Evaluación de los diferentes tipos de membranas de hemodiálisis

La pluralidad de membranas utilizadas en la fabricación de dializadores, contribuye a que se presente en el mercado gran número de ellos, más de 400 en el ámbito de la EDTA, con características muy diferentes, tanto en lo relativo a sus prestaciones funcionales como a su "biocompatibilidad" y su precio. La trascendencia clínica y económica del uso de uno u otro tipo de dializador ha sido objeto de multitud de publicaciones y considerable debate que no ha llegado a materializarse en un cuerpo de doctrina universalmente aceptado, que sitúe con precisión la contribución relativa de cada tipo de dializador al resultado clínico del tratamiento en diálisis de la insuficiencia renal; y, consecuentemente, la efectividad y eficiencia de este elemento, fundamental en dicho tratamiento. El objeto del presente informe es proporcionar información respecto de dichas cuestiones, desde una perspectiva global, ponderando el valor relativo de los diferentes criterios en juego que afectan a: efectividad clínica, funcionalidad, biocompatibilidad y precio.Presentación, Abreviaturas, Informe de síntesis, Tratamiento de IRCT: Desarrollo actual y resultados, Objetivos y fundamentos de la técnica, Biocompatibilidad, Clasificación de membranas. Criterios y parámetros, Diálisis adecuada, Morbi-mortalidad asociada a diálisis Uso de las diferentes categorías de membranas, Consideraciones económicas, Conclusiones, Hemodiálisis: Evolución histórica y consideraciones generales, Morbilidad asociada a la diálisis Evolución de la técnica y diálisis adecuada, Criterios de clasificación de las membranas, Valoración clínica de las diferentes categorías de membranas, Extensión del uso de las diferentes categorías de membranas Aspectos económicos del tratamiento, Anexos

Ruling Frameworks and Fire Use‐Conflicts in Tropical Forests of Chiapas, Mexico: A Discourse Analysis

The use of fire within tropical forests to settle agriculture and livestock systems has long been causing a bottle-neck for governmental and environmental development agencies, especially in natural forested areas with local population. An international strategy followed since many years ago is the decree of special territories with vast forests as natural protected areas (NPA). In Mexico, environmental laws can run contrary to customs and practices of natural resource-dependent communities which still use fire to farm their lands as unique livelihood activity. The chapter examines two conflicting frameworks of resource management (forest and soil) and governance in a forest village’s efforts to comply with federal policies against fires in a NPA of Chiapas, Mexico. Forest and soil management is a key locus in California village, where governance structures come into conflict with hierarchical State power. Participatory workshops and semi-structured interviews were primary research instruments for data collection and discovery of community front and backstage. Ethnography and discourse analysis were used as main tools for the analysis of information. While the State leads the conservation efforts and limits cultural activities and local actions through coercive laws, the land use and resource-dependent communities defend their access rights, and they also determine how to individual or collectively manage fires in daily activities. Finding collective solutions with horizontal-dialogue strategies represent an important issue and a pending task for the development and preservation agencies focused on forested areas. Backstage dialogue is a tool for village self-preservation when livelihood strategies are at odds with protectionist conservation efforts

Uso de los modelos 3D de los corazones fetales en la docencia multidisciplinar del diagnóstico tratamiento y pronóstico de las cardiopatías congénitas complejas

Como continuidad a un proyecto de innovación docente previo basado en el desarrollo de los modelos 3D del corazón fetal, normal y patológico, en estos momentos somos más conscientes como esta tecnología La tecnología 3D supone un cambio de paradigma en docencia en la que pueden participar, obstetras, pediatras, cirujanos cardiacos infantiles y además anatomopatólogos. Como hemos destacado los modelos 3d son un tipo de manufactura aditiva que permite transformar un modelo digital en un objeto tridimensional real y tangible. Esto permite una docencia teórico-práctica innovadora que se enmarca en el contexto moderno de una atención médica personalizada (medicina de precisión centrada en el paciente, visible y comprensible por el estudiante, comprensión en el proceso de comunicación médica con el paciente y con el resto de profesionales médicos que atienden a los pacientes, ayuda en la toma de decisiones ante el diagnostico de entidades patológicas, entre otras cuestiones)

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: A nationwide study in Spain

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. Participants This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. Interventions An exploratory factorial analysis was performed to select the most relevant variables of the sample. Primary and secondary outcome measures Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. Results Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10 5 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade =3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10 5 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. Conclusions Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10 5 people/week) was a statistically independent predictor of mortality. Trial registration number CEIM 20/217

Detection of kinase domain mutations in BCR::ABL1 leukemia by ultra-deep sequencing of genomic DNA

The screening of the BCR::ABL1 kinase domain (KD) mutation has become a routine analysis in case of warning/failure for chronic myeloid leukemia (CML) and B-cell precursor acute lymphoblastic leukemia (ALL) Philadelphia (Ph)-positive patients. In this study, we present a novel DNA-based next-generation sequencing (NGS) methodology for KD ABL1 mutation detection and monitoring with a 1.0E-4 sensitivity. This approach was validated with a well-stablished RNA-based nested NGS method. The correlation of both techniques for the quantification of ABL1 mutations was high (Pearson r = 0.858, p < 0.001), offering DNA-DeepNGS a sensitivity of 92% and specificity of 82%. The clinical impact was studied in a cohort of 129 patients (n = 67 for CML and n = 62 for B-ALL patients). A total of 162 samples (n = 86 CML and n = 76 B-ALL) were studied. Of them, 27 out of 86 harbored mutations (6 in warning and 21 in failure) for CML, and 13 out of 76 (2 diagnostic and 11 relapse samples) did in B-ALL patients. In addition, in four cases were detected mutation despite BCR::ABL1 < 1%. In conclusion, we were able to detect KD ABL1 mutations with a 1.0E-4 sensitivity by NGS using DNA as starting material even in patients with low levels of disease

La ganadería ante escenarios complejos.

La calidad de las contribuciones, producto de la pluma de especialistas en los temas tratados, el presente es un libro que esperamos, basándonos en la importancia de los temas tratados, sea de utilidad y abone a la reflexión de los estudiosos de la ganadería mexicana y, por supuesto, en beneficio de las familias ganaderas y de los consumidores de sus productos.este libro refleja en muchos sentidos la situación de la ganadería mexicana, a la que se le están demandando mayor producción y productividad, que los procesos productivos tengan la menor huella ecológicposible, que los alimentos sean inocuos, que se abatan costos de producción y, cada vez aumentan las presiones de diversos grupos para, que se incluyan los protocolos de bienestar animal, solamente por citar algunos de los retos que tiene. Algunas de estas demandas son complementarias, otras se contraponen, lo que hace valiosos a los estudios que desde las ciencias sociales se realizan y, desde diversas ópticas, se hagan propuestas de política pública balanceadas que consideren lo mejor de cada enfoque, pero sin desechar por completo los antagónicos.Universidad Autónoma Chaping

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation