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Evaluación del impacto de una mezcla de disruptores endocrinos sobre la viabilidad y funcionalidad de células β expuestas a un mimético de infecciones virales
Get PDFLa diabetes tipo 1 (DT1) es una enfermedad autoinmune caracterizada por la destrucción selectiva de las células β pancreáticas. Su incidencia ha aumentado de manera significativa en las últimas décadas, lo que sugiere un papel creciente de factores ambientales más allá de la predisposición genética. Entre ellos, las infecciones virales y la exposición a disruptores endocrinos han sido propuestos como desencadenantes relevantes. El objetivo de este estudio fue evaluar el impacto de una mezcla de disruptores endocrinos sobre la viabilidad y función de las células β, así como su respuesta a un mimético sintético de infección viral (PIC). Para ello, se utilizaron tres líneas celulares de células β pancreáticas (EndoC-βH1, INS-1E y MIN6), expuestas a la mezcla y/o a PIC. Se analizaron la viabilidad celular, la apoptosis, la producción de especies reactivas de oxígeno (ERO), la expresión de marcadores de estrés del retículo endoplasmático (RE) y de proteínas relacionadas con la apoptosis, además de la secreción de insulina estimulada por glucosa. La mezcla de disruptores indujo apoptosis sin alterar la producción de ERO ni la expresión de las proteínas antiapoptóticas Bcl-xL y Bcl-2. El PIC incrementó la apoptosis y la generación de ERO en células INS-1E, y redujo la expresión de Bcl-xL y Bcl-2. El tratamiento combinado con ambos potenció la apoptosis y aumentó la expresión de marcadores de estrés del RE (BiP, Chop, Xbp1s), aunque el pretratamiento con la mezcla no amplificó el efecto del PIC. Ni la mezcla ni el PIC modificaron de forma significativa la secreción de insulina estimulada por glucosa. En conclusión, la exposición a concentraciones ambientalmente relevantes de disruptores endocrinos compromete la supervivencia de las células β, especialmente bajo condiciones de estrés viral, a través de mecanismos asociados a la apoptosis y al estrés del retículo endoplasmático. Estos hallazgos respaldan la hipótesis de que la exposición crónica a mezclas de disruptores podría contribuir a la vulnerabilidad de las células β y al desarrollo de DT1 en individuos con predisposición genética
Estimation of simultaneous equation models by backpropagation method using stochastic gradient descent
Get PDFSimultaneous equation model (SEM) is an econometric technique traditionally used
in economics but with many applications in other sciences. This model allows the
bidirectional relationship between variables and a simultaneous relationship between
the equation set. There are many estimators used for solving an SEM. Two-steps least
squares (2SLS), three-steps least squares (3SLS), indirect least squares (ILS), etc. are
some of the most used of them. These estimators let us obtain a value of the coefficient
of an SEM showing the relationship between the variables. There are different works
to study and compare the estimators of an SEM comparing the error in the prediction
of the data, the computational cost, etc. Some of these works study the estimators from
different paradigms such as classical statistics, Bayesian statistics, non-linear regression
models, etc. This work proposes to assume an SEM as a particular case of an artificial
neural networks (ANN), considering the neurons of the ANN as the variables of the
SEM and the weight of the connections of the neurons the coefficients of the SEM.
Thus, backpropagation method using stochastic gradient descent (SGD) is proposed
and studied as a new method to obtain the coefficient of an SEM
Utilización de aceites esenciales extraídos de zumo y corteza de limón como herramienta poscosecha para alargar la vida útil del limón ecológico
Get PDFLos limones son susceptibles a las enfermedades fúngicas postcosecha, siendo las más
importantes las causadas por Penicillium digitatum, Penicillium italicum y Geotrichum citriaurantii.
El objetivo de este estudio fue evaluar el efecto de la aplicación postcosecha de aceites
esenciales obtenidos del zumo (AEZ) y de corteza de limón (AEC) para prolongar la vida útil del
limón. Se trataron limones ecológicos de la variedad ‘Fino’ con aceite esencial obtenido a partir
de AEC y AEZ a tres concentraciones (100, 500 y 1000 μL/L) y se compararon con limones
control. Se evaluaron parámetros físico-químicos y la incidencia de podredumbres durante 28
días de almacenamiento en frío. Los resultados mostraron que los limones tratados con AEC a
500 y 1000 μL/L mostraron una mayor reducción del porcentaje de podredumbre acumulada
tras 28 días de almacenamiento sin afectar al resto de parámetros de calidad del limón
evaluados.Lemons are susceptible to postharvest fungal diseases, the most important being those caused
by Penicillium digitatum, Penicillium italicum and Geotrichum citri-aurantii. The aim of this study
was to evaluate the eeect of postharvest application of essential oils obtained from lemon juice
(AEZ) and lemon peel (AEC) to prolong the shelf-life of lemons. Organic lemons of the ‘Fino’
variety were treated with essential oil obtained from AEC and AEZ at three concentrations (100,
500 and 1000 μL/L) and compared with control lemons. Physico-chemical parameters and the
fungal decay incidence were evaluated during 28 days of cold storage. The results showed that
lemons treated with AEC at 500 and 1000 μL/L showed a greater reduction in the percentage of
accumulated fungal decay incidence after 28 days of storage without aeecting the rest of the
lemon quality parameters evaluated
Estudio de factores de riesgo de la aparición de angiomas de cereza en la piel en grupo de pacientes de la consulta de Dermatología del Hospital General Universitario Dr. Balmis de Alicante.
Get PDFAntecedentes: Los angiomas en cereza (AC) son tumores vasculares cutáneos benignos muy prevalentes cuya asociación con algunas enfermedades, especialmente el melanoma, ha sido descrita, aunque de manera preliminar.
Objetivos: Los objetivos de este estudio es investigar si existe asociación entre el número de AC con los antecedentes familiares de AC, antecedentes personales de cáncer cutáneo melanoma y no melanoma, antecedentes personales de cáncer no cutáneo, edad, sexo, factores fenotípicos raciales, presencia de queratosis seborreicas (QS), y de daño solar crónico.
Ámbito de estudio: Comunidad Valenciana. Departamento de salud número 19. Consulta de Lesiones Pigmentadas y Melanoma del Servicio de Dermatología en el Hospital General Universitario Dr. Balmis de Alicante (HGUA).
Métodos: Se estudiaron 207 pacientes adultos que acudieron a esta consulta y que cumplían los criterios de inclusión. La variable de resultado fue el recuento de AC ≥ 1 mm. Las variables explicativas fueron las siguientes: edad, sexo, características fenotípicas raciales, historial familiar de CC, de daño solar crónico y antecedente de CNC. Se construyó una base de datos ad hoc anonimizada. Posteriormente, elaboramos un estudio descriptivo de las variables y se efectuaron pruebas de normalidad de las variables continuas. Los test estadísticos empleados para comparar entre la variable continua y las cualitativas fueron test no paramétricos para muestras independientes. Para estudiar la relación entre variables continuas, se utilizó pruebas de correlación como el test de Spearman Para la relación entre variables cualitativas se empleó el test de Chi-cuadrado/test de Fisher. Para cuantificar la magnitud de asociación, se utilizó la cOR(IC 95%). Posteriormente se realizó un estudio multivariante mediante un modelo de regresión logística binaria, calculando la aOR(IC 95%). El nivel de significación utilizado fue p<0,05.
Resultados: Los resultados del estudio multivariante mostraron que la única variable que explicaba de manera independiente el número de AC fue la edad. Así, en comparación con los pacientes menores de 50 años, aquellos entre 51 y 65 años presentaron un mayor riesgo de tener >8 AC, con una OR ajustada (aOR) de 2,8 (IC95%: 1,3–6,1; p=0,009). Este riesgo fue aún mayor en los mayores de 65 años, con una aOR de 5,5 (IC95%: 2,4–12,3; p<0,001).
También se encontró una asociación estadísticamente significativa, aunque no independiente, entre el número de AC (NAC) y los antecedentes personales de melanoma (OR=2.2), carcinoma basocelular (OR=2.3) y carcinoma espinocelular (OR=4.5).
El análisis de correlación de Spearman mostró una asociación positiva entre la edad y el NAC (r=0.428; p<0.001). Al desglosar esta relación por localizaciones corporales, se observaron las correlaciones más altas en el abdomen (r=0.430) y el pecho (r=0.410), mientras que en las piernas no se observó correlación significativa. Además, se identificaron asociaciones positivas y significativas entre distintas regiones anatómicas, especialmente entre el abdomen y la espalda baja (r=0.729), el abdomen y el pecho (r=0.742), y el pecho y la espalda baja (r=0.693), lo que sugiere una distribución agrupada de los AC en el tronco.
No se encontró relación entre el NAC y el sexo de los pacientes, las características fenotípicas raciales, la edad de aparición de los AC según refieren los pacientes, los antecedentes de AC familiares (maternos y paternos), los antecedentes personales de otras neoplasias no cutáneas, presencia de queratosis seborreicas y nevus melanocíticos.
Conclusión: El riesgo de tener > 8 AC aumenta de forma progresiva con la edad, siendo este el principal factor asociado a su presencia.Background: Cherry angiomas (CA) are very common benign cutaneous vascular tumors. Their association with certain diseases, particularly melanoma, has been described, although only preliminarily.
Objectives: The aim of this study is to investigate whether there is an association between the number of CA and the following factors: family history of CA, personal history of cutaneous cancer (melanoma and non-melanoma), personal history of non-cutaneous cancer, age, sex, racial phenotypic factors, presence of seborrheic keratoses (SK), and chronic sun damage.
Study Setting: Valencian Community. Health Department No. 19. Pigmented Lesions and Melanoma Clinic of the Dermatology Department at Dr. Balmis General University Hospital in Alicante (HGUA).
Methods: The study included 207 adult patients who attended this clinic and met the inclusion criteria. The outcome variable was the count of CA ≥ 1 mm. The explanatory variables included: age, sex, racial phenotypic characteristics, family history of skin cancer, chronic sun damage, and history of non-cutaneous cancer. An anonymized ad hoc database was created. A descriptive analysis of the variables was conducted, and normality tests were applied to continuous variables. Non-parametric tests for independent samples were used to compare continuous and qualitative variables. Spearman’s correlation test was used to study the relationship between continuous variables. For the relationship between qualitative variables, Chi-square/Fisher’s exact test was applied. To quantify the magnitude of association, crude Odds Ratios (cOR) with 95% Confidence Intervals (CI) were calculated. A multivariate analysis was subsequently performed using a binary logistic regression model, calculating adjusted Odds Ratios (aOR) with 95% CIs. The significance level was set at p<0.05.
Results: The results of the multivariate analysis showed that the only variable independently explaining the number of CA was age. Compared to patients under 50, those aged 51–65 had a higher risk of having more than 8 CA, with an adjusted OR (aOR) of 2.8 (95% CI: 1.3–6.1; p=0.009). This risk was even greater in those over 65 years, with an aOR of 5.5 (95% CI: 2.4–12.3; p<0.001).
A statistically significant, though not independent, association was also found between the number of CA and personal history of melanoma (OR=2.2), basal cell carcinoma (OR=2.3), and squamous cell carcinoma (OR=4.5).
Spearman's correlation analysis revealed a positive association between age and number of CA (r=0.428; p<0.001). When broken down by body locations, the strongest correlations were observed in the abdomen (r=0.430) and chest (r=0.410), whereas no significant correlation was found in the legs. Additionally, positive and significant associations were identified between different anatomical regions, particularly between the abdomen and lower back (r=0.729), abdomen and chest (r=0.742), and chest and lower back (r=0.693), suggesting a clustered distribution of CA on the trunk. No relationship was found between the number of CA and patient sex, racial phenotypic characteristics, age of CA onset as reported by patients, family history of CA (maternal and paternal), personal history of other non-cutaneous neoplasms, presence of seborrheic keratoses, or melanocytic nevi.
Conclusion: The risk of having more than 8 CA increases progressively with age, which is the main factor associated with their presence
Mutations in the plant‑conserved uL1m mitochondrial ribosomal protein significantly affect development, growth and abiotic stress tolerance in Arabidopsis thaliana
Get PDFMitochondria ribosomes, or mitoribosomes, reflect the endosymbiotic origin of this organelle. Mitoribosomes are made
up of RNAs and proteins (mitochondrial ribosomal proteins, MRPs). Considering the large amount of MRPs identified in
plant mitoribosomes, the number of MRPs for which mutations producing mutant phenotypes have been hitherto reported
is rather limited. Moreover, the contribution of plant mitoribosomes, and hence mitochondrial translation, to abiotic stress,
is almost completely unknown. To advance knowledge about the role of mitochondrial translation in plant development and
stress acclimation, we performed a thorough genetic and phenotypic analysis of the Arabidopsis mrpl1-1 and 3 mutants
affected in the MRPL1 (MITOCHONDRIAL RIBOSOMAL PROTEIN L1) gene encoding MRP uL1m. Compared to the
wild type, the mrpl1-1 and 3 mutants show delayed growth, small body size and smaller leaf palisade cells, although the
morphology of chloroplasts and mitochondria is similar. We identified a novel MRPL1 mutant allele, mrpl1-2, that causes
early seedling lethality, which reveals that Arabidopsis MRPL1 is an essential gene. Furthermore, the mrpl1 viable mutants
are less responsive than the wild type to increased growth temperature, and are hypersensitive to antibiotics doxycycline
and chloramphenicol, and also to salt, osmotic and ABA stress. In summary, impaired MRPL1 function severely hinders
plant growth and development, likely by triggering retrograde signaling due to translational perturbation, and it enhances
sensitivity to abiotic stress. Besides, our results support a role for mitochondria translation in acclimation to adverse environmental
conditions. To our knowledge this is the first work to report an altered abiotic stress sensitivity phenotype due to
mutations in a plant MRP gene
Population Pharmacokinetics of Risperidone and Paliperidone in Schizophrenia: A Systematic Review
Get PDFBackground: The primary treatment of schizophrenia is pharmacotherapy with
antipsychotic agents, such as risperidone and paliperidone. Population pharmacokinetic
(PopPK) modelling plays a crucial role in optimising therapy by predicting of plasma
concentrations, therapeutic efficacy, and the risk of adverse effects using model informed
precision dosing. Objectives: This systematic review examined the PopPK models of
risperidone and paliperidone in patients diagnosed with schizophrenia based on the available scientific evidence. Methods: A systematic review of the health science databases
was conducted. The inclusion criteria were original articles published in peer-reviewed
journals, studies focusing on the development of original PopPK models of risperidone and
paliperidone, and clinical studies. The exclusion criteria were full-text articles that could not
be retrieved; studies not including subjects diagnosed with schizophrenia or schizoaffective
disorders; and studies that did not investigate risperidone or paliperidone. Results: A total
of 19 studies developing PopPK models were analysed, including one- or two-compartment
PopPK model structures. Interindividual variability in the pharmacokinetic parameters
was shown to be influenced by factors such as CYP2D6 activity, renal function, body mass
index, and sex. Parameter estimation revealed high variability in clearance and volume of
distribution. Conclusion: Numerous PopPK models for risperidone and paliperidone have
been published with a detailed characterisation of absorption, metabolism, and elimination.
Therefore, future research should focus on the external validation of these models to facilitate their integration into clinical practice and optimise individualised dosing, ultimately
improving treatment efficacy and safety across diverse patient populations
Cirugía Robótica: Análisis de la Plataforma HugoTM RAS en Cirugía General.
Get PDFIntroducción: La cirugía robótica abdominal ha evolucionado significativamente en las últimas
décadas, destacando inicialmente la plataforma da Vinci®. Recientemente, la aparición del
sistema Hugo™ RAS (Medtronic) promete ofrecer alternativas tecnológicas innovadoras en
cirugía general. Este trabajo busca revisar y realizar una revisión bibliográfica de la literatura
disponible sobre la plataforma Hugo™ RAS, explorando sus ventajas y limitaciones en
procedimientos de cirugía general. La hipótesis principal es que el sistema Hugo™ RAS
representa una alternativa segura y eficaz, especialmente para procedimientos multicuadrante.
Material y Métodos: Se llevó a cabo una revisión sistemática de literatura publicada entre enero
de 2021 y abril de 2025, utilizando las bases de datos PubMed, Scopus y Web of Science. Se
incluyeron estudios originales, revisiones, cohortes, casos clínicos y series que abordaron
procedimientos en cirugía general realizados con el sistema Hugo™ RAS. Se extrajeron datos
sobre pacientes intervenidos, técnicas quirúrgicas empleadas, tiempos operatorios,
complicaciones y configuraciones del sistema.
Resultados: De 48 publicaciones iniciales, se seleccionaron 30 estudios, que comprendieron
entre 431 y 456 pacientes operados. Las operaciones más frecuentes fueron la cirugía colorrectal,
colecistectomía, cirugía esofagogástrica y reparaciones de hernias abdominales. Las ventajas
principales identificadas incluyeron la modularidad del sistema, que ofrece flexibilidad en
procedimientos multicuadrantes, y la consola abierta, que mejora la interacción del cirujano con
el equipo quirúrgico. No obstante, se observaron desafíos relacionados con la configuración de
los brazos robóticos y limitaciones en instrumental específico. Discusión: La literatura actual muestra que Hugo™ RAS es una plataforma segura, factible y
reproducible en cirugía general. Sin embargo, aún prevalece la heterogeneidad en las técnicas
quirúrgicas y falta consenso sobre configuraciones óptimas, lo que dificulta establecer
conclusiones sólidas. La necesidad frecuente de reacoplar el sistema en cirugías complejas
destaca como un aspecto mejorable, aunque esto no afecta significativamente los resultados
globales. La incorporación progresiva de instrumentos específicos promete superar algunas
limitaciones actuales.
Conclusiones: Aunque la experiencia clínica con Hugo™ RAS aún es limitada, los resultados
iniciales son prometedores y sugieren potenciales ventajas en términos de flexibilidad y
ergonomía. Se requiere investigación adicional con estudios comparativos multicéntricos para
consolidar su utilidad clínica y definir estándares operativos claros en cirugía general.Introduction: Robotic abdominal surgery has significantly evolved over recent decades, initially
highlighting the da Vinci® platform. Recently, the emergence of the Hugo™ RAS system
(Medtronic) promises innovative technological alternatives in general surgery. This study aims
to critically review and analyze available literature on the Hugo™ RAS platform, exploring its
advantages and limitations in general surgical procedures. The underlying hypothesis is that the
Hugo™ RAS system represents a safe and effective alternative, particularly for multiquadrant
operations. Material and Methods: A systematic review was conducted covering literature published
between January 2021 and April 2025, using PubMed, Scopus, and Web of Science databases.
Original studies, reviews, cohorts, clinical cases, and series addressing general surgery
procedures performed with the Hugo™ RAS system were included. Data were extracted
regarding patients, surgical techniques, operative times, complications, and system
configurations.
Results: From an initial 48 publications, 30 studies were selected, encompassing between 431
and 456 operated patients. The most frequent surgical fields included colorectal surgery,
cholecystectomy, esophagogastric surgery, and abdominal hernia repairs. Major identified
advantages included system modularity, offering flexibility in multiquadrant procedures, and the
open console design, improving surgeon-team interaction. However, challenges were observed
regarding robotic arm configuration and specific instrument limitations.
Discussion: Current literature indicates that Hugo™ RAS is a safe, feasible, and reproducible
platform for general surgery. Nonetheless, considerable heterogeneity in surgical techniques and
lack of consensus on optimal configurations remain, complicating definitive conclusions. The
frequent need for re-docking in complex surgeries emerges as an aspect needing improvement,
though it does not significantly impact overall outcomes. Progressive incorporation of specialized
instruments is expected to overcome current limitations.
Conclusions: Although clinical experience with Hugo™ RAS remains limited, initial outcomes
are promising, suggesting potential advantages in flexibility and ergonomics. Further multicentric
comparative studies are required to consolidate clinical utility and establish clear operational
standards in general surgery
Evaluación del grado de cumplimiento de las recomendaciones de vacunación en personas que conviven con el VIH.
Get PDFIntroducción: La vacunación en personas que viven con VIH es esencial para prevenir infecciones graves, pero la cobertura vacunal sigue siendo inferior a la de la población general y a los estándares de GESIDA.
Métodos: Se realizó un estudio observacional retrospectivo en el Hospital Clínico Universitario de San Juan con 198 adultos con infección crónica por VIH. Los objetivos incluyen el análisis de la derivación y asistencia a Medicina Preventiva, la cobertura vacunal frente a neumococo, hepatitis B (VHB), varicela-zóster (VVZ) y papilomavirus humano (VPH), y los factores asociados a la falta de vacunación.
Resultados: Se incluyeron 198 pacientes adultos con infección por VIH, la mayoría varones (82,3%) con una media de edad de 46,1 años. El 83,3% de los pacientes fueron derivados y el 71,7% acudieron a consultas de Medicina Preventiva. La tasa de vacunación completa fue del 60,8% para neumococo, 72,6% para hepatitis B, 49,3% para varicela-zóster y 28,3% para papilomavirus humano (≤45 años). Las pérdidas de oportunidad fueron del 39,2% en el caso de neumococo, 27,4% para la vacuna de hepatitis B, casi del 50% para la vacuna del varicela-zóster y cercano al 80% para la vacunación del papilomavirus humano. La derivación y asistencia a Medicina Preventiva fueron factores predictores de vacunación (p<0,001), mientras que la pérdida de seguimiento (p=0,003) y la carga viral detectable (p=0,048) se asociaron negativamente. Un mayor tiempo desde el diagnóstico de VIH se asoció con mayor probabilidad de vacunación completa.
Conclusiones: En nuestro hospital existe una buena adherencia al circuito de derivación de Medicina Preventiva, sin embargo, la cobertura vacunal continúa siendo baja. Es imprescindible reforzar los protocolos de derivación y asegurar el seguimiento activo de los pacientes con el fin de reducir las pérdidas de oportunidad y aumentar la cobertura vacunal en este grupo de riesgo.Background: Vaccination is crucial for people living with HIV to prevent serious infections; however, immunization rates remain lower than those observed in the general population and fall short of GESIDA recommendations. Methods: We conducted a retrospective observational study at San Juan University Clinical Hospital (Alicante), including adults with chronic HIV infection. The study aimed to assess referral and attendance to Preventive Medicine, vaccination coverage for pneumococcus, hepatitis B, varicella-zoster, and human papillomavirus, as well as factors associated with incomplete vaccination. Both univariate and multivariate statistical analyses were performed. Results: The cohort comprised adults with HIV, predominantly male, with a mean age of 46.1 years. Referral to Preventive Medicine was recorded in most cases, and a majority attended the consultations. Complete vaccination coverage was moderate for pneumococcus and hepatitis B, lower for varicella-zoster, and lowest for human papillomavirus (in those aged ≤45 years). Missed vaccination opportunities were notable for all vaccines, especially varicella-zoster and human papillomavirus. Referral and attendance at Preventive Medicine were significant predictors of vaccination, while loss to follow-up and detectable viral load were negatively associated. A longer duration since HIV diagnosis correlated with higher rates of complete vaccination. Conclusions: Despite high referral rates to Preventive Medicine in our center, overall vaccination coverage remains suboptimal. Strengthening referral pathways and ensuring proactive patient follow-up are essential to reduce missed opportunities and enhance immunization rates in this high-risk population
Triglyceride-glucose index in adolescents with type 1 diabetes mellitus
Get PDFBackground and Aim: Even though HbA1c can be obtained easily and accurately by blood test, the cost may limit its availability for some patients and their proper follow-up. The triglyceride-glucose index has been shown to have an association with HbA1c in other populations, but it hasn’t been studied in adolescents with T1DM yet. The aim of this study is to assess the association of TyG index with glycaemic control in adolescents with T1DM. Methods: This cross-sectional study included a sample of 36 adolescents (50% female) from the paediatric unit of the San Juan Hospital in Alicante (Spain). Data on sociodemographics, growth parameters, glycaemic control, and blood tests results were collected after routine visits. Results: A higher TyG index was statistically associated with a higher BMI, percentile and z-score, a higher triglyceride, HbA1c and glucose levels and with the triglycerides/HDL, the total cholesterol/HDL, the TyG-BMI and the TyG-waist circumference indexes. Conclusion: The TyG index is a simple and non-invasive biomarker that could serve as a valuable adjunct to HbA1c monitoring in adolescents with T1DM. It may have a potential utility as a screening tool for early identification of patients at risk for developing metabolic complications such as insulin resistance and dyslipidemia
Water Security Under Climate Change: Challenges and Solutions Across 43 Countries
Get PDFDifferent countries face significant challenges in managing water-related natural
hazards, such as floods and shortages, while ensuring adequate water quality and quantity
to satisfy human needs and preserve ecosystems. Climate change projections exacerbate
this situation by intensifying the hydrological cycle, resulting in substantial changes in precipitation
patterns, evapotranspiration, and groundwater storage. This study reviews water
security challenges across 43 countries, drawing on 128 articles obtained from databases
including EBSCOHOST, Scopus and ResearchGate, as well as specific journals. Key search
terms included “water security”, “water security and climate change”, “water scarcity”,
“water risk index”, “water balance”, “water assessment”, and “land use and land cover
change”. The analysis reveals the main water security issues present in 43 countries (flash
floods, drought and water quality), and the response measures identified these challenges
to water security. All the countries studied face one or more critical water-related effects.
Afghanistan, Bangladesh, India, and Mexico were identified as the most severely affected,
dealing with a combination of water scarcity, flooding, and water pollution. The most
suggested strategies for improving water security include sustainable urban planning,
improving consumption efficiency, strategic land-use planning, applying technologies to
predict availability of water resources and planning according to variations in resource
availability over time. In addition, other general actions include enhancing water storage
infrastructure, improving consumption efficiency and adopting sustainable urban planning