Resumen: Los corticoides prenatales disminuyen la mortalidad y el distrés respiratorio (SDR) en recién nacidos prematuros (RNPT). Estos beneficios decrecen tras la semana de su administración, recomendándose un rescate si existe una nueva amenaza de parto prematuro. La repetición de corticoides prenatales puede tener efectos deletéreos y sus beneficios son controvertidos en el retraso del crecimiento intrauterino (RCIU). Objetivo: comprobar los efectos del rescate con betametasona prenatal en la morbimortalidad neonatal, el SDR y el neurodesarrollo a los 2 años en prematuros con RCIU. Pacientes y Método: Estudio retrospectivo de RNPT ≤ 34 semanas y ≤ 1.500 g divididos en cohortes según la exposición a betametasona prenatal: Ciclo-único (2 dosis) vs Rescate (3 dosis). Se realizan subgrupos para ≥ 30 semanas. Se realizó un seguimiento de ambas cohortes hasta los 24 meses de edad corregida. Se aplicó el cuestionario Ages & Stages Questionnaire (ASQ)® para evaluar el neurodesarrollo. Resultados: Se incluyen 62 RNPT. El grupo Rescate vs. Ciclo-único no muestra diferencias en morbimortalidad y sí menor intubación (p = 0,02), sin diferencias en el soporte respiratorio a los 7 días de vida. RNPT ≥ 30 semanas con Rescate presentan mayor morbimortalidad (p = 0,03) y displasia broncopulmonar (DBP) (p = 0,02), sin diferencias en el SDR. El grupo rescate muestra peores puntuaciones medias en la escala ASQ-3, sin diferencias significativas en parálisis cerebral o déficits sensoriales. Conclusiones: El rescate no disminuye la morbimortalidad y sí reduce la intubación al nacimiento. Sin embargo, en ≥ 30 semanas no se observa este beneficio y la población expuesta a rescate presenta más DBP y menores puntuaciones en la escala ASQ-3 a los 2 años. Futuros estudios deben ir encaminados a la individualización de la terapia con corticoides prenatales.

Abstract: Antenatal corticosteroids reduce mortality and respiratory distress syndrome (RDS) in preterm newborns. These benefits decrease after a week of administration, recommending a rescue therapy if there is a new threat of premature delivery. Repeated administration of antenatal corticosteroids may have deleterious effects and their benefits are controversial in intrauterine growth restriction (IUGR). Objective: to verify the effects in the IUGR population of antenatal betamethasone rescue therapy on neonatal morbidity and mortality, RDS, and neurodevelopment at 2 years. Patients and Method: Retrospective study including ≤ 34 weeks and ≤ 1,500g preterm newborns divided according to antenatal betamethasone exposure: Single-cycle (2 doses) vs Rescue therapy (3 doses). Subgroups were created for those ≥ 30 weeks. Both cohorts were followed up to 24 months of corrected age. The Ages & Stages Questionnaires (ASQ)® was administered to assess neurodevelopment. Results: 62 preterm infants with a diagnosis of IUGR were included. The rescue therapy group compared with the single-dose group showed no differences in morbidity and mortality and less intubation rate at birth (p = 0.02), with no differences in respiratory support at 7 days of life. Preterm newborns ≥ 30 weeks exposed to rescue therapy showed higher morbidity and mortality (p = 0.03) and bronchopulmonary dysplasia (BPD) (p = 0.02), showing no differences in RDS. The rescue therapy group showed worse mean scores on the ASQ-3 scale, with no significant differences in cerebral palsy or sensory deficits. Conclusions: Rescue therapy reduces intubation at birth but does not reduce morbidity and mortality. However, at ≥ 30 weeks, this benefit is not observed and the IUGR population exposed to rescue therapy presented more BPD and lower scores on the ASQ-3 scale at 2 years. Future studies should be aimed at the individualization of antenatal corticosteroid therapy.

Resumen: Los corticoides prenatales disminuyen la mortalidad y el distrés respiratorio (SDR) en recién nacidos prematuros (RNPT). Estos beneficios decrecen tras la semana de su administración, recomendándose un rescate si existe una nueva amenaza de parto prematuro. La repetición de corticoides prenatales puede tener efectos deletéreos y sus beneficios son controvertidos en el retraso del crecimiento intrauterino (RCIU). Objetivo: comprobar los efectos del rescate con betametasona prenatal en la morbimortalidad neonatal, el SDR y el neurodesarrollo a los 2 años en prematuros con RCIU. Pacientes y Método: Estudio retrospectivo de RNPT ≤ 34 semanas y ≤ 1.500 g divididos en cohortes según la exposición a betametasona prenatal: Ciclo-único (2 dosis) vs Rescate (3 dosis). Se realizan subgrupos para ≥ 30 semanas. Se realizó un seguimiento de ambas cohortes hasta los 24 meses de edad corregida. Se aplicó el cuestionario Ages & Stages Questionnaire (ASQ)® para evaluar el neurodesarrollo. Resultados: Se incluyen 62 RNPT. El grupo Rescate vs. Ciclo-único no muestra diferencias en morbimortalidad y sí menor intubación (p = 0,02), sin diferencias en el soporte respiratorio a los 7 días de vida. RNPT ≥ 30 semanas con Rescate presentan mayor morbimortalidad (p = 0,03) y displasia broncopulmonar (DBP) (p = 0,02), sin diferencias en el SDR. El grupo rescate muestra peores puntuaciones medias en la escala ASQ-3, sin diferencias significativas en parálisis cerebral o déficits sensoriales. Conclusiones: El rescate no disminuye la morbimortalidad y sí reduce la intubación al nacimiento. Sin embargo, en ≥ 30 semanas no se observa este beneficio y la población expuesta a rescate presenta más DBP y menores puntuaciones en la escala ASQ-3 a los 2 años. Futuros estudios deben ir encaminados a la individualización de la terapia con corticoides prenatales.

Abstract: Antenatal corticosteroids reduce mortality and respiratory distress syndrome (RDS) in preterm newborns. These benefits decrease after a week of administration, recommending a rescue therapy if there is a new threat of premature delivery. Repeated administration of antenatal corticosteroids may have deleterious effects and their benefits are controversial in intrauterine growth restriction (IUGR). Objective: to verify the effects in the IUGR population of antenatal betamethasone rescue therapy on neonatal morbidity and mortality, RDS, and neurodevelopment at 2 years. Patients and Method: Retrospective study including ≤ 34 weeks and ≤ 1,500g preterm newborns divided according to antenatal betamethasone exposure: Single-cycle (2 doses) vs Rescue therapy (3 doses). Subgroups were created for those ≥ 30 weeks. Both cohorts were followed up to 24 months of corrected age. The Ages & Stages Questionnaires (ASQ)® was administered to assess neurodevelopment. Results: 62 preterm infants with a diagnosis of IUGR were included. The rescue therapy group compared with the single-dose group showed no differences in morbidity and mortality and less intubation rate at birth (p = 0.02), with no differences in respiratory support at 7 days of life. Preterm newborns ≥ 30 weeks exposed to rescue therapy showed higher morbidity and mortality (p = 0.03) and bronchopulmonary dysplasia (BPD) (p = 0.02), showing no differences in RDS. The rescue therapy group showed worse mean scores on the ASQ-3 scale, with no significant differences in cerebral palsy or sensory deficits. Conclusions: Rescue therapy reduces intubation at birth but does not reduce morbidity and mortality. However, at > 30 weeks, this benefit is not observed and the IUGR population exposed to rescue therapy presented more BPD and lower scores on the ASQ-3 scale at 2 years. Future studies should be aimed at the individualization of antenatal corticosteroid therapy.

ABSTRACT: Multiplex 330 (MX) is a portable, non-invasive fluorescence sensor that provides different multiparametric indices that are sensitive to the concentration of chlorophylls, flavonols, and anthocyanins on the leaf surface. This study investigated the use of these indices to assess the variability on free volatile composition of grapes (Vitis vinifera L.) in the field as well as other components of their quality potential in vineyards affected by iron deficiency chlorosis (IDC). Twenty non-irrigated Tempranillo/110 Richter vineyard subzones from non-affected to moderately affected by IDC were monitored in Ribera del Duero area (Spain) during two seasons. The results indicated that MX can characterize the spatial variation of leaf pigment concentrations, agronomic performance, and grape quality in vineyards affected by IDC. The MX indices measured at the leaf level close to harvest had better predictive values for the concentrations of free alcohols, volatile acids, C13-norisoprenoids, esters and acetates in the must than vine vigor, size or degree of technological maturity of the grapes. Our study demonstrates that the MX indices to estimate leaf pigment concentrations can be helpful to assess the technological maturity and free volatile composition of wine grapes in vineyards affected by IDC; nevertheless, the efficacy of the indexes may vary according to the year season.

ABSTRACT The building that was built with the name of Nicolás Salvador Acea de los Ríos in the province of Las Villas is currently the physical space of “Paquito González Cueto” University Pediatric Hospital of Cienfuegos territory. That is why, we carried out a literature review using induction-deduction methods; analysis and synthesis and historical-logical method with the aim of enunciating the contribution of Nicolás Acea as benefactor of Cienfuegos in the construction of the elder’s home of the same name after he died. Although there are no longer free spaces between the building and the sea walk, nor the breeze of the nearby sea that impacted fully on its façade, benefits that endorsed the construction; after the revolutionary triumph on 1st. of January 1959 changes its social purpose, but it is maintained as a vocation the health care, now of infants and adolescents of the territory.

RESUMEN La edificación que se construyera con el nombre de Nicolás Salvador Acea de los Ríos en la provincia de las Villas, en la actualidad es el espacio físico del Hospital Pediátrico Universitario “Paquito González Cueto” del territorio cienfueguero. Es por ello que realizamos una revisión bibliográfica empleando los métodos de inducción-deducción, análisis y síntesis e histórico-lógico con el objetivo de enunciar el aporte de Nicolás Acea como benefactor de Cienfuegos, en la construcción del asilo de su mismo nombre, después de su fallecimiento. Aunque ya no existen espacios libres entre el edificio y el malecón, ni la brisa del mar cercano que impactaba a plenitud sobre su fachada, bondades que avalaron la construcción, luego del triunfo revolucionario el 1ero. de enero de 1959 cambia su objeto social, pero mantiene como vocación el cuidado de la salud, ahora de los infantes y adolescentes del territorio.

RESUMEN Las infecciones osteoarticulares por anaerobios son muy raras en los niños, siendo el género Fusobacterium el que se aisla con más frecuencia. El curso suele ser subagudo y, aunque hay factores predisponentes descritos, la mayoría de los pacientes no los presenta. Generalmente, los cultivos de liquido articular son estériles ya que estos microorganismos son muy sensibles al contacto con el oxigeno, por lo que precisan medios de cultivo específicos. Todo lo anterior hace que el diagnóstico se retrase y que el riesgo de secuelas a largo plazo aumente. Sin embargo, el pronóstico mejora cuando el tratamiento se inicia de modo precoz. Por todo ello, presentamos el caso de un paciente de 10 anos con una artritis séptica de cadera derecha por Fusobacterium nucleatum que permaneció ingresado 30 dias. Durante el ingreso precisó 3 intervenciones quirúrgicas y cumplió 6 semanas de antibioterapia efectiva, con buena evolución; permanece asintomático en el momento actual.

ABSTRACT Osteoarticular infections due to anaerobes are very rare in children, with the Fusobacterium genus being the most frequently isolated. The course is usually subacute and, although there are predisposing factors described, most patients do not present with them. Generally, joint fluid cultures are sterile since these microorganisms are very sensitive to contact with oxygen, so they require specific culture media. All of the above causes the diagnosis to be delayed, increasing the risk of long-term sequelae. However, the prognosis improves when treatment is started early. The case is presented of a 10-year-old patient who was admitted for 30 days due septic arthritis of the right hip caused by Fusobacterium nucleatum During the admission, he required three surgical interventions, and completed 6 weeks of effective antibiotic therapy, with a good outcome and remaining asymptomatic at the current time.

Resumo: Strongyloides stercoralis é um nematódo intestinal que coloniza e se reproduz na mucosa do intestino delgado proximal. A infeção em hospedeiros imunocompetentes é auto-limitada mas em doentes imunocomprometidos pode ter um curso complicado e causar hiperinfeção. Apresentamos um caso de uma mulher de 60 anos que é admitida devido a uma exacerbação de uma púrpura trombocitopénica trombótica adquirida com necessidade de altas doses de corticoides. A doente inicia quadro de pirose persistente, náuseas, vómitos e intolerância alimentar. Faz-se o diagnóstico de síndrome de secreção inapropriada de hormona antidiurética (SIADH). A endoscopia digestiva alta evidencia mucosa gástrica e duodenal com edema e eritema, para além de erosões e pregas espessadas duodenais. O TC e a enteroRMN mostram dilatação duodenal e alterações inflamatórias. A histologia mostra S. stercoralis a colonizar a mucosa do antro e duodeno. O S. stercolaris é um parasita humano, endémico em regiões tropicais e subtropicais. Tem um ciclo de vida complexo já que completa o seu ciclo todo dentro do organismo humano: penetra pela pele, migra para os pulmões e atinge o trato gastrointestinal. Os sítios mais afetados são o duodeno e o jejuno proximal. O ciclo de vida envolve autoinfeção na mucosa intestinal ou pele perianal, especialmente em doentes imunocomprometidos, com a imunodepressão podendo levar a síndrome de hiperinfeção e doença disseminada. Contudo, o envolvi mento gástrico é raramente descrito. O SIADH tem sido relacionado com o síndrome de hiperinfeção, contudo, o seu mecanismo não é claro. O relativo inespecífico quadro clínico e alterações imagiológicas, assim como a baixa sensibilidade dos testes de parasitas de rotina atrasam e fazem o diagnóstico desafiante.

Abstract: Strongyloides stercoralis is an intestinal nematode that colonizes and reproduces in the upper small intestinal mucosa. Infection in immunocompetent hosts is self-limited but in immunocompromised patients it can be complicated and cause hyperinfection. We present a 60-year-old female who was admitted due to an exacerbation of acquired thrombotic thrombocytopenic purpura requiring high doses of corticosteroids. The patient began to experience persistent pyrosis, nausea, vomiting, and oral intolerance. She was di agnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Upper endoscopy was performed and showed esophageal, gastric, and duodenal mucosa with edema and erythema. Moreover, there were superficial erosions and thickened folds in duodenum. Gastric and duodenal biopsies were taken. Abdominal computed tomography and magnetic enteroresonance displayed duodenal dilation and inflammatory changes. The histological study of biopsies showed colonization by S. stercolaris in the antrum and duodenum. S. stercolaris is a human parasite that is endemic in tropical, subtropical, and temperate regions. Its lifecycle is complex because it completes its entire cycle within the human host; it penetrates the skin, migrates to the lungs, and reach the gastrointestinal tract. The most affected site is the duodenum and upper jejunum. The lifecycle includes autoinfection through the intestinal mucosa or perianal skin, especially in immunocompromised hosts. Immunossuppression can lead to hyperinfection syndrome and disseminated disease. However, involvement of the stomach has relatively rarely been reported. SIADH has been related to systemic hyperinfection, although the mechanism is not clear. The relatively nonspecific clinical and imaging features and the low sensitivity of routine parasite tests make the diagnosis challenging and delayed.

ABSTRACT: Water deficit and iron nutritional deficiency (iron chlorosis) are frequent environmental stresses affecting grapevine production in the Mediterranean region. The objectives of this work were (i) to study the combined effects of both stresses on aromatic profile of Tempranillo grapes, occurring simultaneously in the vineyard, and (ii) to evaluate the viability of foliar chlorophyll content at veraison (Chl) to early assess aromatic quality potential of grapes in those conditions. Twenty non-irrigated vineyard subzones (10 m × 10 m each), affected and non-affected by iron chlorosis, were monitored in Ribera del Duero Appellation of Origin (North-Central Spain) during two consecutive seasons. Factorial ANOVA was performed to study the effects of predawn leaf water potential and Chl measured at veraison on the must composition parameters and, specifically, on the concentrations of free and bound aromatic compounds. Water deficit tended to increase color intensity and extractable anthocyanin content of the grapes, whereas the incidence of iron deficiency enhanced total phenolic compound content within subzones with better water status. More water or iron stressed subzones restricted C6-alcohols contents than less stressed subzones. Without significant effects on vine vigor, yield or berry size, the incidence of iron chlorosis increased the concentrations of some specific terpenes, C13-norisoprenoids, volatile acids and volatile phenols. These results showed that low to moderate iron stress can have positive effects on grape aromatic quality, and demonstrated that Chl can be a useful tool in precision viticulture to map the aromatic potential within rainfed vineyards affected by iron chlorosis.

ABSTRACT Lipschütz ulcer is a rare underdiagnosed entity. We present the case of a 24-year-old patient without history of sexual contact who consulted for sudden occurrence of painful vulvar ulcers, in the context of flu-like symptoms. The main differential diagnoses are discussed, as it is a disease unrelated to sexually transmitted diseases and little recognized by health professionals, which requires conservative management.

RESUMEN La úlcera de Lipschütz es una entidad poco frecuente e infradiagnosticada. Se presenta el caso de una paciente de 24 años sin antecedente de contacto sexual que consultó por aparición súbita de úlceras vulvares dolorosas, en el contexto de un cuadro pseudogripal. Se discuten los principales diagnósticos diferenciales, dado que es una enfermedad no relacionada con enfermedades de transmisión sexual y poco reconocida por los profesionales de la salud, que precisa de manejo conservador.

Abstract The current university environment is characterised by the implementation of an education system focused on competence-based learning. The present study has concentrated on the subject Applied Analytical Chemistry of the Pharmacy Degree and has made it possible to clearly establish the specific competences of the subject, based on levels of acquisition, as well as to design a system of assessment, based on the use of rubrics, which provides the corresponding equivalences in the grading system currently used in the university. This new form of assessment allows the teacher to know where there are gaps in student learning, and this information can be subsequently used to prioritize the training of those skills. The implementation of these rubrics has made it possible to obtain relevant information related to the students’ acquisition of competences.

Resumen El entorno universitario actual se caracteriza por la implementación de un sistema educativo centrado en el aprendizaje basado en competencias. Este trabajo se centra en la asignatura de Química Analítica Aplicada del Grado en Farmacia y trata de establecer claramente las competencias específicas de la asignatura, en función de los niveles de adquisición, así como diseñar un sistema de evaluación, basado en el uso de rúbricas, proporcionando las equivalencias correspondientes en el sistema de calificación actualmente utilizado en la Universidad. Esta nueva forma de evaluación permite al docente saber dónde hay vacíos en el aprendizaje de los estudiantes, de modo que esta información puede usarse posteriormente para priorizar el entrenamiento de esas habilidades. La implementación de estas rúbricas ha permitido obtener información relevante relacionada con la adquisición de competencias de los estudiantes.

SUMMARY Introduction: The main pathologies that require a recompression therapy are decompression sickness (DCS) and arterial gas embolism (AGE), boths can be caused by pressure-related activites and certain amount of gas (dissolved or not) in the victim´s blood. Besides diving other pressure-related activities put the person in risk of this pathologies. Aim: To investigate the main place of production of these pathologies and their physiological base. Methods: we reviewed all charts of patients with DCS and AGE from 1970-2017 at Centro de Buceo de la Armada (Cartagena). Results: There were 392 cases, 345 (88%) diving related, 36 (9,18%) hyperbaric chamber-related, 6 (1,53%) submarine activities related and 4 (1,02%) hypobaric activities-related. Conclusions: Diving injuries rates are the most important but any pressure-related activity can be risky even hyperbaric chamber activity, considered the safest pressure-related activity.

RESUMEN: Introducción: Las principales patologías que requieren tratamiento en cámara hiperbárica son la enfermedad descompresiva y el embolismo arterial gaseoso. Ambas comparten la necesidad de cambios de la presión ambiental y del contenido gaseoso en el organismo. Además del buceo, existen otras situaciones que suponen cambios de presión y por tanto propician el riesgo de presentar lesiones que requieran recompresión. Objetivos: Describir los principales lugares de producción de estas patologías y los mecanismos fisiopatológicos que las generan. Material y Método: Expedientes de accidentes de buceo recogidos en el Centro de Buceo de la Armada desde 1970 hasta 2017. Resultados: Total 392 casos, 345 (88%) se producen en la mar, 36 (9,18%) en cámara hiperbárica, 6 (1,53%) en relación con submarinos y 4 (1,02%) en actividades hipobáricas. Conclusiones: Cualquier situación que suponga un cambio de presión expone al sujeto a presentar una patología descompresiva y a necesitar un tratamiento hiperbárico. El lugar más frecuente es en la mar pero pruebas, en principio no lesivas, como un tratamiento hiperbárico, pueden predisponer a estas lesiones.

ABSTRACT: The growing interest in camelina (Camelina sativa L. Crantz) is increasing for animal nutrition and for biofuel. A trial was carried out in a greenhouse with camelina cv. ‘Calena’ cultivated in pots in order to evaluate the effect of residual poultry manure and mineral fertilization after a crop of barley (Hordeum vulgare L.) and to determine the grain’s yield and quality. The treatments applied to the first culture of barley were two: poultry manure or mineral fertilizer N-P-K, at rates of 0, 1, 1.5 and 2 (0, 60, 90, 120 nitrogen fertilizing units). The variables analyzed were the following: dry weight of: seed and aerial biomass and 1,000 seeds; percentages of Kjeldhal nitrogen in: seed, and aerial biomass; percentages of: crude protein and oil content. Treatment type and rates were significant. Treatment*rate interaction was significant (P<0.05) for the analyzed variables except for weight of seed and weight of 1,000 seeds. For the laying hen or mineral the highest values in terms of grain weight were obtained with rates 1 and 1.5, with grain yields equivalent of 1,547 and 1,504 kg/ha, respectively. In terms of crude protein grain the highest values were obtained with rate 1.5 for both treatments, with protein yield equivalent of 455.08 and 478.72 kg/ha and in terms of oil content seed the highest values were obtained with rates 1 and 1.5 with oil content yield of 481.27 and 454.06 kg/ha. In general, camelina had a good response to residual poultry manure or mineral fertilizer in yield and quality of grain.

RESUMEN: El interés por el cultivo de camelina [Camelina sativa (L.) Crantz] para alimentación animal y biocombustible se está incrementando. Se condujo un ensayo en invernadero y tiestos con camelina cv. Calena después de un primer cultivo de cebada (Hordeum vulgare L.), con el fin de estudiar el efecto de la fertilización residual de gallinazas y mineral en el rendimiento y la calidad del grano. Los tratamientos aplicados en el cultivo anterior de cebada fueron: gallinaza o fertilizante mineral, N-P-K en dosis 0, 1, 1.5 y 2 (0, 60, 90,120 unidades fertilizantes de nitrógeno). Las variables estudiadas fueron: peso seco de biomasa aérea, peso seco de grano, peso de 1,000 granos, porcentaje de nitrógeno en biomasa aérea, porcentaje de nitrógeno en grano, porcentaje de proteína bruta en grano y porcentaje de grasa bruta en grano. Los tratamientos y dosis fueron significativamente diferentes. La interacción tratamiento*dosis fue significativa (P<0.05) para las variables estudiadas excepto para peso grano y peso de 1,000 granos. Para la gallinaza y el mineral los valores más altos en peso de grano se obtuvieron con dosis de 1 y 1.5, con rendimientos equivalentes en grano de 1,547 kg/ha y 1,504 kg/ha, para proteína bruta en grano fueron para dosis 1.5 en ambos tratamientos con 455.08 y 478.72 kg/ha y para grasa bruta del grano fueron los más altos, para dosis de 1 y 1.5 con 481.27 y 454.06 kg/ha. En general, la camelina tuvo una buena respuesta a la fertilización residual con fertilización a partir de la gallinaza o mineral en rendimiento y calidad de grano.

The objective of this study was to evaluate the distribution of mercury in Cienfuegos Bay using P. viridis as a bioconcentrator organism. The average concentrations in sediment ranged between 0,04 and 0,09 mg kg-1, in seawater between 0,19 and 0,33 mg L-1 and in P. viridis between 0,024 and 0,026 mg kg-1, none value exceeded the maximum permissible limit, except for the fraction of sediment 0,5-0,25 mm in Prácticos del Puerto station. P. viridis is a low mercury bioconcentrator organism, however it can be used as a sentinel of Cienfuegos Bay waters quality, because it bioconcentrates about 100 times the concentrations of mercury in seawater.

El objetivo de la investigación fue evaluar la distribución del mercurio en la Bahía de Cienfuegos utilizando P. viridis como organismo bioconcentrador. El rango de las concentraciones de mercurio encontradas en el sedimento fue entre 0,04-0,09 mg kg-1, en agua de mar entre 0,19-0,33 µg L-1 y en P. viridis entre 0,024-0,026 mg kg-1; ninguno de los valores sobrepasaron el límite máximo permisible, exceptuando la fracción del sedimento menor de 0,5 mm en la estación Prácticos del Puerto. P. viridis es un bajo bioconcentrador de mercurio, sin embargo puede ser utilizado como centinela de la calidad de las aguas de la Bahía de Cienfuegos, pues bioconcentra aproximadamente cien veces los niveles de mercurio presentes en el agua de mar.

To incorporate economic evaluation into decision-making, we need to know how much a health system is willing and able to invest in a quality-adjusted life year (QALY). In Spain, the figure of €30,000 per QALY as cost-effectiveness (CE) threshold has been widely cited. However, as in most health systems, no value has been formally adopted; mainly because of the arbitrariness, the lack of theoretical and scientific basis, and the controversy around its estimation and what the threshold should represent. Based on a systematic review of empirical studies on the estimation of the CE threshold undertaken by this research team, we conducted a critical appraisal of the state of the art, using a Delphi with the participation of 13 national experts. This paper contributes to assess the research progress on the CE threshold in Spain, to consider its utility in the decision making process supported by economic evaluation, and to propose further research to improve what has been achieved so far.

Para que la evaluación económica pueda ser incorporada en la toma de decisiones se debe conocer cuánto está dispuesto y es capaz de invertir por un Año de Vida Ajustado por Calidad (AVAC) el Sistema Nacional de Salud. En España se ha extendido el uso de 30.000€ por AVAC como umbral coste-efectividad (CE) pero, como en la mayoría de los sistemas sanitarios, no se ha adoptado un valor formalmente. Esto se debe en parte a la arbitrariedad, la falta de base teórica y científica para su fijación y la controversia que persiste sobre su estimación y lo que dicho umbral CE debe representar. A partir de una revisión sistemática de trabajos empíricos sobre la estimación del umbral CE realizada por este equipo investigador, se llevó a cabo una valoración crítica del estado del arte utilizando un grupo Delphi con la participación de 13 expertos nacionales. Este artículo contribuye a reflexionar cuánto se ha avanzado en investigación sobre el umbral CE en España, a considerar su utilidad para completar el proceso de toma de decisiones bajo evaluación económica, y a plantear líneas de investigación para mejorar lo logrado hasta la fecha.

To incorporate economic evaluation into decision-making, we need to know how much a health system is willing and able to invest in a quality-adjusted life year (QALY). In Spain, the figure of €30,000 per QALY as cost-effectiveness (CE) threshold has been widely cited. However, as in most health systems, no value has been formally adopted; mainly because of the arbitrariness, the lack of theoretical and scientific basis, and the controversy around its estimation and what the threshold should represent. Based on a systematic review of empirical studies on the estimation of the CE threshold undertaken by this research team, we conducted a critical appraisal of the state of the art, using a Delphi with the participation of 13 national experts. This paper contributes to assess the research progress on the CE threshold in Spain, to consider its utility in the decision making process supported by economic evaluation, and to propose further research to improve what has been achieved so far.

Para que la evaluación económica pueda ser incorporada en la toma de decisiones se debe conocer cuánto está dispuesto y es capaz de invertir por un Año de Vida Ajustado por Calidad (AVAC) el Sistema Nacional de Salud. En España se ha extendido el uso de 30.000€ por AVAC como umbral coste-efectividad (CE) pero, como en la mayoría de los sistemas sanitarios, no se ha adoptado un valor formalmente. Esto se debe en parte a la arbitrariedad, la falta de base teórica y científica para su fijación y la controversia que persiste sobre su estimación y lo que dicho umbral CE debe representar. A partir de una revisión sistemática de trabajos empíricos sobre la estimación del umbral CE realizada por este equipo investigador, se llevó a cabo una valoración crítica del estado del arte utilizando un grupo Delphi con la participación de 13 expertos nacionales. Este artículo contribuye a reflexionar cuánto se ha avanzado en investigación sobre el umbral CE en España, a considerar su utilidad para completar el proceso de toma de decisiones bajo evaluación económica, y a plantear líneas de investigación para mejorar lo logrado hasta la fecha.