Recent studies have shown that liver cirrhosis (LC) behaves as an acquired hypercoagulable state with increased thrombotic risk. This is why anticoagulation therapy (AT) is now frequently used in ...these patients. Variceal bleeding is a severe complication of LC. It is unknown whether AT may impact the outcome of bleeding in these patients. Fifty‐two patients on AT with upper gastrointestinal bleeding (UGIB) were evaluated. Portal vein thrombosis (PVT) and different cardiovascular disorders (CVDs) were the indication for AT in 14 and 38 patients, respectively. Overall, 104 patients with LC and UGIB not under AT matched for severity of LC, age, sex, source of bleeding, and Sequential Organ Failure Assessment (SOFA) score served as controls. UGIB was attributed to portal hypertension (PH) in 99 (63%) patients and peptic/vascular lesions in 57 (37%). Twenty‐six (17%) patients experienced 5‐day failure; SOFA, source of UGIB, and PVT, but not AT, were independent predictors of 5‐day failure. In addition, independent predictors of 6‐week mortality, which was observed in 26 (11%) patients, were SOFA, Charlson Comorbidity index, and use of AT for a CVD. There were no differences between patients with/without AT in needs for rescue therapies, intensive care unit admission, transfusions, and hospital stay. Conclusions: Factors that impact the outcome of UGIB in patients under AT are degree of multiorgan failure and comorbidity, but not AT itself. (Hepatology 2015;62:575–583
Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in patients with coronavirus disease 2019 (COVID-19). Hypertension and age are the 2 principal ...determinants of arterial stiffness (AS). This study aimed to estimate AS in patients with COVID-19 requiring hospitalization and analyze its association with all-cause in-hospital mortality. This observational, retrospective, multicenter cohort study analyzed 12 170 patients admitted to 150 Spanish centers included in the SEMI-COVID-19 Network. We compared AS, defined as pulse pressure ≥60 mm Hg, and clinical characteristics between survivors and nonsurvivors. Mean age was 67.5 (±16.1) years and 42.5% were women. Overall, 2606 (21.4%) subjects died. Admission systolic blood pressure (BP) <120 and ≥140 mm Hg was a predictor of higher all-cause mortality (23.5% and 22.8%, respectively,
<0.001), compared with systolic BP between 120 and 140 mm Hg (18.6%). The 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that AS and systolic BP <120 mm Hg significantly and independently predicted all-cause in-hospital mortality (adjusted odds ratio ORadj: 1.27,
=0.0001; ORadj: 1.48,
=0.0001, respectively) after adjusting for sex (males, ORadj: 1.6,
=0.0001), age tertiles (second and third tertiles, ORadj: 2.0 and 4.7,
=0.0001), Charlson Comorbidity Index (second and third tertiles, ORadj: 4.8 and 8.6,
=0.0001), heart failure, and previous and in-hospital antihypertensive treatment. Our data show that AS and admission systolic BP <120 mm Hg had independent prognostic value for all-cause mortality in patients with COVID-19 requiring hospitalization.
La determinación de perfiles de riesgo académico a través de la medición de diversos factores considerados relevantes en el estudio de la retención y la deserción han sido un trabajo continuo de las ...instituciones de educación superior. La definición de los constructos y la creación de los instrumentos adecuados son los principales retos que deben ser abordados desde cada institución, debido a que los perfiles de los estudiantes llegan a variar ampliamente entre regiones de un mismo país.
El presente estudio describe la construcción y validación del Cuestionario Psicopedagógico de Antecedentes Académicos (CPAA), instrumento que aborda los constructos actuales para medir los factores generales de riesgo que puedan orientarnos en la creación de perfiles específicos de alumnos. Este instrumento es un acercamiento general al inicio de un proceso de definición de perfiles de alumnos que ingresan a la universidad. Se realizó el análisis de exploración y de validación en una muestra de 630 participantes. El instrumento consta de 84 ítems que abordan los factores: académico, personal y vocacional. Como evidencia de consistencia interna de alfa de Cronbach calculado tomando todos los ítems como una sola dimensión fue de 0.84, y el ω_t fue de 0.88 (ω_h= 0.49), indicando en general una adecuada consistencia interna.
Se realizaron tres modelos de regresión lineal donde se tomaron los datos obtenidos del cuestionario junto con tres métricas institucionales: ausentismo, promedio de aprovechamiento escolar semestral y deserción al segundo semestre. los cuales muestran que el área personal del cuestionario es estadísticamente significativa en dichas correlaciones lo cual puede constituir un valor predictivo para los indicadores institucionales considerados en el estudio que se presenta y que pueden servir como base para la caracterización de la población de nuevo ingreso a la educación superior.
Antibiotic prophylaxis reduces the risk of infection and mortality in patients with cirrhosis and acute variceal bleeding (AVB). This study examines the incidence of, and risk factors for, bacterial ...infections during hospitalization in patients with AVB on antibiotic prophylaxis.
A post hoc analysis was performed using the database of an international, multicenter, observational study designed to examine the role of pre-emptive transjugular intrahepatic portosystemic shunts in patients with cirrhosis and AVB. Data were collected on patients with cirrhosis hospitalized for AVB (n = 2,138) from a prospective cohort (October 2013-May 2015) at 34 referral centers, and a retrospective cohort (October 2011-September 2013) at 19 of these centers. The primary outcome was incidence of bacterial infection during hospitalization.
A total of 1,656 patients out of 1,770 (93.6%) received antibiotic prophylaxis; third-generation cephalosporins (76.2%) and quinolones (19.0%) were used most frequently. Of the patients on antibiotic prophylaxis, 320 patients developed bacterial infection during hospitalization. Respiratory infection accounted for 43.6% of infections and for 49.7% of infected patients, and occurred early after admission (median 3 days, IQR 1-6). On multivariate analysis, respiratory infection was independently associated with Child-Pugh C (odds ratio OR 3.1; 95% CI 1.4-6.7), grade III-IV encephalopathy (OR 2.8; 95% CI 1.8-4.4), orotracheal intubation for endoscopy (OR 2.6; 95% CI 1.8-3.8), nasogastric tube placement (OR 1.7; 95% CI 1.2-2.4) or esophageal balloon tamponade (OR 2.4; 95% CI 1.2-4.9).
Bacterial infections develop in almost one-fifth of patients with AVB despite antibiotic prophylaxis. Respiratory infection is the most frequent, is an early event after admission, and is associated with advanced liver failure, severe hepatic encephalopathy and use of nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.
Bacterial infections develop during hospitalization in close to 20% of patients with acute variceal bleeding despite antibiotic prophylaxis. Respiratory bacterial infections are the most frequent and occur early after admission. Respiratory infection is associated with advanced liver disease, severe hepatic encephalopathy and a need for a nasogastric tube, orotracheal intubation for endoscopy or esophageal balloon tamponade.
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•Bacterial infections still occur in around one-fifth of patients with cirrhosis and acute variceal bleeding despite antibiotic prophylaxis.•Respiratory bacterial infections are the most frequent, occurring early after admission.•Respiratory infections are related to the severity of cirrhosis, presence of severe hepatic encephalopathy and airway manipulation.•Over 50% of the bacteria isolated in this series were resistant to third-generation cephalosporines.
Nowadays, there is a growing trend to incorporate renewables in electrical power systems and, in particular, wind energy, which has become an important primary source in the electricity mix of many ...countries, where wind farms have been proliferating in recent years. This circumstance makes it particularly interesting to understand wind behavior because generated power depends on it. In this paper, a method is proposed to synthetically generate sequences of wind speed values satisfying two important constraints. The first consists of fitting the given statistical distributions, as the generally accepted fact is assumed that the measured wind speed in a location follows a certain distribution. The second consists of imposing spatial and temporal correlations among the simulated wind speed sequences. The method was successfully checked under different scenarios, depending on variables, such as the number of locations, the duration of the data collection period or the size of the simulated series, and the results were of high accuracy.
Diabetes mellitus is a chronic disease often accompanied by diabetic retinopathy (DR), one of the most common diabetic complications. DR is an eye condition that causes vision deficiency and often ...leads to blindness. DR develops when blood vessels damage the retina, the light-sensitive tissue at the back of the eye. Before changes in retinal blood vessel permeability, different molecular and anatomical modifications take place in the retina, including early neural changes. This review will summarize the current status of knowledge regarding pathophysiological mechanisms underlying DR, with a special focus on early neural modifications associated with DR. We describe hyperglycemia-associated molecular and cellular alterations linked to the initiation and progression of DR. We also discuss retinal neurodegeneration as a shared feature in different in vitro and in vivo models of DR. Given how ubiquitous diabetes is and how severe the effects of DR are, we also examine the current pharmacological and genetic approaches for combatting this disease.
In the current context of a world energy situation that demands high-quality indoor environments compatible with rational energy use, the purpose of this work is to present a successful case study of ...a comfortable low-energy office building in Madrid, Spain. An exhaustive indoor air quality and thermal comfort field measurement survey was carried out during the summer period. The main global and local thermal comfort parameters in several workplaces, as well as CO
2
concentration in supply air, exhaust air, and occupied space, were registered. Correct operation of the demand-controlled ventilation system and air distribution is observed. Also, thermally activated building systems and shading design make it possible to get high levels of indoor thermal comfort, as derived from measurements. This proves that the integration of novel energy-efficient concepts in office building design can not only contribute to a minimization of the energy use but can simultaneously favor the achievement of high indoor environmental quality.
Hyperspaces C(p,X) of finite graphs Corona-Vázquez, Florencio; Quiñones-Estrella, Russell Aarón; Sánchez-Martínez, Javier ...
Topology and its applications,
10/2018, Volume:
248
Journal Article
Peer reviewed
Open access
Given a continuum X and p∈X, we will consider the hyperspace C(p,X) of all subcontinua of X containing p and the family K(X) of all hyperspaces C(q,X), where q∈X. In this paper we give some ...conditions on the points p,q∈X to guarantee that C(p,X) and C(q,X) are homeomorphic, for finite graphs X. Also, we study the relationship between the homogeneity degree of a finite graph X and the number of topologically distinct spaces in K(X), called the size of K(X). In addition, we construct for each positive integer n, a finite graph Xn such that K(Xn) has size n, and we present a theorem that allows to construct finite graphs X with a degree of homogeneity different from the size of the family K(X).
Patients admitted with acute variceal bleeding (AVB) and Child‐Pugh C score (CP‐C) or Child‐Pugh B plus active bleeding at endoscopy (CP‐B+AB) are at high risk for treatment failure, rebleeding, and ...mortality. A preemptive transjugular intrahepatic portosystemic shunt (p‐TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high‐risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p‐TIPS was based on individual center policy. p‐TIPS in the setting of AVB is associated with a lower mortality in CP‐C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP‐B+AB patients was low, and p‐TIPS did not improve it. In CP‐C and CP‐B+AB patients, p‐TIPS reduced treatment failure and rebleeding (1‐year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p‐TIPS must be the treatment of choice in CP‐C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p‐TIPS could be a good treatment strategy for CP‐B+AB patients.
In a predominantly digital communicative context, the political practices of young university students are relevant for the vitality of public spheres and the consolidation of participatory ...democracy. The objective of this study was to learn how the use of digital media relates to the political talk and participation practices of university students. Using quota sampling, a survey was conducted among 435 undergraduate students residing in the Metropolitan Area of Monterrey, Mexico, during the second semester of 2020. Among these students with favorable access to digital media, positive correlations with small to moderate and statistically significant magnitudes were found between the various uses of digital media and their political practices. News use was moderately correlated with political talk, as was social use with politically motivated activities, and creative use with all forms of participation. Political talk mainly affected the relationship between participation and news use. These findings support the relevance of the active role of young people in their political socialization, as social interaction and content creation were more closely correlated with political participation than news consumption was, which was more beneficial to participation when articulated through political talk.
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