Adequacy and study of skeletal remains in forensic anthropology

Demostrada la importancia de la antropología forense en la identificación positiva de restos óseos humanos, consideramos relevante el aprendizaje de un manejo básico de las técnicas por los estudiantes del Grado de Medicina, en el contexto de la asignatura “Medicina Legal y Ética”. El objetivo principal era aplicar conocimientos teóricos y técnicas de antropología física y forense para identificación de casos reales mediante dinámicas de trabajo en grupo, concluyendo con una toma de decisiones justificada. Se organizaron 16 talleres de 2 horas de duración para grupos de 8 alumnos, utilizando restos esqueléticos de 4 individuos mezclados con huesos animales. Distribuidos por parejas, y una vez identificados los restos humanos, aislaron los 4 esqueletos realizando un inventario de los huesos disponibles, y una estimación básica del perfil biológico de cada uno de ellos: sexo, edad y estatura. Dichos datos fueron consignados en un formulario protocolizado de trabajo, que entregaron al finalizar la práctica. Posteriormente, realizaron un cuestionario anónimo de 10 preguntas, sobre el grado de satisfacción acerca de contenidos, metodología, y utilidad en su formación. Con una tasa de respuesta del 78,4% (n=125) las puntuaciones medias más elevadas fueron otorgadas a los ítems relacionados con: profesor y materia (χ 4,98; Dt. 0,14), claridad expositiva (χ 4,94; Dt. 0,24) y adecuación de metodología (χ 4,92; Dt. 0,28). Además de los resultados favorables obtenidos, se objetivó mediante los formularios protocolizados, la adecuada resolución de casos prácticos reales, basada en una toma de decisiones conjunta y justificada en base a los conocimientos teóricos aprendidos.Having demonstrated the importance of forensic anthropology in the positive identification of human skeletal remains, we consider it relevant to learn a basic management of the techniques by the students of the Medical Degree, in the context of the subject "Legal Medicine and Ethics". The main objective was to apply theoretical and technical knowledge on physical and forensic anthropology to identify real cases through group work dynamics, concluding with justified decision making. Sixteen 2-hour workshops were organized for groups of 8 students, using skeletal remains of 4 individuals mixed with animal bones. After the human remains were identified, the four skeletons were isolated and an inventory of the available bones was made. The basic biological profile of each of them was analyzed: sex, age and height. These data were entered in a protocol form, which they delivered at the end of the practice. Subsequently, they conducted an anonymous questionnaire of 10 items about the degree of satisfaction on contents, methodology, and utility in their training. With a response rate of 78.4% (n = 125), the highest mean scores were given to items related to: teacher and subject (χ 4,98; Dt. 0.14), expository clarity (χ 4, 94, Dt. 0.24) and adequacy of methodology (χ 4,92, Dt. 0,28). In addition to the favorable results obtained, it was objectified through the protocolized forms, the adequate resolution of real practical cases, based on a joint decision making and justified on the theoretical contents learned

Adquisición, entrenamiento y práctica de competencias y destrezas digitales para estudiar Historia Contemporánea del primer curso de los grados de Antropología Social y Cultural y de la Administración Pública en las Facultades de Políticas y Sociología

Depto. de Historia, Teorías y Geografías PolíticasFac. de Ciencias Políticas y SociologíaFALSEsubmitte

ADECUACIÓN Y ESTUDIO DE RESTOS ÓSEOS EN ANTROPOLOGÍA FORENSE

Having demonstrated the importance of forensic anthropology in the positive identification of human skeletal remains, we consider it relevant to learn a basic management of the techniques by the students of the Medical Degree, in the context of the subject "Legal Medicine and Ethics". The main objective was to apply theoretical and technical knowledge on physical and forensic anthropology to identify real cases through group work dynamics, concluding with justified decision making. Sixteen 2-hour workshops were organized for groups of 8 students, using skeletal remains of 4 individuals mixed with animal bones. After the human remains were identified, the four skeletons were isolated and an inventory of the available bones was made. The basic biological profile of each of them was analyzed: sex, age and height. These data were entered in a protocol form, which they delivered at the end of the practice. Subsequently, they conducted an anonymous questionnaire of 10 items about the degree of satisfaction on contents, methodology, and utility in their training. With a response rate of 78.4% (n = 125), the highest mean scores were given to items related to: teacher and subject (χ 4,98; Dt. 0.14), expository clarity (χ 4, 94, Dt. 0.24) and adequacy of methodology (χ 4,92, Dt. 0,28). In addition to the favorable results obtained, it was objectified through the protocolized forms, the adequate resolution of real practical cases, based on a joint decision making and justified on the theoretical contents learned.Demostrada la importancia de la antropología forense en la identificación positiva de restos óseos humanos, consideramos relevante el aprendizaje de un manejo básico de las técnicas por los estudiantes del Grado de Medicina, en el contexto de la asignatura “Medicina Legal y Ética”. El objetivo principal era aplicar conocimientos teóricos y técnicas de antropología física y forense para identificación de casos reales mediante dinámicas de trabajo en grupo, concluyendo con una toma de decisiones justificada. Se organizaron 16 talleres de 2 horas de duración para grupos de 8 alumnos, utilizando restos esqueléticos de 4 individuos mezclados con huesos animales. Distribuidos por parejas, y una vez identificados los restos humanos, aislaron los 4 esqueletos realizando un inventario de los huesos disponibles, y una estimación básica del perfil biológico de cada uno de ellos: sexo, edad y estatura. Dichos datos fueron consignados en un formulario protocolizado de trabajo, que entregaron al finalizar la práctica. Posteriormente, realizaron un cuestionario anónimo de 10 preguntas, sobre el grado de satisfacción acerca de contenidos, metodología, y utilidad en su formación. Con una tasa de respuesta del 78,4% (n=125) las puntuaciones medias más elevadas fueron otorgadas a los ítems relacionados con: profesor y materia (χ 4,98; Dt. 0,14), claridad expositiva (χ 4,94; Dt. 0,24) y adecuación de metodología (χ 4,92; Dt. 0,28). Además de los resultados favorables obtenidos, se objetivó mediante los formularios protocolizados, la adecuada resolución de casos prácticos reales, basada en una toma de decisiones conjunta y justificada en base a los conocimientos teóricos aprendidos

Impact of SARS-CoV-2 pandemic among health care workers in a secondary teaching hospital in Spain.

BackgroundThe COVID-19 pandemic has posed a huge challenge to healthcare systems and their personnel worldwide. The study of the impact of SARS-CoV-2 infection among healthcare workers (HCW), through prevalence studies, will let us know viral expansion, individuals at most risk and the most exposed areas in healthcare organizations. The aim of this study is to gauge the impact of SARS-CoV-2 pandemic in our hospital workforce and identify groups and areas at increased risk.Methods and findingsThis is a cross-sectional and incidence study carried out on healthcare workers based on molecular and serological diagnosis of SARS-CoV-2 infection. Of the 3013 HCW invited to participate, 2439 (80.9%) were recruited, including 674 (22.4%) who had previously consulted at the Occupational Health Service (OHS) for confirmed exposure and/or presenting symptoms suggestive of COVID-19. A total of 411 (16.9%) and 264 (10.8%) healthcare workers were SARS-CoV-2 IgG and rRT-PCR positive, respectively. The cumulative prevalence considering all studies (IgG positive HCW and/or rRT-PCR positive detection) was 485 (19.9%). SARS-CoV-2 IgG-positive patients in whom the virus was not detected were 221 (9.1%); up to 151 of them (68.3%) did not report any compatible symptoms nor consult at the OHS for this reason. Men became more infected than women (25% vs 18.5%, p = 0.0009), including when data were also classified by age. COVID-19 cumulative prevalence among the HCW assigned to medical departments was higher (25.2%) than others, as well as among medical staff (25.4%) compared with other professional categories (pConclusionsThe global impact of the COVID-19 pandemic on HCW of our centre has been 19.9%. Doctors and medical services personnel have had the highest prevalence of SARS-CoV-2 infection, but many of them have not presented compatible symptoms. This emphasizes the performance of continuous surveillance methods of the most exposed health personnel and not only based on the appearance of symptoms

Atypical Hemolytic Uremic Syndrome: A Nationwide Colombian Pediatric Series

Objectives. Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease with genetic predisposition and represents up to 10% of pediatric hemolytic uremic syndrome (HUS) cases. Few studies have evaluated aHUS in Latin American population. We studied a Colombian pediatric cohort to delineate disease presentation and outcomes. Methods. A multicenter cohort of 27 Colombian children with aHUS were included. Patients were grouped by age at onset. Clinical features were compared using analysis of variance (ANOVA) and Fisher exact tests. Renal biopsy was performed on 6 patients who were suspected of having other renal diseases before aHUS diagnosis. Results. Most patients were male (70%). The onset of aHUS occurred frequently before age 4 years (60%) and followed gastroenteritis as the main triggering event (52%). Age groups showed comparable clinical presentation, disease severity, treatment, and outcomes. Pulmonary involvement (67%) was the main extrarenal manifestation, particularly in the 1 to 7 age group (P = .01). Renal biopsies were as follows: 3 had membranoproliferative glomerulonephritis (MPGN) type I, one MPGN type III, one C3-glomerulonephritis, and one rapidly progressive GN. Genetic screening was available in 6 patients and identified 2xCFHR5, 2xMCP, 1xADAMTS13/ THBD, and 1xDGKE mutations. A total of 15 relapses were seen, of which 8 (72%) occurred in the 1 to 7 age group. The renal outcome was not significantly different regardless of age group. Conclusion. In our cohort, we observed a relatively high frequency of extrarenal involvement at first presentation represented by pulmonary manifestations. The renal prognosis at initial presentation was worse than in previous reports

Recomendaciones para el uso racional de la prueba 25-hidroxi vitamina D Policy Brief

El incremento exponencial en la solicitud de pruebas de laboratorio de 25-Hidroxivitamina D o [25(OH)D ha encendido las alarmas y generado un fuerte llamado de atención, dado que puede reflejar falencias en la estandarización de la práctica clínica y en el uso no sistemático de la evidencia científica para la toma de decisiones en la vida real, que permitan analizar las indicaciones de la prueba, su frecuencia, interpretación e incluso para valorar el impacto para los sistemas de salud, especialmente cuando se contrasta con los mínimos o casi nulos efectos de la estrategia de tamizar o suplir indiscriminadamente a la población general, sin considerar una evaluación clínica integral de riesgos y necesidades de las personas. Desde un punto de vista meramente de impacto en salud pública, la consecuencia de solicitudes masivas y no indicadas, están afectando a la mayoría de los sistemas e instituciones de salud a nivel global. Los estudios primarios que determinaban valores de ingesta promedio poblacional, han sido ampliamente utilizados en la formulación de recomendaciones en Guías de Práctica Clínica (GPC), pero lastimosamente interpretados de forma errónea como puntos de corte para diagnosticar enfermedad y permitir la exagerada prescripción de esquemas de suplencia. El coeficiente de variación en los ensayos de rutina para medir niveles sanguíneos de 25(OH)D3 es alto (28%), disminuyendo la precisión global de la prueba y de forma simultánea, incrementando tanto los valores falsamente altos como falsamente bajos. La evidencia científica más reciente, analiza y cuestiona seriamente, la utilidad y el efecto real de la práctica masiva e indiscriminada de prescribir vitamina D sin un análisis exhaustivo de riesgo. La evidencia disponible es insuficiente para recomendar de forma general la suplencia de vitamina D para prevenir fracturas, caídas, cambios en la densidad mineral ósea, incidencia de enfermedades cardiovasculares, enfermedad cerebrovascular, neoplasias y tampoco en modificar la curva de crecimiento de hijos de madres que recibieron vitamina D como suplencia durante la gestación. Las recomendaciones presentadas en el documento se sustentan en el análisis crítico de la evidencia actual y en los principios de buenas prácticas clínicas e invitan a considerar un uso racional de las pruebas de 25(OH)D en el contexto de una práctica clínica centrada en las personas y una evaluación integral de necesidades y riesgos. Los principios de buena práctica sugieren que los clínicos puedan ser capaces de justificar que los resultados de la prueba de 25(OH)D influyen de manera contundente y definida la práctica clínica y modifican los desenlaces que interesan a las personas e impactan en su salud y bienestar. En la actualidad no hay claridad de cómo interpretar los resultados, y la relación entre los síntomas y los niveles de 25(OH)D, la cual, podría no ser consistente con la alta prevalencia de deficiencia de vitamina D reportada. Por tal razón, se sugiere revisar la racionalidad de la solicitud de pruebas para monitoreo sistemático de niveles de 25(OH)D o en todos los casos donde se realiza suplencia. Considerar el uso de las pruebas de 25(OH)D dentro de la evaluación integral de personas con sospecha o confirmación de las siguientes condiciones: raquitismo, osteomalacia, osteoporosis, híper o hipo paratiroidismo, síndromes de mala absorción, sarcopenia, enfermedad ósea metabólica

Characteristics, complications and outcomes among 1549 patients hospitalised with COVID-19 in a secondary hospital in Madrid, Spain: a retrospective case series study

Objectives To describe demographic, clinical, radiological and laboratory characteristics, as well as outcomes, of patients admitted for COVID-19 in a secondary hospital.Design and setting Retrospective case series of sequentially hospitalised patients with confirmed SARS-CoV-2, at Infanta Leonor University Hospital (ILUH) in Madrid, Spain.Participants All patients attended at ILUH testing positive to reverse transcriptase-PCR on nasopharyngeal swabs and diagnosed with COVID-19 between 1 March 2020 and 28 May 2020.Results A total of 1549 COVID-19 cases were included (median age 69 years (IQR 55.0–81.0), 57.5% men). 78.2% had at least one underlying comorbidity, the most frequent was hypertension (55.8%). Most frequent symptoms at presentation were fever (75.3%), cough (65.7%) and dyspnoea (58.1%). 81 (5.8%) patients were admitted to the intensive care unit (ICU) (median age 62 years (IQR 51–71); 74.1% men; median length of stay 9 days (IQR 5–19)) 82.7% of them needed invasive ventilation support. 1393 patients had an outcome at the end of the study period (case fatality ratio: 21.2% (296/1393)). The independent factors associated with fatality (OR; 95% CI): age (1.07; 1.06 to 1.09), male sex (2.86; 1.85 to 4.50), neurological disease (1.93; 1.19 to 3.13), chronic kidney disease (2.83; 1.40 to 5.71) and neoplasia (4.29; 2.40 to 7.67). The percentage of hospital beds occupied with COVID-19 almost doubled (702/361), with the number of patients in ICU quadrupling its capacity (32/8). Median length of stay was 9 days (IQR 6–14).Conclusions This study provides clinical characteristics, complications and outcomes of patients with COVID-19 admitted to a European secondary hospital. Fatal outcomes were similar to those reported by hospitals with a higher level of complexity

Efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate in ten countries in Europe and Latin America (HERALD): a randomised, observer-blinded, placebo-controlled, phase 2b/3 trial

Background: Additional safe and efficacious vaccines are needed to control the COVID-19 pandemic. We aimed to analyse the efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate. Methods: HERALD is a randomised, observer-blinded, placebo-controlled, phase 2b/3 clinical trial conducted in 47 centres in ten countries in Europe and Latin America. By use of an interactive web response system and stratification by country and age group (18–60 years and ≥61 years), adults with no history of virologically confirmed COVID-19 were randomly assigned (1:1) to receive intramuscularly either two 0·6 mL doses of CVnCoV containing 12 μg of mRNA or two 0·6 mL doses of 0·9% NaCl (placebo) on days 1 and 29. The primary efficacy endpoint was the occurrence of a first episode of virologically confirmed symptomatic COVID-19 of any severity and caused by any strain from 15 days after the second dose. For the primary endpoint, the trial was considered successful if the lower limit of the CI was greater than 30%. Key secondary endpoints were the occurrence of a first episode of virologically confirmed moderate-to-severe COVID-19, severe COVID-19, and COVID-19 of any severity by age group. Primary safety outcomes were solicited local and systemic adverse events within 7 days after each dose and unsolicited adverse events within 28 days after each dose in phase 2b participants, and serious adverse events and adverse events of special interest up to 1 year after the second dose in phase 2b and phase 3 participants. Here, we report data up to June 18, 2021. The study is registered at ClinicalTrials.gov, NCT04652102, and EudraCT, 2020–003998–22, and is ongoing. Findings: Between Dec 11, 2020, and April 12, 2021, 39 680 participants were enrolled and randomly assigned to receive either CVnCoV (n=19 846) or placebo (n=19 834), of whom 19 783 received at least one dose of CVnCoV and 19 746 received at least one dose of placebo. After a mean observation period of 48·2 days (SE 0·2), 83 cases of COVID-19 occurred in the CVnCoV group (n=12 851) in 1735·29 person-years and 145 cases occurred in the placebo group (n=12 211) in 1569·87 person-years, resulting in an overall vaccine efficacy against symptomatic COVID-19 of 48·2% (95·826% CI 31·0–61·4; p=0·016). Vaccine efficacy against moderate-to-severe COVID-19 was 70·7% (95% CI 42·5–86·1; CVnCoV 12 cases in 1735·29 person-years, placebo 37 cases in 1569·87 person-years). In participants aged 18–60 years, vaccine efficacy against symptomatic disease was 52·5% (95% CI 36·2–64·8; CVnCoV 71 cases in 1591·47 person-years, placebo, 136 cases in 1449·23 person-years). Too few cases occurred in participants aged 61 years or older (CVnCoV 12, placebo nine) to allow meaningful assessment of vaccine efficacy. Solicited adverse events, which were mostly systemic, were more common in CVnCoV recipients (1933 [96·5%] of 2003) than in placebo recipients (1344 [67·9%] of 1978), with 542 (27·1%) CVnCoV recipients and 61 (3·1%) placebo recipients reporting grade 3 solicited adverse events. The most frequently reported local reaction after any dose in the CVnCoV group was injection-site pain (1678 [83·6%] of 2007), with 22 grade 3 reactions, and the most frequently reported systematic reactions were fatigue (1603 [80·0%] of 2003) and headache (1541 [76·9%] of 2003). 82 (0·4%) of 19 783 CVnCoV recipients reported 100 serious adverse events and 66 (0·3%) of 19 746 placebo recipients reported 76 serious adverse events. Eight serious adverse events in five CVnCoV recipients and two serious adverse events in two placebo recipients were considered vaccination-related. None of the fatal serious adverse events reported (eight in the CVnCoV group and six in the placebo group) were considered to be related to study vaccination. Adverse events of special interest were reported for 38 (0·2%) participants in the CVnCoV group and 31 (0·2%) participants in the placebo group. These events were considered to be related to the trial vaccine for 14 (<0·1%) participants in the CVnCoV group and for five (<0·1%) participants in the placebo group. Interpretation: CVnCoV was efficacious in the prevention of COVID-19 of any severity and had an acceptable safety profile. Taking into account the changing environment, including the emergence of SARS-CoV-2 variants, and timelines for further development, the decision has been made to cease activities on the CVnCoV candidate and to focus efforts on the development of next-generation vaccine candidates. Funding: German Federal Ministry of Education and Research and CureVac