Cada uno en su traje. Vida cotidiana y prácticas indumentarias en Aragón en la Edad Moderna

Vida/cotidiana/prácticas/indumentarias/Aragón/Edad/ModernaLos hombres y mujeres que vivieron durante la Edad Moderna no utilizaron las prendas de vestido solamente para protegerse de los agentes atmosféricos, sino que las pusieron al servicio de sus necesidades e intereses sociales, económicos, religiosos y políticos. Los pequeños fragmentos de historias individuales y cotidianas, generados por hombres y mujeres de las diferentes condiciones sociales, proporcionados por la documentación notarial y un nutrido conjunto de fuentes indirectas compuesto fundamentalmente por obras literarias escritas por moralistas, legislación indumentaria, tratados sobre el oficio de sastre, relaciones de fiestas y repertorios de términos publicados durante la Edad Moderna constituyen la parte fundamental del corpus de fuentes documentales utilizado para realizar este trabajo de investigación.Desde las últimas décadas del siglo XX la relación entre vestidos y personas constituye un tema fundamental para los historiadores de la Nueva Historia Cultural. El estudio de las características formales y materiales de las diferentes prendas de vestido que las familias conservaban en el interior de la casa y de las prácticas indumentarias desarrolladas por los individuos con aquellas prendas de vestido que tenían al alcance de su mano constituyen el doble objetivo de este trabajo de investigación. En especial, estas últimas permiten conocer algunos aspectos intelectuales de los individuos relacionados con sus inquietudes personales como el gusto y las aspiraciones sociales, y sus sentimientos más íntimos vinculados con los afectos y la religiosidad. <br /

A low altitude forest dwelling Pyrenean chamois population increases the potential habitat of this subspecies

Aim of the study: To demonstrate if a population of Pyrenean chamois Rupicapra p. pyrenaica can live at low altitudes all year long. This could enlarge dramatically its potential habitat.&#x0D; Area of study: A hunting ground in Sobrarbe County, Pyrenees, Spain, in 2022.&#x0D; Material and methods. We interviewed local hunters to find out when the presence of the subspecies in the area dates back. We performed block counts from April to December in the target area for calculating the size of the population.&#x0D; Main results: There was a presence of at least 15 years of the subspecies living at 600 m asl. The population was at least 18 animals, reproduces, and shows a normal demographic structure of kids, yearlings, adult females, and adult males.&#x0D; Research highlights: Low-altitude chamois populations living in forests could be a result of important ecological changes in high mountain pastures producing migrations to newly suitable areas as low-altitude forests. The potential habitat of the subspecies should be broadened

Influencia de las comorbilidades en el pronóstico vital y funcional de los pacientes con ictus isquémico agudo tratados mediante fibrinolisis intravenosa.

Introducción: El ictus sigue siendo la segunda causa de muerte en el mundo Occidental, la segunda causa de demencia y la primera de discapacidad permanente adquirida. Se estima que su incidencia siga incrementándose en los próximos años. Es importante no considerar al ictus como una enfermedad aislada, si no como algo que acontece en un paciente que ya presenta otros procesos crónicos que van a condicionar su pronóstico vital y funcional a corto y largo plazo. Tomar conciencia de esto nos ayudará en el desarrollo de las estrategias de prevención y manejo. Hipótesis y objetivos: La presencia de comorbilidades crónicas tiene un papel determinante en la evolución, supervivencia y pronóstico funcional en los pacientes con ictus isquémico tratados con fibrinolisis intravenosa. Se ha realizado un estudio descriptivo de las comorbilidades crónicas presentes en nuestra muestra así como se ha analizado la repercusión de las mismas en el pronóstico funcional y vital. Metodología: Estudio retrospectivo observacional de una muestra de 80 pacientes que sufrieron un ictus isquémico y fueron tratados mediante fibrinolisis intravenosa durante el año 2018 en el Hospital Universitario Miguel Servet. Se valoraron las comorbilidades crónicas que presentaban así como su relación con el pronóstico funcional (escala mRankin) a 3 meses, mortalidad intrahospitalaria, mortalidad final y transformación hemorrágica sintomática. Resultados: Se trata de una muestra de edad avanzada y con alta frecuencia de multimorbilidad. Se demostró relación estadísticamente significativa entre la edad avanzada, el síndrome clínico (TACI y PACI), NIHSS, antecedente de AIT y demencia y el mal pronóstico funcional a 3 meses. Así mismo, se demostró asociación entre el antecedente de AIT y el NIHSS con la mayor mortalidad intrahospitalaria. Conclusión: La población afectada por el ictus presenta alta multimorbilidad lo que va a condicionar su respuesta al tratamiento, evolución y pronóstico vital y funcional. Las comorbilidades más frecuente son las referentes a los FRCV. No se demostró relación del Charlson con el pronóstico vital ni funcional. Es necesaria la realización de estudios más amplios para valorar adecuadamente esta asociación, así como diseñar escalas enfocadas a valorar específicamente a este perfil de paciente. Necesitamos conocer la multimorbilidad para poder mejorar las estrategias de prevención y tratamiento. <br /

Guillain–Barré syndrome associated with leptomeningeal enhancement following SARS-CoV-2 infection

INTRODUCTION: Patients with coronavirus disease 2019 (COVID-19) typically present with respiratory symptoms, but little is known about the disease''s potential neurological complications.We report a case of Guillain-Barré syndrome (GBS) following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in association with leptomeningeal enhancement. CASE PRESENTATION: A 56-year-old woman presented with recent unsteadiness and paraesthesia in both hands. Fifteen days earlier, she complained of fever, dry cough and shortness of breath. Her chest X-ray showed a lobar consolidation and PCR was positive for SARS-CoV-2; she was admitted due to mild COVID-19 pneumonia.In the first 48 hours of hospitalisation, she started to experience lumbar pain and weakness of the proximal lower extremities, progressing to bilateral facial nerve palsy, oropharyngeal weakness and severe proximal tetraparesis with cervical flexion 2/5 on the MRC scale. Full spine magnetic resonance imaging (MRI) showed a brainstem and cervical leptomeningeal enhancement. Analysis of cerebrospinal fluid (CSF) revealed albumin-cytological dissociation. Microbiological studies on CSF, including SARS-CoV-2, were negative. Nerve conduction studies were consistent with demyelinating neuropathy. She was treated with intravenous immunoglobulin, with significant neurological improvement noted over the next 2 weeks. CONCLUSION: Leptomeningeal enhancement is an atypical feature in GBS, but could be a marker of its association with SARS-CoV-2 infection

Impacto en los tiempos puerta-aguja de un conjunto de medidas para optimizar la atención hospitalaria del código ictus

Introducción: El tiempo sigue siendo una variable determinante para los tratamientos de reper-fusión del ictus isquémico agudo. A pesar de las recomendaciones de las guías clínicas, soloalrededor de la tercera parte de los pacientes con ictus isquémico agudo son fibrinolizadosen = 60 min. El objetivo de este trabajo es describir nuestra experiencia implementando unprotocolo específico de atención del ictus isquémico agudo y evaluar su impacto en nuestrostiempos puerta-aguja. Métodos: A finales del 2015, se implantaron gradualmente unas medidas dise ~nadas para acortarlos tiempos de actuación y optimizar la atención del ictus isquémico agudo incluyendo unaguardia específica de Neurovascular. Se compararon los tiempos de actuación antes (2013-2015)y después (2017-2019) de la introducción de este protocolo. Resultados: Se incluyó a 182 pacientes antes y 249 después de la intervención. Cuando todas lasmedidas fueron introducidas, la mediana global de tiempo puerta-aguja fue de 45 min (previa74 min, 39% menos, p < 0, 001) con un 73, 5% de pacientes tratados en = 60 min (47% más quepreintervención, p < 0, 001). El tiempo global al tratamiento (inicio síntoma-aguja) se redujo en20 min de mediana (p < 0, 001). Conclusiones: Las medidas asociadas en nuestro protocolo han conseguido una disminución deltiempo puerta-aguja de forma significativa y sostenida, aunque todavía nos queda margen demejora, la dinámica establecida de control de resultados y mejora continua hará posible seguiravanzando en este sentido. Introduction: Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60 minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital. Methods: Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol. Results: The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45 minutes (vs 74 minutes before, a 39% reduction; P<.001), with 73.5% of patients treated within 60 minutes (a 47% increase; P<.001). Median overall time to treatment (onset-to-needle time) was reduced by 20 minutes (P<.001). Conclusions: The measures included in our protocol achieved a significant, sustained reduction in door-to-needle times, although there remains room for improvement. The mechanisms established for monitoring outcomes and for continuous improvement will enable further advances in this regard

Tratamiento endovascular del ictus isquémico vertebrobasilar en Aragón: características clínicas, radiológicas, tiempos de atención y pronóstico a los 3 meses

Introducción: Los ictus de circulación posterior suponen el 15-20% del total de los ictus isquémicos, pero asocian en más del 60% de los casos mal pronóstico funcional y vital. Por sus características clínicas y radiológicas, su diagnóstico y manejo son más complejos que los de los ictus de circulación anterior. El objetivo de nuestro trabajo es analizar a los pacientes con ictus del sistema vertebrobasilar tratados con trombectomía mecánica en nuestra comunidad y definir sus características. Método: Análisis retrospectivo-descriptivo de los pacientes con ictus del sistema vertebrobasilar tratados mediante trombectomía mecánica en nuestro centro (hospital de referencia para la enfermedad cerebrovascular urgente en Aragón). Se definen características basales, factores de riesgo, signos y síntomas de presentación, escalas radiológicas, variables del procedimiento, tiempos de atención y pronóstico funcional a los 3 meses. Resultados: Se incluyó a 37 pacientes (39,5% mujeres) con una edad media de 68,34 ± 14,1 años. La primera causa etiológica fue la cardioembólica (42,1%), seguida de la aterotrombótica (28,9%). La localización más frecuente de la obstrucción fue el top de la basilar (55,3%). Los síntomas más frecuentes fueron somnolencia (76,3%), déficit motor (71,1%) y náuseas (55,3%). Se logró reperfusión exitosa (mTICIx ≥ 2b) en el 81,1% de pacientes. El pronóstico funcional a 90 días fue desfavorable (mRS < 3) en el 59% de los casos. Conclusiones: Los ictus de circulación posterior se asocian a una importante morbimortalidad. Su presentación clínica subaguda y larvada dilata los tiempos de atención y dificulta una identificación precoz. La trombectomía mecánica es un procedimiento seguro y eficaz, si bien son necesarios más estudios que esclarezcan la selección de pacientes. Introduction: Posterior circulation stroke accounts for 15%-20% of ischaemic strokes, but is associated with poor functional and vital prognosis in over 60% of cases. Due to its clinical and radiological peculiarities, diagnosis and management are more complex than in anterior circulation stroke. This study analyses and characterises patients with vertebrobasilar strokes treated with mechanical thrombectomy in our region. Methods: We conducted a descriptive, retrospective analysis of patients with vertebrobasilar stroke and treated with mechanical thrombectomy at our centre, a reference centre for cerebrovascular emergencies for the region of Aragon. We recorded baseline characteristics, risk factors, signs and symptoms at onset, radiological assessment scale scores, procedure-related variables, management times, and functional prognosis at 3 months. Results: We selected 37 patients (39.5% women; mean age [standard deviation], 68.34 [14.1] years). Cardioembolic stroke (42.1%) was the most common aetiology, followed by atherothrombosis (28.9%). The top of the basilar artery was the most common site of obstruction (55.3%). The most frequent clinical features were somnolence (76.3%), motor deficits (71.1%), and nausea (55.3%). Successful reperfusion (mTICI ≥ 2b) was achieved in 81.1% of patients. Functional outcome at 90 days was poor (mRS < 3) in 59% of patients. Conclusions: Posterior circulation stroke is associated with high rates of morbidity and mortality. Its subacute, nonspecific clinical course prolongs management times and hinders early detection. Mechanical thrombectomy is a safe and effective procedure, although further studies are needed to establish the optimal patient profile

Association of a single nucleotide polymorphism combination pattern of the Klotho gene with non-cardiovascular death in patients with chronic kidney disease

Chronic kidney disease (CKD) is associated with an elevated risk of all-cause mortality, with cardiovascular death being extensively investigated. However, non-cardiovascular mortality represents the biggest percentage, showing an evident increase in recent years. Klotho is a gene highly expressed in the kidney, with a clear influence on lifespan. Low levels of Klotho have been linked to CKD progression and adverse outcomes. Single nucleotide polymorphisms (SNPs) of the Klotho gene have been associated with several diseases, but studies investigating the association of Klotho SNPs with noncardiovascular death in CKD populations are lacking. The main aim of this study was to assess whether 11 Klotho SNPs were associated with non-cardiovascular death in a subpopulation of the National Observatory of Atherosclerosis in Nephrology (NEFRONA) study (n ¼ 2185 CKD patients). After 48 months of follow-up, 62 cardiovascular deaths and 108 non-cardiovascular deaths were recorded. We identified a high non-cardiovascular death risk combination of SNPs corresponding to individuals carrying the most frequent allele (G) at rs562020, the rare allele (C) at rs2283368 and homozygotes for the rare allele (G) at rs2320762 (rs562020 GG/AG þ rs2283368 CC/CT þ rs2320762 GG). Among the patients with the three SNPs genotyped (n ¼ 1016), 75 (7.4%) showed this combination. Furthermore, 95 (9.3%) patients showed a low-risk combination carrying all the opposite genotypes (rs562020 AA þ rs2283368 TT þ rs2320762 GT/TT). All the other combinations [n ¼ 846 (83.3%)] were considered as normal risk. Using competing risk regression analysis, we confirmed that the proposed combinations are independently associated with a higher fhazard ratio [HR] 3.28 [confidence interval (CI) 1.51-7.12]g and lower [HR 6 × 10- (95% CI 3.3 × 10--1.1 × 10-)] risk of suffering a non-cardiovascular death in the CKD population of the NEFRONA cohort compared with patients with the normal-risk combination. Determination of three SNPs of the Klotho gene could help in the prediction of non-cardiovascular death in CKD

Association of candidate gene polymorphisms with chronic kidney disease : Results of a case-control analysis in the NEFRONA cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2,445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionization-time of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD

Association of Candidate Gene Polymorphisms With Chronic Kidney Disease: Results of a Case-Control Analysis in the Nefrona Cohort

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Despite classical clinical risk factors for CKD and some genetic risk factors have been identified, the residual risk observed in prediction models is still high. Therefore, new risk factors need to be identified in order to better predict the risk of CKD in the population. Here, we analyzed the genetic association of 79 SNPs of proteins associated with mineral metabolism disturbances with CKD in a cohort that includes 2, 445 CKD cases and 559 controls. Genotyping was performed with matrix assisted laser desorption ionizationtime of flight mass spectrometry. We used logistic regression models considering different genetic inheritance models to assess the association of the SNPs with the prevalence of CKD, adjusting for known risk factors. Eight SNPs (rs1126616, rs35068180, rs2238135, rs1800247, rs385564, rs4236, rs2248359, and rs1564858) were associated with CKD even after adjusting by sex, age and race. A model containing five of these SNPs (rs1126616, rs35068180, rs1800247, rs4236, and rs2248359), diabetes and hypertension showed better performance than models considering only clinical risk factors, significantly increasing the area under the curve of the model without polymorphisms. Furthermore, one of the SNPs (the rs2248359) showed an interaction with hypertension, being the risk genotype affecting only hypertensive patients. We conclude that 5 SNPs related to proteins implicated in mineral metabolism disturbances (Osteopontin, osteocalcin, matrix gla protein, matrix metalloprotease 3 and 24 hydroxylase) are associated to an increased risk of suffering CKD