Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients

Fundamento. El objetivo de este estudio fue valorar la afectación microangiopática mediante capilaroscopia en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Apenas ha sido estudiada y podría constituir una herramienta de diagnóstico precoz de afectación cardiovascular en estos pacientes. Material y métodos. Estudio transversal que incluyó pacientes mayores de 18 años, diagnosticados de infección por VIH entre 2008 y 2018. Se recogieron variables demográficas (sexo, edad), analíticas (tiempo de infección, CD4, CD4/CD8, coinfección por otros virus), tratamiento antirretroviral y comorbilidades (tabaquismo, enolismo, hipertensión arterial, dislipemia, diabetes, cardiopatía). Se realizó una capilaroscopia y un análisis de sangre en el mismo acto. Las alteraciones capilaroscópicas evaluadas fueron: congestión, tortuosidades, hemorragias, dilataciones, pérdida capilar y megacapilares. Resultados. Se incluyeron 102 pacientes, 73,5% hombres, edad media 40 años (DE: 10) y tiempo medio de infección 4,5 años (DE: 3,1). Al diagnóstico, la media de CD4 fue 408 células/mm3 y la razón CD4/CD8 fue 0,4. El 14,7% presentaban coinfección por el virus de la hepatitis B, el 31,3% tabaquismo y el 13,7% enolismo. El 93,1% de pacientes mostró alguna alteración capilaroscópica. Se observaron, por orden de frecuencia, congestión (78,5%), tortuosidades (77,5%), hemorragias (13,8%), dilataciones (11,8%), pérdida capilar (5%) y megacapilares (1%). Las torutuosidades se asociaron a edad y tabaquismo, y las hemorragias a edad, CD4, tratamiento antirretroviral, e hipertensión. Conclusiones. Los pacientes con infección por VIH presentan una prevalencia importante de alteraciones capilaroscópicas, principalmente tortuosidades y congestión. Es la primera descripción de áreas de congestión como hallazgo capilaroscópico en este grupo de pacientes.Background. In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. Methodology. Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. Results. One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. Conclusion. Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients

Tecnología industrial y espacio sacro. Iglesia de Baranzate 1957

[EN] In Baranzate a church is erected designed with four concrete pilasters, bush-hammered by hand to give the rough appearance needed to contrast it against the fi neness of the board that supports them; a cover with a prefabricated and post-tensioned section. A system which frees up the enclosure from the structural work and defi nes itself as a fi ne element of thin double transparent glass. A dialogue between the lightweight and thin light box and a concrete structure with texture and volume. An encounter between two materials addressed by A.Manigiarotti and B. Morassutti with the most current advanced technology.[ES] En Baranzate se levanta una iglesia concebida con cuatro pilastras de hormigón, abujardado a mano para otorgarle el aspecto rugoso necesario por el contraste a la fi nura del tablero que soportan; una cubierta de secciones prefabricadas y pos-tesadas. Un sistema que libera al cerramiento del trabajo estructural defi niéndose como elemento fi no de doble vidrio transparente. Un diálogo entre la ligera y fi na caja de luz y una estructura con textura y volumen en hormigón. Un encuentro entre dos materiales abordados por A. Mangiarotti y B. Morassutti con las técnicas más avanzadas del momento.Mocholí Ferrándiz, G.; Serra Soriano, B.; Verdejo Gimeno, P. (2013). Tecnología industrial y espacio sacro. Iglesia de Baranzate 1957. EN BLANCO. Revista de Arquitectura. 5(11):26-29. doi:10.4995/eb.2013.6625SWORD262951

Effect of albumin administration on outcomes in hypoalbuminemic patients hospitalized with community-acquired pneumonia (ALBUCAP): a prospective, randomized, phase III clinical controlled trial - a trial protocol

Background: Community-acquired pneumonia (CAP) remains a leading cause of death worldwide, and hypoalbuminemia is associated with worse outcomes. However, it remains uncertain whether albumin administration could have any beneficial effects. We aim to assess whether the administration of albumin in hypoalbuminemic patients with CAP increases the proportion of clinically stable patients at day 5 compared with the standard of care alone. Methods: This is a trial protocol for a superiority, non-blinded, multicenter, randomized, phase 3, interventional controlled clinical trial. The primary endpoint will be the proportion of clinical stable patients at day 5 (intention to treat), defined as those with stable vital signs for at least 24 h. The secondary endpoints will be time to clinical stability, duration of intravenous and total antibiotic treatment, length of hospital stay, intensive care unit admission, duration of mechanical ventilation and vasopressor treatment, adverse events, readmission within 30 days, and all-cause mortality. The trial has been approved by the Spanish Medicines and Healthcare Products Regulatory Agency. The investigators commit to publish the data in peer-reviewed journals within a year of the study completion date. Subjects will be recruited from three Spanish hospitals over a planned enrolment period of 2 years. A follow-up visit will be performed 1 month after discharge. We have estimated the need for a sample size of 360 patients at a two-sided 5% alpha-level with a power of 80% based on intention to treat. Eligible participants must be hospitalized, hypoalbuminemic (≤ 30 g/L), non-immunosuppressed, adults, and diagnosed with CAP. They will be randomly assigned (1:1) to receive standard care plus albumin (20 g in 100 mL) every 12 h for 4 days or standard care alone. Discussion: If this randomized trial confirms the hypothesis, it should lead to a change in current clinical practice for the management of hypoalbuminemic patients with CAP

Deepint.net: A rapid deployment platform for smart territories

This paper presents an efficient cyberphysical platform for the smart management of smart territories. It is efficient because it facilitates the implementation of data acquisition and data management methods, as well as data representation and dashboard configuration. The platform allows for the use of any type of data source, ranging from the measurements of a multi-functional IoT sensing devices to relational and non-relational databases. It is also smart because it incorporates a complete artificial intelligence suit for data analysis; it includes techniques for data classification, clustering, forecasting, optimization, visualization, etc. It is also compatible with the edge computing concept, allowing for the distribution of intelligence and the use of intelligent sensors. The concept of smart cities is evolving and adapting to new applications; the trend to create intelligent neighbourhoods, districts or territories is becoming increasingly popular, as opposed to the previous approach of managing an entire megacity. In this paper, the platform is presented, and its architecture and functionalities are described. Moreover, its operation has been validated in a case study where the bike renting service of Paris—Vélib’ Métropole has been managed. This platform could enable smart territories to develop adapted knowledge management systems, adapt them to new requirements and to use multiple types of data, and execute efficient computational and artificial intelligence algorithms. The platform optimizes the decisions taken by human experts through explainable artificial intelligence models that obtain data from IoT sensors, databases, the Internet, etc. The global intelligence of the platform could potentially coordinate its decision-making processes with intelligent nodes installed in the edge, which would use the most advanced data processing techniques.This work has been partially supported by the European Regional Development Fund (ERDF) through the Interreg Spain-Portugal V-A Program (POCTEP) under grant 0677_DISRUPTIVE_2_E, the project My-TRAC: My TRAvel Companion (H2020-S2RJU-2017), the project LAPASSION, CITIES (CYTED 518RT0558) and the company DCSC. Pablo Chamoso’s research work has been funded through the Santander Iberoamerican Research Grants, call 2020/2021, under the direction of Paulo Novais

Study protocol of a randomized controlled trial to assess safety of teleconsultation compared with face-to-face consultation: the ECASeT study

BackgroundThe use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting.MethodsMulticenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024.DiscussionThe scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript.Trial registrationNCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021

Estudio de microangiopatía y macroangiopatía en población VIH. Prevención del riesgo cardiovascular

Introducción: La enfermedad cardiovascular en personas que viven con VIH (PVV) está en relación con los factores de riesgo cardiovascular (FRCV) clásicos, y con formas de inflamación vascular y disfunción endotelial inducidas por el propio VIH. Esta inflamación crónica puede afectar tanto a la macrocirculación (macroangiopatía) como a la microcirculación (microangiopatía) El estudio de la afectación microangiopática a través de la capilaroscopia no ha sido ampliamente estudiado en este tipo de pacientes y su potencial utilidad como factor pronóstico es desconocida. Del mismo modo su correlación con la detección de afectación macroangiopática mediante ecografía femoral añadida a la exploración carotidea podría permitir aumentar la capacidad de detección de enfermedad. Material y métodos: Estudio observacional, transversal y prospectivo. Se recogieron variables epidemiológicas, analíticas previas y se llevo a cabo una capilaroscopia, ecografía carotidea/femoral y un análisis de sangre en el mismo acto. Criterios de inclusión: PVV >18 años en seguimiento ambulatorio por el servicio de Enfermedades infecciosas del hospital clínico Lozano Blesa. Zaragoza. España. Análisis estadístico a través del SPSS. Resultados: 102 PVV. Edad media 40 años, 73,5% varones, en su mayoría de origen español. Vía de transmisión sexual en el 98%. FRCV: tabaquismo (31,3%), enolismo (13,7%). Solo 2 pacientes con viremia detectable. Cifra media de CD4 695,2mm3.Capilaroscopia: 78.5% áreas de congestión o halo, 77.5% tortuosidades, 13.8% hemorragias, 11.8% dilataciones, 5% pérdida capilar y 1% megacapilares. Ecografía: ateromatosis carotídea en el 15,7%, ateromatosis femoral en el 18,6%. Proporción de pacientes con criterios de EAS global (carotídea o femoral) del 23,5%.. Conclusiones: Los signos capilaroscópicos más frecuentes observados fueron:áreas de congestión, seguido de tortuosidades, se relacionaron con la edad, inmunidad, grosor intima medio, y ateromatosis. La detección de macroangiopatía en forma de enfermedad arteromatosa subclínica aumenta cuando a la exploración ecográfica carotídea, se añade la exploración del territorio femoral.Introduction: Cardiovascular disease in persons living with HIV(PLWH) is related to classical cardiovascular risk factors (CVRF), and to forms of vascular inflammation and endothelial dysfunction induced by HIV itself. This chronic inflammation can affect both the macrocirculation (macroangiopathy) and the microcirculation (microangiopathy). The study of microangiopathic involvement through capillaroscopy has not been widely studied in this type of patient and its potential usefulness as a prognostic factor is unknown. Likewise, its correlation with the detection of macroangiopathic involvement by femoral ultrasound added to carotid scanning could increase the ability to detect disease. Material and methods: Observational, cross-sectional, prospective study. Epidemiological and analytical variables were collected and a capillaroscopy, carotid/femoral ultrasound and a blood test were performed at the same time. Inclusion criteria: PLWH >18 years old in outpatient follow-up by the infectious diseases service of the Lozano Blesa clinical hospital. Zaragoza. Spain. Statistical analysis through SPSS. Results: 102 patients. Mean age 40 years, 73.5% male, mostly of Spanish origin. Sexual transmission route 98%. CVRF: smoking (31.3%), alcoholism (13.7%). Only 2 patients with detectable viremia. The mean CD4 count was 695.2mm3.Capillaroscopy: 78.5% areas of congestion or halo, 77.5% tortuosity, 13.8% hemorrhages, 11.8% dilatations, 5% capillary loss and 1% megacapillaries. Ultrasound: carotid atheromatosis 15.7%, femoral atheromatosis 18.6%. The proportion of patients with global SAE criteria (carotid or femoral involvement) 23.5%. Conclusions: The most frequent capillaroscopic signs observed were; areas of congestion, followed by tortuosity, were related to age, immunity, intima media thickness, and atheromatosis. The detection of macroangiopathy in the form of subclinical atheromatous disease increases when the exploration of the femoral territory is added to the carotid ultrasound examination

Experiencias escolares de las/los estudiantes universitarios de la Universidad Pedagógica Nacional: un análisis pendiente

Licenciatura en Sociología de la Educació

Participación en competiciones internacionales como experiencia para dinamizar la universidad

Durante los años 2008-2010 en la Universidad Cardenal Herrera-Ceu de Valencia, se desarrollo el Proyecto SML House para participar el Concurso Internacional Solar Decathlon, que junto 19 universidades de todo el mundo pretende fomentar el diseño y construcción de viviendas autosuficientes, que utilicen solo energía procedente del sol y que hagan un uso eficiente de los recursos naturales. Durante estos años, la Universidad formo un equipo multidisciplinar con alumnos y profesores de diferentes áreas de conocimiento, y definió diversas estrategias para involucrar a los alumnos ofertando formación tanto en las propias escuelas como con empresas externas a la Universida