Aplicación de la regla de San Francisco para predicción de resultados serios a corto plazo en pacientes con sincope

Objetivos: La regla de san Francisco representa una de las primeras reglas de decisión clínica enl sincope, se deriva de un estudio prospectivo de 684 pacientes por Quinn y col. en 2004 (5,6), sin embargo los intentos de validación externa de esta regla han resultado discordantes (5,14,15), el objetivo del trabajo fue evaluar el impacto de la aplicación de la regla en los servicios de urgencias en la estimación del riesgo de complicaciones cardiovasculares y no cardiovasculares a corto plazo en pacientes quienes ingresan con sincope, que permita implementar una estrategia de juicio clínico segura para el paciente. Métodos Es un estudio descriptivo de cohorte longitudinal, consecutiva, prospectiva, de pacientes con que ingresaron en el servicio de urgencias de 3 centros hospitalarios, entre 01 de septiembre de 2013 y 30 de Junio de 2014. Se incluyeron pacientes mayores de 18 años de edad, que ingresaron con sincope como principal motivo de consulta; se excluyeron pacientes con consumo de alcohol reciente, hipoglucemia, trauma craneoencefálico o que no cumplieran criterios diagnósticos de sincope. Médicos aplicaron los componentes de la regla de San Francisco después de su evaluación (Hematocrito 30%, disnea, antecedente de insuficiencia cardiaca congestiva, ECG anormal y PAS 90 mmhg) y cada uno de los probables desenlaces serios definidos en el estudio original, con seguimiento a 7 y 30 días después de consultar a urgencias. Resultados Se incluyeron 98 pacientes con sincope, con edad promedio de 63±21 años y género femenino predominantemente en el 60,2% (n=59). La regla de San Francisco evaluada en esta población reporto una sensibilidad 97,5%, especificidad 22,41%, Valor Predictivo Positivo 46,43%, Valor Predictivo Negativo 92,86%. Las características operativas evaluadas con una curva ROC reporto un área bajo la curva de 0,75 (IC 95%: 0,66-0,85), siendo solamente la disnea y falla cardiaca estadísticamente significativa (IC 95%: 0,502-0,72 y 0,56-0,79, respectivamente). Conclusiones La regla de San Francisco reporto una alta sensibilidad, por lo que su validez en la población colombiana cumple con el propósito de identificar a aquellas personas con riesgo de desarrollar eventos a 7 días; pero debido a su baja especificidad no permite tomar decisiones sobre a quienes realizar estudios clínicos adicionales lo cual debe soportarse en la historia médica de cada paciente, más que con solo la información que nos brinda la escala.Abstract. Study Objective: The San Francisco Syncope Rule, is one of the first clinical decision rules in syncope, is derived from a prospective study of 684 patients by Quinn et al. in 2004 (5.6), however attempts to external validation of this rule have been discordant (5,14,15), the objective was to evaluate the impact of the application of the rule in emergency departments in the estimate of the risk of cardiovascular complications and no short-term cardiovascular patients who are admitted with syncope, implement a strategy that allows safe clinical judgment for the patient. Methods In a descriptive prospective cohort longitudinal study, consecutive, patients admitted the emergency department of 3 hospitals enrolled from September 1, 2013 to June 30, 2014. Patients older than 18 years to age were included admitted with syncope as the main reason for consultation; excluded patients with recent alcohol intake, hypoglycemia, head trauma or who did not meet diagnostic criteria for syncope. Physicians applied the San Francisco Rule after their evaluation (hematocrit 30%, complaint of shortness of breath, history of congestive heart failure, abnormal ECG result (new changes o non-sinus rhythm and systolic blood pressure 90 mmHg) and each prospective serious outcomes defined in the original study, with followed up applied 7 and 30 days of their visit Emergency department. Results 98 patients with syncope, with a mean age of 63 ± 21 years and predominantly female gender in 60.2% (n = 59). The San Francisco rule evaluated in this population reported a sensitivity 97.5%, specificity 22.41%, positive predictive value 46.43%, 92.86% Negative Predictive Value. The operational characteristics evaluated with a ROC curve reported an area under the curve of 0.75 (95% CI: 0.66-0.85), being only complaint of shortness of breath and history of congestive heart failure statistically significant (95% CI: 0.502 to 0, 72 and 0.56-0.79 respectively). Conclusions The San Francisco Rule reported a high sensitivity, so that its validity in this population fulfills the purpose of identifying those at risk of developing events to 7 days; but because of its low specificity does not allow to make decisions about further trials which must be endured in the medical history of each patient, rather than just the information you give us the scale.Otr

“Aprovechamiento sistémico de la pulpa de café como residuo agrícola y tratamiento de las aguas mieles por biorremediación en el alto mayo”-2014”

The first phase consisted of removing and reducing non-reducing sugars and tannins. By anaerobic fermentation processes in a bioreactor BATCH type agitator, far preparing alcohols. The second phase addressed the honey water treatment; bioremediation using a model of effective microorganisms (EM) and aquatic macrophytes was used. Under the study conditions 18.8 g of reducing sugars per liter Totals were obtained from the dried pulp and 2.0% bioethanol per liter of wine. Gallic acid was obtained as primary and most abundant polyphenols in a concentration of 4555.2 mg / kg of dry pulp. Regarding treatment of honey water results BOD and COD decreased, not reaching below the LMP, the STS is able to reduce below the LMP, the pH is within the range of the LMP, the temperature is below the LMP, like nitrates. Thus, it was concluded that it is possible, first use and transform agricultura! waste coffee to add value hoiisticaily, and on the other hand reduce the negative impacts on the environment generated by the wastewater.La primera fase consistió en extraer azucares reductores y no reductores así como de taninos. Mediante los procesos de fermentación anaerobia en un biorreactor tipo BATCH con agitador, para la obtención de alcoholes. La segunda fase se dirigió al tratamiento de aguas mieles, se utilizó un modelo de biorremediación utilizando los microorganismos eficaces (ME) y macrofitas acuáticas. Bajo las condiciones de estudio se obtuvieron 18,8 g de Azucares Reductores Totales por litro a partir de la pulpa seca y 2,0 % de bioetanol por cada litro de mosto. Se obtuvo Ácido Gálico como principal y más abundante de los polifenoles en una concentración de 4555,2 mg/kg de pulpa seca. Respecto al tratamiento de aguas mieles los resultados de DBO y DQO disminuyeron, no llegando por debajo de los LMP, los STS se logró disminuir por debajo de los LMP, el pH están dentro del rango de los LMP, la temperatura está por debajo de los LMP, al igual que los nitratos. De esta manera se pudo concluir que es posible, por un lado utilizar y transformar los residuos agrícolas de café para darle valor agregado de manera integral, y por otro lado disminuir los impactos negativos que genera sobre el ambiente las aguas mieles.Tesi

Effect of Acid Treatment on the Physicochemical Characteristics and Sorption Capacity of a Natural Zeolite

Mining is a very important industry for the development of emerging economies; however, it generates a large number of environmental externalities such as acid mine drainages; these have acid pH values and high heavy metal content. Although there are several methods for the elimination of metals in different solutions, they require a large economic investment. Recently, the use of adsorbent materials for the removal of heavy metals in acid drains such as agricultural by-products and natural zeolites has been developed as a cheaper alternative. In spite of the environmental benefits of using natural zeolites as adsorbent, one of the disadvantages is dealumination, which to a great extent could depend on the geological origin of the mineral that shapes some of its characteristics. This study characterized chemical and physical properties of natural and modified zeolites using various techniques, such as X-ray diffraction (XRD), N2 adsorption- desorption, inductively coupled plasma − optical emission spectroscopy (ICP-OES), and SEM-EDS to determine the effect of an acid treatment on the physical and chemical characteristics of a natural zeolite, correlating these with their sorption capacity. When giving acid treatment to a zeolite there are no significant changes in the crystal structure, the Si/Al ratio indicates a dealumination of the structure but with minimal changes, the surface area and density of the micropores increased considerably. A significant increase in the capacity of copper adsorption was registered. According to XRD, no significant changes occur to the structures. Keywords: Dealumination; aluminosilicates; AMD; acid treatment; metal removal. DOI: 10.7176/JEES/10-9-05 Publication date:September 30th 202

Contribution of cardio-vascular risk factors to depressive status in the PREDIMED-PLUS Trial. A cross-sectional and a 2-year longitudinal study

Background Cardio-vascular disease and depression are thought to be closely related, due to shared risk factors. The aim of the study was to determine the association between cardio-vascular risk (CVR) factors and depressive status in a population (55-75 years) with metabolic syndrome (MetS) from the PREDIMED-Plus trial. Methods and findings Participants were classified into three groups of CVR according to the Framingham-based REGICOR function: (1) low (LR), (2) medium (MR) or (3) high/very high (HR). The Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms at baseline and after 2 years. The association between CVR and depressive status at baseline (n = 6545), and their changes after 2 years (n = 4566) were evaluated through multivariable regression models (logistic and linear models). HR women showed higher odds of depressive status than LR [OR (95% CI) = 1.78 (1.26, 2.50)]. MR and HR participants with total cholesterol <160 mg/mL showed higher odds of depression than LR [OR (95% CI) = 1.77 (1.13, 2.77) and 2.83 (1.25, 6.42) respectively)] but those with total cholesterol ¿280 mg/mL showed lower odds of depression than LR [OR (95% CI) = 0.26 (0.07, 0.98) and 0.23 (0.05, 0.95), respectively]. All participants decreased their BDI-II score after 2 years, being the decrease smaller in MR and HR diabetic compared to LR [adjusted mean±SE = -0.52±0.20, -0.41 ±0.27 and -1.25±0.31 respectively). MR and HR participants with total cholesterol between 240-279 mg/mL showed greater decreases in the BDI-II score compared to LR (adjusted mean±SE = -0.83±0.37, -0.77±0.64 and 0.97±0.52 respectively). Conclusions Improving cardiovascular health could prevent the onset of depression in the elderly. Diabetes and total cholesterol in individuals at high CVR, may play a specific role in the precise response.The PREDIMED-Plus trial was supported by the European Research Council through a grant to MAM (Advanced Research Grant 2013-2018; 340918). The project was also supported by the official funding agency for biomedical research of the Spanish Government (ISCIII) through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects), who awarded grants to JS and JV (PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732 and PI17/00926). The International Nut&Dried Fruit Council-FESNAD also provided funding through a grant to MAM (201302), and Recercaixa also awarded a grant to JS (2013ACUP00194). The Department of Health, Generalitat de Cataluña by the calls 'Acció instrumental de programes de recerca orientats en lámbit de la recercaila innovació en salut' and 'Pla estrategic de recerca i innovació en salut (PERIS),' also awarded a grant to FF (SLT006/17/00246). This research was also partially funded by: Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, PI0137/2018); Generalitat Valenciana (PROMETEO/2017/017); SEMERGEN, CIBEROBN, FEDER and ISCIII (CB06/03); EU-H2020 Grants (Eat2beNICE/h2020-sfs-2016-2, ref.728018; PRIME/h2020-SC1-BHC-2018-2020, ref: 847879)

Cross-disease Meta-analysis of Genome-wide Association Studies for Systemic Sclerosis and Rheumatoid Arthritis Reveals IRF4 as a New Common Susceptibility Locus

Objectives: Systemic sclerosis (SSc) and rheumatoid arthritis (RA) are autoimmune diseases that share clinical and immunological characteristics. To date, several shared SSc- RA loci have been identified independently. In this study, we aimed to systematically search for new common SSc-RA loci through an inter-disease meta-GWAS strategy. Methods: We performed a meta-analysis combining GWAS datasets of SSc and RA using a strategy that allowed identification of loci with both same-direction and opposingdirection allelic effects. The top single-nucleotide polymorphisms (SNPs) were followed-up in independent SSc and RA case-control cohorts. This allowed us to increase the sample size to a total of 8,830 SSc patients, 16,870 RA patients and 43,393 controls. Results: The cross-disease meta-analysis of the GWAS datasets identified several loci with nominal association signals (P-value < 5 x 10-6), which also showed evidence of association in the disease-specific GWAS scan. These loci included several genomic regions not previously reported as shared loci, besides risk factors associated with both diseases in previous studies. The follow-up of the putatively new SSc-RA loci identified IRF4 as a shared risk factor for these two diseases (Pcombined = 3.29 x 10-12). In addition, the analysis of the biological relevance of the known SSc-RA shared loci pointed to the type I interferon and the interleukin 12 signaling pathways as the main common etiopathogenic factors. Conclusions: Our study has identified a novel shared locus, IRF4, for SSc and RA and highlighted the usefulness of cross-disease GWAS meta-analysis in the identification of common risk loci

Relationship between olive oil consumption and ankle-brachial pressure index in a population at high cardiovascular risk

The aim of this study was to ascertain the association between the consumption of different categories of edible olive oils (virgin olive oils and olive oil) and olive pomace oil and ankle-brachial pressure index (ABI) in participants in the PREDIMED-Plus study, a trial of lifestyle modification for weight and cardiovascular event reduction in individuals with overweight/obesity harboring the metabolic syndrome. Methods: We performed a cross-sectional analysis of the PREDIMED-Plus trial. Consumption of any category of olive oil and olive pomace oil was assessed through a validated food-frequency questionnaire. Multivariable linear regression models were fitted to assess associations between olive oil consumption and ABI. Additionally, ABI ≤1 was considered as the outcome in logistic models with different categories of olive oil and olive pomace oil as exposure. Results: Among 4330 participants, the highest quintile of total olive oil consumption (sum of all categories of olive oil and olive pomace oil) was associated with higher mean values of ABI (beta coefficient: 0.014, 95% confidence interval [CI]: 0.002, 0.027) (p for trend = 0.010). Logistic models comparing the consumption of different categories of olive oils, olive pomace oil and ABI ≤1 values revealed an inverse association between virgin olive oils consumption and the likelihood of a low ABI (odds ratio [OR] 0.73, 95% CI [0.56, 0.97]), while consumption of olive pomace oil was positively associated with a low ABI (OR 1.22 95% CI [1.00, 1.48]). Conclusions: In a Mediterranean population at high cardiovascular risk, total olive oil consumption was associated with a higher mean ABI. These results suggest that olive oil consumption may be beneficial for peripheral artery disease prevention, but longitudinal studies are needed

Complement component C4 structural variation and quantitative traits contribute to sex-biased vulnerability in systemic sclerosis

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER), "A way of making Europe".Copy number (CN) polymorphisms of complement C4 play distinct roles in many conditions, including immune-mediated diseases. We investigated the association of C4 CN with systemic sclerosis (SSc) risk. Imputed total C4, C4A, C4B, and HERV-K CN were analyzed in 26,633 individuals and validated in an independent cohort. Our results showed that higher C4 CN confers protection to SSc, and deviations from CN parity of C4A and C4B augmented risk. The protection contributed per copy of C4A and C4B differed by sex. Stronger protection was afforded by C4A in men and by C4B in women. C4 CN correlated well with its gene expression and serum protein levels, and less C4 was detected for both in SSc patients. Conditioned analysis suggests that C4 genetics strongly contributes to the SSc association within the major histocompatibility complex locus and highlights classical alleles and amino acid variants of HLA-DRB1 and HLA-DPB1 as C4-independent signals

Incidencias de la Universidad Politécnica Salesiana en la sociedad ecuatoriana

En agosto de 1994, luego de 106 años de acción salesiana en el Ecuador, nace oficialmente la Universidad Politécnica Salesiana, obra que da continuidad a la presencia pastoral-educativa iniciada en Quito, en 1888, cuando los salesianos asumen la responsabilidad del Protectorado Católico de Artes y Oficios e inician el primer Oratorio Festivo. Posteriormente, la acción salesiana se extendió a Riobamba (1891), Cuenca (1893), Gualaquiza (1893), Guayaquil (1902), Manabí (1927), Indanza (1914), Méndez (1915), Macas (1924), Sucúa (1931) y Limón (1936). La educación, para Don Bosco y los salesianos, constituye la mejor opción para el desarrollo de la persona, específicamente de niños y jóvenes, quienes desde su propia realidad y circunstancias son actores de transformación y mejora social, siendo honrados ciudadanos y buenos cristianos. La presencia universitaria salesiana responde a las exigencias actuales de la pastoral juvenil, experiencia que tributa a la continuidad educativa de acompañamiento más allá de la adolescencia, con la voluntad de crear oportunidades de estudios universitarios a personas de los sectores sociales que tradicionalmente no las han tenido. En homenaje a los 25 años de vida institucional y a su memoria histórica, esta edición presenta una síntesis de la presencia e incidencia social de la Universidad Politécnica Salesiana en el Ecuador durante este período, realidad que fue posible gracias el apoyo recibido de las autoridades universitarias, docentes y estudiantes de la Carrera de Comunicación Social en las sedes Cuenca, Quito y Guayaquil, de los integrantes del Grupo de Investigación de Ciencias de la Educación (GICCEE) y del Grupo de Investigación en Comunicación de la Universidad Politécnica Salesiana (GICUPS)

Precariedad, exclusión social y diversidad funcional (discapacidad): lógicas y efectos subjetivos del sufrimiento social contemporáneo (III). Innovación docente en Filosofía

El PIMCD Precariedad, exclusión social y diversidad funcional (discapacidad): lógicas y efectos subjetivos del sufrimiento social contemporáneo (III). Innovación docente en Filosofía se ocupa de conceptos que generalmente han tendido a ser eludidos en la enseñanza académica de filosofía. Se trata de la tercera edición de un PIMCD que ha venido recibiendo financiación en las últimas convocatorias PIMCD UCM, de los que se han derivado publicaciones colectivas publicadas por Ediciones Complutense y Siglo XXI

Precariedad, exclusión social y diversidad funcional (discapacidad): lógicas y efectos subjetivos del sufrimiento social contemporáneo (II). Innovación docente en Filosofía

El PIMCD "Precariedad, exclusión social y diversidad funcional (discapacidad): lógicas y efectos subjetivos del sufrimiento social contemporáneo (II). Innovación docente en Filosofía" se ocupa de conceptos generalmente eludidos por la tradición teórica (contando como núcleos aglutinantes los de la precariedad laboral, la exclusión social y diversidad funcional o discapacidad), cuyo análisis propicia nuevas prácticas en la enseñanza universitaria de filosofía, adoptando como meta principal el aprendizaje centrado en el estudiantado, el diseño de nuevas herramientas de enseñanza y el fomento de una universidad inclusiva. El proyecto cuenta con 26 docentes de la UCM y otros 28 docentes de otras 17 universidades españolas (UV, UNED, UGR, UNIZAR, UAH, UC3M, UCA, UNIOVI, ULL, EHU/UPV, UA, UAM, Deusto, IFS/CSIC, UCJC, URJC y Univ. Pontificia de Comillas), que permitirán dotar a las actividades programadas de un alcance idóneo para consolidar la adquisición de competencias argumentativas y dialécticas por parte de lxs estudiantes implicados en el marco de los seminarios previstos. Se integrarán en el PIMCD, aparte de PDI, al menos 26 estudiantes de máster y doctorado de la Facultad de Filosofía, a lxs que acompañarán durante el desarrollo del PIMCD 4 Alumni de la Facultad de Filosofía de la UCM, actualmente investigadores post-doc y profesorxs de IES, cuya experiencia será beneficiosa para su introducción en la investigación. Asimismo, el equipo cuenta con el apoyo de varixs profesorxs asociadxs, que en algunos casos son también profesores de IES. Varixs docentes externos a la UCM participantes en el PIMCD poseen una dilatada experiencia en la coordinación de proyectos de innovación de otras universidades, lo que redundará en beneficio de las actividades a desarrollar. La coordinadora y otrxs miembros del PIMCD pertenecen a la Red de Innovación Docente en Filosofia (RIEF), puesta en marcha desde la Universitat de València (http://rief.blogs.uv.es/encuentros-de-la-rief/), a la que mantendremos informada de las actividades realizadas en el proyecto. Asimismo, lxs 6 miembros del PAS permitirán difundir debidamente las actividades realizadas en el PIMCD entre lxs estudiantes Erasmus IN del curso 2019/20 en la Facultad de Filosofía, de la misma manera que orientar en las tareas de maquetación y edición que puedan ser necesarias de cara a la publicación de lxs resultados del PIMCD y en las tareas de pesquisa bibliográfica necesarias para el desarrollo de los objetivos propuestos. Han manifestado su interés en los resultados derivados del PIMCD editoriales especializadas en la difusión de investigaciones predoctorales como Ápeiron y CTK E-Books