Seroprevalence of trypanosomosis and associated risk factors in cattle from coast and amazonian provinces of Ecuador.

Trypanosomosis is a tropical disease caused by various protozoan haemoparasites, which affects wild and domestic animals, the latter ones related to worldwide livestock production systems. Species such as Trypanosoma vivax and Trypanosoma evansi have been described using serological and molecular tools in several countries from South and Central America. However, Ecuador presents a relevant knowledge gap in the associated general epidemiology and risk factors of the disease. Therefore, the objective of this study was to determine the seroprevalence of trypanosomosis in cattle from different regions of Ecuador. 745 serum samples from 7 Coastal and 3 Amazon provinces were screened for IgG anti-Trypanosoma spp. antibodies, using an in-house indirect ELISA. The seropositivity was explored and associated with several variables such as sex, age, breed, region, management, and province, using statistical tools. The general seroprevalence of trypanosomosis was 19.1% (95% CI: 16.30-22.1%). The Amazonian provinces of Sucumbíos and Napo and the Coastal province of Esmeraldas presented the highest seroprevalence values of 36.7% (95% CI: 27.67-46.47%), 23.64% (95% CI: 16.06-32.68%) and 25% (95% CI: 15.99-35.94%), respectively. Statistical significance was found for the region, province, and management variables, indicating as relevant risk factors the extensive management and Amazon location of the cattle analyzed. Specific actions should be taken to identify the exact species on reservoirs and susceptible hosts, evaluate the implication of farm management and cattle movement as risk factors, and implement surveillance and treatment plans for affected herds.

Triclabendazole efficacy, prevalence, and re-infection of Fasciola hepatica in bovine and ovine naturally infected in the Andes of Ecuador.

Fasciola spp., infections are distributed worldwide including the Andes region of Ecuador, affecting cattle, sheep, porcine, humans, and other herbivores. Triclabendazole (TCBZ) is commonly used to treat animal infections. However, prospective studies on TCBZ efficacy and fascioliosis prevalence have not been studied in the highlands of Ecuador. This study was performed in a rural community at central of the Ecuadorian Andes in freely roaming bovine and ovine aimed to 1) evaluate the efficacy of TCBZ by administering a single oral dose of 12 mg/kg body weight, 2) assess the prevalence of F. hepatica infection and 3) to monitor re-infections for a follow-up period of five months. In total, 122, 86, 111, 110, 89, and 90 and 49, 34, 47, 28, 27, and 31 stool samples were collected each month from bovines and ovine, respectively. Besides, 32 stool samples from porcine were also collected at the beginning of the study. Stools were microscopically analyzed by formalin-ether concentration method to detect F. hepatica ova. The prevalence of F. hepatica infections before treatment was 55,7% and 63,3% for bovine and ovine, respectively. The infection prevalence was of 22% in porcine. The efficacity of triclabendazole was 83% and 97% in bovines and ovine, respectively, at 30 days post-treatment. The re-infection reaches to 54,4% in bovines and 61,3% in ovine after five months. TCBZ had a high efficacy and could be used for bovines and ovine Fasciola infections in the study region; however, re-infections reach the initial prevalence after five months. Therefore, we recommend integrated control strategies, including chemotherapy with a single oral dose of TCBZ, vector control, and future drug resistance studies.

Proficiency of European GMO control laboratories to quantify MON89788 soybean in a meat pâté matrix.

GMO control laboratories in the EU routinely monitor the presence and content of genetically modified organisms (GMOs) in food and feed products collected from the EU market. As the vast majority of GMOs comprize genetically modified plants, most control samples have a plant-based origin. For the first time, a pilot proficiency test was organised requiring the analysis of GMOs in a meat matrix. Meat pâté, a product in which soybean is occasionally identified, was spiked with GM soybean event MON89788, homogenised by mixing, aliquoted in sachets and frozen. The assigned value was determined by two independent expert laboratories. Several DNA extraction methods were tested and proved to be insufficient for the removal of PCR inhibitors present in the DNA extracts, resulting in a GM content underestimated by at least 30%. This problem was solved either by using hot-start qPCR chemistry or by applying the same method in a digital PCR format. A total of 52 laboratories participated in the study. They were requested to verify the presence of any GM soybean in the test item and to quantify the GM event(s) identified by their method of choice. All but one laboratory identified the MON89788 soybean event present in the pâté matrix. The majority of the quantitative results reported were below the assigned value, but did not deviate more than 50% from it. This study demonstrated the proficiency of most GMO control laboratories for the analysis of GMOs in a meat-based product. It also shows that method optimisation for GMO analysis in meat products is nevertheless advisable.

Shape matters: Competing mechanisms of particle shape segregation.

It is well known that granular mixtures that differ in size or shape segregate when sheared. In the past, two mechanisms have been proposed to describe this effect, and it is unclear if both exist. To settle this question, we consider a bidisperse mixture of spheroids of equal volume in a rotating drum, where the two mechanisms are predicted to act in opposite directions. We present evidence that there are two distinct segregation mechanisms driven by relative overstress. Additionally, we showed that, for nonspherical particles, these two mechanisms (kinetic and gravity) can act in different directions leading to a competition between the effects of the two. As a result, the segregation intensity varies nonmonotonically as a function of aspect ratio (AR), and, at specific points, the segregation direction changes for both prolate and oblate spheroids, explaining the surprising segregation reversal previously reported. Consistent with previous results, we found that the kinetic mechanism is dominant for (almost) spherical particles. Furthermore, for moderate aspect ratios, the kinetic mechanism is responsible for the spherical particles' segregation to the periphery of the drum, and the gravity mechanism plays only a minor role. Whereas, at the extreme values of AR, the gravity mechanism notably increases and overtakes its kinetic counterpart.

[Periodic plasmapheresis as maintenance treatment in relapsing-remitting multiple sclerosis, a new therapeutic line? A case report]. / Plasmaféresis periódica como tratamiento de mantenimiento en la esclerosis múltiple remitente-recurrente, ¿nueva línea terapéutica? A propósito de un caso.

INTRODUCTION: Relapsing-remitting multiple sclerosis (RRMS) treatment has significantly changed in recent years because of the discovery of new molecules that have shown efficacy as maintenance treatment. However, the classical treatment for acute attacks is based on corticosteroids administration, being the periodical plasmapheresis the alternative treatment in the case of refractory patients. We introduce a case of relapsing-remitting multiple sclerosis treated with a classical acute attacks therapy: plasmapheresis. CASE REPORT: The case of a 39-year-old patient who was diagnosed with relapsing-remitting multiple sclerosis, postpartum debut and aggresive course, who, after suboptimal response to disease modifying therapies (alemtuzumab and ocrelizumab), receives combination treatment with outpatient periodic plasmapheresis every 3 weeks as maintenance therapy. Good tolerance and response. Clinical stability with this treatment. She has not required new hospital admissions for acute attacks of multiple sclerosis from February 2020 to March 2021. CONCLUSION: Although more specific studies are needed, this case provides information on a potential new maintenance treatment for patients with relapsing-remitting multiple sclerosis refractory to disease-modifying drug therapies.

TITLE: Plasmaféresis periódica como tratamiento de mantenimiento en la esclerosis múltiple remitente-recurrente, ¿nueva línea terapéutica? A propósito de un caso.Introducción. El tratamiento de la esclerosis múltiple remitente-recurrente ha evolucionado significativamente en los últimos años con el descubrimiento de nuevas moléculas eficaces como tratamiento de mantenimiento. Por otro lado, el tratamiento de los brotes de esta enfermedad se basa clásicamente en corticoides, y en los casos refractarios a esta terapia se utiliza plasmaféresis. Presentamos un caso de esclerosis múltiple remitente-recurrente tratada periódicamente con una terapia que se ha utilizado clásicamente para los brotes: plasmaféresis. Caso clínico. Mujer de 39 años con esclerosis múltiple remitente-recurrente de inicio en el posparto, gran carga lesional y curso agresivo, en quien, ante una respuesta subóptima a terapias modificadoras de la enfermedad (alemtuzumab y ocrelizumab), se decide iniciar un tratamiento combinado junto con plasmaféresis periódicas ambulatorias cada tres semanas como tratamiento de mantenimiento. Se constata una buena tolerancia a esta terapia y evolución, y se produce estabilidad clínica. No ha requerido nuevos ingresos hospitalarios por brotes desde febrero de 2020 a marzo de 2021. Conclusión. Aunque es necesario que se realicen más estudios, este caso ofrece información sobre un potencial tratamiento de mantenimiento para pacientes con esclerosis múltiple remitente-recurrente refractaria a terapias con fármacos modificadores de la enfermedad.

Plasmaféresis periódica como tratamiento de mantenimiento en la esclerosis múltiple remitente-recurrente, ¿nueva línea terapéutica? A propósito de un caso / Periodic plasmapheresis as maintenance treatment in relapsing-remitting multiple sclerosis, a new therapeutic line? A case report

Introducción: El tratamiento de la esclerosis múltiple remitente-recurrente ha evolucionado significativamente en los últimos años con el descubrimiento de nuevas moléculas eficaces como tratamiento de mantenimiento. Por otro lado, el tratamiento de los brotes de esta enfermedad se basa clásicamente en corticoides, y en los casos refractarios a esta terapia se utiliza plasmaféresis. Presentamos un caso de esclerosis múltiple remitente-recurrente tratada periódicamente con una terapia que se ha utilizado clásicamente para los brotes: plasmaféresis. Caso clínico: Mujer de 39 años con esclerosis múltiple remitente-recurrente de inicio en el posparto, gran carga lesional y curso agresivo, en quien, ante una respuesta subóptima a terapias modificadoras de la enfermedad (alemtuzumab y ocrelizumab), se decide iniciar un tratamiento combinado junto con plasmaféresis periódicas ambulatorias cada tres semanas como tratamiento de mantenimiento. Se constata una buena tolerancia a esta terapia y evolución, y se produce estabilidad clínica. No ha requerido nuevos ingresos hospitalarios por brotes desde febrero de 2020 a marzo de 2021. Conclusión: Aunque es necesario que se realicen más estudios, este caso ofrece información sobre un potencial tratamiento de mantenimiento para pacientes con esclerosis múltiple remitente-recurrente refractaria a terapias con fármacos modificadores de la enfermedad.(AU)

Introduction: Relapsing-remitting multiple sclerosis (RRMS) treatment has significantly changed in recent years because of the discovery of new molecules that have shown efficacy as maintenance treatment. However, the classical treatment for acute attacks is based on corticosteroids administration, being the periodical plasmapheresis the alternative treatment in the case of refractory patients. We introduce a case of relapsing-remitting multiple sclerosis treated with a classical acute attacks therapy: plasmapheresis. Case report: The case of a 39-year-old patient who was diagnosed with relapsing-remitting multiple sclerosis, postpartum debut and aggresive course, who, after suboptimal response to disease modifying therapies (alemtuzumab and ocrelizumab), receives combination treatment with outpatient periodic plasmapheresis every 3 weeks as maintenance therapy. Good tolerance and response. Clinical stability with this treatment. She has not required new hospital admissions for acute attacks of multiple sclerosis from February 2020 to March 2021. Conclusion: Although more specific studies are needed, this case provides information on a potential new maintenance treatment for patients with relapsing-remitting multiple sclerosis refractory to disease-modifying drug therapies.(AU)

Self-diffusion of spherocylindrical particles flowing under non-uniform shear rate.

This work is devoted to study numerically the self-diffusion of spherocylindrical particles flowing down an inclined plane, using the discrete element method (DEM). This system is challenging due to particles being non-spherical and because they are subjected to a non-uniform shear rate. We performed simulations for several aspect ratios and inclination angles, tracking individual particle trajectories. Using the simulation data, we computed the diffusion coefficients D, and a coarse-graining methodology allowed accessing the shear rate spatial profiles (z). This data enabled us to identify the spatial regions where the diffusivity strongly correlates with the local shear rate. Introducing an effective particle size d⊥, we proposed a well-rationalized scaling law between D and . Our findings also identified specific locations where the diffusivity does not correlate with the shear rate. This observation corresponds to zones where  has non-linear spatial variation, and the velocity probability density distributions exhibit asymmetric shapes.

Air pollution and surrounding greenness in relation to ischemic stroke: A population-based cohort study.

BACKGROUND: Evidence for the association between environmental exposures and ischemic stroke (IS) is limited and inconsistent. We aimed to assess the relationship between exposure to air pollutants, residential surrounding greenness, and incident IS, and to identify population subgroups particularly sensitive to these exposures. METHODS: We used data from administrative health registries of the public healthcare system in Catalonia, Spain to construct a cohort of individuals aged 18 years and older without a previous stroke diagnosis at 1st January 2016 (n = 3 521 274). We collected data on sociodemographic characteristics and cerebrovascular risk factors, and derived exposure at the participant's residence to ambient levels of fine particulate matter (PM2.5), black carbon (BC), nitrogen dioxide (NO2), and Normalized Difference Vegetation Index (NDVI) in a 300 m buffer as an indicator of greenness. The primary outcome was IS diagnosis at any point during the follow-up. We used Cox proportional hazards models to estimate associations between environmental exposures and incident IS and stratified analyses to investigate effect modification. RESULTS: Between 1st January 2016 and 31st December 2017, 10 865 individuals were admitted to public hospitals with an IS diagnosis. Median exposure levels were: 17 µg/m3 PM2.5, 35 µg/m3 NO2, 2.28 µg/m3 BC and 0.27 NDVI. Individuals with higher residential exposure to air pollution were at greater risk of IS: HR 1·04 (95% CI:0·99-1·10) per 5 µg/m3 of PM2.5; HR 1.05 (95% CI:1·00-1·10) per 1 µg/m3 of BC; HR 1·04 (95% CI:1·03-1·06) per 10 µg/m3 of NO2. Conversely, individuals with higher residential surrounding green space, had lower risk of IS (HR 0·84; CI 95%:0·7-1.0). There was no evidence of effect modification by individual characteristics. CONCLUSIONS: Higher incidence of IS was observed in relation to long-term exposures to air pollution, particularly NO2, in a region that meets European health-based air quality standards. Residential surrounding greenness was associated with lower incidence of IS.

Antecedentes de neoplasias urológicas previos al trasplante renal. Resultados oncológicos a largo plazo / History of urological malignancies before kidney transplantation, oncological outcome on the long term

Introducción: Nuestro objetivo ha sido informar de los resultados oncológicos de pacientes con ERET y antecedentes de neoplasias urológicas que fueron sometidos posteriormente a un trasplante renal (TR).Material y métodoEstudio retrospectivo llevado a cabo en el registro de la Fundación Puigvert (Barcelona) con 1.200 TR realizados entre 1988 y 2018. Se identificaron 85 neoplasias urológicas que recibieron tratamiento previo al TR en 81 pacientes: 15 (18%) cánceres de próstata, 49 (58%) carcinoma de células renales (CCR), 19 (22%) carcinomas uroteliales y 2 (2%) cánceres de testículo. Se registraron datos de las características basales, la estadificación del cáncer, el tratamiento y el seguimiento, y sobre la cronología del inicio de diálisis, la inscripción en la lista de espera y el TR. Los criterios de valoración fueron la recidiva del cáncer, la progresión metastásica, la muerte específica por cáncer y la supervivencia global.ResultadosEn una mediana de seguimiento de 13,1 años (2,2-32), se registraron 16/85 (19%) recidivas del cáncer, con 3 (4%) progresiones a metástasis y muerte por cáncer. La mediana de supervivencia global tras el tratamiento del cáncer fue de 25,3 años y la supervivencia por cáncer específica fue del 95% a los 25 años.La mediana de tiempo desde el tratamiento del cáncer hasta el trasplante de riñón fue de 4,8 años: 3,7 años en el cáncer de próstata, 3,9 años en el CCR y 8,8 años en el cáncer vesical. La mediana de tiempo desde el inicio de diálisis hasta el TR fue de 1,8 años en los pacientes con antecedentes de neoplasia urológica, frente a 0,5 años en la cohorte total de 1.200 trasplantes renales durante el mismo periodo. (AU)

Introduction: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT).Material and methodRetrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival.ResultsIn a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years.Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period. (AU)

History of urological malignancies before kidney transplantation, oncological outcome on the long term.

INTRODUCTION: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT). MATERIAL AND METHOD: Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival. RESULTS: In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period. CONCLUSIONS: Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed.

History of urological malignancies before kidney transplantation, oncological outcome on the long term. / Antecedentes de neoplasias urológicas previos al trasplante renal. Resultados oncológicos a largo plazo.

INTRODUCTION: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT). MATERIAL AND METHOD: Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival. RESULTS: In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period. CONCLUSIONS: Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed.

Estimating density limits for walking pedestrians keeping a safe interpersonal distancing.

With people trying to keep a safe distance from others due to the COVID-19 outbreak, the way in which pedestrians walk has completely changed since the pandemic broke out1,2. In this work, laboratory experiments demonstrate the effect of several variables-such as the pedestrian density, the walking speed and the prescribed safety distance-on the interpersonal distance established when people move within relatively dense crowds. Notably, we observe that the density should not be higher than 0.16 pedestrians per square meter (around 6 m2 per pedestrian) in order to guarantee an interpersonal distance of 1 m. Although the extrapolation of our findings to other more realistic scenarios is not straightforward, they can be used as a first approach to establish density restrictions in urban and architectonic spaces based on scientific evidence.

Particle flow rate in silos under rotational shear.

Very recently, To et al. have experimentally explored granular flow in a cylindrical silo, with a bottom wall that rotates horizontally with respect to the lateral wall [Phys. Rev. E 100, 012906 (2019)10.1103/PhysRevE.100.012906]. Here we numerically reproduce their experimental findings, in particular, the peculiar behavior of the mass flow rate Q as a function of the frequency of rotation f. Namely, we find that for small outlet diameters D the flow rate increased with f, while for larger D a nonmonotonic behavior is confirmed. Furthermore, using a coarse-graining technique, we compute the macroscopic density, momentum, and the stress tensor fields. These results show conclusively that changes in the discharge process are directly related to changes in the flow pattern from funnel flow to mass flow. Moreover, by decomposing the mass flux (linear momentum field) at the orifice into two main factors, macroscopic velocity and density fields, we obtain that the nonmonotonic behavior of the linear momentum is caused by density changes rather than by changes in the macroscopic velocity. In addition, by analyzing the spatial distribution of the kinetic stress, we find that for small orifices increasing rotational shear enhances the mean kinetic pressure 〈p^{k}〉 and the system dilatancy. This reduces the stability of the arches, and, consequently, the volumetric flow rate increases monotonically. For large orifices, however, we detected that 〈p^{k}〉 changes nonmonotonically, which might explain the nonmonotonic behavior of Q when varying the rotational shear.

Pedestrian evacuation simulation in the presence of an obstacle using self-propelled spherocylinders.

We explore the role that the obstacle position plays in the evacuation time of agents when leaving a room. To this end, we simulate a system of nonsymmetric spherocylinders that have a prescribed desired velocity and angular orientation. In this way, we reproduce the nonmonotonous dependence of the pedestrian flow rate on the obstacle distance to the door. For short distances, the obstacle delays the evacuation because the exit size is effectively reduced; i.e., the distance between the obstacle and the wall is smaller than the door width. By increasing the obstacle distance to the door, clogging is reduced leading to an optimal obstacle position (maximum flow rate) in agreement with results reported in numerical simulations of pedestrian evacuations and granular flows. For further locations, however, a counterintuitive behavior occurs as the flow rate values fall again below the one corresponding to the case without obstacle. Analyzing the head-times distribution, we evidence that this new feature is not linked to the formation of clogs, but is caused by a reduction of the efficiency of the agent's instantaneous flow rate when the exit is not blocked.

Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy.

BACKGROUND: To investigate the incidence of non-cancer mortalities and prognostic factors associated with competitive causes of death in a homogeneous cohort of patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment. METHODS: This study included 284 patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment between 2005 and 2017. The cumulative incidence of death associated with tumour, second tumours, treatment, side effects and comorbidity was calculated. A Fine and Gray regression model was used to investigate factors associated with cancer and competitive mortality. RESULTS: The cumulative incidence of tumoral death at 5 and 10 years were 35 and 47% respectively, whereas the cumulative incidence of competitive mortality were 10 and 12% respectively. In the multivariate analysis, age and comorbidity were independent factors for non-cancer mortality. Patients with a high risk of non-cancer mortality presented a cumulative incidence of 17.3% at 5 years and 18.4% at 10 years. CONCLUSIONS: This study demonstrated a high incidence of competing mortality in older patients with comorbidities. Non-cancer deaths should be considered when selecting patients for combination therapies and in the study design ofclinical trials.

El método AMFE (Análisis Modal de Fallos y Efectos) aplicado a la anticoagulación de pacientes con fibrilación auricular no valvular / Failure Mode and Effects Analysis (FMEA) method applied to anticoagulation of patients with non-valvular atrial fibrillation

OBJETIVOS: El propósito de este trabajo es contribuir a mejorar el proceso de la anticoagulación en pacientes con fibrilación auricular no valvular (FANV) mediante acciones de sensibilización y formación al colectivo de atención primaria. MATERIALES Y MÉTODOS: Se realizaron 38 grupos focales secuenciados según una adaptación del método de Análisis Modal de Fallos y Efectos. Cada reunión fue dinamizada mediante una metodología de «tormenta de ideas» (brainstorming). Participaron 482 médicos (444 de atención primaria y 38 cardiólogos) de ámbito nacional con representación geográfica homogénea. El trabajo de campo se extendió entre el 28 de marzo y el 20 de junio de 2017. RESULTADOS: Las principales acciones inseguras que pueden comportar un evento hemorrágico o trombótico son la anticoagulación incorrecta o la falta de seguimiento del paciente, debidos sobre todo a carencias formativas en el manejo de la FANV y no tener en cuenta posibles interacciones que pueden darse con fármacos antagonistas de la vitamina K. Las principales recomendaciones para paliar estos fallos se centraron en un buen seguimiento de los pacientes con FANV, en realizar o actualizar los protocolos o guías de práctica clínica y en potenciar la formación continuada de los médicos que habitualmente manejan a pacientes con FANV tratados con anticoagulantes orales. CONCLUSIONES: Un porcentaje significativo de pacientes con FANV no están correctamente anticoagulados, y para paliar este problema se requieren acciones específicas, entre las que destaca la formación sobre anticoagulación en general, y sobre uso de los anticoagulantes orales de acción directa en particular

OBJECTIVES: To contribute to the improvement of the process of anticoagulation in patients with nonvalvular atrial fibrillation (NVAF) through awareness and training activities for Primary Care Physicians. MATERIALS AND METHODS: A total of 38 focus groups, sequenced according to an adaptation of the Failure Mode and Effects Analysis (FMEA) method. Each meeting was driven by "brainstorming" methodology. The geographical representation was homogeneous, with a total of 482 national. physicians (444 Primary Care Physicians, and 38 cardiologists). The meetings were held between March 28 and June 20, 2017. RESULTS: The main unsafe actions that can lead to a haemorrhagic or thrombotic event are incorrect anticoagulation or lack of patient follow-up. These events are mainly caused by training deficiencies in the management of NVAF, or by not taking into account possible interactions with vitamin K antagonist drugs. The main recommendations to alleviate these failures were focused on a good follow-up of patients with NVAF, on creating or updating the protocols or clinical practice guidelines, and on promoting the continuous training of physicians who usually manage patients with non-valvular AF treated with oral anticoagulants. CONCLUSIONS: A significant percentage of patients with NVAF are not correctly anticoagulated. Specific actions are required to alleviate this problem. Among them, the importance of a general anticoagulation training was emphasised, and particularly, the use of direct oral anticoagulants

[Failure Mode and Effects Analysis (FMEA) method applied to anticoagulation of patients with non-valvular atrial fibrillation]. / El método AMFE (Análisis Modal de Fallos y Efectos) aplicado a la anticoagulación de pacientes con fibrilación auricular no valvular.

OBJECTIVES: To contribute to the improvement of the process of anticoagulation in patients with nonvalvular atrial fibrillation (NVAF) through awareness and training activities for Primary Care Physicians. MATERIALS AND METHODS: A total of 38 focus groups, sequenced according to an adaptation of the Failure Mode and Effects Analysis (FMEA) method. Each meeting was driven by «brainstorming¼ methodology. The geographical representation was homogeneous, with a total of 482 national. physicians (444 Primary Care Physicians, and 38 cardiologists). The meetings were held between March 28 and June 20, 2017. RESULTS: The main unsafe actions that can lead to a haemorrhagic or thrombotic event are incorrect anticoagulation or lack of patient follow-up. These events are mainly caused by training deficiencies in the management of NVAF, or by not taking into account possible interactions with vitamin K antagonist drugs. The main recommendations to alleviate these failures were focused on a good follow-up of patients with NVAF, on creating or updating the protocols or clinical practice guidelines, and on promoting the continuous training of physicians who usually manage patients with non-valvular AF treated with oral anticoagulants. CONCLUSIONS: A significant percentage of patients with NVAF are not correctly anticoagulated. Specific actions are required to alleviate this problem. Among them, the importance of a general anticoagulation training was emphasised, and particularly, the use of direct oral anticoagulants.

Alcohol overuse and intracerebral hemorrhage: characteristics and long-term outcome.

BACKGROUND AND PURPOSE: Alcohol overuse (AOu) is considered an important risk factor for spontaneous intracerebral hemorrhage (ICH). The clinical and outcome characteristics of these patients (AOu-ICH) are not well known. METHODS: All patients with ICH admitted to a single university tertiary stroke center were prospectively studied from May 2005 to May 2015. Demographic profiles, radiologic characteristics and clinical outcomes of patients with acute ICH and previous AOu (>40 g/day or >300 g/week) were analyzed. RESULTS: During the study period, 555 patients with spontaneous primary ICH met the inclusion criteria. A total of 81 patients (14.6%) reported AOu (24.3% of men vs. 3.1% of women; P < 0.0001; mean age, 63 years old for AOu vs. 74 years old for non-AOu; P < 0.0001). Of the classic cardiovascular risk factors, only smoking was associated with AOu (63% vs. 12.2% of non-AOu; P < 0.0001). Initial severity and hematoma volume were similar in both groups, with no observed differences in stroke care or in-hospital medical complications. Patients with AOu had worse outcome (modified Rankin Scale score, 3-6 points) than patients without AOu at 3 months [odds ratio (OR), 2.50; 95% confidence interval (CI), 1.32-4.75; P = 0.005] and 12 months (OR, 2.47; 95% CI, 1.23-5.00; P = 0.011). A similar trend was observed at 5 years (OR, 2.48; 95% CI, 0.96-6.39; P = 0.059). CONCLUSIONS: Alcohol overuse was present in 14.6% of patients with ICH, who were predominantly male, smokers and a mean of 11 years younger than the non-AOu group. Despite a lack of differences in initial clinical severity, stroke care and early medical complications, patients with AOu had worse short- and long-term outcomes.