32 research outputs found
Kaposi's sarcoma in a patient with erythroblastopenia and thymoma: Reactivation after topical corticosteroids
We report a 69-year-old female with erythroblastopenia and thymoma who developed lesions of Kaposi's sarcoma (KS) after thymectomy, 2 months after the initiation of therapy with methylprednisolone. Control of mucocutaneous KS lesions was obtained with radiotherapy, interferon alfa-2b and withdrawal of systemic immunosuppressive therapy. Erosive oral lichen planus appeared later, and after therapy with topical corticosteroids a new lesion of KS developed that regressed after withdrawal of topical corticosteroids. The detection of HHV-8 only in lesional skin supports the hypothesis that this virus can trigger the development of KS lesions
Population variability in some genes involving the haemostatic system: data on the general population of Corsica (France), Sardinia and Sicily (Italy)
Three different population samples from Corsica (France), Sardinia and Sicily (Italy) were studied using nine genetic markers. For the first time, allele distributions of FGA TaqI, FGB Bcl I, FGB Hind III, PAI-1 Hind III, PLAT TPA-25, GPIIIa Taq I, GPIIb I/D 9bp, FVII HVR4 and FVII -323 10 bp markers, which are thought to be associated with cardiovascular disease risk, were studied in the general population of the three islands. The frequencies of the markers analysed in the present work show some peculiarities: the locus FVII HVR4 is characterized by the presence of a rare allele (H5), found in Corsicans and in Sardinians; the locus FBG BcII shows a low frequency of the B1 allele and the absence of the B1B1 genotype. The frequencies of some alleles have a distribution that is in agreement with the low risk for cardiovascular diseases in south European countries. The results highlight a genetic differentiation between the three Mediterranean islands and the other European populations
Molecular Variation in Endothelial Nitric Oxide Synthase Gene (eNOS) in Western Mediterranean Populations
Endothelial nitric oxide synthase (eNOS or NOS3) is the main responsible for nitric
oxide (NO) production in vascular system and different polymorphisms have been identified
in epidemiological studies. Trying to test the eNOS genetic variation in general
populations we studied the 27-bp VNTR in intron 4 and G894T substitution in exon 7
markers in 6 Western Mediterranean populations (3 from Iberian Peninsula, 1 from
North Africa, and 2 from Sardinia) and a sample from Ivory Coast. The VNTR frequencies
in Western Mediterranean and Ivory Coast fit well into the ranges previously described
for Europeans and Sub-Saharans respectively, and a typical African allele has
been detected in polymorphic frequencies in the Berber sample. The G894T substitution
presents the highest frequencies described for the T allele in the North Mediterranean
populations. Linkage disequilibrium is present between both markers in all populations
except in the Ivory Coast sample. The variation found for these polymorphisms indicates
that they may be a useful tool for population studies even at microgeographical
level
Molecular Variation at Functional Genes and the History of Human Populations – Data on Candidate Genes for Cardiovascular Risk in the Mediterranean
A screening of 22 DNA polymorphisms has been performed in western Mediterranean
populations (Iberian Peninsula, Morocco, and Central Mediterranean Islands).
The analyzed markers correspond to polymorphic sites in several candidate genes for
cardiovascular disease including apolipopoteins and their receptors (APOA1, APOB,
APOE, APOC1, APOC2, LPA, and LDLR), genes implied in the hemostasis regulation
(Factor VII, and -fibrinogen, and platelet-integrin, tissue plasminogen activator,
and plasminogen activator inhibitor-1), and the angiotensin converting enzyme gene.
The results are presented of a partial analysis carried out in following population samples:
6 from the Iberian Peninsula, 2 from Morocco, and 3 from Central Islands. The degree
of interpopulation diversity was significant and consistent with data from other
kind of genetic polymorphisms. The apportionment of the allele frequency variance supported
a geographic structure into three main regions: Central Mediterranean Islands,
the Iberia Peninsula and North Africa. The genetic distance pattern is compatible with
a south-to-north North African influence in the Iberian Peninsula and a remarkable
gene flow from sub-Saharan Africa into Morocco. Epidemiologicaly, North Africa is characterized
by high frequencies of LPA PNR alleles with high number of repeats (protective
for cardiovascular risk) and high frequencies of the APOE*E4 allele (risk factor) as
compared with European populations
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely
Base de datos de abejas ibéricas
Las abejas son un grupo extremadamente diverso con más de 1000 especies descritas en la península ibérica. Además, son excelentes polinizadores y aportan numerosos servicios ecosistémicos fundamentales para la mayoría de ecosistemas terrestres. Debido a los diversos cambios ambientales inducidos por el ser humano, existen evidencias del declive de algunas de sus poblaciones para ciertas especies. Sin embargo, conocemos muy poco del estado de conservación de la mayoría de especies y de muchas de ellas ignoramos cuál es su distribución en la península ibérica. En este trabajo presentamos un esfuerzo colaborativo para crear una base de datos de ocurrencias de abejas que abarca la península ibérica e islas Baleares que permitirá resolver cuestiones como la distribución de las diferentes especies, preferencia de hábitat, fenología o tendencias históricas. En su versión actual, esta base de datos contiene un total de 87 684 registros de 923 especies recolectados entre 1830 y 2022, de los cuales un 87% presentan información georreferenciada. Para cada registro se incluye información relativa a la localidad de muestreo (89%), identificador y colector de la especie (64%), fecha de captura (54%) y planta donde se recolectó (20%). Creemos que esta base de datos es el punto de partida para conocer y conservar mejor la biodiversidad de abejas en la península ibérica e Islas Baleares. Se puede acceder a estos datos a través del siguiente enlace permanente: https://doi.org/10.5281/zenodo.6354502ABSTRACT: Bees are a diverse group with more than 1000 species known from the Iberian Peninsula. They have increasingly received special attention due to their important role as pollinators and providers of ecosystem services. In addition, various rapid human-induced environmental changes are leading to the decline of some of its populations. However, we know very little about the conservation status of most species and for many species, we hardly know their true distributions across the Iberian Peninsula. Here, we present a collaborative effort to collate and curate a database of Iberian bee occurrences to answer questions about their distribution, habitat preference, phenology, or historical trends. In total we have accumulated 87 684 records from the Iberian Peninsula and the Balearic Islands of 923 different species with 87% of georeferenced records collected between 1830 and 2022. In addition, each record has associated information such as the sampling location (89%), collector and person who identified the species (64%), date of the capture (54%) and plant species where the bees were captured (20%). We believe that this database is the starting point to better understand and conserve bee biodiversity in the Iberian Peninsula. It can be accessed at: https://doi.org/10.5281/zenodo.6354502Esta base de datos se ha realizado con la ayuda de los proyectos EUCLIPO (Fundação para a Ciência e a Tecnologia, LISBOA-01-0145-FEDER-028360/EUCLIPO) y SAFEGUARD (ref. 101003476 H2020 -SFS-2019-2).info:eu-repo/semantics/publishedVersio
Manual de simulación clínica en especialidades médicas
Manual sobre técnicas y modos de simulación clínica en diversas especialidades médicas.La enseñanza y formación en medicina necesita el uso de la simulación. Existen evidencias de su uso desde hace cientos de años, pero, en los últimos años se ha incrementado y diseminado.
La simulación clínica está validada científicamente en múltiples contextos médicos y de otras áreas profesionales de la salud. Y es considerada de gran importancia como proceso de entrenamiento y de mejora de las competencias y adquisición de habilidades médicas en campos que incluye desde la historia clínica, comunicación con el paciente, exploración, diagnóstico terapéutica médica-farmacológica y quirúrgica y seguridad al tratar al paciente.
Hoy en día, para muchas técnicas y situaciones clínicas es inaceptable llegar junto a los pacientes sin un dominio adquirido en simulación. La simulación puede ocurrir sin el uso de recursos adicionales, solo las personas, o utilizando pocos o muchos recursos de baja hasta alta tecnología y se puede adaptar a los recursos disponibles, abarcando todas las áreas de conocimiento, y dentro de ellas competencias técnicas o actitudes, solas o en conjunto.
El uso racional y basado en evidencia de la simulación es de la mayor importancia por la necesidad de una mayor efectividad y eficiencia en la transformación de los profesionales de la salud para que puedan mejorar su capacidad de atender a los pacientes.
La simulación es también una buena herramienta de evaluación de competencias y habilidades en Medicina y otras disciplinas de las Ciencias de la Salud
Este manual incluye técnicas y modos de simulación clínica en diversas especialidades médicas, útiles, para quien busque un manual práctico y actualizado.Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Terapias Avanzadas en Patología Cardiovascular
Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Investigación Biomédica Quirón Salu
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Tractatus de Sacra doctrina [Manuscrito] ;]Brevis tractatus de sensibus Sacrae Scripturae /
Copia digital. España : Ministerio de Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria, 2022_L1Enc. perg.La primera obra comienza en la h. 1, la segunda en la h. 46, la tercera en la h. 57, la cuarta en la h. 85, la quinta en la h. 133 y la sexta en la h. 153
Encuesta sobre la situación de los profesionales de la salud bucodental de las islas baleares frente al COVID-19 en tiempo de confinamiento de la población e inicio de la desescalada
Introduction: The ADEMA-UIB University School of Dentistry, faced with the situation caused by COVID-19, has carried out a survey for dentists and stomatologists, superior technicians in oral hygiene and superior technicians in dental prosthesis of the Ba-learic Islands, in order to know various important aspects of their work and personal situation in relation to COVID-19, as well as the measures adopted and the functionality of the Dental Clinics and the Dental Prosthesis Laboratories, during the confinement of the population and the start of de-escalation. The aim of the study is to know the changes produced in the oral care of the population during this stage of the pandemic.
Material and method: We carried out an online self-filling survey, with free access to the 1,482 professionals involved in oral care of the population of the Balearic Islands. The data has been collected between days 1 and 30 of June 2020, through a form served through the Google Forms Gsuit application. This study is quantitative, descriptive and anonymous.
Results: The responses received by the 148 professionals who filled in the form, already reported specific percentage trends. After comparing their sociodemographic aspects, individual protection equipment, infections and operations of dental clinics and prosthetic laboratories, significant differences between them were observed.
Conclusions: The surveyed population presented a greater exposure to the risk of contracting the viral infection than in the general population. Around 30% of those surveyed have maintained their usual activity and around 15% have declared that they have clo-sed their center. Furthermore, the most frequent masks used by them were surgical masks and FFP2, although among the higher technicians in dental prosthesis the use of surgical masks was more frequent.
Discussion: In reference to the data observed in the surveys carried out at a national level, it is worth highlighting some differences between the results from the Balearic Islands surveys and the national ones. While the Balearic Islands had a percentage of 83% in relation to the participation of the urban environment, the national surveys reported a percentage of 58%. Moreover, the use of waterproof suits resulted in 78,7% in the Balearic Islands compared to 15% at a national level and around 11,5% of the participants had difficulties to obtain PPEs in the Islands compared to 80% at a national level. Finally, the number of tests for the diagnosis of COVID-19 which have been carried out on the surveyed professionals reached 43.9% in the Balearic Islands compared to just 1% of professionals nationwide, which justifies the underdiagnoses of COVID-19 among the country.Introducción: La Escuela Universitaria de Odontología ADEMA-UIB, ante la situación creada por el COVID-19, ha realizado una encuesta dirigida a odontólogos y estomatólogos (OE), técnicos superiores en higiene bucodental (HB) y técnicos superiores en prótesis dental (PD) de las Islas Baleares, con el objeto de conocer varios aspectos de relevancia de su situación laboral y personal frente al COVID-19, así como las medidas adoptadas y el grado de funcionamiento de las Clínicas dentales (CD) y los Laboratorios de prótesis dental (LP), durante el confinamiento de la población y el inicio de la desescalada. El objetivo del estudio es conocer los cambios producidos en la atención bucodental de la población durante esta etapa de pandemia.
Material y método: Encuesta de auto relleno online, con acceso libre a los 1.482 profesionales implicados en la atención bu-codental de la población de las Islas Baleares, mediante un estudio cuantitativo, descriptivo, anonimizado, con recogida de datos entre los días 1 y 30 de junio de 2020, mediante un formulario servido a través de la aplicación Gsuit de Google Forms, sin con-tener ningún dato identificativo de los participantes.
Resultados: Las respuestas recibidas por los 148 profesionales que han rellenado el formulario, por sí mismas ya reportan unas tendencias porcentuales concretas, siendo necesario estimar los valores medios e intervalos de confianza (95%) contra hipótesis nulas debidamente estructuradas, tras el cruce de aspectos sociodemográficos, de equipos de protección individual, de contagios, de funcionamiento de Clínicas dentales y Laboratorios de prótesis, observando la existencia de diferencias significativas entre ellos.
Conclusiones: La población encuestada presenta una mayor exposición al riesgo de contraer la infección viral que en la pobla-ción general. Alrededor del 30% de los encuestados ha mantenido su actividad habitual y alrededor del 15% declaró haber cerrado su centro. Lo mas frecuente es el uso conjunto de mascarillas quirúrgicas y FFP2, aunque entre los técnicos superiores en prótesis dental (PD) es mas frecuente el uso de las mascarillas quirúrgicas.
Discusión: En referencia a los datos observados en las encuestas realizadas a nivel nacional, cabe destacar una participación del medio urbano en el 83% de los encuestados en las Islas Baleares frente al 58% a nivel nacional, el uso de trajes impermeables en el 78,7% de las Islas Baleares frente al 15% a nivel nacional y en cuanto a la adquisición de EPIs, sólo el 11,5% de encuestados en las Islas Baleares ha tenido dificultades para obtenerlos, frente al 80% de los profesionales a nivel nacional. El número de test realizados a los profesionales encuestados para el diagnóstico del COVID-19, alcanza al 43,9% en las Islas Baleares frente al 1% de los profesionales a nivel nacional, lo que justifica el infradiagnóstico de COVID-19 entre estos últimos