Aunque el estudio del fenómeno religioso desde la perspectiva de la lived religion nace en los países del Atlántico Norte, varios investigadores han adoptado esta aproximación en el contexto ...latinoamericano para dar cuenta del hecho religioso y su evolución. Esta orientación responde a la insatisfacción que producen las conclusiones a las que llegan las teorías sociológicas clásicas cuando tratan de explicar el lugar y el sentido de la religión en el contexto de la modernidad latinoamericana, como es el caso de las teorías en torno a la secularización. Este abordaje ha resultado prometedor, en la medida en que ofrece evidencias de la presencia del fenómeno religioso en la sociedad contemporánea que no se han tenido suficientemente en cuenta anteriormente. Pero, al mismo tiempo, presenta aspectos que necesitan ser clarificados y/o desarrollados. Uno de ellos es la relación entre la lived religion y los marcos teóricos que, desde las diferentes ciencias sociales, buscan explicar el fenómeno religioso. El presente artículo presenta algunas consideraciones sobre la fecunda relación que puede establecer la lived religion con la fenomenología de la religión. Identifica aspectos en los que ambas disciplinas se complementan y enriquecen mutuamente, así como cuestiones críticas a tener en cuenta. En concreto, se propone un acercamiento fenomenológico a dos ámbitos de análisis diferenciados y, al mismo tiempo, imbricados: la lived religion y la lived spirituality.
The objective of our study is to determine the thickness of the pubovisceral fasciculus of the levator ani muscle and the area of the genital hiatus by means of three-dimensional perineal ultrasound, ...in pregnant women in the 2nd trimester, and to analyze the related maternal, perinatal and postpartum clinical variables. Furthermore, to compare the results of our study with two similar series previously published. An observational, prospective study of pelvic floor ultrasound was carried out, performed at week 20, whose delivery was attended in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period of August from 2021 to June 2022. Maternal, ultrasound, perinatal and postpartum clinical variables were collected from each participant. During the study period, a total of 54 patients were included in it. The mean gestational age at which the ultrasound was performed was 19.81 ± 0.91 weeks. In relation to the ultrasound variables, the mean thickness of the pubovisceral muscle was 0.87 ± 0.13 cm (95% CI, 0.64-1.38 cm), while, in the plane of minimum dimension of the genital hiatus, the hiatal area at rest was 13.41 ± 3.22 (95% CI, 4.60-18.78) cm
. There is a significant correlation between the age of pregnant women (over 35 years of age) and the increase in the area of the genital hiatus (r = 0.295,
= 0.031). 3D ultrasound of the pelvic floor performed at week 20 of gestation can to be an effective, non-invasive, reproducible and cheap tool in the prognosis of the development of labor and of possible subsequent perineal dysfunctions.
: The goal of this study was to evaluate the effect of chorionicity on maternal, fetal and neonatal morbidity and mortality in triplet pregnancies in our environment.
: A retrospective observational ...study was carried out on triplet pregnancies that were delivered in a tertiary center between 2006 and 2020. A total of 76 pregnant women, 228 fetuses and 226 live newborns were analyzed. Of these triplet pregnancies, half were non-trichorionic. We analyzed maternal characteristics and obstetric, fetal, perinatal and neonatal complications based on their chorionicity, comparing trichorionic vs. non-trichorionic triplet pregnancies. Prematurity was defined as <34 weeks. We measured perinatal and neonatal mortality, composite neonatal morbidity and composite maternal morbidity.
: Newborns with a monochorionic component had a lower gestational age at birth, presented greater prematurity under 34 weeks, lower birth weight, greater probability of birth weight under 2000 g and an APGAR score below 7 at 5 min after birth, more respiratory distress syndrome and, overall, higher composite neonatal morbidity. The monochorionic component of triple pregnancies may entail the development of complications intrinsic to shared circulation and require premature elective termination. This greater prematurity is also associated with a lower birth weight and to the main neonatal complications observed. These findings are in line with those that were previously published in the meta-analysis by our research group and previous literature.
: Triplet gestations with a monochorionic component present a higher risk of obstetric, fetal and neonatal morbidity and mortality.
Postpartum hemorrhage (PPH) remains a significant obstetric emergency worldwide and a leading cause of maternal death. However, it is commonly underreported, which can represent a major concern for ...maternal morbidity and mortality. This retrospective case series study analyzed patients with red blood cell transfusion (RBCt) in the postpartum period over a four-year interval at a specific center. A total of 18,674 patients delivered between January 2018 and December 2021. Patients with postpartum RBCt were classified into two groups: those with identified PPH (i-PPH) and those without (non-i-PPH). Clinical variables, delivery details, blood loss data, and treatment information were collected. Statistical analysis involved a comparison of variables between the i-PPH and non-i-PPH groups. Univariate and multivariate analyses were performed, aiming to identify significant associations between the clinical variables and a lack of PPH identification. The incidence of RBCt was 1.26% (236 cases). Patients receiving RBCt had higher rates of cesarean delivery, twin pregnancy, labor induction, and previous cesarean section. Among patients with postpartum RBCt, 34.3% lacked an identified PPH. The rarity of postpartum RBCt contrasts with the increasing rates of PPH, highlighting the importance of diagnosing PPH and postpartum anemia. A strategy of systematic quantification of blood loss during delivery could help detect PPH and anemia before adverse consequences occur.
Men with obesity tend to be insulin resistant and often have low-normal testosterone concentrations. We conducted a clinical trial aimed to evaluate potential therapeutic strategies for low ...testosterone in men with obesity.
We did a 1-year, parallel, randomized, double-blind, placebo-controlled trial, where we evaluated the independent and combined effects of metformin and testosterone in 106 men with obesity, aged 18–50 years, who had low levels of testosterone and no diabetes mellitus. The primary outcome was change in insulin resistance, measured as Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) index. Secondary outcomes included changes in total and free serum testosterone, body composition, metabolic variables, erectile function, and health-related quality of life (HRQoL).
In the intention-to-treat analysis, the HOMA-IR index decreased significantly in all active groups compared to placebo (metformin −2.4, 95 % CI −4.1 to −0.8, p = 0.004; testosterone −2.7, 95 % CI −4.3 to −1.1, p = 0.001; combination −3.4, 95 % CI −5.0 to −1.8, p < 0.001). Combination therapy was not superior to testosterone alone in decreasing insulin resistance (−0.7, 95 % CI −2.3 to 0.9, p = 0.383). Only the combination of metformin plus testosterone significantly increased total and free testosterone concentrations, compared to placebo. No significant changes in body composition (except for a higher decrease in fat mass in the metformin and combination group), metabolic variables, erectile function, or HRQoL were found with any treatment.
Among men with obesity and low testosterone concentrations, the combination of metformin plus testosterone, metformin only, and testosterone only, compared to placebo, reduced insulin resistance with no evidence of additive benefit.
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•Men with obesity tend to be insulin resistant and often have low-normal testosterone concentrations.•We conducted a randomized, double-blind, placebo-controlled trial of metformin, testosterone, or both, with the endpoint of insulin resistance.•Metformin only, testosterone only, and the combination of metformin plus testosterone reduced insulin resistance with no evidence of additive benefit.
To assess whether a clinical simulation-based obstetric blood loss quantification workshop for medical undergraduate trainees improves theoretical-practical knowledge, along with self-assurance and ...self-confidence.
This was a quasi-experimental pre-post learning study conducted at the Gynaecology and Obstetrics Unit of the Hospital Gregorio Marañón, Madrid, Spain. Participants were volunteer students in their fourth year of a 6-year degree course in Medicine. The study period was divided into the stages: pre-workshop, intra-workshop, 2 weeks post-workshop and 6 months post-workshop. In the pre-workshop stage, students completed a brief online course in preparation for the workshop. The effectiveness of the workshop was assessed through multiple choice tests and self-administered questionnaires. Data were compared between time-points using statistical tests for paired samples.
Of the 142 students invited (age 21.94 ± 3.12 years), 138 accepted the offer of the workshop (97.2%), and 85.4% had no experience in managing blood loss. Between the stages pre- and 2 weeks post-workshop, significant improvements were observed in theoretical-practical knowledge (μ = 1.109), self-assurance and self-confidence. At the 6 months post-workshop stage, theoretical-practical knowledge diminished compared with 2 weeks post-workshop, returning to pre-workshop levels, while self-assurance and confidence failed to vary significantly in the longer term.
The obstetric workshop improved theoretical-practical knowledge and the self-assurance and confidence of the medical students. Results 2 weeks post-workshop were maintained up until 6 months after the training intervention. The clinical simulation-based workshop was perceived by the students as useful and necessary.
This article shows a model for the design of circular isolated footings and the column placed anywhere in the footing under minimum cost criteria. Some designs for obtaining the diameter, effective ...depth, and steel areas of the footing under biaxial bending assume the maximum and uniform pressure at the bottom of the footing supported on elastic soils. All these works consider the column placed at the center of the footing. Three numerical problems are given (each problem presents four variants) to determine the lowest cost to design the circular footings under biaxial bending. Problem 1: Column without eccentricity. Problem 2: Column with eccentricity in the direction of the X axis of one quarter of the diameter of the footing. Problem 3: Column placed at the end furthest from the center of the footing on the X axis. The results are verified by the balance of moments, one-way shear or shear and two-way shear or punching. The new model shows a saving of 17.92% in the contact area with soil and of 31.15% in cost compared to the model proposed by other authors. In this way, the proposed minimum cost design model for circular footings will be of great help for the design when the column is placed on the center or edge of the footing.
This paper presents a novel mathematical model to determine the minimum cost for the design of reinforced-concrete strap combined footings under biaxial bending, with each column using a genetic ...algorithm. The pressure is assumed to be linearly distributed along the contact area. This study comprises two steps: firstly, identifying the smallest ground contact area, and secondly, minimizing the cost. The methodology integrates moment, bending shear, and punching shear calculations according to the ACI standard. Some authors present a smaller area (but limited to one or two property lines) and the design considers that the thickness of the footings and beam are equal, and do not show the lower cost of a strap combined footing; generally, the beam has a greater thickness than the footings and therefore the footings would have an unnecessary thickness that would generate a higher cost. A numerical example is shown to find the lowest cost for the design of strap combined footings considering four different conditions such as square footings and other limitation at the ends of the footings. The minimum area does not guarantee that it is the lowest cost. The proposed model is versatile, applicable to T-shaped and rectangular combined footings, and is not restricted to specific property lines. The contributions include eliminating trial and error practices, accommodating various design conditions, and emphasizing equilibrium in the derived equations. The model is adaptable to different building codes, offering a comprehensive approach to achieving optimal design and cost considerations for strap combined footings.
Congenital Ewing Sarcoma is extremely rare, with a poor prognosis despite early detection and intensive treatment. The Ewing Sarcoma family of tumors (ESFT) is a group of undifferentiated small round ...cell sarcomas, that includes Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumor (pPNET), and are defined by translocations that result in the fusion of the EWS gene and a gene of the ETS family of transcription factors, EWS-FLI being the most frequent (Wang et al., 2007) 1. While ES is mainly a primitive bone sarcoma of children or adolescents, up to 15–20% of cases appear in soft tissues, chest wall or visceral sites, and 2.6% of cases occur in patients younger than three years (Akçalı et al., 2017) 2. Neonatal cases are very rare, and we present a male newborn, with a bulky abdominal mass detected on a routine prenatal ultrasound scan (US).
The current European energy policies have an influence on the need to rehabilitate the housing stock in order to meet the objectives of the European Union. Most of this housing stock was built ...without any type of energy regulation in adverse technical and economic conditions and thus is now energetically obsolete. The major rehabilitation effort required must be approached through actions based on previous quantitative energy knowledge of the existing buildings in order to guarantee the efficiency of energy-retrofitted solutions. This assessment can be carried out through monitoring dwellings conditioned by use patterns; through simulation programs, which do not usually offer faithful representations of energy conditions; or by using test cells, which allow us to evaluate a controlled indoor environment without the influence of users. The objective of this paper is to present the design and performance of test cells as an experimental method for vertical facade analysis in order to tackle the problem of retrofitting residential buildings in a Mediterranean climate, taking into account energy and environment. With this equipment, efficiency and energy savings, as well as illumination and interior air quality, can be simultaneously and comprehensively evaluated.
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