Veterinaria y salud pública

Las Ciencias Veterinarias han venido adquiriendo cada vez una mayor dimensión en sus actividades vinculadas a la salud pública, ya sea en organismos de salubridad, integrando el equipo de salud o trabajando en institutos de investigaciones médicas, en el control de alimentos, en veterinaria espacial y aún en el ejercicio de la profesión privada. Esta participación y la demanda de sus servicios es el resultado de los múltiples logros científicos que a lo largo de su historia jalonan su presencia.Academia Nacional de Agronomía y Veterinari

Veterinaria y salud pública

Las Ciencias Veterinarias han venido adquiriendo cada vez una mayor dimensión en sus actividades vinculadas a la salud pública, ya sea en organismos de salubridad, integrando el equipo de salud o trabajando en institutos de investigaciones médicas, en el control de alimentos, en veterinaria espacial y aún en el ejercicio de la profesión privada. Esta participación y la demanda de sus servicios es el resultado de los múltiples logros científicos que a lo largo de su historia jalonan su presencia.Academia Nacional de Agronomía y Veterinari

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Crystal Structure of Defect KBB’O6 Pyrochlores (B,B’: Nb,W,Sb,Te) Revisited from Neutron Diffraction Data

Three defect pyrochlores KNbWO6·xH2O, KNbTeO6 and KSbWO6 were synthesized by solid state reaction at 750 °C, from stoichiometric mixtures of K2C2O4, Sb2O3, Nb2O5, WO3 and 20% excess TeO2. A neutron powder diffraction (NPD) data analysis allowed unveiling some structural features. They are all defined in the cubic F d 3 ¯ m space group symmetry, with α = 10.5068(1) Å, 10.2466(1) Å and 10.2377(1) Å, respectively. Difference Fourier synthesis for KNbWO6·xH2O clearly showed the presence of crystallization water, with extra O’ oxygen and H+ atoms that were located from NPD data. These O’ oxygen atoms are placed at 32e Wyckoff sites, conforming a K2O’ sublattice interpenetrated with the covalent framework constituted by (Nb,W)O6 octahedra. The H+ ions coordinate the O’ atoms at partially occupied 96g Wyckoff sites while K+ ions shift also along 32e sites, but closer to the 16c special site (0,0,0). By contrast, extra H2O molecules are absent in the other two pyrochlores: in KNbTeO6 and KSbWO6 K+ ions are shifted along 32e (x,x,x) sites further away from the origin than for the previous material, and the higher covalency of the octahedral network determines more compact structures, with shorter B–O distances and narrower B–O–B angles in the proposed AB2O6 defect pyrochlore structure

Structure-properties relationship in the hydronium-containing pyrochlores (H3O)1+pSb1+pTe1-pO6 with catalytic activity in the fructose dehydration reaction.

A series of defect pyrochlores of the composition (H3O)1+pSb1+pTe1-pO6 have been prepared by ion exchange from K-containing pyrochlores K1+pSb1+pTe1-pO6 in sulfuric acid at 280 °C for 24 h. The structural characterization of the hydronium-containing pyrochlores, including the location of the H3O+ units within the three-dimensional framework, was possible from neutron powder diffraction data in undeuterated samples. The crystal structure for all the compounds is defined in the Fd3[combining macron]m space group, and consists of a covalent framework of SbVO6 and TeVIO6 octahedra distributed at random and connected by their vertices with (Sb,Te)-O1-(Sb,Te) angles close to 136°, conforming to large cages where the hydronium species are located off-center. The absence of K+ ions in the ion-exchanged pyrochlores was confirmed by inductively coupled plasma optical emission spectroscopy and scanning electron microscopy coupled with energy dispersive X-ray spectroscopy. The shape and size of the hydronium units evolve along with the series, becoming more compact as the framework covalence and Lewis-basicity decrease upon Sb enrichment of the structure (for greater p values). The amount and lability of the H3O+ species also increase throughout the series, as wanted: a straightforward correlation of the catalytic activity in the fructose dehydration reaction to 5-hydroxymethylfurfural has been observed, reaching conversion rates up to 88.5% of concentrated fructose solution for the p = 0.25 catalyst. Moreover, a pseudo-first-order kinetic mechanism was simulated, and the kinetic constants obtained from diluted and concentrated enhanced reaction systems were determined and compared.This work was supported by the Spanish Ministry of Economy and Competitivity through grants MAT2017-84496-R