Kaplan-Meier Type Survival Curves for COVID-19: A Health Data Based Decision-Making Tool.

Countries are recording health information on the global spread of COVID-19 using different methods, sometimes changing the rules after a few days. All of them are publishing the number of new individuals infected, recovered and dead individuals, along with some supplementary material. These data are often recorded in a non-uniform manner and do not conform the standard definitions of these variables. In this paper we show that, using data from the first wave of the epidemic (February-June), Kaplan-Meier curves calculated with them could provide useful information on the dynamics of the disease in different countries. We developed our scheme based on the cumulative total number of infected, recovered and dead individuals provided by the countries. We present a robust and simple model to show certain characteristics of the evolution of the dynamic process, showing that the differences in evolution between countries are reflected in the corresponding Kaplan-Meier-type curves. We compare the curves obtained for the most affected countries at that time, with the corresponding interpretation of the properties that distinguish them. The model is revealed as a practical tool for countries in the management of the Healthcare System.

Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) / Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE)

La ecocardiografía transesfofágica es una técnica semiinvasiva que permite una evaluación de la morfología y función cardiaca a tiempo real y que constituye, a día de hoy, un estándar de calidad en las intervenciones de cirugía cardiovascular. Se ha convertido en una herramienta fundamental tanto de monitorización como de diagnóstico en el perioperatorio que permite la correcta planificación quirúrgica y manejo farmacológico dirigido. El objetivo de este documento es dar respuesta de forma consensuada y avalada por la evidencia científica de cuándo y cómo debe hacerse la ecocardiografía transesfofágica intraoperatoria en cirugía cardiovascular, qué aplicaciones tiene en el intraoperatorio, quién debe realizarla y cómo debe transmitirse la información obtenida durante el estudio. Los autores han hecho una revisión sistemática de las guías internacionales, artículos de revisión y ensayos clínicos para dar respuesta a estas preguntas

Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions

Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). / Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE).

Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.

Anthropogenic versus mineral aerosols in the stimulation of microbial planktonic communities in coastal waters of the northwestern Mediterranean Sea.

The atmosphere of the northwestern (NW) Mediterranean Sea is affected by continuous inputs of anthropogenic aerosols and episodic Saharan dust events. These atmospheric inputs deliver to the surface waters high amounts of macronutrients and trace metals that can constitute their main source at certain times of the year. The effect of both anthropogenic and crustal particles over the autotrophic and heterotrophic planktonic community assembles was evaluated through three microcosm experiments carried out in the summer of 2013 and in the winter and spring of 2014 at an urban coastal location of the NW Mediterranean (Barcelona, Spain). Particles were added to seawater at a concentration of 0.8mgl-1. The results showed that (i) a greater stimulation of the whole community was observed in summer and spring than in winter; (ii) both kinds of aerosols produced an increase in the growth of phytoplankton, although the stimulation of nanoeukaryotes was significantly larger with anthropogenic aerosols; and (iii) bacterial abundance increased more with mineral dust, whereas bacterial production was more stimulated with anthropogenic inputs. Overall, the effect of atmospheric particles was dependent on their composition and solubility in seawater, as well as on the initial biogeochemical conditions present in the seawater and had the potential to change the net metabolic balance of the microbial planktonic community.

Efectividad de la terapia láser de baja intensidad en pacientes con artritis reumatoide: una revisión sistemática de ensayos clínicos / Effectiveness of laser therapy of low intensity in patients with rheumatoid arthritis: a systematic review of clinical trials

Objetivo: Determinar la evidencia científica sobre la efectividad de la terapia láser de baja intensidad en la artritis reumatoide (AR). Estrategia de búsqueda: Se identificaron 1.008 artículos mediante búsqueda electrónica en las bases de datos de PEDro, TRIP, DIALNET, OVIDSP, Cochrane, EMBASE, Pub Med y Enfispo. Se incluyeron ensayos clínicos, controlados, aleatorizados y con simple o doble ciego, publicados entre el 1 de enero de 1990 hasta el 31 de diciembre del 2013, en lengua española e inglesa. Selección de estudios: Se realizó por 2 revisores, de manera no cegada e independiente, y se llevó a cabo una clasificación de los estudios mediante la escala PEDro. Resultados: Se seleccionaron 6 estudios. Estos no obtuvieron resultados estadísticamente significativos sobre el uso de la terapia láser de baja intensidad en la AR. Conclusiones:Existe evidencia limitada sobre el uso del tratamiento con láser en la AR, por lo que es necesario ampliar la investigación sobre este tema

Objective: to determine scientific evidence on the effectiveness of low level laser therapy in rheumatoid arthritis. Search strategy: 1008 articles were identified by searching electronic databases PEDro, TRIP, DIALNET OVIDSP, Cochrane, EMBASE, Pub Med and ENFISPO. We included controlled clinical trials, randomized and single or double-blind studies published between January 1 st 1990 until December 31st 2013, both in Spanish and in English. Study screening: it was performed by two reviewers independently and unblinded manner, and conducted a classification studies using the PEDro scale. Results: 6 studies were selected. They did not obtain statistically significant results on the use of low intensity laser therapy in RA. Conclusions: There is limited evidence on the use of laser therapy in the treatment of RA, so it is necessary to extend the research on this topic

Neural network for estimating energy expenditure in paraplegics from heart rate.

The aim of the present study is to obtain models for estimating energy expenditure based on the heart rates of people with spinal cord injury without requiring individual calibration. A cohort of 20 persons with spinal cord injury performed a routine of 10 activities while their breath-by-breath oxygen consumption and heart rates were monitored. The minute-by-minute oxygen consumption collected from minute 4 to minute 7 was used as the dependent variable. A total of 7 features extracted from the heart rate signals were used as independent variables. 2 mathematical models were used to estimate the oxygen consumption using the heart rate: a multiple linear model and artificial neural networks. We determined that the artificial neural network model provided a better estimation (r=0.88, MSE=4.4 ml · kg(-1) · min(-1)) than the multiple linear model (r=0.78; MSE=7.63 ml · kg(-1) · min(-1)).The goodness of fit with the artificial neural network was similar to previous reported linear models involving individual calibration. In conclusion, we have validated the use of the heart rate to estimate oxygen consumption in paraplegic persons without individual calibration and, under this constraint, we have shown that the artificial neural network is the mathematical tool that provides the better estimation.

Validation of the use of Actigraph GT3X accelerometers to estimate energy expenditure in full time manual wheelchair users with spinal cord injury.

STUDY DESIGN: Cross-sectional validation study. OBJECTIVES: The goals of this study were to validate the use of accelerometers by means of multiple linear models (MLMs) to estimate the O2 consumption (VO2) in paraplegic persons and to determine the best placement for accelerometers on the human body. SETTING: Non-hospitalized paraplegics' community. METHODS: Twenty participants (age=40.03 years, weight=75.8 kg and height=1.76 m) completed sedentary, propulsion and housework activities for 10 min each. A portable gas analyzer was used to record VO2. Additionally, four accelerometers (placed on the non-dominant chest, non-dominant waist and both wrists) were used to collect second-by-second acceleration signals. Minute-by-minute VO2 (ml kg(-1) min(-1)) collected from minutes 4 to 7 was used as the dependent variable. Thirty-six features extracted from the acceleration signals were used as independent variables. These variables were, for each axis including the resultant vector, the percentiles 10th, 25th, 50th, 75th and 90th; the autocorrelation with lag of 1 s and three variables extracted from wavelet analysis. The independent variables that were determined to be statistically significant using the forward stepwise method were subsequently analyzed using MLMs. RESULTS: The model obtained for the non-dominant wrist was the most accurate (VO2=4.0558-0.0318Y25+0.0107Y90+0.0051YND2-0.0061ZND2+0.0357VR50) with an r-value of 0.86 and a root mean square error of 2.23 ml kg(-1) min(-1). CONCLUSIONS: The use of MLMs is appropriate to estimate VO2 by accelerometer data in paraplegic persons. The model obtained to the non-dominant wrist accelerometer (best placement) data improves the previous models for this population.

Resucitación hipotensiva en el paciente politraumatizado con shock hemorrágico / Hypotensive resuscitation of the polytrauma patient with hemorrhagic shock

El shock hemorrágico constituye una importante causa de mortalidad en nuestro medio. A pesar de ello en los últimos 40 años ha habido pocos cambios en su tratamiento en el periodo previo a la hemostasia quirúrgica definitiva. El actual estándar de tratamiento, la reanimación con fluidos que busca la normotensión y normovolemia, se basa en trabajos con modelos animales de los años 50 y 60, que se resumen en esta publicación. En las últimas tres décadas han surgido nuevos modelos de shock hemorrágico experimentales más parecidos a las situaciones reales, basados en una hemorragia “incontrolada”. Estos estudios han demostrado un aumento de la supervivencia cuando se permite una hipotensión moderada durante este tipo de shock en pacientes politraumatizados. Esta terapéutica se denomina reanimación (resucitación) hipotensiva. Finalmente se revisan los ensayos clínicos publicados sobre la reanimación hipotensiva en el shock hemorrágico, así como otros indirectamente relacionados. Los autores consideramos la reanimación hipotensiva como una opción de tratamiento tanto extrahospitalaria como intrahospitalaria, prometedora en el shock hemorrágico, pero creemos necesarios más ensayos clínicos sobre el tema para convertirla en un estándar de tratamiento(AU)

Hemorrhagic shock is a significant cause of death in hospital practice, yet the management of this event in the period prior to definitive surgical hemostasis has changed little in 40 years. Currently, the standard treatment of resuscitation by means of fluid therapy to re-establish normal pressure and volume is based on animal models from the 1950s and 1960s; these studies will be reviewed in this article. However, new experimental models of hemorrhagic shock that have emerged in the last 3 decades are based on uncontrolled bleeding and are more similar to real-life situations. Recent studies using these models have demonstrated increased survival when polytrauma patients with hemorrhagic shock are deliberately allowed to remain in a moderate level of hypotension, a strategy referred to as hypotensive resuscitation. Finally, we review clinical trials of hypotensive resuscitation in hemorrhagic shock as well as studies indirectly related to this management approach. We conclude that hypotensive resuscitation is a promising treatment for use in cases of hemorrhagic shock that occur either in or out of hospital; however, we believe that more trials should be done before it can be considered a standard treatment(AU)

[Hypotensive resuscitation of the polytrauma patient with hemorrhagic shock]. / Resucitación hipotensiva en el paciente politraumatizado con shock hemorrágico.

Hemorrhagic shock is a significant cause of death in hospital practice, yet the management of this event in the period prior to definitive surgical hemostasis has changed little in 40 years. Currently, the standard treatment of resuscitation by means of fluid therapy to re-establish normal pressure and volume is based on animal models from the 1950s and 1960s; these studies will be reviewed in this article. However, new experimental models of hemorrhagic shock that have emerged in the last 3 decades are based on uncontrolled bleeding and are more similar to real-life situations. Recent studies using these models have demonstrated increased survival when polytrauma patients with hemorrhagic shock are deliberately allowed to remain in a moderate level of hypotension, a strategy referred to as hypotensive resuscitation. Finally, we review clinical trials of hypotensive resuscitation in hemorrhagic shock as well as studies indirectly related to this management approach. We conclude that hypotensive resuscitation is a promising treatment for use in cases of hemorrhagic shock that occur either in or out of hospital; however, we believe that more trials should be done before it can be considered a standard treatment.

Contribution of fish consumption to heavy metals exposure in women of childbearing age from a Mediterranean country (Spain).

The concentrations of cadmium (Cd), lead (Pb) and mercury (Hg) were determined in samples from sword-fish (Xiphias gladius, n=37) and louvar (Luvarus imperialis, n=17) taken in an official surveillance programme in Madrid (Spain). The levels of heavy metals were measured by atomic absorption spectrophotometry (hydride generator for Hg and flame atomic absorption for Cd and Pb) after digestion of the samples (microwave digestion for Hg and drying chamber for Cd and Pb). Pb contamination was negligible in both species. Cd was detected in 89.19% of the samples from sword-fish and 52.94% from louver; 17.65% of louvar and none from sword-fish being higher than maximum residue limits (MRL). However, around 90% of louvar samples and around 35% of sword-fish portions exceeded MRL for Hg; around 30% of louvar samples having levels even higher than 1 microg/g. The consumption of one serving of 150 g either of louvar or sword-fish would not be relevant for Cd and Pb provisional tolerable weekly intake (PTWI) of these elements for women in childbearing age, but it would largely exceed the tolerable values for Hg.

[Paroxysmal nocturnal hemoglobinuria: pathogenic and therapeutic news]. / Hemoglobinuria paroxística nocturna. Novedades patogénicas y terapéuticas.

Paroxysmal Nocturnal Haemoglobinuria (PNH) is a clinical manifestation of an haemathology cell disease, whose etiology has been unknown for many years. We try to resume the most relevant facts of this entity and to define the pathogenesis which is responsible of the clinical manifestations of the disease.

Hemoglobinuria paroxística nocturna. Novedades patogénicas y terapéuticas / Paroxysmal nocturnal haemoglobinuria. Pathogenic and therapeutic news

La hemoglobinuria paroxística nocturna (HPN) es la traducción clínica de una alteración de las células hematológicas, cuya etiopatogenia ha sido desconocida hasta hace relativamente poco tiempo. Intentamos resumir los aspectos más relevantes del proceso, y definir las características patogénicas, responsables de las manifestaciones clínicas de la enfermedad (AU)

Actividad biologica de la vacuna pertussis preservada con analogos estructurales del tiomersal. / Biological activity of pertussis vaccine preserved with structural analogs of thiomersal

Estudiamos el efecto de varios analogos del tiomersal sobre la actividad biologica de dos vacunas pertussis producidas una en cultivo estacionario y otra en cultivo sumergido. La prueba de proteccion activa en el raton se efectuo para analizar el efecto. Tambien se determino la concentracion de los diferentes analogos en la vacuna completa, sobrenadante y el paquete celular. Los resultados muestran que existen diferencias en la actividad biologica de la vacuna tratada con los diferentes analogos y se observo ademas que estos compuestos se encuentram en concentraciones diferentes en las tres fracciones estudiadas