ENFERMEDAD DE MOYAMOYA: SITUACIÓN ACTUAL Y PERSPECTIVAS FUTURAS DE UNA ENTIDAD SINGULAR

La Enfermedad de Moyamoya (EMM) es una inusual patología cerebrovascular oclusiva, caracterizada por la estenosis progresiva de la porción distal de ambas arterias carótidas internas y de sus ramas, involucrando especialmente, a la circulación anterior. Presenta dos picos característicos de edad, uno en niños alrededor de los 10 años y otro en adultos en torno a los 30-40 años. Con respecto a su incidencia, es mayor en la población asiática, aunque es cada vez más prevalente en Occidente. Un hallazgo típico de la EMM es la aparición en las zonas hipoperfundidas de una red anómala colateral de vasos, denominados vasos “Moyamoya”, cuyo aspecto en “nube de humo” en la angiografía es característico. Esta patología cursa, principalmente, con isquemia o hemorragia cerebral, siendo la angiografía y la resonancia magnética de alta resolución, herramientas fundamentales para el avance en el diagnóstico neuroradiológico de esta enfermedad. Actualmente la etiología de la EMM continúa siendo desconocida. Sin embargo, estudios recientes han identificado el factor de riesgo genético más importante conocido hasta ahora, el locus RNF213, lo que podría tener grandes repercusiones diagnósticas y terapéuticas en un futuro próximo. En la actualidad, la opción terapéutica más efectiva es la revascularización cerebral quirúrgica. Dentro de las opciones existentes, tanto las técnicas directas como las indirectas, presentan ventajas e inconvenientes, por lo que su elección debe individualizarse según cada paciente. En resumen, la EMM es una patología peculiar, cada vez más prevalente en Occidente. Es de esperar que los futuros avances en el terreno de la genética, neuroradiología y cirugía permitan la consecución de un pronóstico mejor. En conclusión, son necesarios nuevos estudios e investigaciones para lograr un avance en el diagnóstico y tratamiento precoces, imprescindibles para conseguir una mejora en la calidad de vida de estos pacientes.<br /

One year overview and follow-up in a post-COVID consultation of critically ill patients

The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5–24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (<60%), and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) number of symptoms of 5.7 ± 4.6, and 61.3% met the criteria for post-COVID syndrome at 1 year. During the follow-up, 46 patients were discharged, and 16 were transferred to other consultations. Other conditions, such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%), and lung cancer (1%) were identified. A high use of health care resources is observed in the first year. In conclusion, one-third of critically ill COVID-19 patients need to continue follow-up beyond 1 year, due to abnormalities on DLCO, chest CT, or persistent symptoms.This study was supported in part by ISCIII (CIBERESUCICOVID, COV20/00110), co-funded by ERDF, “Una manera de hacer Europa,” donation program “Estar Preparados,” UNESPA, Madrid, Spain and Fundación Soria Melguizo (Madrid, Spain). DG-C had received financial support from Instituto de Salud Carlos III (Miguel Servet 2020: CP20/00041), co-funded by the European Social Fund (ESF)/“Investing in your future.” JB acknowledged receiving financial support from Instituto de Salud Carlos III (ISCIII; Miguel Servet 2019: CP19/00108), co-funded by the European Social Fund (ESF), “Investing in your future.”Peer ReviewedArticle signat per 29 autors/es: Jessica González (1,2,3,4), María Zuil (1,2,3,4), Iván D. Benítez (2,3,4), David de Gonzalo-Calvo (2,3,4), María Aguilar (1,2), Sally Santisteve (1,2,3,4), Rafaela Vaca (1,2), Olga Minguez (1,2), Faty Seck (1,2), Gerard Torres (1,2,3,4), Jordi de Batlle (2,3,4), Silvia Gómez (1,2,3,4), Silvia Barril (1,2,3,4), Anna Moncusí-Moix (2,3,4), Aida Monge (1,2,3,4), Clara Gort-Paniello (2,3,4), Ricard Ferrer (4,5), Adrián Ceccato (4), Laia Fernández (4,6), Ana Motos (4,6), Jordi Riera (4,5), Rosario Menéndez (4,7), Darío Garcia-Gasulla (8), Oscar Peñuelas (4,9), Gonzalo Labarca (10,11), Jesús Caballero (12), Carme Barberà (13), Antoni Torres (4,6) and Ferran Barbé (1,2,3,4) * on behalf of the CIBERESUCICOVID Project (COV20/00110, ISCIII) // (1) Department of Pulmonary, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain, (2) Translational Research in Respiratory Medicine Group, Lleida, Spain, (3) Lleida Biomedical Research Institute, Lleida, Spain, (4) Centro de Investigación Biomédica en Red (CIBER) of Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain, (5) Intensive Care Department, Vall d’Hebron Hospital Universitari, Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d’Hebron Institut de Recerca, Barcelona, Spain, (6) Department of Pulmonary, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, (7) Department of Pulmonary, University and Polytechnic Hospital La Fe, Valencia, Spain, (8) Barcelona Supercomputing Center, Barcelona, Spain, (9) Hospital Universitario de Getafe, Madrid, Spain, (10) Faculty of Medicine, University of Concepción, Concepción, Chile, (11) Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Concepción, Chile, (12) Intensive Care Department, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain, (13) Intensive Care Department, Hospital Universitari Santa Maria de Lleida, Lleida, SpainPostprint (published version

Predicting soybean development with a simple photothermal dynamic algorithm

Predicting the occurrence of the critical period for soybean’s yield determination is important for farmers to decide on variety and sowing date with the objective to expose this period (during which yield is mainly determined) to the best environmental conditionsEEA PergaminoFil: Severini, Alan. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Pergamino. Sección Ecofisiología; ArgentinaFil: Álvarez Prado, S. Universidad de Buenos Aires, Facultad de Agronomía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Otegui, María Elena. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Pergamino. Ecofisiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Vega, Claudia Rosa Cecilia. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Manfredi; ArgentinaFil: Zuil, Sebastian. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Reconquista; ArgentinaFil: Kavanová, M. Instituto Nacional de Investigación Agropecuaria (INIA). La Estanzuela; UruguayFil: Ceretta, S. Instituto Nacional de Investigación Agropecuaria (INIA). La Estanzuela; UruguayFil: Acreche, Martin Moises. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Salta; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Scholz Drodowski, R.F. Instituto Paraguayo de Tecnología Agraria (IPTA). Capitan Miranda; ParaguayFil: Serrago, R.A. Universidad de Buenos Aires, Facultad de Agronomía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miralles, D.J. Universidad de Buenos Aires, Facultad de Agronomía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods: Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results: We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of -¿10.77 (95% CI -¿18.40 to -¿3.15), with a greater number of affected lobes (+¿1.51 [95% CI 0.89–2.13]) and a greater TSS (+¿4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions: Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.Postprint (published version

Pulmonary function and radiologic features in survivors of critical COVID-19: a 3-month prospective cohort

© 2021 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/BACKGROUND: More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear. RESEARCH QUESTION: What are the major long-term pulmonary sequelae in critical patients who survive COVID-19? STUDY DESIGN AND METHODS: Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging. RESULTS: One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID- 19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay. INTERPRETATION: Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID- 19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.This study was supported in part by the Instituto de Salud Carlos III [Grant CIBERESUCICOVID, COV20/00110] and was cofunded by European Regional Development Funds, “Una manera de hacer Europa.” D. d. G.-C. has received financial support from the Instituto de Salud Carlos III [Grant Miguel Servet 2020: CP20/00041], co-funded by the European Social Fund “Investing in Your Future.” L. P. acknowledges receiving financial support from the Ministry of Science, Innovation and Universities for the Training of University Lecturers (FPU19 / 03526).Peer ReviewedPostprint (author's final draft

One Year Overview and Follow-Up in a Post-COVID Consultation of Critically Ill Patients

The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5-24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (<60%), and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) number of symptoms of 5.7 ± 4.6, and 61.3% met the criteria for post-COVID syndrome at 1 year. During the follow-up, 46 patients were discharged, and 16 were transferred to other consultations. Other conditions, such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%), and lung cancer (1%) were identified. A high use of health care resources is observed in the first year. In conclusion, one-third of critically ill COVID-19 patients need to continue follow-up beyond 1 year, due to abnormalities on DLCO, chest CT, or persistent symptoms.This study was supported in part by ISCIII (CIBERESUCICOVID, COV20/00110), co-funded by ERDF, “Una manera de hacer Europa,” donation program “Estar Preparados,” UNESPA, Madrid, Spain and Fundación Soria Melguizo (Madrid, Spain). DG-C had received financial support from Instituto de Salud Carlos III (Miguel Servet 2020: CP20/00041), co-funded by the European Social Fund (ESF)/“Investing in your future.” JB acknowledged receiving financial support from Instituto de Salud Carlos III (ISCIII; Miguel Servet 2019: CP19/00108), co-funded by the European Social Fund (ESF), “Investing in your future.

Impact of time to intubation on mortality and pulmonary sequelae in critically ill patients with COVID-19: a prospective cohort study

Question: We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods: Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results: We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29-4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42-4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of - 10.77 (95% CI - 18.40 to - 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89-2.13]) and a greater TSS (+ 4.35 [95% CI 2.41-6.27]) in the chest CT scan. Conclusions: Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.The study was supported in part by ISCIII (CIBERESUCICOVID, COV20/00110), co‑funded by ERDF, “Una manera de hacer Europa” and Donation pro‑gram "estar preparados". UNESPA. Madrid. Spain David de Gonzalo Calvo acknowledges receiving financial support from Instituto de Salud Carlos III (ISCIII); Miguel Servet 2020: CP20/00041), co‑funded by the European Social Fund (ESF), “Investing in your future”. JdB acknowledges receiving financial support from Instituto de Salud Carlos III (Miguel Servet 2019: CP19/00108), co‑funded by European Regional European Social Fund (ESF), “Investing in your future

Berrita: desarrollo de un espejo inteligente como apoyo para el bienestar de la salud mental

Debido a la pandemia del coronavirus, la cantidad de casos de enfermedades mentales se ha incrementado como consecuencia de los confinamientos, la distancia social, la pérdida de familiares, los despidos laborales… En concreto, las que más han aumentado han sido la depresión y la ansiedad. El presente proyecto propone una solución para poder prevenir estas dos enfermedades mentales haciendo uso del Internet de las Cosas, mediante un cuestionario de control que recoge los posibles síntomas que puedan tener los usuarios y su gravedad, para que en el futuro puedan ser evaluados por profesionales del sector. Para ello, se ha construido un espejo inteligente que permite contestar a las preguntas vía voz o vía teclado, y almacenar las respuestas recibidas en un archivo de datos. Además, no solo se podrán asociar dichos datos a un determinado usuario mediante el reconocimiento facial, sino que también se podrá obtener otra información como la edad, el género o la localización del individuo. También se ha pretendido asegurar la accesibilidad permitiendo ver y escuchar las distintas preguntas y mensajes del espejo, de tal forma que se reduzcan las desigualdades por edad o por algún tipo de discapacidad auditiva o visual.---ABSTRACT---Due to the coronavirus pandemic, the number of cases of mental disorders has increased due to lockdowns, social distance, loss of relatives, job layoffs, etc. Specifically, those that have risen the most have been depression and anxiety. The current project proposes a solution based on the Internet of Things to prevent these two mental diseases, using a monitoring questionnaire that collects the possible symptoms that users may suffer and their severity so that future professionals in the industry could evaluate them. To that end, a smart mirror has been built. It allows answering the questions through oral and written input and stores the responses received in a data file. Furthermore, it cannot only associate data with a specific user by facial recognition, but also other information such as age, gender or location of the individual can be obtained. Accessibility has also been ensured, allowing the user to see and listen to the questions and messages that the smart mirror emits, in such a way that inequalities due to age or some type of hearing or visual disability are reduced

Cáncer de pulmón

Resumen: La evidencia científica durante las últimas 2 décadas respalda que la aplicación de técnicas de cribado de cáncer de pulmón mediante tomografía computarizada (TC) de tórax de baja dosis de radiación contribuye a una reducción significativa de la mortalidad, gracias al diagnóstico en estadios potencialmente curativos. En referencia a dicho diagnóstico, existen además métodos novedosos en estudio, como la biopsia líquida, la identificación del microbioma pulmonar y la utilización de técnicas de inteligencia artificial, que desempeñarán un papel clave en un futuro próximo. En la actualidad, existe una tendencia hacia el tratamiento con cirugías cada vez menos invasivas (segmentectomía vs. lobectomía) basada en 2 ensayos clínicos recientes en tumores periféricos menores de 2 cm. A pesar de mostrar similar supervivencia, todavía existe controversia debido a la incertidumbre en cuanto a la tasa de recidiva y reserva funcional. En cuanto a la terapia adyuvante, la inmunoterapia sola o combinada con quimioterapia ofrece resultados alentadores en estadios resecables del cáncer de pulmón localmente avanzado, con respuestas patológicas completas y mejoría en la supervivencia. Tras el tratamiento con cirugía, a pesar de que no hay evidencia sólida del seguimiento a largo plazo de estos pacientes, en la práctica clínica se recomienda la realización de TC periódicas durante los primeros años.En conclusión, en el cáncer de pulmón existen avances importantes, que han mejorado las técnicas diagnósticas utilizando nuevas tecnologías y programas de cribado. Además, el tratamiento de este cáncer cada vez es más personalizado y todo ello se traduce en una mejora de la supervivencia de los pacientes. Abstract: Over the past 2 decades, scientific evidence has strongly supported the use of low-radiation dose chest computed tomography (CT) as a screening technique for lung cancer. This approach has resulted in a significant reduction in mortality rates by enabling the detection of early-stage lung cancer amenable to potentially curative treatments. Regarding diagnosis, there are also novel methods under study, such as liquid biopsy, identification of the pulmonary microbiome, and the use of artificial intelligence techniques, which will play a key role in the near future. At present, there is a growing trend towards less invasive surgical procedures, such as segmentectomy, as an alternative to lobectomy. This procedure is based on 2 recent clinical trials conducted on peripheral tumors measuring less than 2 cm. Although these approaches have demonstrated comparable survival rates, there remains controversy due to uncertainties surrounding recurrence rates and functional capacity preservation. With regard to adjuvant therapy, immunotherapy, either as a monotherapy or in conjunction with chemotherapy, has shown encouraging results in resectable stages of locally advanced lung cancer, demonstrating complete pathologic responses and improved overall survival.After surgery treatment, despite the lack of solid evidence for long-term follow-up of these patients, clinical practice recommends periodic CT scans during the early years.In conclusion, there have been significant advances in lung cancer that have improved diagnostic techniques using new technologies and screening programs. Furthermore, the treatment of lung cancer is increasingly personalized, resulting in an improvement in the survival of patients