La fragilidad se entiende como un situación clínica de disminución de la reserva homeostática que, ante un desencadenante (enfermedad aguda, caída, toma de un fármaco…), aumenta el riesgo de un ...evento adverso, como ingreso hospitalario, en residencia, deterioro funcional y/o cognitivo, muerte, etc. La fragilidad puede entenderse como fragilidad física, fenotipo de Fried, verdadero síndrome geriátrico, que puede ser reversible evitando su progresión a estadios más avanzados de irreversibilidad y de dependencia, y fragilidad por acúmulo de déficits de Rockwood, como
continuum
de salud o tipología de clasificación del anciano a lo largo del espectro de la fragilidad (sano, robusto, vulnerable, fragilidad leve-moderada-grave y extrema o final de vida). El diagnóstico de fragilidad física forma parte de la valoración geriátrica integral y se recomienda para su diagnóstico utilizar un test de ejecución, como velocidad de la marcha (<0,8 m/s),
Timed Up and Go
(>12 segundos) o
Short Physical Performance Battery
(<10). La fragilidad física es reversible basándose en un tratamiento multidisciplinar sobre tres pilares fundamentales: ejercicio físico multicompetente y contra resistencia, aporte adecuado de proteínas y micronutrientes (leucina, vitamina D, etc.), y adecuada prescripción farmacológica, de tratamiento de comorbilidad y de síndromes geriátricos. La fragilidad es un factor de riesgo de progresión de la enfermedad neurológica y de mayor riesgo de evento adverso tanto en enfermedades neurodegenerativas, como el deterioro cognitivo leve, la demencia o la enfermedad de Parkinson, como en la enfermedad cerebrovascular. La fragilidad a través de la
Clinical Frailty Scale
o el VIG-Frail muestra tipologías de pacientes en relación con un mayor o menor estado de fragilidad, y es una herramienta básica pronóstica de gran utilidad en la toma de decisiones de manejo diagnóstico y terapéutico. Se abre una nueva oportunidad de mejora en el manejo de la enfermedad neurológica ante el diagnóstico y el tratamiento de la fragilidad.
1. Some plant functional traits evolved with high temporal resource variability and disturbance in ecosystems where these factors are prevalent. Persistence of characteristics of these functional ...traits in ecosystems may depend on continued resource variability and disturbance, which in turn may promote functional diversity. In Mediterranean ecosystems, experiments that eliminate temporal resource variability and disturbance are needed to detect functional trait dependence on these factors. 2. The purpose of this study was to experimentally assess how interannual rainfall variability, summer drought and seasonal grazing modify the characteristics of functional traits (life span, flowering time, seed size and plant size) in old-field (6—15 years) Mediterranean herbaceous communities. 3. We designed a 9-year factorial field experiment that manipulated Mediterranean rainfall variability in three ways: (i) constant water availability with no summer drought; (ii) autumn and spring water availability but with summer drought; and (iii) no water supplied to rainfall; and grazing regimes: (i) autumn grazing; (ii) spring grazing; and (iii) non-grazing, in each of the three scenarios of water availability. At a community scale, we measured abundance of different categories within four plant functional traits: plant life span (annual and perennial), flowering time of annuals (spring and summer) and seed and plant sizes of spring annuals (small and large). 4. Interannual rainfall variability in autumn and spring (IRVAS), summer drought and grazing reduced perennial cover. IRVAS was necessary for the persistence of small-seeded and small-size spring annuals. IRVAS and summer drought increased spring annuals in grazed treatments. 5. Results suggest that IRVAS, summer drought and grazing favour the coexistence of species, through improved functional diversity in seed and plant sizes and increased abundance of spring annuals, the most species-rich functional group. Both effects may be the reason for the high species richness in grazed Mediterranean herbaceous communities.
New variants of SARS-CoV-2 Cantón, Rafael; De Lucas Ramos, Pilar; García-Botella, Alejandra ...
Revista española de quimioterapia,
10/2021, Letnik:
34, Številka:
5
Journal Article
Odprti dostop
The emergence and spread of new variants of SARS-CoV-2 has produced enormous interest due to their possible implication in the improved transmissibility of the virus, their consequences in the ...individual evolution of the infection, as well as in the possible escape from the immunity generated by the current vaccines. The variants that attract most attention are those of public health concern, including B.1.1.7 (UK), P.1 (Brazilian) and B.1.351 (South African). This list is extended by the variants of interest that emerge and are expanding in certain countries but are found sporadically in others, such as B.1.427 and B.1.429 (Californians) or B.1.617 (Indian). Whole genome sequencing or strategies specifically targeting the spicule gene are used in the microbiology laboratories for characterization and detection. The number of infected individuals, the sanitary situation of each country, epidemiological measures and vaccination strategies influence its dispersion and new variants are expected to emerge. This emergence can only be avoided today by increasing the vaccinated population in all countries and by not relaxing epidemiological containment measures. It is not excluded that in the future it will be necessary to revaccinate against new variants.
This randomized clinical trial examines the effectiveness and generalizability of implementing a multicomponent exercise program for treating functional decline associated with acute hospitalization ...in very old patients.
Patients with dementia are in themselves more vulnerable, and have been especially affected by the effect of the COVID-19 pandemic, both directly due to the disease itself, and indirectly due to the ...deprivation of cognitive stimulation due to isolation social due to confinement. SARS-CoV-2 virus infection has given rise to a wide variety of symptoms, including neurological symptoms and especially delirium in the elderly with dementia. The virus has affected the central nervous system, both directly due to the neurotropism of the virus, and indirectly due to inflammation and tissue hypoxia of vascular origin. The different causes that have been able to lead, in the different waves prior to the omicron variant, to the significant increase in morbidity and mortality in patients with dementia, especially the elderly, are analyzed.
Since the publication of the European archaeomagnetic field model SCHA.DIF.3k in 2009, the number of paleomagnetic data derived from archaeological materials such as baked clays and volcanic rocks ...coming from Europe has increased by about 90% for directions and around 180% for intensities. Taking advantage of this increase, here we provide an updated regional archaeomagnetic model, called SCHA.DIF.4k, for the European continent and adjacent areas and now covering the last four millennia. To model the three geomagnetic elements, declination, inclination, and intensity, we use the regional R‐SCHA2D technique in space and temporal basis of cubic splines. A critical selection of the archaeomagnetic and volcanic data available in a spherical cap of 30° centered at 40°N latitude and 10°E longitude has been considered. In addition, in order to better constrain the behavior of the archaeomagnetic field during the last centuries, we include the historical data of the HISTMAG compilation. The new regional model allows us to better define the paleomagnetic field over Europe as well as to generate new paleosecular variation curves for archaeomagnetic dating purposes. Using these curves, the dating precision has been estimated for the last 4 kyr. As expected, results show that it strongly depends on the data uncertainties, the temporal data distribution and the behavior of the geomagnetic field itself. In addition, the use of the full vector geomagnetic field, instead of the directional information exclusively, provides more precise archaeomagnetic dating results.
Plain Language Summary
The Earth's magnetic field is generated by complex fluid movements located in the outer core and envelops our planet protecting us against the solar wind. For this reason, the geomagnetic field plays an important role to sustain our life. During the last decades, a worldwide network of observatories and satellites provided an accurate picture of the geomagnetic field changes. Moreover, thanks to the ability of some rocks preserving the ambient geomagnetic field, it is possible to know its past evolution at geological time scales through the so‐called paleomagnetic data. For the Holocene, the paleomagnetic information derived from certain archaeological artifacts and lava flows provides snapshots of the past geomagnetic field (or paleofield) and thus, they can be used to reconstruct it at local and global scales. Europe is the continent with a high density of paleomagnetic data for the last four millennia. Taking advantage of this, here we provide a regional reconstruction of the geomagnetic field for this period valid for Europe and adjacent areas. This new model is a useful tool to analyze the paleofield behavior. In addition, it can be used as an improved tool for dating archaeological remains and volcanic rocks from the target region.
Key Points
An updated archaeomagnetic regional model for Europe for the last 4,000 years
A better knowledge of the spatial and temporal past evolution of the European geomagnetic field
The regional model can be used as a tool for archaeomagnetic dating in Europe
To analyze factors associated with mortality at 3 months and readmissions, functional and cognitive decline, anorexia and affective disorders in patients aged > 70 years surviving after hospital ...admission for SARS-CoV-2.
Patients aged > 70 years, discharged after hospitalization with COVID-19.
mortality, readmissions, functional and cognitive impairment, anorexia and mood disorder.
165 cases at 3 months after hospital discharge, 8.5% died and 20% required at least one hospital readmission. The presence of severe dependence at discharge (BI < 40) was associated at 3 months with a higher risk of mortality (OR 5.08; 95% CI 1.53-16.91) and readmissions (OR 4.53; 95% CI 1.96-10.49). The post-hospitalization functional deterioration was associated with persistence of deterioration at 3 months (OR 24.57; 95% CI 9.24-65.39), cognitive deterioration (OR 2.32; 95% CI 1.03-5.25) and affective (OR 4.40; 95% CI 1.84-10.55) CONCLUSIONS: Loss function in older people after hospitalization by COVID-19 may contribute to identify patients with a higher risk of sequelae in the short term that require closer follow-up.
A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, ...they have characteristics that make them quite similar to a "nosocomiun", i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.
Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF). Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index ...and repeat ablation procedures remain unclear in the older population. The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients. Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci. Older (n=129, ≥70 years) and younger (n=129, <70 years) patients were compared using a propensity-score matching analysis based on age, gender, obesity, hypertension, dyslipidemia, diabetes mellitus, dilated left atrium, severe obstructive sleep apnea, cardiac disease, left systolic ventricular function, AF pattern and ablation technique. Arrhythmia recurrence and reablation were evaluated in both groups using a Cox regression analysis in order to identify predictors. During a 30-month follow-up period, there were no significant differences between older and younger patients in the arrhythmia-free survival (65.1% and 59.7%; log-rank test p=0.403) and complication (10.1% and 10.9%; p>0.999) rates after the index ablation. However, the reablation rate was significantly different (46.7% and 69.2%; p<0.05, respectively). In those patients who underwent reablation procedure (redo subgroups), there were no differences in the incidence of PV reconnection (38.1% redo-older and 27.8% redo-younger patients; p=0.556). However, the redo-older patients had lower reconnected PVs per patient (p<0.01) and lower atrial foci (2.3 and 3.7; p<0.01) than the redo-younger patients. A further important finding was that age was not an independent predictor of arrhythmia recurrence or reablation. Our data reveal that the AF index ablation in older patients had a similar efficacy and safety profile to younger patients. Therefore, age alone must not be considered a prognostic factor for AF ablation but the presence of limiting factors such as frailty and multiple comorbidities.
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