http://hdl.handle.net/10366/3947 Thu, 20 Aug 2026 00:19:59 GMT 2026-08-20T00:19:59Z http://hdl.handle.net/10366/172398 [ES]Se especifica de manera sencilla, estructurada, y actualizada el manejo prehospitalario del paciente en shock hipovolémico hemorrágico. Es un documento de libre acceso, gratuito enfocado a alumnos pregrado de reama sanitaria y egresados con enfoque a emergencias prehospitalarias. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10366/172398 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172394 Background Strong evidence shows the importance of intrinsic foot muscles (IFMs) in balance and foot and ankle biomechanics; despite this, not much research has been published regarding the role of IFMs on chronic ankle instability. The aim of the study was to compare IFMs morphology and function between young handball players with and without chronic ankle instability. The secondary objective was to assess the association between the morphology or function of the IFMs and the foot morphology. Methods Cross-sectional case-control study. A sample of 100 young handball players were recruited and divided into athletes with chronic ankle instability (case group, n = 50) and without (control group, n = 50). Main outcome measures: morphology and function of abductor hallucis, abductor digiti minimi, flexor hallucis brevis, flexor digitorum brevis and quadratus plantae, which were assessed with ultrasound examination at rest and in active contraction. Foot Posture Index-6 was used to analyze foot morphology. Results Significant differences were only found in the abductor hallucis morphology (case group CSA 2.14cm2, control group CSA 1.84cm2, p 0.013) and in the flexor hallucis brevis morphology (case group thickness 1.31 cm, control group thickness 1.41 cm, p 0.005). A significant but weak positive correlation was found between foot morphology and abductor hallucis function (r = 0.32, p = 0.025). Conclusions Between-groups differences were only found in abductor hallucis and flexor hallucis brevis morphology; no differences were found in the rest of IFMs morphology and function outcomes. A significant positive association was only found between foot morphology and AbH function in young athletes with CAI. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10366/172394 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172344 [ES]Se expone de manera secuencial la asistencia inicial al trauma grave en el deporte, con el método de evaluación XABCDE. Sat, 01 Jan 2011 00:00:00 GMT http://hdl.handle.net/10366/172344 2011-01-01T00:00:00Z http://hdl.handle.net/10366/172277 [ES] Debido a la crisis generada por las bacterias resistentes a antibióticos, es necesario identificar nuevas moléculas con potencial antibiótico que permitan tratar las infecciones bacterianas actuales. Uno de los abordajes para conseguir este objetivo es el estudio de la regulación de la producción de antibióticos por microorganismos productores. Entre ellos, las bacterias del género Streptomyces poseen un gran potencial, dada su gran cantidad de genes que permiten la síntesis de metabolitos secundarios. Estos genes están muy controlados por factores de regulación que integran señales externas e internas, de modo que caracterizar estas redes es crucial para comprender qué factores son necesarios para incrementar la producción de antibióticos y para despertar genes no activados en condiciones de laboratorio, que puedan ser claves para la producción de nuevas moléculas. En este trabajo, se ha profundizado en el estudio de las redes de regulación de S. coelicolor, organismo modelo del género Streptomyces. Los sistemas de dos componentes (TCS) en estas bacterias cumplen un papel esencial en el control del desarrollo y del metabolismo. Algunos TCS descritos en nuestro grupo de investigación intervienen en la producción de antibióticos en S. coelicolor, y todos ellos regulan el gen bfr, que codifica la bacterioferritina Bfr. Entre estos TCS destaca el regulador huérfano Aor1, que tiene gran influencia en la expresión del genoma de S. coelicolor y cuya histidina quinasa asociada, encargada de activarlo, se desconoce. En primer lugar, en esta tesis se describe el papel de la bacterioferritina codificada por el gen bfr en el desarrollo de S. coelicolor mediante el estudio del mutante de deleción Δbfr. Bfr es un elemento necesario para una correcta diferenciación y producción de antibióticos (actinorrodina, prodigiosinas y coelimicinas) en medios de cultivo complejos, mientras que en medio mínimo su efecto depende de la concentración de hierro y del estado (sólido o líquido) del medio. Bfr está implicada en la homeostasis del hierro, pero esta no es su función principal al no alterarse los niveles de hierro en el mutante Δbfr. La ausencia de bfr causa cambios a nivel proteómico: aumenta la abundancia de proteínas de estrés oxidativo (y los niveles de especies reactivas de oxígeno en el mutante), del antibiótico dependiente de calcio y de proteínas de respiración, mientras que disminuye la abundancia de proteínas de desarrollo, de varios clústeres para biosíntesis de metabolitos y de traducción. Además, varias proteínas de señalización alteran sus niveles en el mutante Δbfr. Con los datos de esta tesis, se propone un modelo en el que Bfr es necesaria para donar hierro a proteínas de regulación importantes para la síntesis de metabolitos secundarios. En cuanto al regulador huérfano Aor1, mediante varias estrategias, se han identificado varias quinasas que podrían estar asociadas a este regulador: SCO3750 (quinasa huérfana), SCO2215 (asociada al regulador SCO2216) y SCO2359 (asociada al regulador SCO2358). La asociación entre estas proteínas y Aor1 se ha estudiado mediante la generación de mutantes de deleción y CRISPR de interferencia, y se ha validado mediante ensayos de dos híbridos. También se ha estudiado brevemente la relación entre el sistema AbrC, previamente caracterizado en el laboratorio, con Aor1. Aún quedan por caracterizar las señales a las que responden estas proteínas y su mecanismo de regulación. Finalmente, se realizó un estudio metabolómico de varias cepas de interés relacionadas con los TCS estudiados en este trabajo: la cepa silvestre y los mutantes ΔabrA, Δbfr, Δaor1, ΔSCO3750, ΔSCO2359 y ΔSCO2359/2358. Muchos de los metabolitos anotados al comparar los metabolomas de cada mutante con el silvestre no se pudieron identificar con exactitud, lo cual refleja el conocimiento que falta en el metabolismo de S. coelicolor. La identificación de estos metabolitos sería clave para profundizar en los mecanismos de regulación de estos sistemas. En conclusión, esta tesis caracteriza en gran medida el papel de bfr en la red regulatoria de la producción de antibióticos de S. coelicolor, y profundiza en la red molecular del regulador huérfano Aor1 mediante su relación con nuevos elementos no descritos anteriormente (la quinasa huérfana SCO3750 y los TCS SCO2215/2216 y SCO2359/2358) y con el sistema AbrC. Además, este trabajo inicia el estudio metabolómico de estos sistemas involucrados en la síntesis de antibióticos y propone su estudio más detallado para comprender las redes de regulación de S. coelicolor y mejorar la producción y descubrimiento de metabolitos secundarios.; [EN] Due to the crisis caused by antibiotic-resistant bacteria, it is necessary to identify new molecules with antibiotic potential that can treat current bacterial infections. One approach to achieve this goal is to study the regulation of antibiotic production by antibiotic-producing microorganisms. Among these, bacteria from the genus Streptomyces have great potential, given their large number of genes that enable the synthesis of secondary metabolites. These genes are tightly controlled by regulatory factors that integrate external and internal signals, so characterizing these networks is crucial to understand which factors are necessary to increase antibiotic production and to turn on genes that are not activated under laboratory conditions, which may be key to the production of new molecules. In this work, we have delved deeper into the study of the regulatory networks of S. coelicolor, a model organism of the Streptomyces genus. Two-component systems (TCS) in these bacteria play an essential role in controlling development and metabolism. Some TCS described in our research group are involved in the production of antibiotics in S. coelicolor, and all of them regulate the bfr gene, which encodes the bacterioferritin Bfr. Among these TCS, the orphan regulator Aor1 stands out, which has a major influence on the expression of the genome of S. coelicolor and whose associated histidine kinase, responsible for activating it, is unknown. Firstly, this thesis describes the role of the bacterioferritin codified by the bfr gene in the development of S. coelicolor by studying the Δbfr deletion mutant. Bfr is a necessary element for the correct differentiation and production of antibiotics (actinorhodin, prodigiosins and coelimycins) in complex culture media, while in minimal media its effect depends on the iron concentration and the state (solid or liquid) of the medium. Bfr is involved in iron homeostasis, but this is not its main function, as iron levels are not altered in the Δbfr mutant. The lack of bfr produces changes at the proteomic level: the abundance of proteins linked to oxidative stress (and levels of reactive oxygen species in the mutant), calcium-dependent antibiotic and respiration proteins increases, while the abundance of developmental proteins, various clusters for metabolites biosynthesis and translation proteins decreases. In addition, several signaling proteins alter their levels in the Δbfr mutant. Based on the data from this thesis, a model is proposed in which Bfr is necessary to donate iron to regulatory proteins important for the synthesis of secondary metabolites. As for the orphan regulator Aor1, several strategies have been used to identify several kinases that could be associated with this regulator: SCO3750 (orphan kinase), SCO2215 (associated with the regulator SCO2216) and SCO2359 (associated with the regulator SCO2358). The association between these proteins and Aor1 has been studied by generating deletion mutants and CRISPR interference and has been validated by two-hybrid assays. The relationship between the AbrC system, previously characterized in the laboratory, and Aor1 has also been briefly studied. The signals these proteins respond to, and their regulatory mechanism, remain to be characterized. Finally, a metabolomic study was performed on several strains of interest related to the TCS studied in this work: the wild-type strain and the mutants ΔabrA, Δbfr, Δaor1, ΔSCO3750, ΔSCO2359 and ΔSCO2359/2358. Many of the metabolites noted when comparing the metabolomes of each mutant with the wild type could not be identified with certainty, reflecting the lack of knowledge about the metabolism of S. coelicolor. The identification of these metabolites would be key to further understanding the regulatory mechanisms of these systems. In conclusion, this thesis largely characterizes the role of bfr in the regulatory network of antibiotic production in S. coelicolor and delves into the molecular network of the orphan regulator Aor1 through its relationship with new, previously undescribed elements (the orphan kinase SCO3750 and the TCS SCO2215/2216 and SCO2359/2358) and with the AbrC system. Furthermore, this work initiates the metabolomic study of these systems involved in antibiotic synthesis and proposes more detailed studies to understand the regulatory networks of S. coelicolor and improve the production and discovery of secondary metabolites. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10366/172277 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172269 [EN]It is known that Rho GTPases control different aspects of the biology of skin stem cells (SSCs). However, little information is available on the role of their upstream regulators under normal and tumorigenic conditions in this process. To address this issue, we have used here mouse models in which the activity of guanosine nucleotide exchange factors of the Vav subfamily has been manipulated using both gain- and loss-of-function strategies. These experiments indicate that Vav2 and Vav3 regulate the number, functional status, and responsiveness of hair follicle bulge stem cells. This is linked to gene expression programs related to the reinforcement of the identity and the quiescent state of normal SSCs. By contrast, in the case of cancer stem cells, they promote transcriptomal programs associated with the identity, activation state, and cytoskeletal remodeling. These results underscore the role of these Rho exchange factors in the regulation of normal and tumor epidermal stem cells. Wed, 01 Jun 2022 00:00:00 GMT http://hdl.handle.net/10366/172269 2022-06-01T00:00:00Z http://hdl.handle.net/10366/172264 [ES] La búsqueda de una menor pérdida ósea crestal y un aumento de la estabilidad secundaria determinados por AFR (ISQ) durante la osteointegración constituyen la motivación principal del presente estudio clínico experimental. Además, si se confirma que la altura del pilar y el espacio interoclusal condicionan los valores ISQ, los resultados permitirán desarrollar protocolos de selección de pilares de cicatrización más idóneos para cada situación que nos permitirán monitorizar la osteointegración desde su fase inicial hasta la fase protésica permitiendo obtener datos objetivos. Estos hallazgos de investigación contribuirán a una práctica odontológica más personalizada y segura. La hipótesis nula del presente estudio clínico observacional prospectivo de cohortes es que la altura del pilar de cicatrización no influye en la estabilidad secundaria del implante, medida mediante análisis de frecuencia de resonancia durante el periodo de osteointegración bajo carga convencional. La hipótesis alternativa sostiene que altura del pilar de cicatrización, y por tanto la distancia del mismo respecto a la cara oclusal del diente antagonista, si afecta significativamente a la estabilidad secundaria alcanzada al finalizar el periodo de osteointegración. Para comprobar las hipótesis, se han establecido los siguientes objetivos principales: 1. Evaluar los resultados de estabilidad secundaria obtenidos por implantes tipo Tissue Level de conexión interna y cuello pulido de 1.5 m durante el proceso de integración bajo carga convencional (8 semanas), en un protocolo de una fase (no sumergido), medido mediante análisis de frecuencia de resonancia (AFR) cuando se compara el uso de pilares de cicatrización de diferentes alturas 1, 3 y 5 mm, lo cual permite en cada situación clínica obtener diferentes distancias oclusales medidas en mm 2. Comparar la evolución de la estabilidad implantaria mediante AFR en diferentes puntos del seguimiento: colocación del implante, en semana 2, semana 4 y semana 8 del grupo en el que, tras la colocación del pilar de cicatrización, la distancia entre la parte coronal del mismo y la cara oclusal del diente antagonista sea menor a 4 mm. 3. Comparar la evolución de la estabilidad implantaria mediante AFR en diferentes puntos del seguimiento: colocación del implante, en semana 2, semana 4 y semana 8 del grupo en el que, tras la colocación del pilar de cicatrización, la distancia entre la parte coronal del mismo y la cara oclusal del diente antagonista sea mayor o igual a 4 mm. Para ello se ha diseñado un estudio clínico observacional analítico y prospectivo, que puede considerarse un estudio de cohortes, ajustándose a las recomendaciones de la guia STROBE Statement. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10366/172264 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172260 [ES] Esta tesis doctoral se establece como un estudio multicéntrico prospectivo no concurrente observacional de 1136 varones intervenidos mediante prostatecomía robótica (PRR) por cáncer de próstata. Se parte de la hipótesis de que podría existir una relación entre los hallazgos de la resonancia magnética nuclear para la caracterización del cáncer de próstata y los resultados de la prostatecomía radical robótica. Para ello se han establecido los siguientes objetivos: documentar la tasa de uso real de la resonancia magnética, en pacientes con diagnóstico de cáncer de próstata previamente a la prostatectomía radical; identificar la tasa de éxito de curación del cáncer mediante prostatecomía radical robótica; establecer la relación entre la caracterización PIRADS de la resonancia magnética nuclear, así como el pronóstico del cáncer después de la prostatectomía radical robótica; y finalmente, conocer si el uso de la resonancia magnética nuclear influye en el manejo del cáncer de próstata. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10366/172260 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172223 Background: Invasive aspergillosis (IA) is an opportunistic infection that affects immuno compromised patients. While voriconazole is commonly used for IA treatment, it presents the risk of drug interactions, particularly in patients on polytherapy. Isavuconazole may serve as a safer alternative with fewer interactions. However, the use of isavuconazole is typically limited to the parenteral route for patients without access to the enteral route, due to recommendations against tablet handling for enteral administration. The objective of this study was to evaluate the suitability of isavuconazole administration via an enteral tube, by therapeutic drug monitoring of isavuconazole plasma concentrations. Methods: This case study examines a patient with diffuse large B-cell lym phoma who was diagnosed with IA and treated with isavuconazole via an enteral tube. Therapeutic pharmacokinetic monitoring of isavuconazole plasma concentrations was performed to assess the feasibility and safety of enteral administration.The results show that isavuconazole concentrations were maintained within the therapeutic range when administered via an enteral tube. No significant deviations in plasma concentration were noted during the monitoring period. Conclusions: Administering isavuconazole through an enteral tube is a safe and viable alternative for patients that are unable to receive the drug via the oral route. Therapeutic monitoring of plasma concentrations is recommended to ensure proper dosing and efficacy. Mon, 01 Jan 2024 00:00:00 GMT http://hdl.handle.net/10366/172223 2024-01-01T00:00:00Z http://hdl.handle.net/10366/172222 Background: Isavuconazole is a broad-spectrum antifungal agent used for treating invasive fungal infections (IFIs). Its pharmacokinetics may be impacted in hematologic patients due to concomitant clinical and therapeutic factors potentially affecting drug exposure. The aim of this study was to develop a population pharmacokinetic (popPK) model of isavuconazole in adult hematologic patients to support model-informed precision dosing. Materials and method: Prospective, non-controlled study performed in adult hematologic patients receiving isa vuconazole for IFIs and followed up by a therapeutic drug monitoring (TDM) program. Isavuconazole plasma concentrations were quantified using an ultra-high-performance liquid chromatography (UPLC) with UV de tector. A popPK model was developed using NONMEM v.7.5.0. Simulations were based on the final model to evaluate the differences across physiological variables with impact on drug exposure. Results: A one-compartment model with first-order absorption and elimination described adequately 121 isa vuconazole concentrations from 52 patients. Body surface area (BSA) and serum albumin (ALB) significantly influenced drug clearance. The final popPK model showed good precision, robustness, and predictive perfor mance, supporting its use for individualized isavuconazole dosing in this population. Conclusions: BSA and serum ALB were identified as covariates influencing isavuconazole clearance in adult he matologic patients. Further studies are needed to better characterize the absorption of isavuconazole and im plications on dosage recommendations, especially for higher proposed doses. Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/10366/172222 2025-01-01T00:00:00Z http://hdl.handle.net/10366/172221 Therapeutic drug monitoring (TDM) is routinely recommended for most antifungal triazoles to ensure efficacy and safety. Isavuconazole, however, was initially approved without this recommendation due to its predictable pharmacokinetic profile. Later clinical data have raised concerns about subtherapeutic exposures in certain populations. This prospective, single-center study aimed to assess the need for TDM of isavuconazole in critically ill and hematologic patients with invasive fungal infections. Between March 2022 and November 2023, patients receiving standard dosing of isavuconazole were enrolled, and plasma concentrations were measured to determine the proportion of patients with values outside the therapeutic range (1–4 µg/mL), particularly focusing on subtherapeutic levels. A total of 65 isavuconazole plasma concentrations from 24 patients (9 critically ill and 15 hematologic) were analyzed. Critically ill patients had lower initial concentrations than hematologic patients (median [range]: 0.75 [not detectable (ND)–5.18] vs. 3.03 [1.03–6.65] µg/mL), with 66.7% showing levels outside the therapeutic range and 55.5% having subtherapeutic concentrations. The coefficient of variation (CV%) of concentrations values at the first TDM was 124.7% in critically ill patients and 57.3% in hematologic patients. After dose adjustment in critically ill patients, the proportion with levels outside the therapeutic range decreased to 28.6%. These findings suggest that, despite initial assumptions, isavuconazole exhibits considerable pharmacokinetic variability in specific populations, particularly in critically ill patients, and the findings support the implementation of TDM to optimize antifungal therapy and improve patient outcomes in real-world clinical settings. Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/10366/172221 2025-01-01T00:00:00Z http://hdl.handle.net/10366/172220 Purpose Drug (or medicine) recalls represent a public health risk and may contribute to shortages, potentially affecting sup ply continuity and, consequently, patient care. This study analyzed drug recalls issued by the Spanish Agency of Medicines and Medical Devices (AEMPS) and conducted an additional descriptive recall-related shortage assessment to estimate their potential impact on supply continuity in Spain. Methods A descriptive retrospective regulatory analysis was conducted on drug recalls in Spain over a 14-year period (2010–2023). Data from the AEMPS website were analyzed, and drug recalls recorded during the last 4 years of the study period (2020–2023) were cross‑referenced with national shortage records to assess their supply impact. Results A total of 1,120 drug recalls were identified, 87.86% (n = 984) involved prescriptions and 57.32% (n = 642) were classified as Class 2, recalls with a moderate risk of temporary or medically reversible adverse health consequences. The presence of nitrosamines (22.50%, n = 252) was the leading cause of recalls, driven by a phase-specific crisis (2018–2019), with the highest number of issued recalls (19.19%, n = 215) observed in 2018. Five manufacturers of active substances and finished products accounted for 27.32% (n = 306) of all recalls. Drug recalls issued between 2020 and 2023 (n = 195) resulted in a total of 55 drug shortages. Of these shortages, 10.91% (n = 6) were considered to have a high clinical impact on supply continuity. Conclusion Nitrosamines emerged as the leading cause of recalls in Spain during the study period. A subset of recalls was linked to shortages affecting supply continuity, posing a potential risk to patients’ health. These findings underscore the importance of monitoring recalls and addressing supply chain vulnerabilities to mitigate negative effects on patients’ health and access to essential medications Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10366/172220 2026-01-01T00:00:00Z http://hdl.handle.net/10366/172219 Background In this study, the efficacy of three essential oil extraction techniques steam entrainment, Soxhlet extraction, and supercritical fluid extraction (SCF) was evaluated. Aim Determine the most effective method for obtaining bioactive compounds from Cymbopogon citratus, Origanum vulgare, and Coriandrum sativum, plant species recognized for their antimicrobial and anti-inflammatory properties with potential applications in dentistry. The selected plants, identified based on scientific evidence, were certified and lyophilized prior to extraction. The efficiency of each technique was assessed in terms of essential oil yield, purity, and biological activity. Methodology The plant species were selected for their therapeutic properties based on scientific reports, certified, and lyophilized before proceeding with the different extraction methods. The efficacy of each technique was compared in terms of the purity and yield of the essential oils obtained. The statistical analysis was performed using SPSS version 25. Results It was shown that FSC extraction is the method that allows obtaining essential oils with the highest purity and yield, followed by steam entrainment, with the Soxhlet method being the least efficient. However, in the microbiological analysis, the essential oil obtained by steam entrainment showed a greater inhibitory effect against Candida albicans ATCC 90028. Conclusion In this study, the FSC and steam entrainment techniques are the most suitable for obtaining essential oils for therapeutic applications in dentistry, since they allow better preservation of the bioactive components and reduce the environmental impact. These results position FSC and vapor entrainment extraction as promising options for the development of therapeutic products in dentistry. Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/10366/172219 2025-01-01T00:00:00Z http://hdl.handle.net/10366/172218 Background: The increasing resistance of Candida albicans to conventional antifungal agents has intensified the search for alternative therapies based on natural metabolites. Aim: This study aimed to evaluate the phytochemical profile and antifungal activity of a phytopharmaceutical formulation composed of essential oils from Cymbopogon citratus (lemongrass), Coriandrum sativum (coriander), and Origanum vulgare (oregano), obtained by steam distillation from plants collected in the southern region of Ecuador. Methodology: The chemical composition was characterized by gas chromatography coupled with mass spectrometry (GC–MS). A total of 40 compounds were identified, with carvacrol (30.01%), α-citral (12.57%), β-citral (9.55%), linalool (8.47%), (E)-2-decenal (8.38%), and geraniol (2.81%) as the major constituents. Antifungal activity was assessed using the agar diffusion method against C. albicans ATCC 90028, comparing formulations at 2.5%, 5%, 10%, and 25%. Results: The ternary formulation at 10% in an alcoholic vehicle exhibited the largest inhibition zone (77.89 ± 2.48 mm), significantly surpassing both positive controls, including 0.12% chlorhexidine gluconate (35.13 ± 0.01 mm) and fluconazole (21.63 ± 6.29 mm). The aqueous formulation also demonstrated considerable antifungal activity, although lower than the alcoholic system. Conclusion: The novel phytopharmaceutical formulation demonstrated notable antifungal activity and may represent a promising natural alternative for oral candidiasis management. Nevertheless, further studies incorporating complementary methodologies, such as minimum inhibitory and fungicidal concentration (MIC/MFC) assays, as well as in vivo and biocompatibility evaluations, would contribute to strengthening the translational potential and clinical applicability of these findings. Fri, 26 Jun 2026 00:00:00 GMT http://hdl.handle.net/10366/172218 2026-06-26T00:00:00Z http://hdl.handle.net/10366/172194 Guía informativa dirigida a cuidadores de personas con daño cerebral adquirido (DCA). Se explica de forma sencilla qué es el DCA, sus causas más frecuentes y las principales áreas afectadas. Incluye recomendaciones para el cuidado físico y emocional de la persona con DCA; así como, pautas para el autocuidado del cuidador y el acceso a recursos especializados. Su diseño visual facilita la comprensión y la difusión de información básica sobre el cuidado integral de las personas con DCA. Se ha desarrollado dentro del proyecto NeuroMotion-USAL. Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/10366/172194 2025-01-01T00:00:00Z http://hdl.handle.net/10366/172152 [EN]Lifestyle factors may influence disability trajectories in multiple sclerosis (MS), yet prospective data linking sustained dietary adherence to objective clinical outcomes remain limited. Homocysteine, a metabolite involved in one-carbon metabolism, represents a biologically plausible mediator between nutrition and neurodegeneration, although its longitudinal clinical relevance in MS is uncertain. This study aimed to investigate whether adherence to a structured dietary intervention is associated with longitudinal changes in plasma homocysteine levels and disability progression in patients with MS over 12 months. In this prospective cohort study, 41 patients with MS were followed for 12 months. Dietary adherence was quantified using a structured follow-up scale (range 2-6). Plasma homocysteine levels and Expanded Disability Status Scale (EDSS) scores were assessed at baseline, 6 months, and 12 months. Associations between adherence, metabolic changes, and EDSS evolution were evaluated using correlation analyses and multivariate linear regression adjusting for age, sex, BMI, baseline EDSS, and treatment line. Baseline mean homocysteine was 10.91 ± 6.94 μmol/L and decreased to 8.24 ± 3.33 μmol/L at 6 months, remaining stable at 8.27 ± 2.42 μmol/L at 12 months. Between-group differences in homocysteine showed a trend toward significance at 12 months (ANOVA p = 0.059). Mean EDSS increased slightly from 1.14 to 1.23 in the overall cohort (p > 0.05). However, EDSS evolution differed according to dietary adherence (ANOVA p = 0.009): low-adherence patients showed a mean EDSS increase (+0.53 ± 0.72), whereas high-adherence patients showed a mean EDSS decrease (-0.56 ± 1.08). Given the low baseline EDSS, short follow-up, and small high-adherence subgroup, these changes should be interpreted as exploratory differences in short-term EDSS trajectory rather than confirmed clinical improvement and do not establish causality. Adherence score was inversely correlated with EDSS change (r = -0.57, p = 0.0006) and remained independently associated in multivariate analysis (β = -0.45, 95% CI -0.68 to -0.22, p = 0.0005). Higher adherence to the dietary counselling programme was associated with a more favourable short-term disability trajectory over 12 months. However, causality cannot be inferred, and the clinical significance of these modest changes remains uncertain. Because the adherence score was not formally validated and may partly reflect broader health-related behaviours or engagement with care, and because the dietary intervention was individualized, the study cannot identify specific dietary components or dietary patterns associated with disability trajectories. These exploratory findings require confirmation in larger controlled studies using validated dietary assessment instruments. Tue, 07 Jul 2026 00:00:00 GMT http://hdl.handle.net/10366/172152 2026-07-07T00:00:00Z http://hdl.handle.net/10366/172128 [ENG]Background: Cancer cachexia and sarcopenia are highly prevalent complications affecting up to 50% of patients with cancer and are associated with increased treatment toxicity, poorer functional outcomes, and reduced survival. Early identification of muscle deterioration during hospitalization remains challenging. Objective: To evaluate the change in dominant-hand handgrip strength between hospital admission and discharge in hospitalized oncology patients. Methods: This prospective longitudinal study will evaluate hospitalized adults with confirmed malignancy and an expected hospital stay of ≥5 days. Daily handgrip strength and sEMG assessments will be performed as exploratory secondary measures to characterize temporal patterns of muscle function during hospitalization. Baseline and discharge evaluations will additionally include bioelectrical impedance analysis, validated patient-reported outcome measures (SARC-F, EORTC QLQ-C30, PSQI), and serum biomarkers related to inflammatory and nutritional status. Linear mixed models will be used to evaluate longitudinal changes and associations between functional, electrophysiological, and biochemical parameters. Expected results: The study aims to characterize trajectories of muscle function decline during hospitalization, identify candidate biomarker signatures for cachexia detection, and evaluate neuromuscular fatigue patterns using sEMG. Conclusions: This protocol proposes a feasible multimodal framework for monitoring skeletal muscle deterioration during acute oncology hospitalization and may inform future interventional strategies targeting cancer-related cachexia and sarcopenia. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/10366/172128 2026-01-01T00:00:00Z