Low-molecular-weight heparins (LMWH) have shown to be at least as safe and efficient as non-fractionated heparin in the treatment of deep-vein thrombosis (DVT). Moreover, no serial laboratory ...controls are required. Therefore, LMWH allow the patients to be treated at home. From July 1995 to July 1996, 30 consecutive patients with DVT were enrolled in a prospective study and treated with nadroparin. Ambulatory treatment was feasible in 24 patients (9 patients did not require admission and 15 patients were discharged in less than 6 days). The main causes for admission were the inability to obtain a diagnosis, the severity of symptoms in the involved limb, and the presence of associated disease. None of the 24 patients to whom the possibility of home therapy was offered desired to remain at hospital. The ambulatory care of these patients increased the burden on primary care teams. There was no case of clinical recurrent thromboembolism nor a major hemorrhagic complication. Ambulatory treatment of DVT with nadroparin seems to be feasible, efficient and safe. Nevertheless, before using this therapeutic alternative a series of factors should be considered, which include the severity of clinical presentation, the embolic and hemorrhagic risks, and the presence of associated diseases.
The sharing of legacy preclinical safety data among pharmaceutical companies and its integration with other information sources offers unprecedented opportunities to improve the early assessment of ...drug safety. Here, we discuss the experience of the eTOX project, which was established through the Innovative Medicines Initiative to explore this possibility.
Alzheimer's disease (AD) is a multifactorial neurodegenerative disorder without a cure, despite the enormous number of investigations and therapeutic approaches. AD is a consequence of microglial ...responses to "damage signals", such as aggregated tau oligomers, which trigger a neuro-inflammatory reaction, promoting the misfolding of cytoskeleton structure. Since AD is the most prevalent cause of dementia in the elderly (>60 years old), new treatments are essential to improve the well-being of affected subjects. The pharmaceutical industry has not developed new drugs with efficacy for controlling AD. In this context, major attention has been given to nutraceuticals and novel bioactive compounds, such as molecules from the Andean Shilajit (AnSh), obtained from the Andes of Chile. Primary cultures of rat hippocampal neurons and mouse neuroblastoma cells were evaluated to examine the functional and neuroprotective role of different AnSh fractions. Our findings show that AnSh fractions increase the number and length of neuronal processes at a differential dose. All fractions were viable in neurons. The AnSh fractions inhibit tau self-aggregation after 10 days of treatment. Finally, we identified two candidate molecules in M3 fractions assayed by UPLC/MS. Our research points to a novel AnSh-derived fraction that is helpful in AD. Intensive work toward elucidation of the molecular mechanisms is being carried out. AnSh is an alternative for AD treatment or as a coadjuvant for an effective treatment.
El objetivo del estudio fue analizar el aporte ambiental hacia la calidad del río Torres considerando la remoción de contaminantes fisicoquímicos y microbiológicos de la planta de tratamiento de ...aguas residuales (PTAR) Los Tajos. Se realizó el análisis de datos fisicoquímicos y microbiológicos de las aguas de afluente y efluente de la PTAR (DBO, DQO, SST, STT, N-NH4+, P-PO43-, GyA, SAAM y coliformes fecales principalmente) y se analizó la variación en concentración de contaminantes en el río Torres previo y posterior a la construcción de la PTAR, que realiza un tratamiento primario a las aguas, todo asociado a la estacionalidad. Los datos se analizaron en R versión 3.6.1. Según la metodología del índice holandés, el río Torres se clasificó severamente contaminado previo a la construcción de la PTAR, y actualmente aumenta su grado de contaminación después de la descarga de la PTAR, principalmente en época lluviosa. La PTAR presenta remoción significativa para siete de los ocho parámetros analizados, los porcentajes de remoción más representativos son: SST (68.5 %), DBO (49.8 %) y GyA (54.7 %). Se demostró el aporte cuantitativo de la PTAR al río Torres removiendo toneladas de contaminantes de las aguas residuales desde el 2015 hasta el 2020, principalmente DQO (26,791.8 Mg), SST (24,162.6 Mg), DBO (12,290.0 Mg) y STT (30,267.7 Mg). Finalmente se dejó en evidencia la necesidad de construir las siguientes etapas de la PTAR que incluyen tratamiento secundario, que mejoraría la remoción de materia orgánica, surfactantes y nutrientes.
El Partenón, construido en Atenas entre el 447 a.C. y el 432 a.C., es una arquitectura herida y dispersa que ha sufrido múltiples destrucciones e intentos de restitución. Sus fragmentos ...supervivientes se ubican hoy en Grecia, en Reino Unido y en, al menos, otros siete países europeos, y gran parte de su sentido constructivo y simbólico sigue siendo un enigma sin resolver. La selección y disposición crítica de una serie de dibujos, tomados como tentativas de aproximación a esta obra estallada, proponen una experiencia ampliada de su observación y de su decodificación en todas sus dimensiones, justa con su naturaleza vibrante y con la complejidad inherente a la mirada contemporánea. Aunque la mayor parte de estas capturas pueden enmarcarse en la categoría de lo disciplinar –apuntes, dibujos, grabados, acuarelas, óleos, fotomontajes–, su aportación en el presente trasciende su función descriptiva original.
This study introduces an innovative solution to address the challenges arising from the volatile natural gas market and the growing integration of renewable energy sources within the industrial ...sector. The research strives to confront this challenge by including renewable methanol (CH3OH) and converting it into methane (CH4), with an intermediate step involving synthesis gas (CO/H2) by using concentrating solar power. This approach provides a sustainable and adaptable solution to reduce dependence on natural gas. The process entails a methanol decomposition reaction at moderate temperatures (<350 °C). Subsequently, the synthesis gas is compressed to 40 bar, stored, and discharged through a methanation process that can be conducted at high temperatures (>500 °C). The resulting methane is used as fuel for gas turbines and can also serve as feedstock in the chemical industry. The simulations were conducted in ASPEN HYSYS and yielded overall system efficiencies exceeding 29% and roundtrip efficiencies of 44%. Through techno-economic optimisation of the reaction conditions, competitive levelized fuel costs (LCOF) of €172/MWh and future LCOE values of €145/MWh were achieved. These findings present an innovative strategy for integrating gas turbine cycles and additional conversion pathways for green methanol.
•A novel flexible storage system for conventional power generation is proposed.•Green methanol to methane conversion process from intermediate step to synthesis gas.•Overall system efficiencies above 29% and roundtrip efficiencies of 44% were achieved.•Competitive levelized fuel cost of €172/MWh and future LCOE values <€265/MWh are reached.
Strongyloidiasis is a parasitosis characterized by persistent infection before dissemination and the development of potentially fatal disease. Since diagnosis is difficult, knowledge of the ...prevalence and geographic distribution of the disease is of practical importance. A study was made of Strongyloides stercoralis infection in a random and representative sample of farm workers in a tourist region in Spain based on the detection of larvae of triple stool samples. The prevalence of infection was 12.4% (95% confidence interval CI = 8.4-16.4). None of the 26 clinical or epidemiologic variables analyzed were found to be predictive of infection. Only eosinophilia (> 400 eosinophils/mm3) was significantly greater among the infected individuals (odds ratio = 73.4, 95% CI = 16.3-327.0), with a sensitivity of 93.5% and a specificity of 93.1%. A screening program is proposed to detect eosinophilia, to provide treatment without stool examinations, and thus afford a cost-effective policy for preventing the development of severe forms of the disease among specific risk groups where the prevalence of other parasitoses is low.
Background and purpose
For patients with acute ischaemic stroke due to large‐vessel occlusion, it has recently been shown that mechanical thrombectomy (MT) with stent retrievers is better than ...medical treatment alone. However, few hospitals can provide MT 24 h/day 365 days/year, and it remains unclear whether selected patients with acute stroke should be directly transferred to the nearest MT‐providing hospital to prevent treatment delays. Clinical scales such as Rapid Arterial Occlusion Evaluation (RACE) have been developed to predict large‐vessel occlusion at a pre‐hospital level, but their predictive value for MT is low. We propose new criteria to identify patients eligible for MT, with higher accuracy.
Methods
The Direct Referral to Endovascular Center criteria were defined based on a retrospective cohort of 317 patients admitted to a stroke center. The association of age, sex, RACE scale score and blood pressure with the likelihood of receiving MT were analyzed. Cut‐off points with the highest association were thereafter evaluated in a prospective cohort of 153 patients from nine stroke units comprising the Madrid Stroke Network.
Results
Patients with a RACE scale score ≥ 5, systolic blood pressure <190 mmHg and age <81 years showed a significantly higher probability of undergoing MT (odds ratio, 33.38; 95% confidence interval, 12–92.9). This outcome was confirmed in the prospective cohort, with 68% sensitivity, 84% specificity, 42% positive and 94% negative predictive values for MT, ruling out 83% of hemorrhagic strokes.
Conclusions
The Direct Referral to Endovascular Center criteria could be useful for identifying patients suitable for MT.
BackgroundIn Spain, a therapeutic positioning report (TPR) for sacubitril valsartan indicates its use in adult patients for the treatment of symptomatic chronic heart failure and reduced ejection ...fraction (left ventricular ejection fraction (LVEF) ≤35%), elevated B-type natriuretic peptid (BNP) seric levels and patients previously treated well with standard of care therapy (ACE inhibitors/ARBs, beta-blockers, mineralcorticoid antagonists and diuretics).PurposeTo evaluate the suitability of sacubitril valsartan prescriptions to the recommendations in a health management area.Material and methodsRetrospective descriptive study including patients treated with sacubitril valsartan from September 2016 until July 2017.Variables considered were: sex, age, treatment with ACE inhibitors/ARBs, beta-blockers, mineralcorticoid antagonists and/or diuretics, dosage regimen, contraindications or intolerance to standard therapy, LVEF previous to sacubitril valsartan, dose escalation, dose reduction, discontinuation and cause of discontinuation.To evaluate the suitability of the prescriptions we analysed: intolerance/contraindications to standard therapy, therapy before change, dosage regimen, dose tritation and LEVF ≤35%. Audit data were sent to their prescriptors to review.For data compilation we used the Microstrategy® prescription database and medical records.ResultsFifty-three patients started treatment with sacubitril valsartan in the cited period. Median age was 66.6 years: 83% (n=44) were men.According to previous standard care received: seven patients (13.2%) had not received ACE inhibitors/ARBs and only six patients (11.3%) received optimal doses of these.As for beta-blockers, nine patients (16.98%) had not received them and only five patients (9.4%) had received the optimal dose. Regarding mineralcorticoid antagonist, 14 patients had not received them (26.4%) and three patients received the optimal dose. LVEF was >35% in 16 patients.Overall, none of our patients met all the predetermined conditions in the TPR. No intolerance or contraindication to standard therapy was notified.A correct dose tritation or appropiate periodic examination was made in only 16 patients (30%).During the considered period, one patient received a reduced dose for hypotension and 10 patients discontinued treatment: four lack of indication, one economic conditions, one death, two hypotension and one cardiac transplantation.ConclusionThe results show an inadequate use of sacubitril valsartan according to TPR indications in most cases. With this analysis we intend to improve sacubitril valsartan use in our reference area. Audits are an effective method to improve the rational use of medicines.No conflict of interest
To evaluate the association between receiving information on obstetric complications and institutional delivery in Peruvian women in 2019.
We conducted a secondary analysis of the 2019 Peruvian ...Demographic and Family Health Survey (ENDES) database. The dependent variable was the type of delivery (institutional or non-institutional). The exposure variable was self-reporting of having received information on obstetric complications during prenatal care. The association of interest was evaluated using binary logistic regression models, obtaining crude odds ratios (cOR) and adjusted odds ratios (aOR) with their respective 95 % confidence intervals (95%CI). Values of p < 0.05 were considered statistically significant.
We included a total of 14,835 women in the analysis. Of the total, 14,088 (94.1 %) reported having received information on pregnancy complications. Also, 13,883 (92.5 %) had an institutional delivery in their last pregnancy. The adjusted model showed that women who reported knowing the complications that can occur in pregnancy had a higher probability of presenting an institutional delivery (aOR = 1.47; 95%CI: 1.04–2.08).
Receiving information about pregnancy complications was found to be associated with a higher probability of institutional delivery. Ensuring the provision of information to the pregnant woman about pregnancy complications can be a useful strategy to increase institutional delivery.
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