•La pandemia de COVID-19 nos ha obligado a diseñar nuevas formas de dispensar cuidados médicos. En este contexto, la telemedicina se propone como principal alternativa a la clásica atención sanitaria ...presencial.•El colapso de los centros sanitarios durante la pandemia ha dificultado el seguimiento de los problemas crónicos de salud como la diabetes tipo 2, impidiendo un seguimiento o tratamiento adecuado.•Adaptar las guías de práctica clínica en forma de recomendaciones y algoritmos de decisión adaptados al nuevo escenario profesional permite homogeneizar y estandarizar la atención sanitaria que se ofrece a los pacientes con diabetes tipo 2.
Las circunstancias actuales provocadas por la COVID-19 nos obligan a los profesionales de atención primaria a idear nuevas formas de garantizar la atención sanitaria de nuestros pacientes con diabetes tipo 2 (DM2). Existen evidencias que respaldan la eficacia de la telemedicina en el control glucémico de los pacientes con DM2. Ante la rápida adaptación de la práctica clínica al uso de la telemedicina, el Grupo de Trabajo de Diabetes de la Sociedad Española de Medicina Familiar y Comunitaria (SemFyC) optó por elaborar un documento de consenso plasmado en un algoritmo de actuación/seguimiento telemático en la atención de los pacientes con DM2.
The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.
The current circumstances cause by the COVID-19 force primary care doctors to find out new ways to guarantee the health care of our type 2 diabetes patients. There is evidence that supports the ...remote consultation efficacy in the glycemic control in patients with type 2 diabetes. Facing the rapid adaptation of clinical practice to the remote consultation use, from de Diabetes Group of the Spanish Society of Family and Community Medicine (SemFyC), we have prepared a document embodied in a telematic action / monitoring algorithm in the care of patients with type 2 diabetes.
The COVID-19 pandemic severely disrupted cardiovascular care during the spring of 2020 in Europe. Our study analyzed the clinical profile, COVID-19 impact, and 30-day prognosis of invasively managed ...patients with acute coronary syndrome (ACS) compared to a historical cohort.All invasively managed ACS patients from March 1st to April 30th, 2020 were compared to a cohort from the same timeframe of 2019 (n = 316). COVID-19 confirmed cases were defined by a positive SARS-CoV-2 polymerase chain reaction (PCR) test (CoV+). The primary outcome was all-cause 30-day mortality and multivariable predictors of this outcome.A 40.4% reduction in ACS patients was noted (198 cases in 2019 to 118 in 2020), and 11% of 2020 ACS patients were CoV+. Baseline characteristics were similar between groups. There were significantly more in-hospital patients with ACS (15.3% versus 6.1%, P = 0.007), and fewer patients were found to have a culprit lesion (58.5% versus 74.2%, P = 0.004) in 2020 compared to 2019. Thirty-day mortality in 2020 (7%) was not different from that in 2019 (4.2%), P = 0.294, but it was significantly higher in CoV+ patients (23.1%) compared to that in negative SARS-CoV-2 PCR test (CoV−) patients (5%), P = 0.047, in the 2020 group. In the multivariate analysis, CoV+ was an independent mortality predictor (OR = 9.8, 95% CI = 1.48-64.78), along with the left ventricular ejection fraction (LVEF) (OR = 0.91, 95% CI = 0.86-0.97), P = 0.0006.This study found increased 30-day mortality of invasively managed CoV+ ACS patients compared to that of CoV− patients during the 2020 COVID-19 spring outbreak. In the multivariable analysis, a SARS-CoV-2 positive test was independently associated with 30-day mortality. Further investigations of the underlying physiopathological relations between COVID-19 and ACS are warranted.
The disease produced by the new coronavirus known as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), named COVID-19 (Coronavirus Disease-2019) has recently been classified as a pandemic ...by the World Health Organization (WHO). However, scarce clinical data is available and generally limited to the Chinese population due to the first cases were identified in Wuhan (Hubei, China).
This article describes the rationale and design of the HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) registry (ClinicalTrials.gov Identifier: NCT04334291). With an ambispective cohort design, eligible patients are those discharged, deceased or alive, from any hospital center with a confirmed diagnosis or a COVID-19 high suspicion. With a current recruitment of more than 7000 cases, in 46 hospitals in 8 countries, since it is not possible to estimate the sample size based on literature reports, the investigators will try to get the maximum numbers of patients possible. The study primary objective is all cause mortality and aims to characterize the clinical profile of patients infected in order to develop a prognostic clinical score allowing, rapid logistic decision making. As secondary objectives, the analysis of other clinical events, the risk-adjusted influence of treatments and previous comorbidities of patients infected with the disease will be performed.
The results of HOPE COVID-19 will contribute to a better understanding of this condition. We aim to describe the management of this condition as well as the outcomes in relation to the therapy chosen, in order to gain insight into improving patient care in the coming months.
ClinicalTrials.gov. Unique identifier: NCT04334291.
La cadena de valor consiste en una serie de acciones requeridas para obtener un producto o servicio; añadido valor al producto trae consigo beneficios a quienes lo producen. El objetivo de este ...artículo es describir las condiciones de la cadena de valor del maíz duro en Ecuador. La metodología se basa en una revisión crítica de la información documental y análisis de informaciones institucionales que describen el desempeño de los mercados de la materia prima agrícolas, la comercialización de estos actores, el funcionamiento de la cadena de valor del maíz en Ecuador y las estrategias para este producto. Uno de los resultados se plantea dentro del contexto de desarrollo del maíz ecuatoriano y sus ventajas, debido a la situación que tienen los principales exportadores en América. El apoyo que brinda el Estado a los actores sociales involucrados en la organización de la producción de maíz debe ser aprovechada a través del desarrollo de la cadena de valor.
In this study, we evaluated the phytoremediation ability of three different genotypes of cowpea (Vigna unguiculata L. Walp) grown on mercury-contaminated soils from gold mining areas. In particular ...we compared a native genotype with two commercial lines L-019 and L-042. The plants were cultivated in soils amended at different concentrations of Hg (i.e. 0.2, 1, 2, 5 and 8 mg kg−1). After three months exposure, we determined plant growth, seed production, and Hg accumulation in different plant tissues (root, leaf, seed and stem). Indices of soil-plant metal transfer such as translocation, bioconcentration and bioaccumulation factors were calculated. Results showed that the native variety presented the highest seed production (3.8 g), however the highest plant biomass (7.9 g) was observed in line L-019, both on Hg-contaminated soil of 1 mg kg−1. The different plant tissues differed in terms of Hg concentration (root > leaf > stem). In the highest treated soil, the line L-042 accumulates higher Hg in both roots and leaves, while line L-019 accumulates more metal in stems. In line L-019, Hg concentrations in the fruit showed significant differences being higher in the valves than in the seeds. The transfer factors were generally lower than 1 and indicates the low accumulation of Hg by cowpeas. The estimated daily Hg intake through cowpea consumption showed values far below the threshold of 0.57 μg kg−1 dw day−1 recommended by the World Health Organization. Our results show cowpea V. unguiculata as a good protein-rich food substitute of Hg-contaminated fish for populations living near gold mining sites.
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•Mercury uptake in cowpea was determined in three genotypes using polluted soil.•In all the lines, Hg levels in plant tissues followed this order root > leaf > stem.•Native variety showed resistance to translocate Hg to the fruit vs commercial lines.•The daily Hg intake through cowpea are far below the health risk according to WHO.•Cowpea is a protein-rich food that can reduce the high intake of contaminated fish.
To the Editor, Acute SARS-CoV-2 infections (COVID-19) have caused a global pandemic since the first cases were described in Wuhan, China, back in December 2019. The first wave of COVID-19 cases in ...Western Europe led to substantial healthcare disruption and population lockdowns from March 2020 through May 2020. Regarding the cardiovascular implications, COVID-19 has been associated with higher in-hospital mortality rates in patients with coronary syndromes.1 Among others, a higher thrombogenic risk has been proposed as the underlying mechanism of this increased rate of adverse events.2 Subsequently, observational studies have suggested an increased number of stent thrombosis during acute COVID-19 infections.3 The underlying mechanisms of this stent thrombosis are endotheliitis, platelet activation, and coagulopathy. It is unknown whether these mechanisms could also lead to late adverse cardiovascular events or stent failure. We previously reported on an increased 30-day mortality rate in patients with acute coronary syndrome and COVID-19 compared to non-COVID-19 patients.4 Later studies confirmed similar rates of death after myocardial infarction.5 This study aimed to analyze the 1-year rate of adverse cardiovascular events and stent failure in consecutive patients referred for coronary angiography from March through April 2020. All the participant patients gave their informed consent and the project was approved by...
The optimal duration of dual antiplatelet therapy (DAPT) ought to be determined taking into account individual ischaemic or bleeding events risks. To date, studies have provided inconclusive evidence ...on the effects of prolonged DAPT. We sought to evaluate the long-term outcomes of this strategy following percutaneous revascularization in the context of acute coronary syndrome (ACS).
Retrospectively from four centers in Madrid, we identified 750 consecutive ACS patients, divided in two groups of DAPT duration: <13 months and >13 months, with a mean follow-up of 48 months.
Patients with DAPT > 13 months had a higher non-adjusted incidence of Major Adverse Cardiovascular Events (11.6% vs. 17.3%) and new revascularization (3.7% vs. 8.7%). Differences in all-cause death, cardiac death, myocardial infarction, stent thrombosis and stroke were non-significant. There was no difference in the incidence of major bleeding (7.4% vs. 6.3%). Multivariable Cox regression analysis showed that the independent risk predictors of MACE were age (HR: 1.04, 95% CI: 1.02-1.06,
< 0.001) and multivessel disease (HR: 2.29, 95% CI: 1.32-3.95,
= 0.003), whereas the independent protective predictor was normal hemoglobin (HR: 0.88, 95% CI: 0.78-0.98,
= 0.022).
In this real-world registry cohort of ACS patients treated with PCI and 1 year of DAPT in Spain, we report a trend of increased rate of MACE and new revascularization not associated with TVR in patients with longer DAPT. Our findings support the need for future randomized controlled trials to confirm or refute these results.
Sr. Editor: Las infecciones agudas por el SARS-CoV-2 (COVID-19) han provocado una pandemia global desde que aparecieran los primeros casos en Wuhan (China) en diciembre de 2019. La primera oleada de ...casos de COVID-19 que golpeó Europa occidental azotó los sistemas de salud pública y provocó confinamientos de la población entre los meses de marzo y mayo de 2020. En lo que respecta a las implicaciones cardiovasculares, la COVID-19 se asocia a índices más altos de mortalidad intrahospitalaria en pacientes con síndromes coronarios1. Entre otros, se ha sugerido un mayor riesgo trombogénico como mecanismo subyacente de este mayor índice de eventos adversos2. Posteriormente, estudios observacionales han sugerido que ocurren muchas más trombosis de los stents durante las infecciones agudas por COVID-193. Los posibles mecanismos subyacentes de esta trombosis del stent son la endotelitis, la activación plaquetaria y la coagulopatía. Se desconoce si estos mecanismos implican también un aumento de eventos cardiovasculares adversos tardíos o fracaso del stent. Anteriormente, ya se observó una mayor mortalidad a 30 días en pacientes con síndrome coronario agudo y COVID-19 comparados con pacientes sin COVID-194. Posteriores estudios han confirmado unos índices similares de mortalidad tras la ocurrencia de infartos de miocardio en esta población5. El objetivo de este...
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