A Prospective Observational Study of Frailty in Geriatric Revitalization Aimed at Community-Dwelling Elderly.

(1) Background: The increasing life expectancy brings an increase in geriatric syndromes, specifically frailty. The literature shows that exercise is a key to preventing, or even reversing, frailty in community-dwelling populations. The main objective is to demonstrate how an intervention based on multicomponent exercise produces an improvement in frailty and pre-frailty in a community-dwelling population. (2) Methods: a prospective observational study of a multicomponent exercise program for geriatric revitalization with people aged over 65 holding Barthel Index scores equal to, or beyond, 90. The program was developed over 30 weeks, three times a week, in sessions lasting 45-50 min each. Frailty levels were registered by the Short Physical Performance Battery, FRAIL Questionnaire Screening Tool, and Timed "Up & Go" at the beginning of the program, 30 weeks later (at the end of the program), and following 13 weeks without training; (3) Results: 360 participants completed the program; a greater risk of frailty was found before the program started among older women living in urban areas, with a more elevated fat percentage, more baseline pathologies, and wider baseline medication use. Furthermore, heterogeneous results were observed both in training periods and in periods without physical activity. However, they are consistent over time and show improvement after training. They show a good correlation between TUG and SPPB; (4) Conclusions: A thirty-week multicomponent exercise program improves frailty and pre-frailty status in a community-dwelling population with no functional decline. Nevertheless, a lack of homogeneity is evident among the various tools used for measuring frailty over training periods and inactivity periods.

Nintedanib in chronic fibrosing interstitial lung diseases. A case series.

Progressive pulmonary fibrosis (PPF) can be fatal in non-idiopathic interstitial lung diseases. We report a descriptive series of 13 patients with PPF who received treatment with nintedanib, a multitargeted tyrosine kinase inhibitor with antifibrotic effect. Although the reduced number of patients and the observational nature of a case series prevent us from providing strong evidence, our results suggest that nintedanib could be effective in PPF of various etiologies. Nintedanib could also be useful in specific populations such as patients awaiting lung transplant and elderly patients.

Removal of contaminants of emerging concern from pig manure in different operation stages of a thin-layer cascade photobioreactor. Relationship with concentrations in microalgae and manure.

The performance of a pilot-scale thin-layer cascade photobioreactor, operated in semicontinuous mode, for the removal of veterinary drug residues and other contaminants of emerging concern (CECs) from pig manure has been assessed in six operation stages. Chlorella sp. (70-90%), Scenedesmus sp. (10-25%) and Diatomea (<5%) comprise the microalgae species present during the stages. The global performance to remove the total CEC content in the photobioreactor effluent varied from 62 to 86% on each stage, while an CEC mean amount close to 8% was accumulated in the photobioreactor biomass. A relation with weather conditions was not observed. Elimination ratio was not related to the concentration in the influent which reached up to 8000 ng L-1 for some CECs. As expected, the concentrations of veterinary drugs were higher than those of non-veterinary CECs. The concentrations accumulated in the grown biomass were relative low, lower than 10 ng per fresh g excepting for a few cases. However, statistical data suggested that the linkage of CECs to microalgae biomass boosted their removal from the influent. Furthermore, it was observed that the manure liquid phase contained higher amounts of CECs than the solid phase.

Combination of different noninvasive brain stimulation treatments for upper limb recovery in stroke patients: A systematic review.

We report a review of Pubmed (Medline), CENTRAL, Web of Science, and Scopus to test the effectiveness of the combined application of repetitive transcranial magnetic stimulation and transcranial direct current stimulation in the improvement of different functional variables of the upper limb in people with stroke. Two independent reviewers assessed eligibility and evaluated the quality of the studies. Five articles were included in the final review according to the inclusion criteria: Most show statistically significant differences in motor function improvement in favor of the experimental group, but not in activity. Due to the heterogeneity of the observed studies, the results should be interpreted with caution-more high-quality studies are needed to investigate the effectiveness of these interventions in different stages of stroke patients.

Geographic Analysis of the Safety and Efficacy of Filgotinib in Rheumatoid Arthritis.

INTRODUCTION: Global clinical trials in rheumatoid arthritis (RA) often do not recruit enough patients from diverse racial and ethnic backgrounds to identify any potential differences in treatment outcome across such groups. To overcome this limitation, using data from five previous clinical trials and two ongoing trial extensions, this study aimed to assess the efficacy and safety of filgotinib in patients with RA across geographic regions. METHODS: This was a post hoc, exploratory analysis of data from male and female patients with RA meeting the 2010 RA criteria as defined by the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology. Data were analyzed from phase 2 (DARWIN 1-2) and phase 3 (FINCH 1-3) clinical trials, as well as two long-term extension studies (DARWIN 3, FINCH 4), of filgotinib. Efficacy endpoints included ACR 20%/50%/70% improvement (ACR20/50/70) responses, disease activity score in 28 joints using C-reactive protein [DAS28(CRP)], Clinical Disease Activity Index scores, Boolean remission, and change from baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI). Safety data were presented as exposure-adjusted incidence rates per 100 patient-years of exposure of treatment-emergent adverse events. RESULTS: Compared with placebo, at week 12 a greater proportion of patients receiving filgotinib 200 mg (FIL200) or 100 mg (FIL100) achieved ACR20 (p < 0.01), with similar outcomes in most regions. Overall, the reduction in HAQ-DI with FIL200 or FIL100 was greater than with placebo (p < 0.05) at week 12. Compared with placebo, at week 24 the proportions of patients achieving DAS28(CRP) ≤ 3.2 were greater for both doses of FIL, as seen in most regions (p < 0.01). Safety outcomes did not indicate regional or ethnic differences in the safety profile of filgotinib. CONCLUSION: Filgotinib efficacy and safety in patients with RA were generally consistent across geographic regions. GOV TRIAL REGISTRATION NUMBERS: NCT02889796; NCT02873936; NCT02886728; NCT03025308; NCT01888874; NCT01894516; NCT02065700.

Clinical trials in rheumatoid arthritis recruit too few patients from diverse ethnic backgrounds to be able to identify differences in treatment outcomes. In adults with moderate-to-severe active rheumatoid arthritis who do not tolerate or have responded poorly to other advanced treatments, the Janus kinase inhibitor filgotinib can be used alone or in combination with the immunosuppressant methotrexate. Using data from 4695 patients with rheumatoid arthritis from five previous clinical trials and two ongoing trial extensions, this paper examined the efficacy and safety of filgotinib in patients with rheumatoid arthritis across geographic locations worldwide.Patients were grouped by region: North America, South and Central America, Western Europe, Eastern Europe, East Asia, South and Southeast Asia, and Other (South Africa, New Zealand, Australia, and Israel). The efficacy of filgotinib in treating the symptoms of rheumatoid arthritis was assessed using several measures of disease activity, with changes in patient quality of life determined using a health assessment questionnaire. Safety data were reported as the rates of side effects experienced by patients.Across different geographic regions, no major differences in filgotinib treatment response were observed. Rheumatoid arthritis disease activity levels were consistently lower in patients receiving filgotinib than in patients receiving placebo. Across the regions examined, quality-of-life scores also improved to a greater degree in patients receiving filgotinib compared with placebo. The rates of side effects, including infections, were similar irrespective of region. The number of deaths was low, mostly resulting from cardiovascular events, infections, and malignancies.This study demonstrates that the efficacy and safety of filgotinib are consistent in patients with rheumatoid arthritis from a broad range of geographic regions and ethnic backgrounds.

Percepción de brechas y oportunidades en eSalud de estudiantes de último año de Medicina en Colombia

Introducción: En los últimos años la explosión de dispositivos con acceso a internet en el mundo ha presentado una oportunidad para el desarrollo de intervenciones en salud. Métodos: Se realizó un estudio observacional transversal de tipo descriptivo; se clasificaron las propuestas de innovación presentadas por estudiantes de último año de medicina como trabajo final de un curso de eSalud. Los proyectos se clasificaron en tres dimensiones: grupo poblacional, problema de salud a resolver y tipo de intervención de salud digital. Resultados: Se analizaron 86 proyectos entre los años 2017 y 2020. El 80,2 % se orienta a la población general, seguidos por la gestante (10,4 %), la infantil (8,14 %) y la geriátrica (1,2 %). El 36 % de los proyectos no mencionaban una condición particular de salud; el 12,8 % se dedicó a la salud sexual y reproductiva; el 10,4 % a las enfermedades cardiovasculares; el 9,3 % a la salud mental y el 4,65 % a aspectos de crecimiento y desarrollo. El 59,3 % de los proyectos se dirigía a apoyar las actividades del prestador de servicios de salud; el 34,9 % estaba orientado hacia las necesidades de los usuarios de los sistemas de salud y el 5,9 % se enfocó en los servicios de datos. Conclusiones: La percepción colectiva de los estudiantes refleja la oportunidad de fortalecer la atención primaria en salud mediante el uso de las tecnologías de la información y las comunicaciones, con énfasis en las poblaciones vulnerables. Los estudiantes empiezan a identificar los servicios de datos como oportunidad de intervención.

Introduction: In recent years, the explosion of devices with Internet access in the world has presented an opportunity for the development of health interventions. Methods: A descriptive cross-sectional observational study was carried out. Innovation proposals submitted by last-year medical students were classified as the final project of an eHealth course. The projects were classified into three dimensions: population group, health problem to be solved, and type of digital health intervention. Results: Eighty-six projects were analyzed from 2017 to 2020. 80.2% were aimed at the general population, followed by pregnant women (10.4%), children (8.14%) and geriatrics (1, 2 %). 36% of the projects did not mention a particular health condition; 12.8% was dedicated to sexual and reproductive health; 10.4% to cardiovascular diseases; 9.3% to mental health and 4.65% to aspects of growth and development. 59.3% of the projects were aimed at supporting the activities of the health service provider; 34.9% were oriented towards the needs of users of health systems and 5.9% focused on data services. Conclusions: The collective perception of the students reflects the opportunity to strengthen primary health care through the use of information and communication technologies, with emphasis on vulnerable populations. Students begin to identify data services as an opportunity for intervention.

Impacto del lugar de residencia en la supervivencia de los pacientes con trasplante renal. ¿Puede la telemedicina mejorar este desenlace?

Antecedente: el trasplante renal es el tratamiento de elección en la enfermedad crónica terminal. Un adecuado seguimiento en el postrasplante mejora la supervivencia del injerto y del paciente a largo plazo. Objetivo: comparar los desenlaces clínicos de la población trasplantada renal que vive en el área metropolitana de Medellín con los que residen por fuera de este lugar, con el fin de plantear un modelo de atención para el seguimiento por medio de la telemedicina. Métodos: estudio descriptivo, retrospectivo y de un único centro. Se determinó la tasa de supervivencia mediante las curvas de Kaplan-Meier. Resultados: durante el período 2005-2015 se realizaron 754 trasplantes, el 42 % vivía por fuera del área metropolitana. Al agrupar esta cohorte según el lugar de residencia, se observó que la supervivencia de los pacientes residentes en el área metropolitana a 1, 3 y 5 años fue del 96,8 %, 93,7 % y 91,8 %, respectivamente, en contraste con el 94,4 %, 90,3 % y 85,2 % de los del área rural. Esta diferencia fue estadísticamente significativa a favor de los que viven en Medellín (log-rank test p = 0,048; Hazard ratio = 1,68; IC 95 % 0,99-2,84, p = 0,052). Conclusión: la supervivencia fue inferior en los pacientes trasplantados renales que viven por fuera del área Metropolitana. Lo anterior motiva el desarrollo de un modelo de atención para estos pacientes mediado por la telemedicina para facilitar el acceso al seguimiento postrasplante.

Background: Kidney transplantation is the treatment of choice for end-stage renal disease. An adequate post-transplant follow-up improves the graft and patient's long-term survival. Objective: The aim of this study was to compare the outcomes of kidney transplant patients who live in the Medellin metropolitan area with those who live outside this area, to propose a model for follow-up care through telemedicine. Methods: Descriptive, retrospective and one-center study. Kaplan-Meier method was used to determine the survival rate. Results: Between 2005 and 2015, 742 patients were transplanted, 42% of whom lived outside the metropolitan area. The survival rates after 1, 3 and 5 years of treatment in patients in the metropolitan area of Medellín compared to those outside were 96.8%, 93.7% y 91.8% and 94.4%, 90.3% y 85.2% respectively, with statistically significant differences (Log-rank test p=0.048, Hazard ratio 1.68, IC 95% 0.99-2.84, p=0.052). Conclusion: The survival rate was lower in kidney transplant patients living outside the urban area. These findings motivate the development of a telemedicine project to facilitate the follow-up of these patients after a kidney transplantation.

Determination of contaminants of emerging concern in raw pig manure as a whole: difference with the analysis of solid and liquid phases separately.

The content of veterinary drugs in manure is usually estimated by the amount of residues determined in its solid or liquid phase, individually, which previously required a separation step. As an alternative, a multiresidue method for the analysis of 48 veterinary drugs and other contaminants of emerging concern (CECs) in swine raw manure as a whole has been developed and in-house validated in this work. The impact of several experimental factors during ultrasound assisted extraction was assessed. Hence, the use of alumina seemed to especially decrease the matrix effect and improve the overall recovery of drugs, mainly those with a high octanol-water partition coefficient. CECs in the extracts were analyzed by ultra-high performance liquid chromatography coupled to mass spectrometry in tandem. A standard addition-matrix matched calibration was used for quantification. Application of the method to two related samples (raw manure and farm centrifuged raw manure) from a facility revealed that the concentrations of CECs determined in the raw manure by the comprehensive methodology were higher than those calculated by adding the concentrations measured in the solid and liquid phases, separately. This was attributed to the loss of CECs adsorbed on fine particles in the suspension during the sample preparation procedure of the liquid-phase. Furthermore, the decrease of residues in the raw manure when this is centrifuged in the farm to yield compost is shown.

Global distribution of soil fauna functional groups and their estimated litter consumption across biomes.

Soil invertebrates (i.e., soil fauna) are important drivers of many key processes in soils including soil aggregate formation, water retention, and soil organic matter transformation. Many soil fauna groups directly or indirectly participate in litter consumption. However, the quantity of litter consumed by major faunal groups across biomes remains unknown. To estimate this quantity, we reviewed > 1000 observations from 70 studies that determined the biomass of soil fauna across various biomes and 200 observations from 44 studies on litter consumption by soil fauna. To compare litter consumption with annual litterfall, we analyzed 692 observations from 24 litterfall studies and 183 observations from 28 litter stock studies. The biomass of faunal groups was highest in temperate grasslands and then decreased in the following order: boreal forest > temperate forest > tropical grassland > tundra > tropical forest > Mediterranean ecosystems > desert and semidesert. Tropical grasslands, desert biomes, and Mediterranean ecosystems were dominated by termites. Temperate grasslands were dominated by omnivores, while temperate forests were dominated by earthworms. On average, estimated litter consumption (relative to total litter input) ranged from a low of 14.9% in deserts to a high of 100.4% in temperate grassland. Litter consumption by soil fauna was greater in grasslands than in forests. This is the first study to estimate the effect of different soil fauna groups on litter consumption and related processes at global scale.

Lung Volume Calculation in Preclinical MicroCT: A Fast Geometrical Approach.

In this study, we present a time-efficient protocol for thoracic volume calculation as a proxy for total lung volume. We hypothesize that lung volume can be calculated indirectly from this thoracic volume. We compared the measured thoracic volume with manually segmented and automatically thresholded lung volumes, with manual segmentation as the gold standard. A linear regression formula was obtained and used for calculating the theoretical lung volume. This volume was compared with the gold standard volumes. In healthy animals, thoracic volume was 887.45 mm3, manually delineated lung volume 554.33 mm3 and thresholded aerated lung volume 495.38 mm3 on average. Theoretical lung volume was 554.30 mm3. Finally, the protocol was applied to three animal models of lung pathology (lung metastasis and transgenic primary lung tumor and fungal infection). In confirmed pathologic animals, thoracic volumes were: 893.20 mm3, 860.12 and 1027.28 mm3. Manually delineated volumes were 640.58, 503.91 and 882.42 mm3, respectively. Thresholded lung volumes were 315.92 mm3, 408.72 and 236 mm3, respectively. Theoretical lung volume resulted in 635.28, 524.30 and 863.10.42 mm3. No significant differences were observed between volumes. This confirmed the potential use of this protocol for lung volume calculation in pathologic models.

COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study.

Introduction: COVID-19 has initially been studied in terms of an acute-phase disease, although recently more attention has been given to the long-term consequences. In this study, we examined COVID-19 as an independent risk factor for long-term mortality in patients with acute illness treated by EMS (emergency medical services) who have previously had the disease against those who have not had the disease. Methods: A prospective, multicenter, ambulance-based, ongoing study was performed with adult patients with acute disease managed by EMS and transferred with high priority to the emergency department (ED) as study subjects. The study involved six advanced life support units, 38 basic life support units, and five emergency departments from Spain. Sociodemographic inputs, baseline vital signs, pre-hospital blood tests, and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, which was classified into 1-year all-cause mortality and 1-year in- and out-of-hospital mortality. To compare both the patients with COVID-19 vs. patients without COVID-19 and to compare survival vs non-survival, two main statistical analyses were performed, namely, a longitudinal analysis (Cox regression) and a logistic regression analysis. Results: Between 12 March 2020 and 30 September 2021, a total of 3,107 patients were included in the study, with 2,594 patients without COVID-19 and 513 patients previously suffering from COVID-19. The mortality rate was higher in patients with COVID-19 than in patients without COVID-19 (31.8 vs. 17.9%). A logistic regression showed that patients previously diagnosed with COVID-19 presented higher rates of nursing home residency, a higher number of breaths per minute, and suffering from connective disease, dementia, and congestive heart failure. The longitudinal analysis showed that COVID-19 was a risk factor for mortality [hazard ratio 1.33 (1.10-1.61); p < 0.001]. Conclusion: The COVID-19 group presented an almost double mortality rate compared with the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.

The role of unenhanced phase of the liver in the scanning protocol of metastatic breast cancer: implications for sensitivity, response evaluation and size measurement.

BACKGROUND: To analyse if performing unenhanced CT of the liver aids in the evaluation of metastatic lesions, response assessment or alter the size of the lesions, compared with portal phase alone, in patients with hepatic metastases from breast carcinoma. PATIENTS AND METHODS: One-hundred and fifty-three CT scans of 36 women were included. Scans consisted of unenhanced, arterial and portal delayed phases of the liver. Two readers sorted which phase was best for visualization of metastases, evaluated the number of lesions detected in each phase, selected the best phase for assessment of response in two consecutive scans, and measured one target lesion in all the phases. Χ2 was used to compare differences among phases and paired t test for measurement differences. RESULTS: Unenhanced, arterial and portal phases were considered better phases by readers 1/2 in 68/67%, 27/28% and 69/70%, and some lesions were missed in 2%, 11% and 7%, respectively. Sensitivity was significantly better for unenhanced and portal phases compared to arterial phase. Comparison between consecutive scans was considered better in unenhanced (80/79%), followed by portal (70/69%) and arterial phases (31/31%). Maximum diameter of target lesions was 15% greater in unenhanced phase (p < 0.001). CONCLUSIONS: Portal and unenhanced phases of the liver allow better detection and delineation of metastatic hepatic lesions from breast carcinoma. In most cases, unenhanced CT is the best phase to assess response and provides the largest diameter. Therefore, we recommend the use of unenhanced CT in the evaluation of patients with breast carcinoma and suspected or known hepatic metastatic disease.

Determination of antibiotics and other veterinary drugs in the solid phase of pig manure.

The presence of residues of veterinary pharmaceuticals in farm wastewaters such as pig slurry represents a problem that needs to be tackled to avoid further contamination of environmental waters and the development of resistant bacteria. For their monitoring and control, it is necessary the existence of reliable analytical tools. The present paper describes for the first time the development and optimization by statistical experimental design of a specifically designed analytical method for the analysis of 21 veterinary drugs, including 18 antibiotics of several families (ß-lactams, tetracyclines, fluoroquinolones, sulfonamides, macrolides, among others), 1 antiparasitic, 1 analgesic and 1 hormone, in a complex environmental matrix such as the fresh solid phase of pig slurry. The resulting method, consisted of an ultrasound assisted extraction (UAE) combined with in-situ dispersive solid phase extraction (d-SPE) from a 0.3 g of freeze-dried sample aliquot followed by a preconcentration step by compact solid phase extraction (c-SPE) and subsequent instrumental analysis by ultra-high-performance-liquid-chromatography (UHPLC) coupled to mass spectrometry in tandem (MS/MS) by a triple quadrupole, was successfully validated as a very sensitive (method limit of quantification in the low ng g-1) and reliable method (relative recoveries around 100% and method repeatability featured by a general relative standard deviation below 20%). Provided raw data was intended to be processed by matrix-matched quantification approach. The resulting methodology was applied to the characterization of several pig manures from different Spanish farms sampled across breeding season between 2018 and 2019. Sample precedence showed to have a high impact in the positives, its frequency and concentration.

Physiological Response of Quality Cardiopulmonary Resuscitation, Crossover Trial on Mannequin in Extreme Temperature Conditions.

BACKGROUND: To determine the relationship between physiological fatigue and the quality of cardiopulmonary resuscitation (CPR) in trained resuscitators in hostile thermal environments (extreme cold and heat) simulating the different conditions found in an out-of-hospital cardiorespiratory arrest. METHODS: Prospective observational study involving 60 students of the health sciences with training in resuscitation, who simulated CPR on a mannequin for 10 min in different thermal environments: thermo-neutral environment (21 °C and 60% humidity), heat environment (41 °C and 98% humidity) and cold environment (-35 °C and 80% humidity). Physiological parameters (heart rate and lactic acid) and CPR quality were monitored. RESULTS: We detected a significant increase in the number of compressions per minute in the "heat environment" group after three minutes and in the mean rate after one minute. We observed a negative correlation between the total number of compressions and mean rate with respect to mean depth. The fraction of compressions (proportion of time in which chest compressions are carried out) was significant over time and the mean rate was higher in the "heat environment". Physiological parameters revealed no differences in heart rate depending on the resuscitation scenario; however, there was a greater and faster increase in lactate in the "heat environment" (significant at minute 3). The total proportion of participants reaching metabolic fatigue was also higher in the "heat environment". CONCLUSIONS: A warm climate modifies metabolic parameters, reducing the quality of the CPR maneuver.

Surface water quality assessment in a semiarid Mediterranean region (Medjerda, Northern Tunisia) using partial triadic analysis.

A range of methods have been developed specifically to analyze several tables of data simultaneously (variable × space × time) in the field of ecological research, although they have been less widely used to examine water quality. In this study, we assessed the spatiotemporal variability of water quality in the Medjerda River basin (Northern Tunisia). Partial triadic analysis (PTA) provides an effective framework for the assessment of spatiotemporal variability of water quality in the Medjerda River basin (Northern Tunisia). Fourteen physicochemical variables were monitored from 12 sampling sites monthly during 2013. PTA allowed correlations among different physicochemical parameters to be identified and to assess overall water quality in the Medjerda River. Salinity (S), Cl-, SO42-, Ca2+, and Mg2+ ions were associated with intensive agricultural activities (agricultural pollution sources) leading to salinization. However, NH4+, PO43-, chemical oxygen demand (COD), and biochemical oxygen demand (BOD5) we more strongly associated with polluted urban sites. PTA helped illustrate that strong links exist between land uses and adjacent water quality. The advantages of this multi-table method approach for water quality monitoring include as follows: (1) identifying common multivariate spatial structures and problems associated with maintaining water quality, (2) allowing identification of consistent patterns in water chemistry, and (3) allowing analysis on the temporal variability of water chemistry.

Telemedicina en trasplante hepático. Revisión rápida de la literatura / Telemedicine in liver transplantation. Brief review of the literature

Introducción. La tecnología de la información y la comunicación en la atención en salud viene en aumento en Colombia, al igual que en el resto del mundo. El uso de la telemedicina para el manejo y seguimiento del paciente con patologías crónicas ha demostrado gran utilidad. En el área del trasplante hepático en particular, la telemedicina busca, entre otras cosas, reducir las dificultades de acceso a cuidados especializados. Objetivo. Identificar si la atención por telemedicina en pacientes con trasplante hepático tiene desenlaces clínicos similares en cuanto a mortalidad, rechazo del injerto y adherencia, comparada con la atención presencial. Metodología. Revisión rápida de la literatura en las bases de datos MEDLINE, EMBASE, LILACS, Cochrane, Web Of Science y Google Scholar con los términos telemedicina y trasplante hepático, sin límite temporal ni de idiomas. Se incluyeron estudios de corte transversal, ensayos clínicos de asignación aleatoria y cuasi-experimentales que evaluaran adherencia o complicaciones asociadas a trasplante hepático. La revisión de artículos y extracción de datos fue realizada en forma independiente por ambos autores y resumida en forma cualitativa. No se consideró metaanálisis dada la alta heterogeneidad prevista de los estudios. Resultados. Se incluyeron un total de cinco artículos, todos con alto riesgo de sesgos, cuyos estudios fueron realizados en centros de los Estados Unidos. Ninguno de ellos evaluó los desenlaces de mortalidad o rechazo del injerto. Se identificó adherencia a los seguimientos, similar a la atención tradicional. Un estudio demostró disminución significativa en la proporción de pacientes excluidos para ingresar al protocolo de trasplante. Conclusión. Se requieren estudios para determinar si la atención bajo telemedicina tiene desenlaces clínicos similares a la atención personal, durante el seguimiento de pacientes con trasplante hepático.

Introduction. Information and communication technology in health care is increasing in Colombia as in the rest of the world. The use of telemedicine for the management and monitoring of patients with chronic pathologies has proved to be very useful. Specifically, in the area of liver transplantation telemedicine seeks, among other things, to reduce the difficulties of access to specialized care. Objective. To identify whether care through telemedicine in patients with liver transplantation has similar clinical outcomes in terms of mortality, graft rejection and adherence, compared with face-to-face care. Methodology. Brief literature review in MEDLINE, EMBASE, LILACS, Cochrane, Web Of Science and Google Scholar databases with the terms telemedicine and liver transplantation, without time or language limitation. We included cross-sectional studies, randomized and quasi-experimental clinical trials that evaluated adherence or complications associated with liver transplantation. The review of articles and data extraction was carried out independently by both authors and summarized qualitatively. Meta-analysis was not considered given the high expected heterogeneity of the studies. Results. A total of five articles were included, all with a high risk of bias, in centers in the United States. None of them evaluated mortality outcomes or graft rejection. Follow-up adherence was identified similar to traditional care. One study showed a significant decrease in the proportion of patients excluded to enter the transplant protocol. Conclusion. Studies are required to determine if care through telemedicine has clinical outcomes similar to personal care, during the follow-up of patients with liver transplantation.

Photobioreactors based on microalgae-bacteria and purple phototrophic bacteria consortia: A promising technology to reduce the load of veterinary drugs from piggery wastewater.

Traditional swine manure treatments are not fully effective in the removal of veterinary drugs. Moreover, they are costly and entail a significant carbon footprint in many cases. Innovative biological approaches based on phototrophic microorganisms have recently emerged as promising alternatives to overcome those limitations. This work evaluated the removal of 19 veterinary drugs (i.e., 16 antibiotics, 1 analgesic, 1 anti-parasitic and 1 hormone) from piggery wastewater (PWW) in two open photobioreactors (PBR) operated with a consortium of microalgae-bacteria (AB-PBR) and purple photosynthetic bacteria (PPB-PBR). Multiple hydraulic retention times (HRT), in particular 11, 8 and 4 days, were tested during stage I, II and III, respectively. Ten out of 19 target compounds were detected with inlet drug concentrations ranging from 'non-detected' (n.d.) to almost 23,000 ng L-1 for the antibiotic oxytetracycline. Moreover, three of the antibiotics (i.e., enrofloxacin, sulfadiazine and oxytetracycline) were found at concentrations above the analytical linearity range in some or all of the samples under study. AB-PBR supported higher removal efficiencies (REs) than PPB-PBR, except for danofloxacin. Overall, REs progressively decreased when decreasing the HRT. The highest REs (>90%) were observed for doxycycline (95 ±â€¯3%) and oxytetracycline (93 ±â€¯3%) in AB-PBR during stage I. The other drugs, except sulfadimidine that was the most recalcitrant, showed REs above 70% during stage I in the same photobioreactor. In contrast, no removal was observed for danofloxacin in AB-PBR during stage III, sulfadimidine in PPB-PBR during stage III or marbofloxacin in PPB-PBR during the entire experiment.

Neuroprotective Effects of Diets Containing Olive Oil and DHA/EPA in a Mouse Model of Cerebral Ischemia.

Stroke is one of the leading causes of death worldwide and while there is increasing evidence that a Mediterranean diet might decrease the risk of a stroke, the effects of dietary fat composition on stroke outcomes have not been fully explored. We hypothesize that the brain damage provoked by a stroke would be different depending on the source of dietary fat. To test this, male C57BL/6J mice were fed for 4 weeks with a standard low-fat diet (LFD), a high-fat diet (HFD) rich in saturated fatty acids (HFD-SFA), an HFD containing monounsaturated fatty acids (MUFAs) from olive oil (HFD-OO), or an HFD containing MUFAs from olive oil plus polyunsaturated fatty acids (PUFAs) docosahexaenoic acid/eicosapentaenoic acid (DHA/EPA) (HFD-OO-ω3). These mice were then subjected to transient middle cerebral artery occlusion (tMCAo). Behavioural tests and histological analyses were performed 24 and/or 48 h after tMCAo in order to elucidate the impact of these diets with different fatty acid profiles on the ischemic lesion and on neurological functions. Mice fed with HFD-OO-ω3 displayed better histological outcomes after cerebral ischemia than mice that received an HFD-SFA or LFD. Furthermore, PUFA- and MUFA-enriched diets improved the motor function and neurological performance of ischemic mice relative to those fed with an LFD or HFD-SFA. These findings support the use of DHA/EPA-omega-3-fatty acid supplementation and olive oil as dietary source of MUFAs in order to reduce the damage and protect the brain when a stroke occurs.

Role of echocardiography in a patient with suspected acute pulmonary embolism: a case report.

BACKGROUND: Approximately half of pulmonary embolism cases are diagnosed in an emergency context. The classic symptoms of pulmonary embolism are absent in intensive care unit patients who are under sedation and on mechanical ventilation. In this scenario, after the development of sudden, severe hypotension, pulmonary embolism must be considered and included in a differential diagnosis according to the cause of admission. Echocardiography may be of further help in a differential diagnosis of the cause of shock. CASE PRESENTATION: We present a case of a 44-year-old Caucasian man who was admitted to the intensive care unit with a diagnosis of community-acquired pneumonia and respiratory failure and who required invasive mechanical ventilation. During admission, the patient developed sudden, severe hypotension that was refractory to treatment. An adequate diagnosis with transthoracic echocardiography was unachievable because of a poor echocardiographic window. However, the combined use of electrocardiography and transesophageal echocardiography established pulmonary embolism as a high-probability diagnosis based on findings of right ventricular pressure overload and right ventricular dysfunction. The unfavorable hemodynamic situation of the patient prevented his transfer to carry out other complementary tests that could confirm the diagnosis of pulmonary embolism. Fibrinolytic and anticoagulant therapies were administered immediately, and a favorable clinical outcome was achieved. CONCLUSION: This case highlights the fundamental role that echocardiography played in a patient in the intensive care unit who presented with shock secondary to pulmonary embolism with an unfavorable hemodynamic situation and in whom an unnecessary transfer to perform other complementary diagnostic tests was avoided. The combined use of electrocardiography and echocardiography provided a complete differential diagnosis, identifying the cause of shock and allowing the initiation of specific treatment without further delay. Knowledge of the echocardiographic results that are characteristic of pulmonary embolism can aid in the diagnosis.