El desgaste por empatía es un concepto relativamente reciente y en evolución que ha captado el interés de los profesionales sanitarios debido a que el trabajo en el ámbito de la salud implica un coste emocional que repercute en la misma salud del trabajador y en su labor profesional. Según la literatura revisada, los programas en prevención en todos los niveles de este tipo de estrés son escasos, por lo tanto, el objetivo de este trabajo es proponer un programa de prevención del desgaste por empatía en profesionales sanitarios de una unidad de diálisis de hospital. La idea surgió de la necesidad manifiesta por la Unidad de Diálisis del Hospital Universitario Infanta Sofía (HUIS), hacia la Unidad de Salud Mental del mismo Hospital y de la confianza depositada en la investigación académica, relacionada con la dificultad en el afrontamiento a la muerte de pacientes de la Unidad, por parte del personal asistencial. El propósito es entonces entrenar a los profesionales en estrategias de regulación emocional del desgaste por empatía, con el fin de disminuir los niveles de este tipo de estrés y prevenir su futura aparición, por medio del desarrollo de 6 módulos, que se llevarán a cabo a través de diferentes ciclos y que puede tener continuidad a través de una modalidad de Formación Continuada. Se ha diseñado una evaluación estandarizada con el fin de medir la presunta efectividad del programa para prevenir el desgaste por empatía. Se realiza una valoración sobre los resultados esperados, las conclusiones del diseño de la propuesta del programa, así como de sus limitaciones y sobre futuras líneas de investigación. Abstract: The compassion fatigue is a relatively recent and evolving concept that has captured the interest of health professionals because working in health implies an emotional cost that affects the health and the worker performance. According to the revised literature, prevention programs at all levels of this kind of stress are scarce, therefore, the objective of this work is to propose a program of prevention of compassion fatigue in healthcare professionals of a dialysis unit of a hospital. The idea came up from the necessity exposed by the Dialysis Unit of the Hospital Universitario Infanta Sofia (HUIS), towards the Mental Health Unit of the same Hospital and from the confidence placed in the academic research, related to the difficulty of facing death of patients of the unit, by the assistance personnel. The purpose is then to train professionals in strategies of emotional regulation of compassion fatigue, in order to reduce the levels of this type of stress and prevent its future emergence, through the development of 6 modules, which will be carried out through different cycles and that can have continuity through a continuous training modality. A standardized assessment has been designed to measure the presumed effectiveness of the program to prevent the compassion fatigue. An assessment is made of the expected results, the conclusions of the design of the program proposal, as well as its limitations and future lines of research.

Background: The effect of early surgery in elderly patients with hip fractures has been controversial during the last five decades due to equivocal evidence both in favour and against it. The objective of this thesis is to systematically assess all the available evidence on the effect(s) of early surgery compared with delayed surgery in elderly patients with hip fractures. Methods: Searches for randomised controlled trials (RCTs) or prospective observational studies were conducted from inception to July 2017 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), EMBASE (OVID), and they were complemented with list of references searching, review of both clinical trials registers and archives of orthopaedic meetings. Two reviewers independently selected studies for inclusion, extracted data and evaluated risk of bias; and a third reviewer resolved discrepancies. Risk ratios (RR) were calculated for dichotomous data, and mean difference (MD) or standardised mean difference (SMD) was calculated for continuous data. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: 39 studies were included with 51,857 participants (range of mean age: 74 to 93 years) comparing early versus delayed surgery. Three studies were RCTs and 36 were observational studies. The evidence from RCTs and observational studies showed that early surgery reduces risk of all-cause 3 mortality in elderly patients with a hip fracture (RR 0.73, 95% confidence interval (CI) 0.65 to 0.83; I2 = 67%; number needed to treat for benefit (NNTB) 20; low quality of evidence). Observational studies showed reduced risk of all-cause mortality by early surgery at 6 (RR 0.77, 95% CI 0.66 to 0.91; I2 = 56%; very low quality of evidence) and 12 months postoperative (RR 0.69, 95% CI 0.55 to 0.87; I2 = 76%; very low quality of evidence), and when surgery is performed within the first 48 hours upon hospital admission (RR 0.72, 95% CI 0.62 to 0.84; I2 = 65%; very low quality of evidence). Observational studies also showed a reduction of complications (RR 0.61, 95% CI 0.51 to 0.73; I2 = 64%; very low quality of evidence) and length of hospital stay (MD -5.06, 95% CI -6.52 to -3.60; I2 = 87%; very low quality of evidence) by early surgery, but the evidence was uncertain for functionality (SMD 0.05, 95% CI -0.04 to 0.14; I2 = 0%; low quality of evidence) and pain (RR 0.89, 95% CI 0.67 to 1.17; I2 = 0%; very low quality of evidence). RCTs showed that early surgery reduces length of stay (MD -6.73, 95% CI -12.92 to -0.54; I2 = 54%; very low quality of evidence) and improves functionality (SMD 0.32, 95% CI 0.04 to 0.59; I2 = 5%; low quality of evidence). Conclusions: Low-quality evidence showed that early surgery reduces all-cause mortality at 6 and 12 months post-surgery, especially when it is performed during the first 48 hours after hospital admission. There was very low-quality evidence of a reduction in complications including pneumonia and pressure sores, and low-quality evidence for a reduced risk of urinary tract infection for early compared with delayed surgery. Reductions in length of hospital stay and improvement of postoperative functionality with early surgery were also observed but with very low- and low-quality of evidence respectively. There was very low-quality evidence for no effect of early surgery on postoperative pain.

Colombia is an upper middle-income country with an estimated population of 49.2 million people, and road traffic collisions (RTCs) are the second most common cause of traumatic death. The government established the National Road Safety Plan (PNSV) for the period 2011-2021, to reduce RTC-related deaths by 26%. Study aim was to evaluate whether Road Safety Laws have had a long-term effect on road safety in the country. Data on RTC from January 1, 2001 through December 31, 2017 were collated from official Colombian governmental publications. Three periods were considered for analysis: 2001-2010 evaluating the Transit Code; 2011-2017 evaluating the PNSV; and 2001-2017 evaluating the full study period. A total of 102,723 deaths (12.7%) and 707,778 injuries (87.3%) were reported from 2001 through 2017. Transit Code period showed a 10.1% decline in deaths, 16.6% decline in injuries, and rates per 100,000 inhabitants and per 10,000 registered vehicles also declined. During the PNSV period, there was an increase in deaths by 16.6%, injuries decreased by 1.7%, and death rates per 100,000 inhabitants also increased. During the total study period, a 12.4% reduction in the total number of casualties was achieved, and death and injury rates per 100,000 inhabitants decreased by 12.4% and 27.5%, respectively. Overall, the absolute number of RTCs and deaths has increased. RTCs rates per 10,000 registered vehicles has decreased. Although the goals of the PNSV may not be realized, some laws may be having a beneficial effect. Further study is required to determine the longer-term impact of these initiatives.

El objetivo de este estudio es analizar la relación de las variables de rendimiento físico con los grupos de equipos ganadores, empatados y perdedores de los partidos de la Copa Mundial de la FIFA Rusia 2018. La muestra seleccionada para realizar el presente análisis fue de 32 selecciones nacionales participantes, examinadas por medio de 57 partidos en total. Los equipos fueron divididos en tres diferentes grupos, dependiendo del resultado obtenido: (0) equipos ganadores (N=48), (1) equipos que empataron (N=18) y (2) equipos perdedores (N=48). Los datos recogidos del presente trabajo de investigación han sido analizados a través de la página web https://www.fifa.com. Las variables utilizadas para el análisis de los datos fueron: distancia total recorrida, distancia recorrida con el balón en posesión, distancia recorrida sin el balón en posesión, sprints, posesión del balón lanzamientos a favor, diferencia de lanzamientos, tiempo empleado en la mitad del equipo oponente (OH), tiempo empleado en el tercio ofensivo (A3); Tiempo empleado en el área de penalti (PA), zona 1 de velocidad: 0-7 km/h, zona 2 de velocidad: 7-15 km/h, zona 3 de velocidad: 15-20 km/h, zona 4 de velocidad: 20-25 km/h, zona 5 de velocidad: > 25 km/h. Se realizó la prueba de Kolmogorov-Smirnov, para establecer la normalidad de los datos y posteriormente la prueba ANOVA de un factor para analizar los datos de distribución normal y la prueba de Kruskal-Wallis para muestras independientes, para datos de distribución no normal. Los datos observados no arrojaron diferencias significativas entre los grupos. La conclusión de la presente investigación es que ni las variables de rendimiento físico, ni las variables técnico-tácticas utilizadas, fueron determinantes para ganar, empatar o perder partidos en la Copa Mundial de la FIFA Rusia 2018.

In 2007, Mexico City legalized abortion in the first 12 weeks of pregnancy. By doing so, it became the first and only state in Mexico where abortion on demand is legal. In this paper, I use this natural experiment to estimate the effects of abortion legalization on child and maternal health. I perform Difference-In-Differences estimates using information from all births and deaths occurred between 2002 and 2012. My findings suggest that the change in the abortion legislation in Mexico City reduced the Infant Mortality Rate and the Under 5 Mortality Rate by approximately 2.3 and 2.4 deaths per 1,000 live births, respectively. Moreover, for the Maternal Mortality Rate I find that the estimations range from -5.49 to -6 deaths per 100,000 live births. These results are validated by the use of a more accurate control group generated by the Synthetic Control Method. To the best of my knowledge, this if the first paper that attempts to examine the effects of abortion legalization in Mexico City on child health. En el 2007, Ciudad de México legalizó el aborto en las 12 primeras semanas de gestación. Al hacerlo, se convirtió en el primero y único estado del país en donde el aborto voluntario es legal. En este artículo utilizo este experimento natural para estimar los efectos de la legalización del aborto en la salud materno infantil. Realizo estimaciones de Diferencias en Diferencias utilizando información de todos los nacimientos y muertes ocurridos entre 2002 y 2012. Mis hallazgos sugieren que el cambio en la legislación relativa el aborto en la Ciudad de México redujo la tasa de mortalidad Infantil y la tasa de mortalidad en menores de 5 años en aproximadamente 2.3 y 2.4 muertes por cada 1.000 nacidos vivos, respectivamente. Además, para la tasa de mortalidad materna, encuentro que las estimaciones oscilan entre -5,49 y -6 muertes por 100.000 nacidos vivos. Estos resultados se validan mediante el uso de un grupo de control más preciso, utilizando la metodología de control sintético. Según mi conocimiento, este es el primer artículo que intenta examinar los efectos de la legalización del aborto en la Ciudad de México sobre la salud infantil.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer and its incidence is rising. The introduction of new systemic therapies, including immune-based therapies and biomarker driven therapies, has improved survival in patients at advanced stages. However, overall survival is still poor, and recent advances in understanding of the molecular alterations of HCC have not translated yet into novel biomarkers. Over the past decade, major advancements in 'omic' technologies have enabled monitoring of a variety of molecular and organismal processes. A comprehensive analysis of single gene mutations in HCC might lead to detect biomarkers that improve our prognosis and treatment. We developed a bioinformatics pipeline capable of analyzing genomic data to identify key regulatory molecular changes in HCC development and their influence in patient’s prognosis. By looking at genetically determined subgroups of HCC in the TCGA Liver Cancer dataset, we managed to obtain 15 genes frequently affected by oncogenic mutations and analyzed their influence in patient’s survival, identifying CSMD1 as a prognostic biomarker candidate. Nevertheless, the validation in the ICGC HCC database showed that it did not have any statistically significant influence in overall survival. This work reveals that the most frequent single gene mutations are not enough for significant survival changes in HCC and that we should focus our efforts in integrative analysis of clinical information and multi-omics to maximize our clinical benefits in this devastating disease. Resumen: El carcinoma hepatocelular (CHC) es el tipo más común de cáncer de hígado y su incidencia está aumentando. La introducción de nuevas terapias sistémicas, incluidas las inmunoterapias y las terapias impulsadas por biomarcadores, ha mejorado la supervivencia de los pacientes en etapas avanzadas. Sin embargo, la supervivencia general sigue siendo escasa y los avances recientes en la comprensión de las alteraciones moleculares del CHC aún no se han traducido en nuevos biomarcadores. Durante la última década, los principales avances en las tecnologías "ómicas" han permitido el seguimiento de una variedad de procesos moleculares y orgánicos. Un análisis completo de las mutaciones de un solo gen en el CHC podría conducir a detectar biomarcadores que mejoren nuestro pronóstico y tratamiento. Desarrollamos un protocolo de bioinformática capaz de analizar datos genómicos para identificar cambios moleculares reguladores clave en el desarrollo del CHC y su influencia en el pronóstico del paciente. Al observar subgrupos genéticamente determinados de CHC en la base de datos TCGA-Liver Cancer, logramos obtener 15 genes frecuentemente afectados por mutaciones oncogénicas y analizamos su influencia en la supervivencia del paciente, identificando CSMD1 como un candidato a biomarcador pronóstico. Sin embargo, la validación en la base de datos ICGC-CHC mostró que no tuvo ninguna influencia estadísticamente significativa en la supervivencia global. Este trabajo revela que las mutaciones de un solo gen más frecuentes no son suficientes para cambios significativos en la supervivencia del CHC y que debemos centrar nuestros esfuerzos en el análisis integrador de la información clínica y la multi-ómica para maximizar nuestros beneficios clínicos en esta devastadora enfermedad.

Abstract: From brown algae species, it is a polysaccharide that have been studies due to their potential use in several biomedical applications. This is known as fucoidan. In this research the anti- cancer properties of a commercially available fucoidan (from Fucus vesiculosus) and different molecular weight fractions of fucoidan extracted from a brown algae found in the Colombian caribean coast (Sargassum filipendula, at LMW, (10–50 kDa), medium (MMW, 50–100 kDa) and high (HMW, >100 kDa)) were studied on osteosarcoma cells (MG-63). The results showed penetrability variation of the different fucoidan inside cells. Moreover, the focal adhesion and cell proliferation had a dose-dependent drop for all fucoidan types with strongest effects observed for HMW and F. vesiculosus fucoidan. G1-Phase arrest and accummulation in the sub-G1-phase was induced by F. vesiculosus. Simillarly, HMW and LMW caused G1-phase arrest. All fucoidan caused mitochondrial damage but mithochondrial fragmenttion was only observed with F. vesiculosus. Stress-induced apoptosis-like cell death was observed for F. vesiculosus fucoidan and stress-induced necrosis-like cell death for S. filipendula fucoidans by Annexin V/PI, TUNEL and cytochrome C stainings. As a results, These differences in anti-cancer activity of fucoidans are applicable for osteosarcoma treatment. Resumen: De las algas marrones, hay un polisacárido que ha sido estudiado debido a su potencial uso en diversas aplicaciones biomédicas. Estos se conocen como fucoidanos. En esta investigación, las propiedades anticancerígenas de los fucoidanos de una especie disponible comercialmente (Fucus vesiculosus)y de diferentes fracciones de peso molecular de fucoidanos extraídos de un alga marrón que se encuentra en la costa caribe colombiana (Sargassum filipendula, en bajo LMW, (10–50 kDa), medio (MMW, 50-100 kDa) y alto peso molecular (HMW,> 100 kDa)) se estudiaron en células de osteosarcoma (MG-63). Los resultados mostraron una variación de la penetrabilidad de los diferentes fucoidan dentro de las células. Además, la adhesión focal y la proliferación celular tuvieron una caída dependiente de la dosis para todos los tipos de fucoidan con efectos más fuertes observados para HMW y F. vesiculosus fucoidan. La detención y acumulación de la fase G1 y la fase sub- G1 fueron inducidas por F. vesiculosus. De manera similar, HMW y LMW causaron la detención de la fase G1. Todos los fucoidan causaron daño mitocondrial, pero solo se observó fragmentación mitocondrial con F. vesiculosus. Se observó muerte celular similar a la apoptosis inducida por estrés para el fucoidano extraido de F. vesiculosus y muerte celular similar a la necrosis inducida por estrés para fucoidanos de S. filipendula mediante tinciones con Anexina V / PI, TUNEL y citocromo C. Como resultado, estas diferencias en la actividad anticancerígena de los fucoidanos podrían ser aplicables para el tratamiento del osteosarcoma.

Abstract: Background: The mechanisms of action of several classes of cardiovascular medications are associated with COVID-19 pathology and have led to conflicting theories about their potential harm or benefits to the clinical outcomes of COVID-19 patients. However, published systematic reviews have only focused on the effects of renin-angiotensin-aldosterone system inhibitors. Objective: to assess the current evidence about the effects of six classes of cardiovascular medications (angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, diuretics, calcium channel blockers, β- and α-blockers) on the clinical outcomes of COVID-19 patients. Search Methods: Systematic searches were conducted at Ovid Medline, Ovid Embase, PubMed, OFSpreprints, MedRxiv, BioRxiv, and LitCovid website to include studies published since the infection outbreak began up to August 2020. The recently updated Ovid Medline expert filter for COVID-19 was used along with validated search filters from previous Cochrane systematic reviews. Additionally, ongoing studies were searched at ClinicalTrials.gov and PROSPERO databases. Selection criteria: English or Spanish observational studies involving minimum 10 participants with confirmed COVID-19 diagnosis and taking ACEI, ARBs, CCBs, diuretics, β- and/or α- blockers were included. Data collection and analysis: The studies were selected based on the inclusion criteria at a title, abstract, and full-text review steps. Main results: 55 observational studies were included involving 780540 confirmed COVID-19 patients. 34 studies obtained consistent evidence that the baseline treatment with neither of the studied cardiovascular medications was associated with: 1) risk of contracting SARS-CoV-2 infection; 2) developing a severe COVID-19 disease; 3) mortality or 4) undergoing clinical complications and poor disease course. In-hospital administration of amlodipine or nifedipine is associated with a lower risk of mortality and mechanical ventilation. Conclusion: most of the current evidence is consistent to suggest that baseline treatments with the studied cardiovascular medications are not associated with worsening clinical outcomes in COVID-19 patients; however, the comprehensive analysis and comparison of the data was limited by the great heterogeneity across the studies’ design. More robust evidence is required to overcome the limitations of the current evidence and to properly address the controversies around this research topic. Resumen: Introducción: Los mecanismos de acción de varias clases de medicamentos cardiovasculares se han asociado a la patogénesis de la infección por COVID-19. Esta asociación ha promovido el surgimiento de diferentes teorías relacionadas con los efectos benéficos o perjudiciales de estos medicamentos en los desenlaces clínicos de pacientes diagnosticados con COVID-19. Sin embargo, las revisiones sistemáticas publicadas a la fecha sobre este tema se han enfocado exclusivamente en los efectos de los medicamentos inhibidores del sistema renina-angiotensina-aldosterona. Objetivo: Evaluar la evidencia sobre los efectos de seis clases de medicamentos cardiovasculares (bloqueadores de los receptores de angiotensina, inhibidores de la enzima de convertidora de angiotensina, diuréticos, bloqueadores de los canales de calcio, bloqueadores beta-adrenérgicos y bloqueadores alfa-adrenérgicos) en los desenlaces clínicos de pacientes con COVID-19. Metodología de búsqueda: Se realizaron búsquedas sistemáticas en Ovid Medline, Ovid Embase, PubMed, OFSpreprints, MedRxiv, BioRxiv, and LitCovid website con el fin de incluir estudios publicados desde el inicio del brote de la infección hasta Agosto de 2020. Se desarrollaron estrategias de búsqueda avanzadas empleando filtros de búsqueda validados como el filtro para COVID-19, desarrollado y actualizado por expertos de Ovid Medline, junto con filtros obtenidos de previas revisiones sistemáticas de Cochrane. Adicionalmente, se realizó una búsqueda de estudios en curso en las bases de datos ClinicalTrials.gov y PROSPERO. Criterios de selección: Estudios observacionales publicados en ingles o español incluyendo mínimo 10 participantes con un diagnóstico confirmado de COVID-19 y en tratamiento con IECA, ARA, BCC, diuréticos, beta-bloqueadores y/o alfa-bloqueadores. Selección y análisis de datos: Los estudios se seleccionaron aplicando los criterios de inclusión en el screening del título, abstract y texto completo. Resultados: Se incluyeron 55 estudios observacionales que involucraron 780540 pacientes con diagnostico confirmado de COVID-19. 34 estudios fueron consistentes al obtener evidencia de que los tratamientos de base con cualquiera de las seis clases de medicamentos cardiovasculares estudiados no se asociaron con 1) mayor riesgo de contraer una infección por SARS-CoV-2; 2) la severidad de la infección por COVID-19; 3) mortalidad o 4) complicaciones clínicas en el curso de la enfermedad. La administración intrahospitalaria de amlodipino o nifedipino puede estar asociada con un menor riesgo de mortalidad y ventilación mecánica en pacientes con COVID-19. Conclusión: La evidencia actual sugiere que los tratamientos de base con IECA, ARA, BCC, diuréticos, beta-bloqueadores y/o alfa-bloqueadores no se asocian con peores desenlaces clínicos en pacientes con COVID-19. Sin embargo, la gran heterogeneidad en el diseño de los estudios limitó el análisis exhaustivo y la comparación de los datos entre los estudios. Evidencia mas robusta que supere estas limitaciones y aborde las controversias generados en torno a este tema de investigación es necesaria.

Abstract: Background & aims In patients with compensated advanced chronic liver disease (cACLD) requiring the use of extralarge (XL) probe for liver stiffness measurement (LSM) due to overweight/obesity, the prognostic value of simple non-invasive surrogates of portal hypertension (PH) and controlled attenuation parameter (CAP) for predicting first clinical decompensation has not been fully assessed. Methods Consecutive patients with cACLD (LSM ≥10 kPa by XL probe) observed between 2015 and 2018 in two large academic centers were included. Clinically relevant events including classical decompensation (ascites, PH bleeding, jaundice, hepatic encephalopathy) and severe bacterial infections were recorded on follow-up. Results 272 patients were followed up for a median of 17 months (IQR 11-24). 17 developed clinically relevant events (12 classical decompensation, 5 severe bacterial infections). LSM, LSPS and PH risk score showed a high prognostic discriminative ability (AUROC) for classical decompensation: LSM 0.848 (95%CI 0.720-0.976, p<.0001), PH risk score 0.881 (95%CI 0.798-0.954, p<.0001), and LSPS 0.890 (95%CI 0.814-0.966, p<.0001) and for clinically relevant events. NASH patients showed similar results. By multivariate Cox regression analysis, in the subgroup of patients with NASH, LSM and CAP remained independently associated with clinically relevant events, being CAP≥220dB/m negatively associated for classical decompensation (HR 0.043 95%CI 0.004-0.476, p=0.01). Conclusions Simple and readily available non-invasive surrogates of portal hypertension help identifying patients with cACLD and obesity/overweight who are at increased risk of developing first clinically relevant events and classical decompensation. Resumen: Antecedentes y objetivos En los pacientes con enfermedad hepática crónica avanzada compensada (cACLD) que requieren el uso de una sonda extralarga (XL) para medir la rigidez del hígado (LSM) debido al sobrepeso/obesidad, no se ha evaluado plenamente el valor pronóstico de los sustitutos no invasivos simples de la hipertensión portal (PH) y el parámetro de atenuación controlada (CAP) para predecir la primera descompensación clínica. Métodos Se incluyeron pacientes consecutivos con cACLD (LSM ≥10 kPa por sonda XL) observados entre 2015 y 2018 en dos grandes centros académicos. En el seguimiento se registraron eventos clínicamente relevantes, incluyendo descompensación clásica (ascitis, hemorragia PH, ictericia, encefalopatía hepática) e infecciones bacterianas graves. Resultados 272 pacientes fueron seguidos durante una mediana de 17 meses (IQR 11-24). 17 pacientes desarrollaron eventos clínicamente relevantes (12 descompensaciones clásicas, 5 infecciones bacterianas graves). LSM, LSPS y PH risk score mostró una alta capacidad de discriminación pronostica (AUROC) para la descompensación clásica: LSM 0.848 (95%CI 0.720-0.976, p<0,0001), puntuación de riesgo de PH 0.881 (95%CI 0.798-0.954, p<.0001), y LSPS 0.890 (95%CI 0.814-0.966, p<.0001) y para eventos clínicamente relevantes. Los pacientes de EHNA mostraron resultados similares. Mediante un análisis de regresión de Cox multivariante, en el subgrupo de pacientes con EHNA, el LSM y el CAP permanecieron asociados de forma independiente con eventos clínicamente relevantes, siendo CAP≥220dB/m asociados negativamente para la descompensación clásica (HR 0.043 95%CI 0.004-0.476, p=0.01). Conclusiones Los sustitutos no invasivos de la hipertensión portal, simples y fácilmente disponibles, ayudan a identificar a los pacientes con cACLD y obesidad/sobrepeso que corren un mayor riesgo de desarrollar los primeros eventos clínicamente relevantes y la descompensación clásica.

Abstract: This research proves that the notion of attunement constitutes an interdisciplinary encounter/space between musical and theatrical training. On this dissertation, I take a look at several notions of attunement to prove It is a physical phenomenon that implies a bodily transformation. Dalcroze's method is the point of departure to define a historical conception of physical training in music and theatre education. However, further developments of his contribution to theatre consider training as a psycho-physical attunement; a method to achieve corporeal plasticity. Next to that, meaningful findings on the study of motion and action in the field of cognitive neuroscience show that the brain works under its independent plasticity, suggesting a more complicated process that attunes two distinct intentionalities in the relation body/mind. This scientific conception of attunement exposes an intricate dialogue between inner and outer bodily dimensions and reveals a relation between individual and collective processes of communication. Neuroscience call to this the mirror mechanism; a system that explains how the process of synapsis occurs as a complex integration that depends on the relation of action and perception of self, others and the environment. Finally, all this knowledge related with instrumental practice will be analyzed and compared with the outcomes of two cases of study; a workshop with members of the Youth Philharmonic Orchestra of Bogotá 2015-2018 and the experience of the performance ‘Blended Affor-dances of Gozo’ at the Royal Central School of Speech and Drama in 2019. Based on this study, I will demonstrate the suitability of conceiving instrumental practice as a collective physical training. A possible emerging method that conceives the development of artistic skills through the practice of physical activity, beyond the childhood period, in later stages of life.