Search

José Ramón González-Juanatey,1 Josep Comín-Colet,2 Domingo Pascual Figal,3 Antoni Bayes-Genis,4 Jose Maria Cepeda,5 José M García-Pinilla,6,7 Antonio García-Quintana,8 Luis Manzano,9 Jose Luis Zamorano10 1Cardiology Department, Hospital Clínico Universitario Santiago de Compostela, Centro de investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain; 2Cardiology Department, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain; 3Cardiology Department, Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain; 4Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 5Department of Internal Medicine, Hospital Vega Baja, Orihuela, Alicante, Spain; 6Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain; 7Department of Medicine and Dermatology, Universidad de Málaga, Málaga, Spain; 8Cardiology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; 9Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain; 10Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, SpainCorrespondence: José Ramón González-Juanatey, Email Jose.Ramon.Gonzalez.Juanatey@sergas.esAbstract: Heart failure (HF) is a progressive condition with periods of apparent stability and repeated worsening HF events. Over time, unless optimization of HF treatment, worsening HF events become more frequent and patients enter into a cycle of recurrent events with high morbidity and mortality. In patients with HF there is an activation of deleterious neurohormonal pathways, such as the renin angiotensin aldosterone system and the sympathetic system, and an inhibition of protective pathways, including natriuretic peptides and guanylate cyclase. Therefore, HF burden can be reduced only through a holistic approach that targets all neurohormonal systems. In this context, vericiguat may play a key role, as it is the only HF drug that activates the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate system. On the other hand, it has been described relevant disparities in the management of HF population. Consequently, it is necessary to homogenize the management of these patients, through an integrated patient-care pathway that should be adapted at the local level. In this context, the development of new technologies (ie, video call, specific platforms, remote control devices, etc.) may be very helpful. In this manuscript, a multidisciplinary group of experts analyzed the current evidence and shared their own experience to provide some recommendations about the therapeutic optimization of patients with recent worsening HF, with a particular focus on vericiguat, and also about how the integrated patient-care pathway should be performed.Keywords: heart failure, worsening heart failure, patient-care pathway, vericiguat

Abstract Aims The aim of this study was to determine the clinical profile, associated events and safety of vericiguat in a real‐world cohort of patients with heart failure with reduced ejection fraction (HFrEF). Methods This study is a prospective and observational cohort study of patients with HFrEF and recent HF worsening episodes requiring intravenous therapy who initiated vericiguat in an HF outpatient clinic. A subanalysis of patients with ≥6 months' follow‐up was performed separately. Results Out of 103 patients initially included, 52 had a follow‐up of at least 6 months (median follow‐up of 303 days). At baseline, the mean age was 71.3 ± 9.4 years, 27.2% were women, the median left ventricular ejection fraction was 34% (28%–39%) and 99% were taking beta‐blockers, 96.1% sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, 95.1% sacubitril–valsartan, 90.3% aldosterone antagonists and 93.2% loop diuretics. During follow‐up, New York Heart Association (NYHA) functional class improved (from 67.3% and 32.7% in classes III and II, respectively, to 22.4% and 75.5% at study end; P

Los estudios de respuesta fotosintética a diversas intensidades lumínicas facilitan comprender la fisiología vegetal, optimizar el manejo y aprovechamiento sostenible de las especies. La investigación tuvo como fin evaluar la respuesta fotosintética de G. angustifolia y B. vulgaris a diferentes intensidades de luz. Las mediciones de asimilación fotosintética se realizaron utilizando un sistema portátil iFL - LCpro-SD. El punto compensación (% U ) se determinó mediante tres curvas A/Ci bajo tres niveles diferentes de intensidad lumínica. La evaluación de la respuesta fotosintética al incremento en la intensidad de luz fue de 25 a 1800 PPFD µmol m-2s-1. G. angustifolia presentó un % U de 73.9 µmol CO, m{ ²s{ ¹, indicando mayor eficiencia en la captura de carbono a concentraciones más bajas en comparación con B. vulgaris, que mostró un % U de 88.1 µmol CO, m{ ²s{ ¹. Además, G. angustifolia exhibió una menor tasa de respiración diurna (Rd) (0.33 µmol CO, m{ ²s{ ¹), lo que optimiza su eficiencia energética, mientras que B. vulgaris presentó una Rd más alta (1.08 µmol CO, m{ ²s{ ¹), lo que implica mayor consumo de energía en condiciones de baja intensidad lumínica. G. angustifolia no mostró fotoinhibición, ya que su tasa de asimilación fotosintética aumentó continuamente con la luz. En contraste, B. vulgaris experimentó fotoinhibición a partir de 700 µmol m{ ²s{ ¹ de PPFD. Estos hallazgos evidencian que G. angustifolia está mejor adaptada para capturar carbono en condiciones de baja concentraciones de CO, y altas intensidades de luz, mientras B. vulgaris parece adaptarse mejor a ambientes con mayor concentración CO.

La fibromialgia es un síndrome que produce dolor muscular generalizado y difuso acompañado de fatiga, aunque también aparecen diversos síntomas, como depresión, ansiedad, alteración del sueño y del descanso, alodinia, problemas cognitivos, psicológicos y sociales. Esta sintomatología ocasiona que la calidad de vida de los pacientes se vea altamente afectada. Las formas de presentación de la patología aumentan la dificultad para el diagnóstico y el tratamiento de los profesionales que abordan a estos pacientes, para lo que destaca una prevalencia de 21:1 a favor de las mujeres sobre los hombres. Por otro lado, esta enfermedad conlleva un coste económico alto, pues 2/3 de los gastos no se invierten directamente para tratar la patología, por lo que se consideran perdidos. El objetivo de esta revisión es demostrar la eficacia de la adición de diferentes tratamientos activos, en comparación con el tratamiento farmacológico usual, en cuanto a la mejora de la calidad de vida y la reducción del dolor y la depresión en mujeres con fibromialgia. Para ello, se emplearon las bases de datos WOS, Cochrane Library y PubMed. Se seleccionaron siete artículos cuyo objetivo fue analizar la eficacia y seguridad del ejercicio terapéutico, una herramienta altamente costo-efectiva, como parte del tratamiento en mujeres con fibromialgia. Se seleccionaron ensayos clínicos con, al menos, un grupo de intervención que realizaba algún tipo de actividad física. Los artículos indicaron que el ejercicio físico como terapia añadida tiene beneficios en la calidad de vida, el alivio del dolor y la disminución de la depresión en mujeres con fibromialgia en comparación con aquellos grupos que simplemente seguían el tratamiento usual. Por ello, podemos concluir que el tratamiento usual (basado en fármacos), acompañado de un tratamiento activo, presenta mayores beneficios en las tres dimensiones ya mencionadas si lo comparamos con el tratamiento exclusivamente con fármacos. El tratamiento activo se considera seguro si deseamos añadirlo a la caja de herramientas que tenemos para tratar la sintomatología de la fibromialgia. Dependiendo de la sintomatología del paciente, y de sus gustos y preferencias, podríamos recomendarle o pautarle distintos tipos de actividad física para así favorecer su adherencia e individualizar cada caso.

En la Amazonía ecuatoriana, cada día son mayores los desafíos para la identificación de especies fitorremediadoras que disminuyan la contaminación por metales pesados producto de la actividad minera. El objetivo de este trabajo fue evaluar el potencial bioacumulador de metales pesados de tres especies forestales de rápido crecimiento (Ochroma pyramidale, Piptocoma discolor y Bambusa vulgaris) en un área de extracción minera, en la comunidad Yutzupino, Napo para la restauración. Se recolectaron muestras de hoja y suelo para determinar la concentración de metales pesados (Cd, Pb, Fe y Ni), mediante espectrometría de absorción atómica y se calculó el factor de bioconcentración (FBC). Los análisis foliares mostraron que B. vulgaris presentó mayor concentración de Ni (6,89 mg kg-1) y Fe (156,33 mg kg-1) y P. discolor contenía Cd (0,35 mg kg-1) y Pb (55,67 mg kg -1). Los análisis de suelos mostraron un patrón de variación en B. vulgaris superior en Cd, Ni y Pb y en O. pyramidale para Fe. El factor de bioconcentración permitió identificar la capacidad acumuladora de las especies, lo que sugiere que P. discolor puede ser utilizada como especie fitorremediadora para sitios contaminada por Cd y Pb, O. pyramidale para Ni y B. vulgaris para Fe.

Aims: The aim of this study was to determine the clinical profile, associated events and safety of vericiguat in a real‐world cohort of patients with heart failure with reduced ejection fraction (HFrEF). Methods: This study is a prospective and observational cohort study of patients with HFrEF and recent HF worsening episodes requiring intravenous therapy who initiated vericiguat in an HF outpatient clinic. A subanalysis of patients with ≥6 months' follow‐up was performed separately. Results: Out of 103 patients initially included, 52 had a follow‐up of at least 6 months (median follow‐up of 303 days). At baseline, the mean age was 71.3 ± 9.4 years, 27.2% were women, the median left ventricular ejection fraction was 34% (28%–39%) and 99% were taking beta‐blockers, 96.1% sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, 95.1% sacubitril–valsartan, 90.3% aldosterone antagonists and 93.2% loop diuretics. During follow‐up, New York Heart Association (NYHA) functional class improved (from 67.3% and 32.7% in classes III and II, respectively, to 22.4% and 75.5% at study end; P < 0.001), as did the EuroQol‐5D (EQ‐5D) and visual analogue scale (VAS) scores (from 0.83 ± 0.13 to 0.87 ± 0.12, P = 0.032, and from 60 to 79, P = 0.005, respectively). Vericiguat was well tolerated (13.5% had symptomatic hypotension, and 11.5% had discontinued treatment), and 78.8% of patients achieved the target dose of 10 mg. The number of HF‐related hospitalizations/decompensations within the previous 12 months was 2.3 ± 1.4 and decreased with vericiguat to 0.79 ± 1.14 (P < 0.001). At study end, 7.7% died (50% for HF). Conclusions: In clinical practice, treatment with vericiguat is associated with substantial improvements in functional class and quality of life and a reduction in hospitalizations for HF, with a low risk of adverse effects. [ABSTRACT FROM AUTHOR]

Copyright of Revista Cubana de Ciencias Forestales is the property of Universidad de Pinar del Rio and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To analyse the cost-effectiveness of multicomponent interventions designed to improve outcomes in type 2 diabetes mellitus (T2DM) in primary care in the Canary Islands, Spain, within the INDICA randomised clinical trial, from the public health system perspective.Design An economic evaluation was conducted for the within-trial period (2 years) comparing the four arms of the INDICA study.Setting Primary care in the Canary Islands, Spain.Participants 2334 patients with T2DM without complications were included.Interventions Interventions for patients (PTI), for primary care professionals (PFI), for both (combined intervention arm for patients and professionals, CBI) and usual care (UC) as a control group.Outcomes The main outcome was the incremental cost per quality-adjusted life-years (QALY). Only the intervention and the healthcare costs were included.Analysis Multilevel models were used to estimate results, and to measure the size and significance of incremental changes. Missed values were treated by means of multiple imputations procedure.Results There were no differences between arms in terms of costs (p=0.093), while some differences were observed in terms of QALYs after 2 years of follow-up (p=0.028). PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and the UC arms were very small in terms of QALYs, but significant in terms of healthcare costs (p=0.045). The total cost of the PTI arm (€2571, 95% CI €2317 to €2826) was lower than the cost in the UC arm (€2750, 95% CI €2506 to €2995), but this difference did not reach statistical significance. Base case estimates of the incremental cost per QALY indicate that the PTI strategy was the cost-effective option.Conclusions The INDICA intervention designed for patients with T2DM and families is likely to be cost-effective from the public healthcare perspective. A cost-effectiveness model should explore this in the long term.Trial registration number NCT01657227.

El presente trabajo de investigación propone el diseño y simulación de una antena de parche pentagonal con polarización circular para la banda de 2.4 GHz mediante acoplamiento electromagnético en una sola capa. La configuración propuesta tiene como objetivo ser utilizada en lectores RFID (Radio Frequency Identification) y lograr buenos resultados de radiación con la mayor sencillez posible en su diseño. La polarización circular es obtenida mediante la técnica de acoplamiento electromagnético modificando las dimensiones de la línea de alimentación y es optimizada introduciendo perturbaciones en la geometría del parche. Con la antena propuesta se obtiene una miniaturización de sus dimensiones, una ganancia de aproximadamente 1.642 dB en 2.44 GHz, anchos de banda de acoplamiento y de polarización circular de 111.6 MHz y 138 MHz, lo que representa un 4.75 % y 5.65 % respectivamente de la frecuencia central.

Objective This study assesses the effectiveness of different interventions of knowledge transfer and behaviour modification to improve type 2 diabetes mellitus patients’ (T2DM) reported outcomes measures (PROMs) in the long-term. Design: open, community-based pragmatic, multicentre, controlled trial with random allocation by clusters to usual care (UC) or to one of the three interventions.Participants A total of 2334 patients with uncomplicated T2DM and 211 healthcare professionals were included of 32 primary care centres.Setting Primary Care Centers in Canary Islands (Spain).Intervention The intervention for patients (PTI) included an educational group programme, logs and a web-based platform for monitoring and automated short message service (SMS). The intervention for professionals (PFI) included an educational programme, a decision support tool embedded into the electronic clinical record and periodic feedback about patients’ results. A third group received both PTI and PFI (combined intervention, CBI).Outcome measure Cognitive-attitudinal, behavioural, affective and health-related quality of life (HQoL) variables.Results Compared with UC at 24 months, the PTI group significantly improved knowledge (p=0.005), self-empowerment (p=0.002), adherence to dietary recommendations (p

Fibromyalgia is a syndrome that causes generalized and diffuse muscle pain accompanied by fatigue, although other symptoms also appear, such as depression, anxiety, sleep and rest disturbances, allodynia, and cognitive, psychological and social problems. These symptoms notably affect the patients' quality of life. The forms of presentation of the pathology increase the difficulty of diagnosis and treatment for professionals who treat these patients, with a significant prevalence ratio of 21:1 in favor of women over men. On the other hand, this disease entails a high economic cost, as 2/3 of the expenses are not directly invested to treat the pathology; therefore, they are considered losses. The objective of this review is to demonstrate the effectiveness of adding various active treatments, compared to the usual pharmacological treatment, in improving quality of life and reducing pain and depression in women with fibromyalgia. For this purpose, the WOS, Cochrane Library and PubMed databases were used. Seven articles were selected, aimed at analyzing the effectiveness and safety of therapeutic exercise, a highly cost-effective tool, as part of the treatment of women with fibromyalgia. Clinical trials were selected with at least one intervention group that performed some type of physical activity. The articles indicated that physical exercise as an additional therapy provided benefits in quality of life, pain relief and reduction of depression in women with fibromyalgia compared to those groups that simply followed the usual treatment. Therefore, we can conclude that the usual (drug-based) treatment, accompanied by an active treatment, offers greater benefits in the three abovementioned aspects when compared to treatment with drugs alone. Active treatment is considered safe to add to our toolbox for treating the symptoms of fibromyalgia. Depending on the patient's symptoms, tastes and preferences, we could recommend or prescribe different types of physical activity to promote adherence and tailor the treatment for each case. [ABSTRACT FROM AUTHOR]

The evergreen forests of the Ecuadorian Amazon Region are altered by anthropogenic and natural factors. This provokes the need to look for tools that facilitate decision-making in support of restoration. We characterized the ecological structure and distribution of an evergreen Amazonian-Andean forest in the upper Puyo River micro-basin as a base for establishing an ecological quality index. The inventory was assessed using transects 0.1 ha (10 m × 100 m), registering the species with diameters at 1.30 m height ≥10 cm. We encountered a high degree of richness (30 families, 65 species and 322 individuals). The structural parameters indicated the predominance of a heterogeneous forest, with characteristics belonging to disturbed forests. A non-continuous vertical distribution pattern was found, determined by 78% of the species in a single stratum. The mixing ratio resulted in a higher proportion (1:5) for the lower class. The species Wettinia maynensis, Alchornea glandulosa, Miconia splendens, Piptocoma discolor and Inga velutina had the highest ecological value. The principal components analysis distinguished the abundance of species that had a high correlation with the sites and a distinct pattern was found in transect three. We developed the Structural Ecological Quality Index, which considers the social position of various species as well as their ecological importance, to reflect alterations in structural parameters. Abundance was concentrated in the 10–20 m strata (10–20 cm diameter class), which showed the presence of disturbance indicator species and a low ecological value. This indicated the real value of the historical succession of the forest, thus we recommend carrying out a restoration of this important reservoir.

Naranjilla (Solanum quitoense Lam.), is an economic input of vital importance for the Ecuadorian Amazon due to multiple benefits that offers, although it requires studies that provide a basis for the naranjilla cultivation management. The aim of this research was to determine the influence of socioeconomic variables on the naranjilla production from the rural community of Wamani, Napo province in the Ecuadorian Amazon. For the study, a group-type questionnaire was conducted to 40 rural producers of naranjilla in the region, which was structured based on three levels, which included data on the property, crop management and socio-economic aspects. Additionally, a factor analysis was applied to reduce the variables dimensionality. The results showed a pattern of own land distribution which is favorable to develop the family economy. It was found that naranjilla cultivation is the most important item in the community, although there are other crops that guarantee the diversification of the productive systems, which is reflected in the socioeconomic indicators. The T-test of independent samples, indicated that there are no significant differences among indicators for clean and chemical crop management (p≥0.05), which demonstrates the feasibility of use for the cultivation of clean naranjilla as a healthier product with additional benefits for rural producers. The factorial analysis have allowed the reduction of the 16 evaluated variables in three components associated with the economic, social and productive indicators, which explained 79.46% of the total accumulated variance.

The Ecuadorian Amazon is recognized worldwide for its extraordinary megadiversity and multiplicity of forest goods and services. However, the inadequate practices of extractive use of non-timber forest products, the clearing of extensive areas of forests for the development of oil activity and the unsustainable use of timber as economic sustenance of communities have led to structural and functional changes In ecosystems. The study was carried out in three sites of a degraded evergreen forest of the eastern Amazon (Mera, Shell and Puyo) in order to evaluate the effect of the degree of intervention on the forest structure. A floristic inventory was carried out with 60 plots of 25 x 25 m2 and tree species ≥ 2.5 cm d1.30 and species in natural regeneration phase with h