Identification of Olives Using In-Field Hyperspectral Imaging with Lightweight Models.

During the growing season, olives progress through nine different phenological stages, starting with bud development and ending with senescence. During their lifespan, olives undergo changes in their external color and chemical properties. To tackle these properties, we used hyperspectral imaging during the growing season of the olives. The objective of this study was to develop a lightweight model capable of identifying olives in the hyperspectral images using their spectral information. To achieve this goal, we utilized the hyperspectral imaging of olives while they were still on the tree and conducted this process throughout the entire growing season directly in the field without artificial light sources. The images were taken on-site every week from 9:00 to 11:00 a.m. UTC to avoid light saturation and glitters. The data were analyzed using training and testing classifiers, including Decision Tree, Logistic Regression, Random Forest, and Support Vector Machine on labeled datasets. The Logistic Regression model showed the best balance between classification success rate, size, and inference time, achieving a 98% F1-score with less than 1 KB in parameters. A reduction in size was achieved by analyzing the wavelengths that were critical in the decision making, reducing the dimensionality of the hypercube. So, with this novel model, olives in a hyperspectral image can be identified during the season, providing data to enhance a farmer's decision-making process through further automatic applications.

Best Nursing Practice: Safe and Inclusive Healthcare Environments for Transgender People: A Systematic Review.

(1) Background: The aim of this study was to review the scope of the existing scientific literature on creating safe and inclusive healthcare environments for transgender people and provide an overview of the resources and nursing skills required to do so. (2) Methods: With the research question in mind, an exploratory search of six databases was conducted to identify all relevant primary studies. After screening and selection of articles based on the inclusion and exclusion criteria, a total of 41 articles were included and reviewed. (3) Results: The results were classified under four headings: the training of health professionals, the creation of safe spaces, the nurse as facilitator, and best care practice. Most of the evidence indicates that it is essential for nurses and other healthcare staff to be trained in specific skills to provide comprehensive, high-quality care to transgender people; however, there is a lack of material and human resources to do so. (4) Conclusions: The trans-inclusive care competent nurse should use neutral language that respects the person's preferred name and pronouns in a safe healthcare environment that offers and ensures warmth, respect, and inclusivity in the care provided. This study was registered with the Open Science Framework (OSF) on 9 January 2024 (osf.io/rpj6a).

Psychotherapeutic nursing as Advanced Clinical Practice for the promotion of mental health in Spain.

OBJECTIVE: To contribute to the recognition of psychotherapeutic nursing (PTN) as a regulated advanced clinical practice (ACP) in Spain, as is the case in other countries. BACKGROUND: Nurses are continually evolving to improve overall health outcomes. PTN has become a reality, with several authors describing it as an ACP. In Spain, psychotherapy is not officially regulated, which has led to a significant number of psychiatric nurses adopting an important ACP in this area without recognition. SOURCES OF EVIDENCE: Evidence confirms that PTN possesses the attributes necessary to be considered an ACP. Nurses, like psychotherapists, independently address the complex needs of individuals and families within the context of therapeutic relationships, and there is a pressing need to advance formal processes of regulation and certification. DISCUSSION: PTN has evolved at different rates depending on local initiatives, policies and various professional interests. In Spain, it is crucial to evaluate its outcomes, recognise it as an ACP and develop training plans for its regulation and accreditation. CONCLUSIONS: Mental health nurses in Spain have a strong interest in PTN being recognised as an ACP. To this end, they should join forces with other partners, scientific associations and international bodies such as the International Council of Nurses (ICN) to make PTN an internationally recognised ACP. IMPLICATIONS FOR NURSING PRACTICE: Psychotherapeutic nurses could contribute to improving mental health outcomes, client satisfaction and health system efficiency, and their formal recognition is an opportunity to enhance their professional identity, competence and autonomy. IMPLICATIONS FOR NURSING POLICY: Nursing policy needs to be reoriented towards strengthening psychotherapy as an ACP. Synergies and alliances between international nursing associations and the ICN can promote its development and implementation, while research, education and leadership are essential to achieving official regulation and accreditation.

A General-Purpose Distributed Analytic Platform Based on Edge Computing and Computational Intelligence Applied on Smart Grids.

Currently, in many data landscapes, the information is distributed across various sources and presented in diverse formats. This fragmentation can pose a significant challenge to the efficient application of analytical methods. In this sense, distributed data mining is mainly based on clustering or classification techniques, which are easier to implement in distributed environments. However, the solution to some problems is based on the usage of mathematical equations or stochastic models, which are more difficult to implement in distributed environments. Usually, these types of problems need to centralize the required information, and then a modelling technique is applied. In some environments, this centralization may cause an overloading of the communication channels due to massive data transmission and may also cause privacy issues when sending sensitive data. To mitigate this problem, this paper describes a general-purpose distributed analytic platform based on edge computing for distributed networks. Through the distributed analytical engine (DAE), the calculation process of the expressions (that requires data from diverse sources) is decomposed and distributed between the existing nodes, and this allows sending partial results without exchanging the original information. In this way, the master node ultimately obtains the result of the expressions. The proposed solution is examined using three different computational intelligence algorithms, i.e., genetic algorithm, genetic algorithm with evolution control, and particle swarm optimization, to decompose the expression to be calculated and to distribute the calculation tasks between the existing nodes. This engine has been successfully applied in a case study focused on the calculation of key performance indicators of a smart grid, achieving a reduction in the number of communication messages by more than 91% compared to the traditional approach.

The Role of Cell Cycle Arrest Biomarkers for Predicting Acute Kidney Injury in Critically Ill COVID-19 Patients: A Multicenter, Observational Study.

OBJECTIVES: Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) have a high risk for developing acute kidney injury (AKI) which is associated with an increased risk of death and persistent renal failure. Early prediction of AKI is crucial in order to implement preventive strategies. The purpose of this study was to investigate the predictive performance of tissue inhibitor of metalloproteinases 2 and insulin like growth factor binding protein 7 (TIMP-2) × (IGFBP7) in critically ill patients with COVID-19-associated ARDS. DESIGN: Multicenter, prospective, observational study. SETTING: Twelve centers across Europe and United Kingdom. PATIENTS: Patients with moderate or severe COVID-19-associated ARDS were included and serial measurements of (TIMP-2) × (IGFBP7) were performed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the development of moderate or severe AKI according to the Kidney Disease: Improving Global Outcomes definition. Three hundred patients were available for the primary analysis, and 39 met the primary endpoint. At enrollment, urinary (TIMP-2) × (IGFBP7) had high predictive value for the primary endpoint with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.84-0.93). (TIMP-2) × (IGFBP7) was significantly higher in endpoint-positive patients at enrollment and at 12 hours. CONCLUSIONS: Urinary (TIMP-2) × (IGFBP7) predicts the occurrence of AKI in critically ill patients with COVID-19-associated ARDS.

Virtual Reality and Simulation Videos as Effective Training Tools for Creating Safe and Inclusive Environments for Transgender People.

BACKGROUND: University education is undergoing a paradigm shift towards active methodologies, such as virtual reality and training videos, which have proven to be valuable resources, especially in the health sciences. The scarcity of existing research on the topic prompted us to conduct this study, which seeks to measure the knowledge gained from the aforementioned tools by users, their level of satisfaction with them, and their perceived utility. METHODS: This is a quasi-experimental intervention study analysing the impact of virtual objects as learning resources for undergraduate nursing students. RESULTS: Fifty-four participants completed the training, yielding highly significant differences between their mean scores, with a high statistical power and a large effect size. A total of 85.46% of participants confirmed that the virtual resources helped them considerably to empathise with the experiences of trans people in healthcare settings. Students were comfortable using the virtual resources, very satisfied with the methodology employed, and would recommend the training received. CONCLUSIONS: University teaching must adapt to meet the current legislations and changing health needs of society, and teaching staff must be prepared to implement new active teaching methodologies that make learning a more dynamic process. Considering these results, our study serves as a guide for other nursing educators who seek to promote inclusive healthcare regarding gender diversity. This study is not registered.

Tratamiento de fístulas perianales complejas mediante tapón de colágeno piramidal. ¿En la geometría está la solución?

Introducción: Las fístulas perianales complejas siguen siendo un auténtico desafío terapéutico en nuestros días, dada la ausencia de una terapia universal y los resultados a largo plazo, ya que el porcentaje de complicaciones o recidivas no es desdeñable. Entre las opciones terapéuticas encontramos los tapones biológicos, siendo respetuosos con los esfínteres, pero con resultados dispares. Objetivos: Evaluar los resultados a largo plazo tras la colocación de un tapón de colágeno piramidal en dos pacientes con fístula perianal compleja. Materiales y Método: Se presentan 2 pacientes con fístula perianal compleja intervenidos mediante colocación de tapón biológico cumpliendo estrictos criterios de inclusión. Discusión: Dentro del arsenal terapéutico disponible actualmente, los tapones biológicos prometen una solución definitiva para determinadas fístulas perianales, evitando una posible incontinencia. Con resultados dispares en la bibliografía, en nuestros dos casos los pacientes han evolucionado de forma excelente, con resolución completa de la enfermedad fistulosa sin complicaciones ni recidiva a largo plazo. Conclusiones: Dados los excepcionales resultados obtenidos en nuestros dos primeros casos con este tipo de tapón, nos planteamos si la morfología del mismo puede ser determinante en su éxito.

Introduction: Complex perianal fistulas continue to be a real therapeutic challenge today, given the absence of universal therapy and long-term results, since the percentage of complications or recurrences is not negligible. Among the therapeutic options we find biological plugs, being respectful with the sphincters but with disparate results. Aim: To evaluate the long-term results after the placement of a pyramidal collagen plug in two patients with complex perianal fistula. Materials and Method: We present two patients with complex perianal fistula who were operated on by placing a biological plug, meeting strict inclusion criteria. Discussion: Within the therapeutic arsenal currently available, biological plugs promise a definitive solution for certain perianal fistulas, avoiding possible incontinence. With different results in the literature, in our two cases the patients have evolved excellently, with complete resolution of the fistulous disease without complications or long-term recurrence. Conclusions: Considering the exceptional results obtained in our first two cases with this type of plug, we wonder if its morphology can be a determining factor in its success.

Nightingale, el ‘espacio para el cuidado’ y su influencia en la arquitectura de hospitales / Nightingale, o ‘espaço do cuidado’ e sua influência na arquitetura hospitalar / Nightingale, the ‘space for care’ and its influence on hospital architecture

A lo largo de la historia la salud y laenfermedad han sido motivo depreocupación para los hombres. Estasituación provocó que se crearan espacios arquitectónicos que sirvieran parareconquistar la primera y dejar atrás lasegunda. Son muchos los ejemplos deedificios, los hospitales, que se hanconstruido, unos con carácter temporal yotros definitivos. Los primeros vienen de lamano del mundo grecorromano que sentaron as bases para los posteriores. Pero a medidaque lo místico daba paso a la ciencia lasnecesidades cambiaron. Poco a poco, sefueron adaptando los espacios para crear lascondiciones más idóneas que facilitaran lacuración y el cuidado de los enfermos. Unode los ejemplos más interesantes, y que esconsiderado punto de partida, es laintervención que realiza FlorenceNightingale primero en el Hospital de St.Thomas y posteriormente en el HospitalHerbert en la segunda mitad del siglo XIX.En ellos, ciencia, arquitectura y salud se danla mano para caminar juntas y lograr así suobjetivo: curar y cuidar a los enfermos.(AU)

Throughout history, health andillness have been of concern to men. Thissituation led to the creation of architecturalspaces that served to reconquer the first andleave the second behind. There are manyexamples of buildings, hospitals, that havebeen built, some temporarily and otherspermanent. The former come from the handof the Greco-Roman world that laid thefoundations for the later ones. But as themystical gave way to science the needschanged. Little by little, the spaces wereadapted to create the most suitableconditions that would facilitate the healingand care of the sick. One of the mostinteresting examples, and which isconsidered a starting point, is theintervention carried out by FlorenceNightingale first at St. Thomas Hospital andlater at Herbert Hospital in the second half ofthe 19th century. In them, science,architecture and health go hand in hand towalk together and thus achieve their goal: tocure and care for the sick.(AU)

Ao longo da história, a saúde e adoença preocupam os homens. Esta situaçãolevou à criação de espaços arquitetônicosque serviram para reconquistar o primeiro edeixar o segundo para trás. Existem muitosexemplos de edifícios, hospitais, que foramconstruídos, alguns temporários e outrospermanentes. Os primeiros vêm das mãos domundo greco-romano que lançou as basespara os posteriores. Mas, à medida que omístico deu lugar à ciência, as necessidadesmudaram. Aos poucos, os espaços foramsendo adaptados para criar as condiçõesmais adequadas que facilitassem a cura e ocuidado dos enfermos. Um dos exemplosmais interessantes, e que é considerado umponto de partida, é a intervenção realizadapor Florence Nightingale primeiro noHospital St. Thomas e depois no HospitalHerbert na segunda metade do século XIX.Neles, ciência, arquitetura e saúdecaminham juntas para caminharem e assimatingirem seu objetivo: curar e cuidar dosenfermos.(AU)

Fuentes documentales para el estudio de la Sanidad en el Imperio Británico a través de la correspondencia de Florence Nightingale en la British Library / Fontes documentais para o estudo da cura no Império Britânico por meio da correspondência de Florence Nightingale na Biblioteca Britânica / Documentary sources for the study of Healing in the British Empire through the correspondence of Florence Nightingale in the British Library

En el presente trabajo analizamos la documentación sobre Florence Nightingale que encontramos en la British Library. Son de gran interés sus cartas con familiares, políticos y altos cargos del Ejército a través de las cuales podemos profundizar en el conocimiento de la Sanidad del Imperio Británico durante el siglo XIX, principios del siglo XX.(AU)

No presente trabalho analisamos adocumentação sobre Florence Nightingaleque encontramos no British Librart. Suascartas a familiares, políticos e altos oficiaisdo Exército, por meio das quais podemosaprofundar nosso conhecimento sobre aSaúde do Império Britânico durante o século19, início do século 20, são de grandeinteresse.(AU)

In the present work we analyze thedocumentation on Florence Nightingale thatwe found in the British Library. Her letterswith family members, politicians and highofficials of the Army through which we candeepen our knowledge of the Health of theBritish Empire during the 19 th century, thebeginning of the 20th century are of greatinterest.(AU)

Tormenta distónica en psiquiatría de enlace: a propósito de un caso / Dystonic storm in consultation-liaison psychiatry

RESUMEN Las distonías son trastornos del movimiento caracterizados por contracciones musculares sostenidas que producen movimientos repetitivos de torsión o posturas anormales. Pueden clasificarse según la etiología como primarias (formas idiopáticas y genéticas) o secundarias. La presentación asociada con episodios generalizados, intensos y con exacerbación de contracturas musculares intensas que suelen ser refractarias a la farmacoterapia tradicional se conoce como status distónico o tormenta distónica. Se presenta el caso de un paciente de 33 arios, con antecedente de sordera congénita, trastorno por consumo de sustancias psicoactivas y tratamiento psicofarmacológico con antipsicóticos, que presentó un cuadro distónico grave que evolucionó a un status distónico.

ABSTRACT Dystonia is a movement disorder characterised by sustained muscle contractions that produce repetitive twisting movements or abnormal postures. It can be classified according to the aetiology as primary (idiopathic and genetic forms), or secondary. The presentation associated with generalised, intense episodes and with exacerbation of severe muscle contractures and usually refractory to traditional pharmacotherapy is known as dystonic status or dystonic storm. In the present article, a case is presented of a 33-year-old patient with a history of congenital deafness, stimulant use disorder and on psychopharmacological treatment with antipsychotics, who presented with a severe dystonic reaction that evolved to a status dystonicus.

Dystonic storm in consultation-liaison psychiatry.

Dystonia is a movement disorder characterised by sustained muscle contractions that produce repetitive twisting movements or abnormal postures. It can be classified according to the aetiology as primary (idiopathic and genetic forms), or secondary. The presentation associated with generalised, intense episodes and with exacerbation of severe muscle contractures and usually refractory to traditional pharmacotherapy is known as dystonic status or dystonic storm. In the present article, a case is presented of a 33-year-old patient with a history of congenital deafness, stimulant use disorder and on psychopharmacological treatment with antipsychotics, who presented with a severe dystonic reaction that evolved to a status dystonicus.

Lateral migration of large sedimentary bodies in a deep-marine system offshore of Argentina.

Contourite features are increasingly identified in seismic data, but the mechanisms controlling their evolution remain poorly understood. Using 2D multichannel reflection seismic and well data, this study describes large Oligocene- to middle Miocene-aged sedimentary bodies that show prominent lateral migration along the base of the Argentine slope. These form part of a contourite depositional system with four morphological elements: a plastered drift, a contourite channel, an asymmetric mounded drift, and an erosive surface. The features appear within four seismic units (SU1-SU4) bounded by discontinuities. Their sedimentary stacking patterns indicate three evolutionary stages: an onset stage (I) (~ 34-25 Ma), a growth stage (II) (~ 25-14 Ma), and (III) a burial stage (< 14 Ma). The system reveals that lateral migration of large sedimentary bodies is not only confined to shallow or littoral marine environments and demonstrates how bottom currents and secondary oceanographic processes influence contourite morphologies. Two cores of a single water mass, in this case, the Antarctic Bottom Water and its upper interface, may drive upslope migration of asymmetric mounded drifts. Seismic images also show evidence of recirculating bottom currents which have modulated the system's evolution. Elucidation of these novel processes will enhance basin analysis and palaeoceanographic reconstructions.

Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain.

BACKGROUND: The identification of factors associated with Intensive Care Unit (ICU) mortality and derived clinical phenotypes in COVID-19 patients could help for a more tailored approach to clinical decision-making that improves prognostic outcomes. METHODS: Prospective, multicenter, observational study of critically ill patients with confirmed COVID-19 disease and acute respiratory failure admitted from 63 ICUs in Spain. The objective was to utilize an unsupervised clustering analysis to derive clinical COVID-19 phenotypes and to analyze patient's factors associated with mortality risk. Patient features including demographics and clinical data at ICU admission were analyzed. Generalized linear models were used to determine ICU morality risk factors. The prognostic models were validated and their performance was measured using accuracy test, sensitivity, specificity and ROC curves. RESULTS: The database included a total of 2022 patients (mean age 64 [IQR 5-71] years, 1423 (70.4%) male, median APACHE II score (13 [IQR 10-17]) and SOFA score (5 [IQR 3-7]) points. The ICU mortality rate was 32.6%. Of the 3 derived phenotypes, the A (mild) phenotype (537; 26.7%) included older age (< 65 years), fewer abnormal laboratory values and less development of complications, B (moderate) phenotype (623, 30.8%) had similar characteristics of A phenotype but were more likely to present shock. The C (severe) phenotype was the most common (857; 42.5%) and was characterized by the interplay of older age (> 65 years), high severity of illness and a higher likelihood of development shock. Crude ICU mortality was 20.3%, 25% and 45.4% for A, B and C phenotype respectively. The ICU mortality risk factors and model performance differed between whole population and phenotype classifications. CONCLUSION: The presented machine learning model identified three clinical phenotypes that significantly correlated with host-response patterns and ICU mortality. Different risk factors across the whole population and clinical phenotypes were observed which may limit the application of a "one-size-fits-all" model in practice.

Caracterización del uso de las redes sociales por estudiantes de Medicina / Characterization of the social networks use by medical students

RESUMEN Fundamento: En la actualidad, las redes sociales se han convertido en parte de la vida cotidiana de las personas; representan una nueva forma de interacción y uno de los servicios más utilizados, especialmente por los jóvenes. Objetivo: caracterizar el uso de las redes sociales por los estudiantes de cuarto año de Medicina de la Universidad de Ciencias Médicas de Cienfuegos. Métodos: estudio observacional, descriptivo, de corte transversal, que tuvo como universo la totalidad de la matrícula de cuarto año de la carrera de Medicina, de la Universidad de Ciencias Médicas de Cienfuegos. La recogida de la información se realizó a través de encuestas. Se confeccionó una base de datos digital, y el análisis estadístico se llevó a cabo por medio de estadística descriptiva. Resultados: el sexo que predominó fue el femenino, y el grupo de edad más numeroso fue el de edades entre 20 y 23 años. Refirieron que navegan en las redes el 96,3 %; y el 68,9 % ha restado tiempo al estudio y otras actividades, para dedicarlo al uso de las redes sociales. Conclusión: Existe una tendencia al uso de las redes sociales virtuales, y la más utilizada es Facebook. El tiempo de permanencia que le dedican los estudiantes es medio, motivados principalmente por la información que visualizan a través de los denominados Me gusta o Like.

ABSTRACT Background: Currently, social networks have become part of people's daily lives; they represent a new form of interaction and one of the most used services, especially by young people. Objective: to characterize the use of social networks by fourth-year medical students at the Cienfuegos University of Medical Sciences. Methods: an observational, descriptive, cross-sectional study, which had as a universe the entire enrollment of the fourth year Medicine career at the Medical Sciences Cienfuegos University. The information was collected through surveys. A digital database was created, and the statistical analysis was carried out by descriptive statistics. Results: female was the predominant sex, and the largest age group was between 20 and 23 years old. The 96.3% reported that surf through the networks; and the 68.9% have taken time away from studying and other activities, to use social networks. Conclusion: There is a tendency to use virtual social networks, and the most used is Facebook. The time spent by the students is medium, motivated mainly by the information they view through the so-called Like or Likes.

El arte de la psicoterapia enfermera / The art of nursing psychotherapy

El progreso y transformación de los cuidados enfermeros en pleno siglo XXI, inherente al propio proceso de globalización y evolución social, conlleva cambios en la educación, formación y capacitación de las enfermeras. Esto da como resultado profesionales cada vez más competentes, eficientes y con autonomía suficiente para dar respuesta a las distintas necesidades de cuidados y requerimientos en salud y bienestar de las personas, familias, grupos sociales. En el ámbito de la práctica y cuidados en salud mental, las transformaciones propuestas en los sistemas sanitarios son claras, debiendo las mismas ser impulsadas por los consumidores, orientadas a la recuperación, basadas en la mejor evidencia disponible y orientadas hacia sistemas coordinados y colaborativos de atención y cuidados. Dentro de esta transformación en los sistemas de atención sanitaria, la psicoterapia enfermera, como competencia avanzada de las enfermeras especialistas, ha venido a consolidar el aporte, compromiso y valor social del cuidado enfermero. El objetivo de este artículo es presentar cómo se ha venido configurando, desde su emergencia, la psicoterapia enfermera en tanto que marco de acción en el quehacer de los cuidados profesionales especializados en salud mental; un recorrido que nos acerca a su conceptualización más internacional para derivar finalmente en la propuesta que desde la Asociación Española de Enfermería de Salud Mental (AEESME) se promueve para su implementación en la Cartera de Servicios del Sistema Nacional de Salud de España

The progress and transformation of nursing care in the middle of the XXI century, attached to the process of globalisation and social development itself, entail changes in education, training and qualification of nurses. As a result, professionals are more and more competent, efficient and with autonomy enough as to meet the various needs for care and the demand for health and welfare of the people, families and social groups. In the field of mental health care practice, there are evident initiatives of transformation in the health system, which ought to be driven by customers, aimed at recovery, evidence-based and directed towards collaborative and coordinated care and assistance systems. Within this process of transformation, and as an advanced competency of nurse specialists, Nurse Psychotherapy has consolidated the contribution, commitment and social value of nursing care. The aim of this article is to shed light on how Nurse Psychotherapy has developed since its inception as a framework for specialized, professional mental health care. Beginning with its international conceptualisation, it then drifts to the proposal promoted by the Spanish Mental Health Nursing Association (AEESME) for its implementation in the portfolio of healthcare Services of the Spanish National Health System

Dystonic Storm in Consultation-Liaison Psychiatry. / Tormenta distónica en psiquiatría de enlace: a propósito de un caso.

Dystonia is a movement disorder characterised by sustained muscle contractions that produce repetitive twisting movements or abnormal postures. It can be classified according to the aetiology as primary (idiopathic and genetic forms), or secondary. The presentation associated with generalised, intense episodes and with exacerbation of severe muscle contractures and usually refractory to traditional pharmacotherapy is known as dystonic status or dystonic storm. In the present article, a case is presented of a 33-year-old patient with a history of congenital deafness, stimulant use disorder and on psychopharmacological treatment with antipsychotics, who presented with a severe dystonic reaction that evolved to a status dystonicus.

Ética VS. Investigación / Ethics VS. Investigation pandemics, feelings and nursing / Ética VS. Investigação

En esta editorial el autor realiza una reflexión sobre la importancia de la presencia de un marco ético en el campo de la investigación, estableciendo ejemplos recientes en relación con la importancia del consentimiento informado y como, progresivamente, se ha procurado dar forma mediante un consenso materializado en documentos tan importantes como la Declaración de Helsinki, el Informe Belmont o el Convenio de Oviedo

In this editorial, the author reflects on the importance of the presence of an ethical framework in the field of research, establishing recent examples in relation to the importance of informed consent and how progressively efforts have been made to shape it through a materialized consensus. in such important documents as the Declaration of Helsinki, the Belmont Report or the Oviedo Convention

Neste editorial, o autor reflecte sobre a importância da presença de um quadro ético no campo da investigação, estabelecendo exemplos recentes em relação à importância do consentimento informado e como, progressivamente, tem sido feita uma tentativa de dar forma através de consensos materializados em documentos tão importantes como a Declaração de Helsínquia, o Relatório Belmont ou a Convenção de Oviedo

Valoración del tratamiento del shunt portosistémico congénito en el adulto en función de la sintomatología asociada / Appreciation of the treatment in adult patients with congenital portosystemic connections in relation with their symptoms

Introducción: las comunicaciones porto-sistémicas congénitas intrahepáticas (síndrome de Abernethy) son variantes anatómicas muy poco frecuentes, estando clasificadas en función del tipo de unión que exista entre la vena porta y el sistema venoso central. En el adulto, su diagnóstico suele ser incidental, aunque algunos casos puede presentarse con clínica de encefalopatía en pacientes sin hepatopatía asociada. Casos clínicos: presentamos dos casos de shunt porto-sistémico, uno con desarrollo de encefalopatía y otro hallado de forma casual. Su tratamiento, por medio de radiología intervencionista se decidió en función de si presentaban o no sintomatología. Ambos casos (tratado y control) se presentan al control en consultas externas asintomáticos, sin asociar complicaciones derivadas de la decisión terapéutica. Este control se realiza anualmente con pruebas de imagen (ecografía/TAC) y análisis sanguíneo. Discusión: dada la escasa prevalencia de este tipo de malformación y su diagnóstico habitual en edades más tempranas (asociada a importantes alteraciones cognitivas) su tratamiento en adultos no está protocolizado. En estos casos la decisión del tratamiento estaría condicionada a la sintomatología asociada, siendo el tratamiento mínimamente invasivo mediante radiología intervencionista una opción terapéutica a valorar en el adulto sintomático. Por su parte la observación por medio de pruebas de imagen y control en consultas externas, sin tratamiento asociado, seria de elección en adultos en los que no se presenta sintomatología asociada

Background: portosystemic intrahepatic venous connections (Abernethy syndrome) are rare anatomical variants, which are classified according to the type of union between the portal venous circulation and the central venous system. In adults, the diagnosis is often incidental, although some cases can be presented with an encephalopathy without associated liver disease. Case reports: here we present two cases of portosystemic shunt, one with encephalopathy development, and the other casually caught. Its treatment by interventionist radiology, was decided in function of clinic symptoms. Both patients were asymptomatic at controls in the outpatient consultation. No complications derived from the therapeutic decision. The control is carried out annually with image tests and blood analysis. Discussion: given the low prevalence of malformation and its usual diagnosis at younger ages (associated with important cognitive alterations) its treatment in adults is not protocolized. In these cases the decision of the treatment would be conditioned to the associated symptomatology, being the minimally invasive treatment (by interventional radiology) a therapeutic option in the symptomatic adult. Observation by imaging tests and control in outpatient consultation (without associated treatment) would be a choice in asymptomatic adults