Eficacia y seguridad de las vacunas contra el SARS-CoV-2 / Efficacy and safety of SARS-CoV-2 vaccines

Ha habido un esfuerzo extraordinario, tanto técnico como económico, para producir vacunas eficaces. Las vacunas de las que existen datos de eficacia son las que han publicado resultados de la fase 3. Se resumen los datos más relevantes de estos ensayos clínicos agrupados por tipo de vacuna. Mientras que los datos de eficacia se obtienen en ensayos clínicos, la efectividad ha de medirse en la vida real, teniendo en cuenta que las vacunas se han empezado a implementar en España el 27 de diciembre de 2020. Las vacunas para prevenir la infección por SARS-CoV-2 parecen seguras y eficaces, con una calidad de la evidencia moderada. En el momento actual se ha vacunado de forma universal a la población adulta (primer grupo en tener evidencias de eficacia y seguridad vacunal) con las vacunas disponibles y según grupos de riesgo establecidos por el Ministerio de Sanidad, posteriormente se han ido incorporando otros grupos como embarazadas y adolescentes, y recientemente se ha incorporado el grupo de escolares entre 5 y 11 años tras la publicación de eficacia y seguridad vacunal en esta franja de edad de una de las vacunas autorizadas en la Unión Europea. A pesar de las limitaciones que presentan los ensayos clínicos, la situación de pandemia actual con gran amenaza para la salud pública y la gran pérdida de vidas que produce la enfermedad por SARS-CoV-2, hace que el balance riesgo beneficio sea favorable a la vacunación (AU)

There has been an extraordinary effort, technical as well as economic to produce effective vaccines. The vaccines with known effectivity data are those that have published phase 3 results. The most relevant data of these clinical trials are resumed here grouped by type of vaccine. While data on effectivity are obtained from clinical trials, the effectiveness must be measured in real life, considering that vaccines have been implemented in Spain since December 27, 2020. The vaccines to prevent SARS-CoV-2 infections seem safe and effective, with a moderate quality of the evidence. Currently, the adult population has been vaccinated (first age group with evidence of effectivity and safety) with the available vaccines and according to risk groups established by the Health Ministry, afterwards other groups have been added such as pregnant women and adolescents, and recently the schoolers 5 to 11 years after the publication of effectivity and safety in this age group of one of the vaccines authorized in the European Union. Despite the limitations of the published clinical trials, the current pandemic situation means a great public health threat and an enormous loss of lives due to SARS-CoV-2, which makes the risk benefit balance favorable to vaccination. (AU)

Pedestrian flow in two dimensions: Optimal psychological stress leads to less evacuation time and decongestion.

Collective motion is an innate ability of all living systems, which depends on physiological and psychosocial factors in the case of humans. Such a collective organization is becoming of great interest in collective motion in human crowds. Using a cellular automaton (CA) simulation model, we demonstrate that emergency egress from a two-dimensional corridor with optimal stress leads to less evacuation time and efficient mass evacuations. We study how three types of stress (i.e., mild stress, optimal stress, and anxiety) described in the literature have a significant impact on the collective dynamics. We found that low-stress levels could decrease the evacuation time in an entire occupied room since agents choose alternative routes rather than the shortest path to the exit and display cooperative behavior. Therefore, the combination of mild and optimal stress can lead to efficient evacuations. Also CA simulations may be used to find safer and more efficient ways to conduct mass evacuation procedures.

Traceability from governmental producers of radiopharmaceuticals in measuring (18)F in Brazil.

Since the inception of its proficiency test program to evaluate radionuclide measurement in hospitals and clinics, the National Metrology Laboratory of Ionizing Radiation-LNMRI, that represents Brazilian National Metrology Institute (NMI) for ionizing radiation has expanded its measurement and calibration capability. Requirements from the National Health Surveillance Agency from Ministry of Health (ANVISA), to producers of radiopharmaceuticals provided an opportunity to improve the full traceability chain to the highest level. Fluorodeoxyglucose (FDG-(18)F) is the only radiopharmaceutical simultaneously produced by all Brazilian radiopharmaceutical production centers (RPCs). By running this proficiency test, LNMRI began to provide them with the required traceability. For evaluation, the ratio of RPC to reference value results and ISO/IEC17043:2010 criteria were used. The reference value established as calibration factor on the secondary standard ionization chamber was obtained from three absolute measurements systems, and routinely confirmed in each round of proficiency test by CIEMAT/NIST liquid scintillation counting. The γ-emitting impurities were checked using a High-Purity Germanium (HPGe) detector. The results show that Brazilian RPCs are in accordance with (accuracy within ±10%) the Brazilian standard for evaluation of measurements with radionuclide calibrators (CNEN NN 3.05., 2013). Nevertheless, the RPCs should improve the methodology of uncertainty estimates, essential when using the statistical criteria of ISO/IEC 17043 standard, in addition to improving accuracy to levels consistent with their position in the national traceability chain.

Effect of the probiotic Saccharomyces cerevisiae on ligature-induced periodontitis in rats.

BACKGROUND AND OBJECTIVE: This study assessed the effects of the local use of Saccharomyces cerevisiae as monotherapy and as an adjuvant to the mechanical treatment of ligature-induced periodontitis in rats. MATERIAL AND METHODS: Periodontitis was induced in 72 rats via the installation of a ligature around the mandibular first molar. After 7 d, the ligature was removed and the rats were placed in one of the following groups: no treatment (C; n = 18); scaling and root planing (SRP; n = 18); local irrigation with probiotics (PRO; n = 18); and SRP followed by local irrigation with probiotics (SRP/PRO; n = 18). Six rats from each group were killed at 7, 15 and 30 d. The histological characteristics, alveolar bone loss (ABL) and immunolabeling of tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1ß), interleukin-10 (IL-10) and TRAP on the furcation area of the first molar were assessed. RESULTS: The PRO group showed features of acceleration of the tissue-repair process during the entire experiment. On day 15, there was less ABL in the SRP/PRO group compared with the C group. There were fewer TRAP-positive cells in the SRP and SRP/PRO groups at 30 d. There was less immunostaining for TNF-α in the PRO and SRP/PRO groups and less immunostaining for IL-1ß in the PRO group. However, there was more immunostaining for IL-10 in the PRO group on day 15. CONCLUSION: Local use of the probiotic did not result in any adverse effects on periodontal tissues. When used as monotherapy or as an adjuvant, the probiotic was effective at controlling periodontitis in rats.

Evolución a largo plazo de los niños tratados con técnicas de depuración extrarrenal continua / Long-term outcomes of children treated with continuous renal replacement therapy

INTRODUCCIÓN: El objetivo de este estudio fue analizar la evolución a largo plazo y la función renal de los niños que han requerido técnicas de depuración extrarrenal continua (TDEC) tras un daño renal agudo. PACIENTES Y MÉTODOS: Se realizó un estudio observacional retrospectivo sobre una base de datos prospectiva en 128 pacientes que requirieron TDEC durante su ingreso en la Unidad de Cuidados Intensivos Pediátrica (UCIP) durante los años 2006 a 2012. Se analizó la evolución de los pacientes que sobrevivieron al alta de la UCIP. RESULTADOS: Setenta y uno de los 128 niños tratados con TDEC, un 54,4%, sobrevivió al alta y se realizó el seguimiento en 66 de ellos (92,9%). Tres pacientes presentaban insuficiencia renal crónica previa al ingreso en UCIP. De los 63 pacientes restantes, 6 presentaron alteración de la función renal prolongada o recaídas, pero solo un paciente con un síndrome hemolítico-urémico atípico quedó en insuficiencia renal terminal, presentando el resto una función renal normal en la última revisión. CONCLUSIONES: La mayoría de los niños que precisan TDEC y que sobreviven al episodio agudo presentan una buena evolución posterior con baja mortalidad y recuperación de la función renal a medio plazo

INTRODUCTION: The objective of this study is to analyze long-term outcomes and kidney function in children requiring continuous renal replacement therapy (CRRT) after an acute kidney injury episode. PATIENTS AND METHODS: A retrospective observational study was performed using a prospective database of 128 patients who required CRRT admitted to the pediatric intensive care unit between years 2006 and 2012. The subsequent outcomes were assessed in those surviving at hospital discharge. RESULTS: Of the 128 children who required RRT in the pediatric intensive care unit, 71 survived at hospital discharge (54.4%), of whom 66 (92.9%) were followed up. Three patients had chronic renal failure prior to admission to the NICU. Of the 63 remaining patients, 6 had prolonged or relapses of renal function disturbances, but only one patient with atypical Hemolytic Uremic Syndrome developed end-stage renal failure. The rest had normal kidney function at the last check-up. CONCLUSIONS: Most of surviving children that required CRRT have a positive outcome later on, presenting low mortality rates and recovery of kidney function in the medium term

[Long-term outcomes of children treated with continuous renal replacement therapy]. / Evolución a largo plazo de los niños tratados con técnicas de depuración extrarrenal continua.

INTRODUCTION: The objective of this study is to analyze long-term outcomes and kidney function in children requiring continuous renal replacement therapy (CRRT) after an acute kidney injury episode. PATIENTS AND METHODS: A retrospective observational study was performed using a prospective database of 128 patients who required CRRT admitted to the pediatric intensive care unit between years 2006 and 2012. The subsequent outcomes were assessed in those surviving at hospital discharge. RESULTS: Of the 128 children who required RRT in the pediatric intensive care unit, 71 survived at hospital discharge (54.4%), of whom 66 (92.9%) were followed up. Three patients had chronic renal failure prior to admission to the NICU. Of the 63 remaining patients, 6 had prolonged or relapses of renal function disturbances, but only one patient with atypical Hemolytic Uremic Syndrome developed end-stage renal failure. The rest had normal kidney function at the last check-up. CONCLUSIONS: Most of surviving children that required CRRT have a positive outcome later on, presenting low mortality rates and recovery of kidney function in the medium term.

Wavelet-based multifractal analysis of nonlinear time series: the earthquake-driven tsunami of 27 February 2010 in Chile.

We study general multifractal properties of tidal gauge and long-wave time series which show a well defined transition between two states, as is the case of sea level when a tsunami arrives. We adopt a method based on discrete wavelets, called wavelet leaders, which has been successfully used in a wide range of applications from image analysis to biomedical signals. First, we analyze an empirical time series of tidal gauge from the tsunami event of 27 February 2010 in Chile. Then, we study a numerical solution of the driven-damped regularized long-wave equation (RLWE) which displays on-off intermittency. Both time series are characterized by a sudden change between two sharply distinct dynamical states. Our analysis suggests a correspondence between the pre- and post-tsunami states (ocean background) and the on state in the RLWE, and also between the tsunami state (disturbed ocean) and the off state in the RLWE. A qualitative similarity in their singularity spectra is observed, and since the RLWE is used to model shallow water dynamics, this result could imply an underlying dynamical similarity.

Colitis ulcerosa: a propósito de un caso / Ulcerative colitis: a case report

La incidencia de la enfermedad inflamatoria intestinal ha experimentado un aumento en los últimos años, y los recientes avances aparecidos, tanto en su diagnóstico como en su tratamiento, obligan a reenfocar el problema desde Atención Primaria. Por eso nos ha parecido oportuno presentar un caso reciente de colitis ulcerosa atendido en nuestro centro (AU)

The incidence of inflammatory bowel disease has increased in the last years. Recent advances that have appeared in diagnosis and treatment make necessary to refocus the problem from primary care. So we felt appropriate to present a recent case of ulcerative colitis treated at our primary health care centre (AU)

Characterization of the nontrivial and chaotic behavior that occurs in a simple city traffic model.

We explore in detail the nontrivial and chaotic behavior of the traffic model proposed by Toledo et al. [Phys. Rev. E 70, 016107 (2004)] due to the richness of behavior present in the model, in spite of the fact that it is a minimalistic representation of basic city traffic dynamics. The chaotic behavior, previously shown for a given lower bound in acceleration/brake ratio, is examined more carefully and the region in parameter space for which we observe this nontrivial behavior is found. This parameter region may be related to the high sensitivity of traffic flow that eventually leads to traffic jams. Approximate scaling laws are proposed.

¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistemática / What medical professional is the most adequate to provide health care to children in primary care in developed countries? Systematic review

Introducción: existe controversia sobre el tipo de profesional más adecuado –pediatras (PED) o médicos de familia/generales (MF/MG)– para prestar atención sanitaria a niños y adolescentes en Atención Primaria (AP). No existen revisiones sistemáticas previas que hayan estudiado este aspecto. El objetivo de este estudio es comparar la atención sanitaria proporcionada por PED y MF/MG en los siguientes aspectos de la práctica clínica: la prescripción de antibióticos (ATB), la indicación de pruebas diagnósticas, el manejo de la otitis media (OMA), del asma, del síndrome febril y de diversas alteraciones psicopatológicas, así como la realización de actividades preventivas. Material y métodos: diseño de estudio: revisión sistemática. Fuente de los datos: hasta diciembre de 2008 se revisaron las bases de datos MEDLINE y CENTRAL, el metabuscador TRIP Database y el buscador Google Académico para recuperar artículos originales y revisiones sistemáticas que compararan la práctica clínica de ambos tipos de profesionales. No se efectuó restricción por idioma. Selección de estudios: se incluyeron estudios de cualquier tipo de diseño (transversal, cohortes, casos y controles, experimentales) que compararan la práctica clínica del PED y el MF/MG. Se excluyeron todas las referencias que no contuvieran investigación original (cartas al director o editoriales). Asimismo, se evaluó la calidad metodológica de cada estudio con el instrumento “OSTEBA; Fichas de lectura crítica”. Dicha calidad era valorada de forma independiente por dos revisores, que llegaban a un consenso en caso de discrepancia. La extracción de datos fue realizada por siete parejas de revisores de forma independiente. Las discrepancias se resolvieron mediante consenso. Resultados: como promedio, los MF/MG prescribieron más ATB que los PED en infecciones del tracto respiratorio superior de probable etiología vírica –odds ratio (OR): 1,4; intervalo de confianza del 95% (IC 95%): 1,1-1,8–. Los PED tuvieron más probabilidades de adherirse a las recomendaciones de guías de práctica clínica sobre el manejo del síndrome febril (OR: 9; IC 95%: 3-25) y del trastorno por déficit de atención con/sin hiperactividad (OR: 5; IC 95%: 3-11), y una mayor capacidad de resolución para otras enfermedades de elevada prevalencia durante la infancia y la adolescencia (como asma y OMA). Los PED presentaban porcentajes de vacunación superiores a los de los MF/MG en todos los estudios que evaluaron este resultado. Conclusión: en vista de los resultados expuestos, parece recomendable mantener la figura del PED en los equipos de AP y reforzar su función específica como primer punto de contacto del niño con el sistema sanitario (AU)

Introduction: There is controversy about which health professional is the most adequate –pediatricians (PED) or family practitioners/general physicians (FP/GP)– to provide health care services to children and adolescents in Primary Care (PC). There are not previous systematic reviews approaching this subject in the previously published literature. The objective of this study is to compare health care provided between PED and FP/GP in the following aspects of the clinical practice: antibiotic (ATB) prescription; diagnostic test indication; acute otitis media (AOM), asthma, febrile syndrome and several psychopathological conditions’ management; and preventive measures accomplishment. Material and methods: study design: systematic review. Data sources: MEDLINE and CENTRAL databases, TRIP Database and Google Scholar, were searched until December 2008 to retrieve original papers and systematic reviews comparing the clinical practice of both kinds of health professionals. No language restriction was made. Studies’ selection: studies of any kind of design were included (cross-sectional, cohorts, case-controls and experimental) comparing the clinical practice of PED and FP/GP. The references without original research were excluded (letters to the editor, editorials). The methodological quality of each study was assessed with the tool “OSTEBA; Critical Appraisal Cards”. Two reviewers assessed the quality of the studies independently, achieving consensus in case of discrepancy. Seven pairs of reviewers made the data extraction independently. Discrepancies were achieved by consensus. Results: On average, FP/GP prescribed more ATB than PED in upper respiratory tract infections of probable viral etiology –odds ratio (OR): 1.4; 95% confidence interval (95% CI): 1.1-1.8–; PED were more likely to adhere to clinical guidelines recommendations on febrile syndrome management (OR: 9; 95% CI: 3-25) and on attention deficit disorder with/without hyperactivity (OR: 5; 95% CI: 3-11), and showed more resolution capacity on other highly prevalent conditions in children and adolescents (such as asthma and AOM). PED showed higher vaccination coverage than FP/GP in all the studies assessing this result. Conclusion: based on the presented results, it seems reasonable to recommend maintaining the PED figure in PC health centers and reinforcing its specific task as the first point of contact of the child with the health care system (AU)

Prevención de riesgos frente a radiaciones no ionizantes en fisioterapia / Risk prevention against nonionizing radiation in physical therapy

El objetivo del presente artículo consiste en actualizar la información normativa y legislativa existente referida al campo de las radiaciones no ionizantes (RNI) y, en concreto, en relación con el ámbito de la fisioterapia. El eje fundamental de éste discurre en torno a las medidas existentes para trabajar en unas condiciones óptimas de protección de la salud.Organizaciones del ámbito nacional e internacional han emitido recomendaciones y directrices para mejorar la seguridad y la salud en el trabajo ante la exposición a RNI. En concreto, la Directiva 2004/40/CE del Parlamento Europeo refleja las disposiciones mínimas de seguridad y salud relativas a la exposición de los trabajadores a riesgos derivados de agentes físicos. En dicho documento se describen los valores límite de la exposición y los valores que dan lugar a una acción.Existen propuestas encaminadas a reducir el riesgo de exposición: sistemas de apantallamiento, gafas de protección, distancias de seguridad, señalización o atención a las normas del fabricante. Por su parte, el empresario se ve directamente implicado, pues tiene la obligación de evaluar, medir y calcular la exposición de sus trabajadores a los campos electromagnéticos.La concienciación del fisioterapeuta, el compromiso del empresario y la aplicación de la normativa vigente suponen tres pilares fundamentales en el largo camino que queda por recorrer hacia la búsqueda de un entorno laboral saludable(AU)

This article aims to up-date the present regulatory and legislative information regarding the field of nonionizing radiations (NIR) and specifically in relationship to the physical therapy setting. Its fundamental axis develops in regards to the existing measures to work under the best conditions for health protection.National and international organizations have issued recommendations and guidelines to improve safety and health at work when exposed to NIR. Specifically, Directive 2004/40/CE of the European Parliament reflects the minimum safety and health stipulations regarding exposure of the workers to risks derived from physical agents. Said documents describe the borderline values of exposure and the values that give rise to an action.There are proposals aimed at reducing risk of exposure: screening systems, protection glasses, safety distances, signs, and attention to manufacturing guidelines. On its part, the employer is directly involved since the employer has the obligation to evaluate, measure and calculate the exposure of its workers to the electromagnetic fields.Making the physiotherapist aware, the commitment of the employer and the application of the existing regulations are three fundamental cornerstones in the long road ahead towards the search for a healthy work setting(AU)

Resonance, criticality, and emergence in city traffic investigated in cellular automaton models.

The complex behavior that occurs when traffic lights are synchronized is studied for a row of interacting cars. The system is modeled through a cellular automaton. Two strategies are considered: all lights in phase and a "green wave" with a propagating green signal. It is found that the mean velocity near the resonant condition follows a critical scaling law. For the green wave, it is shown that the mean velocity scaling law holds even for random separation between traffic lights and is not dependent on the density. This independence on car density is broken when random perturbations are considered in the car velocity. Random velocity perturbations also have the effect of leading the system to an emergent state, where cars move in clusters, but with an average velocity which is independent of traffic light switching for large injection rates.

Optimal control in a noisy system.

We describe a simple method to control a known unstable periodic orbit (UPO) in the presence of noise. The strategy is based on regarding the control method as an optimization problem, which allows us to calculate a control matrix A. We illustrate the idea with the Rossler system, the Lorenz system, and a hyperchaotic system that has two exponents with positive real parts. Initially, a UPO and the corresponding control matrix are found in the absence of noise in these systems. It is shown that the strategy is useful even if noise is added as control is applied. For low noise, it is enough to find a control matrix such that the maximum Lyapunov exponent lambda(max)<0, and with a single non-null entry. If noise is increased, however, this is not the case, and the full control matrix A may be required to keep the UPO under control. Besides the Lyapunov spectrum, a characterization of the control strategies is given in terms of the average distance to the UPO and the control effort required to keep the orbit under control. Finally, particular attention is given to the problem of handling noise, which can affect considerably the estimation of the UPO itself and its exponents, and a cleaning strategy based on singular value decomposition was developed. This strategy gives a consistent manner to approach noisy systems, and may be easily adapted as a parametric control strategy, and to experimental situations, where noise is unavoidable.

¿Tiene este niño una infección de orina? / No disponible

No disponible

Enfermedad neumocócica invasiva: aumento de la incidencia de serotipos no vacunales tras la vacunación universal de los niños nativos de Alaska / No disponible

No disponible

Diagnóstico: apendicitis / No disponible

No disponible

Perspectivas de la vacuna del virus del papiloma humano ante la baja prevalencia de los serotipos vacunales en mujeres norteamericanas / No disponible

No disponible

Universal and nonuniversal features in a model of city traffic.

The complex behavior that occurs when traffic lights are synchronized is studied. Two strategies are considered: all lights in phase, and a "green wave" with a propagating green signal. It is found that traffic variables such as traveling time, velocity, and fuel consumption, near resonance, follow critical scaling laws. For the green wave, it is shown that time and velocity scaling laws hold even for random separation between traffic lights. These results suggest the concept of transient resonances, which can be induced by adaptively changing the phase of traffic lights. This may be important to consider when designing strategies for traffic control in cities, where short trajectories, and thus transient solutions, are likely to be relevant.

¿Se pueden conseguir hábitos saludables en la población infantil desde Atención Primaria? / Can Wholesome habits in children be achieved from Primary Care?

No disponible

Primera relación sexual en adolescentes cubanos / first sexual relations in cuban teenagers

Se realizó un estudio longitudinal descriptivo en 612 adolescentes de ambos sexos en la Escuela de Formación de Técnicos Medios Saúl Delgado del Municipio Plaza de la Revolución en Ciudad de la Habana, seleccionados por muestreo entre las edades de 15-19 años. Se aplicó una encuesta a cada adolescente, donde se investigaron datos de identidad personal, edad de las primeras relaciones sexuales, métodos anticonceptivos utilizados en ellas, números de compañeros sexuales y los anticonceptivos más utilizados en las relaciones subsiguientes. Como resultados encontramos que la gran mayoría de nuestros jóvenes tenían relaciones sexuales precoces, siendo el condón o preservativo el método más conocido y utilizados por ellos, a pesar de que otros métodos son usados pero con menos frecuencia que el antes mencionado. El número de compañeros sexuales según sexo y edad, encontrado fue entre 3 y 6 siendo más representativo para el sexo femenino que para el masculino, trayendo como consecuencia un alto nivel de promiscuidad en nuestras adolescentes. Pudimos concluir que continúa siendo un problema el hecho de las relaciones sexuales cada vez más precoces así como la realización de las mismas sin protección.