atorvastatina en la función endotelial periférica y la microvasculatura coronaria en pacientes dislipémicos. Pacientes y método. Se incluyó a 21 pacientes dislipémicos sin antecedentes de aterosclerosis clínica (edad, 64,9 ± 11 años; mujeres, 61,9%). Se valoraron, basalmente y a los 3 meses de tratamiento con 20 mg/día de atorvastatina, el perfil lipídico, el grosor mediointimal (GMI) carotídeo, la vasodilatación dependiente del endotelio (VDE) y la reserva coronaria (RC) de la arteria descendente anterior (DA). Los estudios se realizaron con ecocardiografía. Resultados. Simultáneamente con la mejoría del perfil lipídico se apreció un incremento del 43% de la VDE (el 4,3 ± 4,4% frente al 6,2 ± 3,8%; p = 0,07) y un 25% de mejoría de la RC (2,5 ± 0,6 frente a 3,1 ± 0,8; p = 0,002). El incremento de la VDE se correlacionaba con la edad (r = -­0,60; p = 0,004), el GMI carotídeo (r = ­-0,47; p = 0,029), el colesterol unido a lipoproteínas de baja densidad (cLDL) basal (r = -­0,43; p = 0,05) y con la VDE basal (r = ­0,63; p = 0,002). El incremento de la RC se correlacionaba con el cLDL final (r = ­-0,51; p = 0,04). Conclusiones. El tratamiento a corto plazo con atorvastatina mejora no sólo el perfil lipídico, sino también la función microvascular coronaria y la vasodilatación periférica dependiente del endotelio. Es posible su monitorización de manera no invasiva con ecocardiografía

Effects of Virtual Reality on Cardiac Rehabilitation Programs for Ischemic Heart Disease: A Randomized Pilot Clinical Trial

(1) Background: The aim of the present study was to determine the effects of a virtual reality (VR) program, as a complementary tool to a conventional cardiac rehabilitation (CR) program in phase II of patients with ischemic heart disease compared to a conventional treatment group. (2) Methods: A single blinded randomized clinical trial was conducted. The patients were randomized to a control group (CG) or an experimental group (EG). The EG carried out a training based on VR of aerobic exercise using the XBOX ONE console and Kinect sensor. Ergometry, metabolic equivalents (METS), Functional Independence Measure, 6-min walk test (6MWT), the Short Form Health Survey-36 Questionnaire (SF-36), the Beck Depression Inventory-II, and the degree of satisfaction and adherence to treatment were used as outcome measures. (3) Results: Our results showed no statistically significant differences between the two groups. Statistical analysis within group for the EG showed statistically significant changes in the variables HR final ergometry, ergometry minutes, % ergometry, METS, final HR 6MWT, 6MWT distance, 6MWT number of laps, and for the SF-36 and Beck Depression Inventory-II. (4) Conclusion: A VR-based video game program, as an adjunct tool to a CR program, showed improvements in ergometry, METS, resistance to fatigue and health-related quality of life with excellent adherence and satisfaction perceived by patients with ischemic heart disease in phase II