Physiotherapeutic approach in a post COVID-19 patient after pulmonary thromboembolism: clinical case

[Resumen] Presentación del caso. Varón de 58 años con neumonía bilateral y síndrome de distrés respiratorio agudo (SDRA) por infección por SARS-CoV-2 grave que cursa con tromboembolismo pulmonar (TEP) bilateral. Objetivo. Mejorar la sintomatología del paciente, recuperar los volúmenes y capacidades pulmonares, reducir las limitaciones en la actividad y mejorar la calidad de vida relacionada con la salud (CVRS) del paciente. Intervención. Se dividió en dos fases, una hospitalaria y otra ambulatoria. En la primera se llevaron a cabo 12 sesiones, con una frecuencia de 5 veces por semana con una duración aproximada de 15-20 minutos. La fase hospitalaria incluía técnicas de fisioterapia respiratoria, ejercicio terapéutico para miembros superiores (MMSS) y miembros inferiores (MMII), así como, entrenamiento aeróbico en bicicleta estática. La segunda fase constó de 2 sesiones de evaluación, 21 sesiones de tratamiento, con una frecuencia semanal de 2-3 días y una duración de entre 1 hora y 1 hora y media diaria y 2 sesiones de reevaluación. Esta constó de un programa de rehabilitación pulmonar (RP) en el que se incluían 30 minutos de entrenamiento aeróbico en cicloergómetro de tipo interválico, entrenamiento de fuerza de MMSS al 70-85 % de su 1RM, así como, técnicas de fisioterapia respiratoria. Resultados. Se observa una mejora en las constantes vitales, en la sintomatología, en la tolerancia al esfuerzo y en la calidad de vida del paciente, eliminando por completo las limitaciones en la actividad encontradas durante la valoración inicial. Conclusiones. Se alcanzaron todos los objetivos inicialmente planteados, reafirmando los potenciales beneficios que tiene la fisioterapia respiratoria en los pacientes post COVID-19. Sin embargo, es necesario continuar investigando para determinar un protocolo de RP en estos pacientes, pues la evidencia al respecto es escasa.[Abstract] Case presentation. A 58-year-old man with bilateral pneumonia and acute respiratory distress syndrome (ARDS) due to severe SARS-CoV-2 infection with bilateral pulmonary thromboembolism (PTE). Objective. To improve the patient's symptoms, to recover lung volumes and capacities, to reduce activity limitations and to improve patient's health-related quality of life (HRQoL). Intervention. It was divided into two phases, an inpatient and an outpatient phase. In the first one, 12 sessions were carried out, with a frequency of 5 times per week with an approximate duration of 15-20 minutes. The inpatient phase included respiratory physiotherapy techniques, therapeutic exercise for upper limbs and lower limbs, as well as aerobic training on a stationary bicycle. The second phase consisted of 2 evaluation sessions, 21 treatment sessions, 2-3 days per week and a duration between 1 hour and 1 hour and a half per session, and 2 reevaluation sessions. This phase consisted of a pulmonary rehabilitation (PR) program that included 30 minutes of aerobic training on an interval-type cycle ergometer, strength training of upper limbs at 70-85% of its 1RM, as well as respiratory physiotherapy techniques. Results. An improvement was observed in the vital signs, in the symptoms, in the effort tolerance and in the patient's quality of life, getting rid of the limitations in the activity found during the initial evaluation. Conclusions. All the objectives initially proposed were achieved, reaffirming the potential benefits of respiratory physiotherapy in post COVID-19 patients. However, further research is needed to determine a protocol for PR in these patients, as the evidence related to this field is still limited.[Resumo] Presentación do caso. Varón de 58 anos con pneumonía bilateral e síndrome de distrés respiratorio agudo (SDRA) por infección por SARS-CoV-2 grave que cursa con tromboembolismo pulmonar (TEP) bilateral. Obxectivo. Os principais obxectivos do presente traballo son mellorar a sintomatoloxía do paciente, recuperar os volumes e capacidades pulmonares, reducir as limitacións na actividade e mellorar a calidade de vida relacionada coa saúde (CVRS) do doente. Intervención. Dividiuse en dúas fases, unha hospitalaria e outra ambulatoria. Na primeira leváronse a cabo 12 sesións, cunha frecuencia de 5 veces por semana cunha duración aproximada de 15-20 minutos. A fase hospitalaria incluía técnicas de fisioterapia respiratoria, exercicio terapéutico para membros superiores (MMSS) e membros inferiores (MMII) con bandas elásticas e pesos, así como, adestramento aeróbico en bicicleta estática. A segunda fase constou de 2 sesións de avaliación, 21 sesións de tratamento, cunha frecuencia semanal de 2-3 días e unha duración de entre 1 hora e 1 hora e media diaria e 2 sesións de reavaliación. Esta constou dun programa de rehabilitación pulmonar (RP) no que se incluían 30 minutos de adestramento aeróbico en cicloergómetro de tipo interválico, adestramento de forza de MMSS ao 70-85 % do seu 1RM, así como, técnicas de fisioterapia respiratoria. Resultados. Móstrase unha mellora nas constantes vitais, na sintomatoloxía, na tolerancia ao esforzo e na calidade de vida do doente, eliminando por completo as limitacións na actividade atopadas durante a valoración inicial. Conclusións. Alcanzáronse tódolos obxectivos inicialmente plantexados, reafirmando os potenciais beneficios que ten a fisioterapia respiratoria nos doentes post COVID-19. Porén, é necesario seguir investigando para determinar o protocolo de RP a seguir neste tipo de doentes, pois a evidencia ao respecto é escasa.Traballo fin de grao (UDC.FCS). Fisioterapia. Curso 2020/202

Numerical analysis of the modal coupling at low resonances in a Colombian Andean Bandola in C using the finite element method

The work presented in this thesis is concerned with the dynamical behavior of a CBandola's acoustical box at low resonances -- Two models consisting of two and three coupled oscillators are proposed in order to analyse the response at the first two and three resonances, respectively -- These models describe the first resonances in a bandola as a combination of the lowest modes of vibration of enclosed air, top and back plates -- Physically, the coupling between these elements is caused by the fluid-structure interaction that gives rise to coupled modes of vibration for the assembled resonance box -- In this sense, the coupling in the models is expressed in terms of the ratio of effective areas and masses of the elements which is an useful parameter to control the coupling -- Numerical models are developed for the analysis of modal coupling which is performed using the Finite Element Method -- First, it is analysed the modal behavior of separate elements: enclosed air, top plate and back plate -- This step is important to identify participating modes in the coupling -- Then, a numerical model of the resonance box is used to compute the coupled modes -- The computation of normal modes of vibration was executed in the frequency range of 0-800Hz -- Although the introduced models of coupled oscillators only predict maximum the first three resonances, they also allow to study qualitatively the coupling between the rest of the computed modes in the range -- Considering that dynamic response of a structure can be described in terms of the modal parameters, this work represents, in a good approach, the basic behavior of a CBandola, although experimental measurements are suggested as further work to verify the obtained results and get more information about some characteristics of the coupled modes, for instance, the phase of vibration of the air mode and the radiation e cienc

Wave propagation in a phase transforming cellular material

The aim of this project is to explore the wave propagation properties in a phase transforming cellular material suitable for energy dissipation applications -- We pretend to understand how to control the dispersion behavior and switch the propagation properties when the phase transition is triggered -- In the long-term, the main objective is to achieve a device with tunable band gaps and wave guide properties -- The first part of this document presents the theoretical background of wave propagation in periodic materials -- The second part is dedicated to the Bloch analysis of the phase transforming cellular materia

The influence of lifestyles to cope with stress over mental health in pregnant and postpartum women during the COVID-19 pandemic

The COVID-19 pandemic afected daily life routines and lifestyles of pregnant and postpartum women and increased their stress and risk of sufering from mental health problems. The aim of this study was to analyse which sociodemographic variables, COVID-19 exposure variables and lifestyles to cope with stress variables predicted anxiety, depression, and PTSD symptoms in pregnant and postpartum women during the COVID-19 pandemic. A cross-sectional design was performed with a sample of 3356 Spanish women participating in the Riseup-PPD-COVID-19 study. These participants completed an online survey composed of measures of anxiety (GAD-7), depression (EPDS), and PTSD related to COVID-19 (Checklist DSM-5), as well as demographics, exposure to COVID-19, and lifestyles to cope with stress. Regarding results, 47.2% showed depression and a third reported anxiety, whereas moderate scores were observed in PTSD symptoms. The most commonly used strategies to cope with stress in the COVID-19 pandemic were talking with friends and family and increasing time with social networks. Better results in mental health were associated with coping strategies such as talking with family and friends or participating in family activities, physical activity, sleeping well at night, eating healthier, and increasing personal care. Furthermore, poor results in mental health were observed in those participants who increased time with screens, ate fast food, reported substance use, and talked more frequently with health professionals. More symptoms were also observed in younger women, primiparous women, and those who reported more exposure to COVID-19. The results underline the need to strengthen the mental health of pregnant and postpartum women

Factors in the acquisition of an ethical training

Society in general demands an ethical behavior in business world. The research problem of the paper is to analyze whether higher education institutions of business contribute to ethical decisions making in students through a specific training approach based on practical methodologies that take into account students’ personal characteristics, which may affect the ethical decisions making. The acquisition of knowledge should be more effective whether is based on personal characteristics

La Dimensión como Estrategia Empresarial

This paper analyzes the possible differences in the economic-financial situation of family organizations based on the business dimension. Then, we focus our analysis on SMEs to analyse the influence of the dimension in their performance. For this, information belonging to a large sample composed of 21,149 family businesses and 5,737 non-family businesses in Spain corresponding to the period 2003–2015 is studied. The conclusions obtained show that, although the increase in the dimension of the family organizations is positively related to their performance, there are limits beyond which the value of certain economic-financial indicators can be negatively affected. This behavior is not observed in non-family businesses.Este trabajo analiza las posibles diferencias existentes en la situación económico-financiera de las empresas familiares en función de la dimensión empresarial. Seguidamente, centrando nuestro análisis en las pymes, analizamos la influencia que ejerce la dimensión en su desempeño. Para ello, se estudia información perteneciente a una amplia muestra formada por 21149 empresas familiares y 5737 no familiares españolas correspondiente al periodo 2003-2015. Las conclusiones obtenidas muestran que, a pesar de que el aumento de la dimensión de la empresa familiar está relacionado positivamente con su desempeño, existen unos límites a partir de los cuales el valor de determinados indicadores económico-financieros puede verse afectado negativamente, a diferencia de lo observado para las empresas no familiares

Influencia de la Razón Social en el Desempeño Económico de las Empresas Familiares: Análisis en Función de la Etapa Generacional

A family identity of a firm, exhibited by the presence of the family name in the business name, can influence the value of economic profitability. The present analysis also explores if this relationship varies depending on the size and the generation running the business. The sample used to conduct this study comprises a panel data set of 21,149 Spanish family firms containing information from 2003 to 2015, which translates into a balanced database including 274,937 observations. For analysis purposes, the firms are classified into small, medium-sized and large ones. Contrary to the competitive advantages brought about by the family identity of the businesses highlighted by previous research, the current study suggests its negative effects on the profitability of small and medium-sized family firms. This effect is more acute when the company is managed by its founding generation. The findings in the case of large family firms indicate that the company name does not have an impact upon economic profitability.La identidad familiar de la empresa, manifestada a través de la presencia del nombre familiar en su razón social, puede influenciar el valor de su rentabilidad económica. Se analiza si esta relación varía en función de la dimensión empresarial, así como de la etapa generacional a cargo de la organización. La muestra objeto de análisis está compuesta por pequeñas, medianas y grandes empresas familiares. El estudio contempla un extenso panel de datos con información de 21149 empresas familiares españolas desde el año 2003 hasta el 2015, obteniendo una base de datos equilibrada compuesta por 274937 observaciones. Contrariamente a las ventajas competitivas señaladas por investigaciones anteriores, el presente estudio señala un efecto negativo de la identidad familiar de la organización sobre la rentabilidad de las pymes familiares. Este efecto es más acentuado cuando la organización es gestionada por la generación fundadora. Los resultados en el caso de las empresas de mayor dimensión indican que tener una razón social familiar no influye sobre el valor de la rentabilidad económica

Trombopenia autoimmune neonatal. En base a un caso clínico

Son varias las enfermedades autoinmunes maternas que pueden tener su repercusión en el neonato a causa del llamado microquimerismo materno-fetal, en el cual se produce la transmisión transplacentaría de autoanticuerpos. Para prevenir en lo posible las manifestaciones neonatales, es fundamental el adecuado control de la enfermedad durante el embarazo. El lupus neonatal con un 30-50% de madres diagnosticadas de LES, o la trombocitopenia autoinmune neonatal son enfermedades neonatales poco frecuentes de origen autoinmune materno. En el caso de la trombocitopenia autoinmune neonatal es imprescindible descartar hemorragias intracraneales de forma precoz en trombopenias severas (30.000/mm3 plaquetas).<br /

Expression and structural properties of a chimeric protein based on the ectodomains of E1 and E2 hepatitis C virus envelope glycoproteins

Hepatitis C virus encodes two enveloped glycoproteins, E1 and E2, which are involved in viral attachment and entry into target cells. We have obtained in insect cells infected by recombinant baculovirus a chimeric secreted recombinant protein, E1341E2661, containing the ectodomains of E1 and E2. The described procedure allows the purification of approximately 2 mg of protein from 1 L of culture media. Sedimentation velocity experiments and SDS-PAGE in the absence of reducing agents indicate that the protein has a high tendency to self-associate, the dimer being the main species observed. All the oligomeric forms observed maintain a conformation which is recognized by the conformation-dependent monoclonal antibody H53 directed against the E2 ectodomain. The spectroscopic properties of E1341E2661 are those of a three-dimensionally structured protein. Moreover, the chimeric protein is able to bind to human antibodies present in HCV-positive human sera. Accordingly, this chimeric soluble polypeptide chain may be a valuable tool to study the structure-function relationship of HCV envelope proteins

Do Stakeholders Modulate Philanthropic Strategy? Corporate Philanthropy as Stakeholders’ Engagement

Corporate philanthropy, as an expression of commitment to the common good, can contribute to the creation of social value in companies. This corporate philanthropy can be managed in various ways. The choice of how to channel corporate philanthropy could be, in accordance with stakeholder theory, the result of companies’ interactions with key stakeholders and, in accordance with the theory of signaling, a signal that companies use to respond to their demands. This approach contributes to the literature on bottom-up initiatives (stakeholder–managers) as opposed to top-down strategies (board–stakeholders) in relation to corporate social responsibility, which is becoming increasingly important in a society where networks of communication, cooperation and interaction are established. To this end, a study was conducted on 221 European companies indexed in the Dow Jones Sustainability Indices in the year 2018. The findings have several practical implications: The management of corporate philanthropy should take into account the stakeholders’ requirements, and stakeholders show greater affinity and trust with the company when philanthropy is channeled through foundations. By contrast, donations are not associated with stakeholder attitudes. As a theoretical implication, this paper supports the theories of stakeholders and signaling by explaining the role of philanthropy in the relationship with stakeholders.RD PROJECTSEuropean Union (EU) B1-SEJ-387-UGR1