Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial.

BACKGROUND: Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19. METHODS: The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm's self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits. CONCLUSIONS: This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population. TRIAL REGISTRATION: # NCT04394169, registered on 5/19/2020.

Medical education from the point of view of medical students: Results from four participatory Delphi panels in Quito, Ecuador.

BACKGROUND: Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers. MATERIAL AND METHODS: Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements. RESULTS: Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.

Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.

BACKGROUND: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. METHODS: The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. RESULTS: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96-0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92-0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00-1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01-1.05). CONCLUSIONS: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.

Constructed wetlands as an alternative for arsenic removal from reverse osmosis effluent.

In Argentina, drinking water for c.a. 10% of the population has arsenic (As) concentrations higher than those recommended by WHO (10 µg L-1). Reverse osmosis (RO) appears as an immediate and effective solution for As remediation. However, this process has a residual flow known as "rejection" or "concentrate" where dissolved species are more concentrated than in the feed flow. In this study, phytoremediation with subsurface horizontal-flow constructed wetlands (CW) was proposed to reduce As concentration in the RO residues. Experiments were carried out during 419 days at room temperature and using a continuous regime (flow of 36 L d-1, As concentration around 85 µg L-1) of RO rejection from a water treatment plant located in Buenos Aires province, Argentina. The study was performed using prototypes planted with Cyperus haspan (PA), Juncus effusus (PB) and a mix of inert gravel and laterite (substrate) that was used as a control (PC). Results showed that after a stabilization time, As removal (%) was between 30% and 80% in the CW planted with J. effusus and between 10 and 40% with C. haspan. As concentration along CW showed similarities between the prototypes PC and PA. The cumulative mass of As was 62%, 34% and 27% for PA, PB and PC, respectively. The contribution of C. haspan and J. effusus during the experimental time was between 12 and 67% and 22 to 87%, respectively. The bioaccumulation and translocation factors indicated that for J. effusus the accumulation is more important than the translocation process (1.6 and 0.2, respectively), while for C. haspan both factors were similar (1.1 and 1.0, respectively). Results suggested that this technology has the potential for an efficient and environmentally sustainable alternative to RO rejection treatment and disposal regarding As concentration.

Altitude effects on technology and productivity of small bovine farms (milk meat) in Veracruz (Gulf of Mexico).

The dual-purpose bovine system represents 98.4% of the bovine livestock of Veracruz, the main cattle-producing state of Mexico. This system supplies calves to meat companies, a sector in which Veracruz has been the national leader in the last decade. The objective of the present study was to analyze the effect of the altitudinal zonation of farms on livestock technology and productivity in a microbasin of the Gulf of Mexico where small farms predominate. Structured interviews were applied to producers located in three altitudinal zones (at average altitudes of 50, 140, and 450 m, respectively, for lower, middle, and upper zones). Sample size was 135 farms having similar land surface (within a range of 15-22 ha). The results indicated multiple differences among farms located in the three zones. Farms in the middle and lower zones presented higher productive indicators than those in the upper zone. Differences in herd structure and management resulted in important differences in productivity, income, and profits in milk and calf production. We concluded from this study that altitudinal zonation in Veracruz had a clear effect on the differentiation of small farms, which are representative of dual-purpose cattle. The upper zone performs cattle activity under conditions with greater disadvantages in the analyzed region.

Checklist en CMA: ¿tenemos el instrumento adecuado? / No disponible

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Reductions of plant cover induced by sheep grazing change the above-belowground partition and chemistry of organic C stocks in arid rangelands of Patagonian Monte, Argentina.

The objective of this study was to estimate the size and chemical quality of the total organic C stock and its partition between above-belowground plant parts and soil at sites with different plant cover induced by sheep grazing in the arid Patagonian Monte. This study was conducted at six representative sites with increasing signs of canopy disturbance attributed to grazing pressure. We used faeces density as a proxy of grazing pressure at each site. We assessed the total plant cover, shrub and perennial grass cover, total standing aboveground biomass (AGB), litter mass and belowground biomass (BGB) at each site. We further estimated the content of organic C, lignin and soluble phenols in plant compartments and the content of organic C, organic C in humic substances (recalcitrant C) and water soluble C (labile C) in soil at each site. Total plant cover was significantly related to grazing pressure. Standing AGB and litter mass decreased with increasing canopy disturbance while BGB did not vary across sites. Total organic C stock and the organic C stock in standing AGB increased with increasing total plant, shrub, and perennial grass cover. The organic C stock in litter mass increased with increasing total plant and shrub cover, while the organic C stock in BGB did not vary across sites. Lignin content in plant compartments increased with increasing total and shrub cover, while soluble phenols content did not change across sites. The organic C stock and the water soluble C content in soil were positively associated with perennial grass cover. Changes in total plant cover induced by grazing pressure negatively affected the size of the total organic C stock, having minor impact on the size of belowground than aboveground components. The reduction of perennial grass cover was reflected in decreasing chemical quality of the organic C stock in soil. Accordingly, plant managerial strategies should not only be focused on the amount of organic C sequestered but also on the chemical quality of organic C stocks since C chemistry could have an important impact on ecosystem functioning.

Meaningful traits for grouping plant species across arid ecosystems.

Grouping species may provide some degree of simplification to understand the ecological function of plants on key ecosystem processes. We asked whether groups of plant species based on morpho-chemical traits associated with plant persistence and stress/disturbance resistance reflect dominant plant growth forms in arid ecosystems. We selected twelve sites across an aridity gradient in northern Patagonia. At each site, we identified modal size plants of each dominant species and assessed specific leaf area (SLA), plant height, seed mass, N and soluble phenol concentration in green and senesced leaves at each plant. Plant species were grouped according with plant growth forms (perennial grasses, evergreen shrubs and deciduous shrubs) and plant morphological and/or chemical traits using cluster analysis. We calculated mean values of each plant trait for each species group and plant growth form. Plant growth forms significantly differed among them in most of the morpho-chemical traits. Evergreen shrubs were tall plants with the highest seed mass and soluble phenols in leaves, deciduous shrubs were also tall plants with high SLA and the highest N in leaves, and perennial grasses were short plants with high SLA and low concentration of N and soluble phenols in leaves. Grouping species by the combination of morpho-chemical traits yielded 4 groups in which species from one growth form prevailed. These species groups differed in soluble phenol concentration in senesced leaves and plant height. These traits were highly correlated. We concluded that (1) plant height is a relevant synthetic variable, (2) growth forms adequately summarize ecological strategies of species in arid ecosystems, and (3) the inclusion of plant morphological and chemical traits related to defenses against environmental stresses and herbivory enhanced the potential of species grouping, particularly within shrubby growth forms.

SPROUTY-2 represses the epithelial phenotype of colon carcinoma cells via upregulation of ZEB1 mediated by ETS1 and miR-200/miR-150.

SPROUTY-2 (SPRY2) is a modulator of tyrosine kinase receptor signaling with receptor- and cell type-dependent inhibitory or enhancing effects. Studies on the action of SPRY2 in major cancers are conflicting and its role remains unclear. Here we have dissected SPRY2 action in human colon cancer. Global transcriptomic analyses show that SPRY2 downregulates genes encoding tight junction proteins such as claudin-7 and occludin and other cell-to-cell and cell-to-matrix adhesion molecules in human SW480-ADH colon carcinoma cells. Moreover, SPRY2 represses LLGL2/HUGL2, PATJ1/INADL and ST14, main regulators of the polarized epithelial phenotype, and ESRP1, an epithelial-to-mesenchymal transition (EMT) inhibitor. A key action of SPRY2 is the upregulation of the major EMT inducer ZEB1, as these effects are reversed by ZEB1 knock-down by means of RNA interference. Consistently, we found an inverse correlation between the expression level of claudin-7 and those of SPRY2 and ZEB1 in human colon tumors. Mechanistically, ZEB1 upregulation by SPRY2 results from the combined induction of ETS1 transcription factor and the repression of microRNAs (miR-200 family, miR-150) that target ZEB1 RNA. Moreover, SPRY2 increased AKT activation by epidermal growth factor, whereas AKT and also Src inhibition reduced the induction of ZEB1. Altogether, these data suggest that AKT and Src are implicated in SPRY2 action. Collectively, these results show a tumorigenic role of SPRY2 in colon cancer that is based on the dysregulation of tight junction and epithelial polarity master genes via upregulation of ZEB1. The dissection of the mechanism of action of SPRY2 in colon cancer cells is important to understand the upregulation of this gene in a subset of patients with this neoplasia that have poor prognosis.

Evaluación de la exposición a factores de riesgo alternativos al tabaco en la EPOC en Neumosur. Resultados del estudio On-Sint / Assessment of exposition to alternative risk factors, other than smoking, in COPD at Neumosur: On-Sint study results

OBJETIVO: El estudio On-Sint es una cohorte retrospectiva que tiene por objetivo la evaluación de la presentación clínica y funcional de la enfermedad pulmonar obstructiva crónica (EPOC) al diagnóstico, así como su evolución en el tiempo, tanto en atención primaria como en atención especializada. MÉTODO: estudio observacional, de no intervención, para la generación de una cohorte retrospectiva, en el que 329 médicos de Atención Primaria o Neumología de todo el ámbito nacional (69 en el ámbito de Neumosur) incluyeron 1.214 sujetos fumadores o exfumadores con el diagnóstico de EPOC (269 en Neumosur). Se recogió información en el momento del diagnóstico y en el actual. RESULTADOS: la cohorte On-Sint estaba compuesta por 1.214 pacientes con EPOC, de los que 257 (21,16%) eran del ámbito de Neumosur. Todos los enfermos eran fumadores o exfumadores. El porcentaje de pacientes fumadores descendió durante el seguimiento del 56,4% al diagnóstico al 34,2% (p < 0,001) en el momento actual. Adicionalmente, 45 casos (17,8%) referían exposición a otras sustancias distintas al tabaco. La exposición a estos factores de riesgo resultó más frecuente (p = 0,001) en Atención Primaria (22,7%) que en Especializada (6,5%). No encontramos relación en la distribución de grados funcionales GOLD y la exposición a estos compuestos, ni en el momento del diagnóstico ni en el actual. CONCLUSIONES: además del tabaco, un número considerable de pacientes con EPOC también están expuestos a otras sustancias inhaladas potencialmente tóxicas. De ellas, las químicas profesionales son más frecuentes que la biomasa. No parece que esta exposición tenga un impacto relevante en la evolución de la enfermedad

OBJECTIVE: the On-Sint study is a retrospective cohort that assesses the clinical and functional diagnostic presentation of chronic obstructive pulmonary disease (COPD), and its development over time from the perspective of primary and specialized care. METHOD: this was an observational, non-interventional study to generate a retrospective cohort, in which 329 primary care doctors or pneumologists were included from all over Spain (69 from within the scope of Neumosur); the cohort included 1214 smokers or former smokers, who were diagnosed with COPD (269 at Neumosur). Information was collected both at the initial diagnosis and at the time of closing the study. RESULTS: the On-Sint cohort included 1214 patients with COPD, of which 257 (21.16%) were from within the scope of Neumosur. All patients were smokers or ex-smokers. The percentage of smokers decreased throughout follow-up, from 56.4% at the time of the diagnosis to 34.2% (p < 0.001) at the current moment. Likewise, 45 cases (17.8%) referred to the exposition of substances, other than smoking. Exposition to these risk factors was more frequent (p = 0.001) in Primary Care (22.7%) than in specialized care (6.5%). We found no relationship in the GOLD classification distribution and the exposition to these compounds, neither when diagnosed nor currently. CONCLUSIONS: n addition to smoking, a considerable number of COPD patients are exposed to inhaling other potentially toxic substances. Among these, professionals from the chemical sector are more frequent than those from the biomass sector. This exposition does not seem to have a relevant impact on the development of the disease

Fístula arteriovenosa tras tratamiento de ablación con láser endovascular / Arteriovenous fistula after endovenous laser ablation

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Effects of long-term grazing disturbance on the belowground storage of organic carbon in the Patagonian Monte, Argentina.

The objective of this study was to analyze the effect of grazing disturbance on the amount and the spatial distribution (vertical and horizontal) of root biomass and soil organic carbon (SOC) in order to evaluate whether grazing alters the belowground storage of organic carbon (C) in arid rangelands of the Patagonian Monte. We selected three representative sites (3 ha each) with low, moderate and high grazing disturbance located far, mid-distance and near the watering point, respectively, in rangelands submitted to sheep grazing for more than 100 years. We assessed the canopy structure and identified the four most frequent plant patch types at each site. We selected four replications of each patch type and extracted a soil sample (0-30 cm depth) underneath the canopy and in the middle of the nearest inter-patch bare soil area in winter and summer. We assessed the root and soil dry mass and the respective organic C concentration in each sample and then we estimated the total belowground organic C storage at each site. Total plant and perennial grass cover were lower with high than low grazing disturbance while the reverse occurred with dwarf shrub cover. High grazing disturbance led to the increase in total root biomass in the whole soil profile of patch areas and in the upper soil of inter-patch areas. SOC was higher in patch than in inter-patch areas at all sites but at both areas was reduced with high grazing disturbance. This was probably the result of the low total plant cover and the low and recalcitrant contribution of above and below-ground plant litter to soils at sites with high grazing disturbance. Accordingly, these changes did not result in variations in the total belowground organic C storage. We concluded that high grazing disturbance did not affect the total belowground organic C storage but led to changes in the spatial patterning of this organic C storage (i.e shifting from soil to roots).

Reparación de aneurisma de aorta abdominal en paciente con riñón en herradura y oclusión ilíaca. ¿Es el tratamiento endovascular la única opción? / Repair of an abdominal aortic aneurysm in a patient with a horseshoe kidney and iliac occlusion. Is endovascular treatment the only option?

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Seudoaneurisma micótico de la arteria carótida interna / Mycotic pseudoaneurysm of the internal carotid artery

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Pseudoaneurismas anastomóticos femorales / Femoral anastomotic pseudoaneurysms

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Consecuencias del abandono intraluminal de material endovascular tras cateterismo cardiaco / Consequences of abandoning endovascular intraluminal material after cardiac catheterisation

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Seguridad de los bifosfonatos en el tratamiento de la osteoporosis / Bisphosphonates safety in osteoporosis treatment

Además de los efectos secundarios de los bifosfonatos descritos en fases de precomercialización, en los últimos años se han publicado series de casos, estudios de farmacovigilancia y alertas por parte de las agencias reguladoras sobre otros efectos secundarios no descritos previamente. El objetivo de nuestro estudio es describir la aparición de efectos secundarios potencialmente atribuibles a bifosfonatos en la práctica clínica habitual de estos medicamentos. En este trabajo se revisan los efectos adversos de dos bifosfonatos (ácido alendrónico y ácido risedrónico) en una cohorte histórica a través de la revisión de sus historias clínicas. Se incluyeron 110 pacientes de 63.4 años, 103 (93,6%) de los cuales eran mujeres. 33 (30%) continuaban en tratamiento con bifosfonatos en el momento de recogida de datos. 68 (61,8%) recibían tratamiento con ácido risedrónico. La prevención primaria de fracturas fue el motivo de inicio de bifosfonatos en el 88,2% de los casos (n = 97) y en 6,4% (n = 7) de pacientes existía un diagnóstico de fractura previa (prevención secundaria). El resto de tratamientos estaban fuera de indicación. En nuestra población, 82 (74,5%) pacientes sufrieron algún efecto adverso atribuible a los bifosfonatos. Los efectos adversos más frecuentes fueron dolores musculoesqueléticos (58,2%) y trastornos gastrointestinales (24,5%).En general, los bifosfonatos son un grupo de fármacos bien tolerados. La incidencia de efectos adversos en nuestra población ha sido similar a la descrita hasta el momento en la bibliografía (AU)

Apart from bisphosphonates adverse events described in premarketing phases; case reports, pharmacovigilance studies and alerts from regulatory agencies about other adverse events not previously described have been published in the last years. The objective of our study is the description of adverse events potentially attributable to bisphosphonates in the usual clinical practice. We describe the adverse events of two bisphosphonates (risedronate and alendronate) in a historical cohort through a revision of medical hystory. A total of 110 patients of 63.4 years were included, 103 (93.6%) of them were women. 33 (30%) were receiving bisphosphonate treatment at the data collection time. 68 (61.8%) received risedronic acid. In 88.2% (n=97) of our patients the reason to start a bisphosphonate treatment was primary prevention of fractures, and in 6.4% (n=7) of patients there was a previous diagnosis of fracture. The rest of treatments were off-label. 82 (74.5%) of our patients had any adverse event potentially attributable to bisphosphonates. The most frequent adverse events were musculoskeletal pain (58.2%) and gastrointestinal effects (24.5%).Bisphosphonates are a well tolerated therapeutic group. The adverse events incidence in our population was similar to the incidence described in literature (AU)

Measurement procedure to assess exposure to extremely low-frequency fields: a primary school case study.

How to correctly measure the exposure of general public to extremely low-frequency (ELF) radiation is a key issue for ELF epidemiological studies. This paper proposes a measurement procedure to accurately assess the exposure of people to electric and magnetic field in the frequency band from 5 Hz to 100 kHz in buildings and their premises. As ELF radiation could be particularly harmful to children, the measurement procedure is focused on exposure to ELF in schools. Thus, the students' exposure to ELF fields can be assessed by correlating the ELF measurements to the hours of school activity. In this paper, the measurement protocol was applied to study the ELF exposure on students from García Quintana primary school in Valladolid, Spain. The campaign of measurements for ELF exposure assessment in this primary school was of great interest for the Regional Council of Public Health because of the social alarm generated by the presence of a significant number cancer cases in children.

Negative screening colonoscopy after a positive guaiac faecal occult blood test: not a contraindication to continued screening.

AIM: In guaiac faecal occult blood test (gFOBT) screening at least 50% of positive individuals will have a colonoscopy negative for colorectal neoplasia. The question of continuing screening in this group has not been addressed. METHOD: Data on participants aged 50-69 years with a positive gFOBT result and a negative colonoscopy were followed through the biennial screening pilot conducted between 2000 and 2007 in Scotland. RESULTS: In the first screening round, 1527 colonoscopies were negative for neoplasia. 1300 were re-invited in the second round, 905 accepted, and 157 had a positive gFOBT result, giving a positivity rate of 17.4%. Colonoscopy revealed 20 subjects with adenoma and six with invasive cancer. In the third screening round 1031 were invited for a third time and 730 accepted: 55 had a positive gFOBT test, giving a positivity rate of 7.5%. In this group, six colonoscopies revealed adenomas but there were no cancers diagnosed. In the third screening round, 108 individuals had had two positive gFOBT results and two subsequent negative colonoscopies. Eighty-four were invited for a third gFOBT, 66 accepted and 19 (25.6%) had a positive result none of whom had an adenoma or carcinoma. CONCLUSION: These data indicate that a negative colonoscopy following a positive gFOBT is not a contraindication for further screening, although this is likely to have a low yield of neoplastic pathology after two negative colonoscopies.