Estudio de la adherencia al tratamiento de pacientes sometidos a trasplante alogénico de precursores hematopoyéticos

El Trasplante alógenico de Precursores Hematopoyéticos (TAPH) es un procedimiento terapéutico que requiere un tratamiento farmacológico y recomendaciones higiénico-sanitarias de alta complejidad siendo clave para su éxito una adecuada adherencia terapéutica (AT). Objetivo principal: Valorar la AT en pacientes a los que se les ha realizado un TAPH en el Hospital Universitario de Salamanca detectando y analizando los problemas de la falta de adherencia y la eficacia de las estrategias establecidas en la consulta de enfermería para mejorar la AT durante los primeros 100 días post-trasplante. Metodología: Se realizó un estudio observacional, descriptivo y transversal. La población a estudio fueron 70 pacientes de TAPH y se consideraron las variables sexo, edad, y las habilidades y conocimientos acerca de los fármacos administrados (identificación, indicación, posología, modo de administración), así como su medición objetiva y subjetiva. Resultados: Comparando la AT entre la primera consulta de enfermería y la realizada el día +100 se encontraron diferencias significativas positivas para la variable habilidades-conocimientos y la medición objetiva (= 0,000 y 0,003 respectivamente). Por el contrario, para la medición subjetiva no ha hubo significación estadística (=0,945). Conclusiones: Se evidencia una mejora en la AT en los pacientes con TAPH tras la intervención de enfermería y el establecimiento de estrategias higiénico sanitarias adecuadas. Se concluye que es necesario un seguimiento por parte de enfermería y se sugiere la creación de herramientas adaptadas a las nuevas tecnologías que faciliten la adherencia

MÓDULO PARA LA DETECCIÓN DE ESTADOS EMOCIONALES A TRAVÉS DE EXPRESIONES FACIALES EN EL AULA TECNOLÓGICA XAUCE ATCNEA

Esta investigación está enmarcada en el proceso de desarrollo de un módulo de reconocimiento de expresiones faciales capaz de reconocer estados emocionales tales como felicidad, ira, tristeza, disgusto, sorpresa, miedo y estado neutral en una audiencia determinada. Dicha investigación persigue el objetivo de brindar al profesor que dirige el proceso una herramienta que le permita estudiar la actitud de sus alumnos frente a las actividades docentes que se llevan a cabo para así determinar la toma de acciones con vistas a incidir en el aspecto motivacional de los estudiantes. Con el resultado de dicho proyecto el aula tecnológica XAUCE ATcnea cuenta con un módulo para la detección de estados emocionales a través de expresiones faciales en imágenes fijas y frames de video. Para llevar a cabo la investigación propuesta se empleó una serie de técnicas e instrumentos de recolección de datos, específicamente el análisis de fuentes documentales. Para el cumplimiento del objetivo planteado se hace uso de la metodología de desarrollo de software Variación de AUP para la UCI

The Interaction of the Eta Carinae Primary Wind with a Century Old Slow Equatorial Ejecta

We argue that the asymmetric morphology of the blue and red shifted components of the outflow at hundreds of AU from the massive binary system Eta Carinae can be understood from the collision of the primary stellar wind with the slowly expanding dense equatorial gas. Recent high spatial observations of some forbidden lines, e.g. [Fe III] lambda4659, reveal the outflowing gas within about one arcsecond (2300 AU) from Eta Car. The distribution of the blue and red shifted components are not symmetric about the center, and they are quite different from each other. The morphologies of the blue and red shifted components correlate with the location of dense slowly moving equatorial gas (termed the Weigelt blob environment; WBE), that is thought to have been ejected during the 1887 - 1895 Lesser Eruption. In our model the division to the blue and red shifted components is caused by the postshock flow of the primary wind on the two sides of the equatorial plane after it collides with the WBE. The fast wind from the secondary star plays no role in our model for these components, and it is the freely expanding primary wind that collides with the WBE. Because the line of sight is inclined to the binary axis, the two components are not symmetric. We show that the postshock gas can also account for the observed intensity in the [Fe III] lambda4659 line.Comment: 15 pages, 3 figures. Accepted to New Astronom

Outpatient treatment with AZD7442 (tixagevimab/cilgavimab) prevented Covid-19 hospitalizations over 6 months and reduced symptom progression in the TACKLE randomized trial

Introduction We assessed effects of AZD7442 (tixagevimab/cilgavimab) on deaths from any cause or hospitalizations due to coronavirus disease 2019 (COVID-19) and symptom severity and longer-term safety in the TACKLE adult outpatient treatment study. Methods Participants received 600 mg AZD7442 (n = 452) or placebo (n = 451) ≤ 7 days of COVID-19 symptom onset. Results Death from any cause or hospitalization for COVID-19 complications or sequelae through day 169 (key secondary endpoint) occurred in 20/399 (5.0%) participants receiving AZD7442 versus 40/407 (9.8%) receiving placebo [relative risk reduction (RRR) 49.1%; 95% confidence interval (CI) 14.5, 69.7; p = 0.009] or 50.7% (95% CI 17.5, 70.5; p = 0.006) after excluding participants unblinded before day 169 for consideration of vaccination). AZD7442 reduced progression of COVID-19 symptoms versus placebo through to day 29 (RRR 12.5%; 95% CI 0.5, 23.0) and improved most symptoms within 1–2 weeks. Over median safety follow-up of 170 days, adverse events occurred in 174 (38.5%) and 196 (43.5%) participants receiving AZD7442 or placebo, respectively. Cardiac serious adverse events occurred in two (0.4%) and three (0.7%) participants receiving AZD7442 or placebo, respectively. Conclusions AZD7442 was well tolerated and reduced hospitalization and mortality through 6 months, and symptom burden through 29 days, in outpatients with mild-to-moderate COVID-19. Clinical Trial Registration Clinicaltrials.gov, NCT04723394. (https://beta.clinicaltrials.gov/study/NCT04723394)

Outpatient Treatment with AZD7442 (Tixagevimab/Cilgavimab) Prevented COVID-19 Hospitalizations over 6 Months and Reduced Symptom Progression in the TACKLE Randomized Trial

INTRODUCTION: We assessed effects of AZD7442 (tixagevimab/cilgavimab) on deaths from any cause or hospitalizations due to coronavirus disease 2019 (COVID-19) and symptom severity and longer-term safety in the TACKLE adult outpatient treatment study. METHODS: Participants received 600 mg AZD7442 (n = 452) or placebo (n = 451) ≤ 7 days of COVID-19 symptom onset. RESULTS: Death from any cause or hospitalization for COVID-19 complications or sequelae through day 169 (key secondary endpoint) occurred in 20/399 (5.0%) participants receiving AZD7442 versus 40/407 (9.8%) receiving placebo [relative risk reduction (RRR) 49.1%; 95% confidence interval (CI) 14.5, 69.7; p = 0.009] or 50.7% (95% CI 17.5, 70.5; p = 0.006) after excluding participants unblinded before day 169 for consideration of vaccination). AZD7442 reduced progression of COVID-19 symptoms versus placebo through to day 29 (RRR 12.5%; 95% CI 0.5, 23.0) and improved most symptoms within 1-2 weeks. Over median safety follow-up of 170 days, adverse events occurred in 174 (38.5%) and 196 (43.5%) participants receiving AZD7442 or placebo, respectively. Cardiac serious adverse events occurred in two (0.4%) and three (0.7%) participants receiving AZD7442 or placebo, respectively. CONCLUSIONS: AZD7442 was well tolerated and reduced hospitalization and mortality through 6 months, and symptom burden through 29 days, in outpatients with mild-to-moderate COVID-19. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT04723394. ( https://beta. CLINICALTRIALS: gov/study/NCT04723394 )

The MAPT H1 Haplotype Is a Risk Factor for Alzheimer's Disease in APOE E4 Non-carriers

An ancestral inversion of 900 kb on chromosome 17q21, which includes the microtubule-associated protein tau (MAPT) gene, defines two haplotype clades in Caucasians (H1 and H2). The H1 haplotype has been linked inconsistently with AD. In a previous study, we showed that an SNP tagging this haplotype (rs1800547) was associated with AD risk in a large population from the Dementia Genetics Spanish Consortium (DEGESCO) including 4435 cases and 6147 controls. The association was mainly driven by individuals that were non-carriers of the APOE ?4 allele. Our aim was to replicate our previous findings in an independent sample of 4124 AD cases and 3290 controls from Spain (GR@ACE project) and to analyze the effect of the H1 sub-haplotype structure on the risk of AD. The H1 haplotype was associated with AD risk (OR = 1.12; p = 0.0025). Stratification analysis showed that this association was mainly driven by the APOE ?4 non-carriers (OR = 1.15; p = 0.0022). Pooled analysis of both Spanish datasets (n = 17,996) showed that the highest AD risk related to the MAPT H1/H2 haplotype was in those individuals that were the oldest [third tertile (>77 years)] and did not carry APOE ?4 allele (p = 0.001). We did not find a significant association between H1 sub-haplotypes and AD. H1c was nominally associated but lost statistical significance after adjusting by population sub-structure. Our results are consistent with the hypothesis that genetic variants linked to the MAPT H1/H2 are tracking a genuine risk allele for AD. The fact that this association is stronger in APOE ?4 non-carriers partially explains previous controversial results and might be related to a slower alternative causal pathway less dependent on brain amyloid load.ACKNOWLEDGMENTS: The Genome Research at Fundacio ACE/Dementia Genetics Spanish Consortium (GR@ACE/DEGESCO) would like to thank patients and controls who participated in this project. GR@ACE/DEGESCO GWAS program was funded by Grifols SA, Fundacion Bancaria “La Caixa,” and Fundació ACE, Institut Català de Neurociències Aplicades. PS-J and AR have also received support by grant PI16/01861. Accion Estrategica en Salud integrated in the Spanish National ICDCi Plan and financed by Instituto de Salud Carlos III (ISCIII) – Subdireccion General de Evaluacion and the Fondo Europeo de Desarrollo Regional (FEDER – “Una Manera de Hacer Europa”). PS-J was supported by IDIVAL, Instituto de Salud Carlos III [Fondo de Investigacion Sanitario, PI08/0139, PI12/02288, PI16/01652, JPND (DEMTEST PI11/03028)], and the CIBERNED program. We thank Biobanco Valdecilla for their support. LM was supported by Consejería de Salud de la Junta de Andalucía (Grant PI-0001/2017). DEGESCO was also sponsored by the Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED, Spain). Control samples and data from patients included in this study were provided in part by the National DNA Bank Carlos III (www.bancoadn.org, University of Salamanca, Spain) and Hospital Universitario Virgen de Valme (Sevilla, Spain) and they were processed following standard operating procedures with the appropriate approval of the Ethical and Scientific Committee. The genotyping service to generate GR@ACE/DEGESCO GWAS data was carried out at CEGEN-PRB3-ISCIII; it was supported by grant PT17/0019, of the PE ICDCi 2013–2016, funded by ISCIII and ERDF. GR@ACE/DEGESCO consortia would also like to thank to all researchers contributing to this project

XLI Jornadas de teatro clásico

Jornadas organizadas por el Instituto Almagro de teatro clásico, dedicadas a la figura de Agustín Moreto

Matsigenka

Está concebido como un texto de referencia para el uso adecuado de las grafías del alfabeto oficial en cada una del Matsigenka. El contenido, esquema final y título fue elaborado de manera participativa con estudiantes, dirigentes, representantes de las organizaciones indígenas de los pueblos involucrados, sabios y sabias de las comunidades y especialistas de educación intercultural bilingüe —todos ellos hablantes de su lengua y conocedores de su cultura—, y con el asesoramiento de lingüistas y educadores en distintos talleres organizados por la DIGEIBIR. Lo señalado ha permitido que cada texto refleje aquellos aspectos de mayor interés e importancia. El objetivo de este material es ayudar a lograr utilizar adecuadamente el alfabeto oficial de tu lengua, y puedas producir y comprender textos escritos con él, respetando las variedades dialectales

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years