Eficacia y seguridad de la Naltrexona en domicilio para el manejo del prurito resistente en paciente oncológico terminal

Pruritus is an unpleasant sensation that has a great impact on the quality of life of the terminal patient. Its etiopathogenesis is complex and little known. One of the theories is the effect of the cerebral opioid tone, the treatment of an opioid antagonist for its control.We present the case of a patient admitted to a load of the Hospitalization and Domicile Unit, which presented an intense pruritus despite the prescribed treatment. Treatment with Naltrexone was initiated orally, presenting symptom improvement with resolution of the symptoms.El prurito es una sensación desagradable que supone un gran impacto en la calidad de vida del paciente terminal. Su etiopatogenia es compleja y poco conocida. Una de las teorías es el incremento del tono opioide cerebral, por lo que uno de los tratamientos es la utilización de un antagonista opioide para su control.Presentamos el caso de un paciente ingresado a cargo de la Unidad de Hospitalización a Domicilio que presentaba prurito intenso a pesar de tratamiento pautado. Se inició tratamiento con Naltrexona por vía oral, presentando mejoría de la sintomatología con resolución del cuadro

Pseudonimización y trazabilidad impersonal mediante códigos QR para la gestión de eventos UCM y gestión digital de certificados y diplomas

Desarrollo de una herramienta portátil, económica y viable, que de servicio más allá de tiempos de covid-19, para disponer de una trazabilidad rápida de las personas con un control respetuoso con los datos personales y escalar la solución a múltiples variantes (asignación de silla numerada, acceso de personas con movilidad reducida, etc.

Randomized Clinical Trial to Determine the Effectiveness of CO-Oximetry and Anti-Smoking Brief Advice in a Cohort of Kidney Transplant Patients who Smoke

[Abstract] Background: measure the efficacy of exhaled carbon monoxide (CO) measurement plus brief advisory sessions to reduce smoking exposure and smoking behaviour in kidney transplant recipients. Methods: Randomized, controlled, open-label clinical trial at a Spanish hospital.Smoking kidney transplant recipients giving their consent to participate were randomized to control (brief advice, n=63) or intervention group (brief advisory session plus measuring exhaled CO, n=59). Measurements: Sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking, drug use, level of dependence and motivation to stop smoking (Fagerström's and Richmond's test) and stage of change (Prochaska and DiClemente's Stages). Efficacy was assessed at 3, 6, 9 and 12 months as: cotinine test, CO levels in exhaled air, nicotine dependence, motivational stages of change, motivation to stop smoking, pattern of tobacco use and smoking cessation rates. Logistic regression models were computed. Results: At 12 months of follow-up, differences were found in exhaled CO between the intervention and control group(6.1±6.8vs.10.2±9.7ppm;p=0.028). Carboxyhemoglobin levels were lower in the intervention group as well as the positive cotinine test (1.2±1.2%vs.2.0±2.4%;p=0.039),(53.4%vs.74.2%). At 12 months, intervention reduces the probability of a positive urine test by 28%. Conclusions: Co-oximetry is a clinically relevant intervention for reduction of tobacco exposure in kidney transplant recipients.Instituto de Salud Carlos III; PI11 /0135

p73 is required for appropriate BMP-induced mesenchymal-to-epithelial transition during somatic cell reprogramming

[EN] The generation of induced pluripotent stem cells (iPSCs) by somatic cell reprogramming holds great potential for modeling human diseases. However, the reprogramming process remains very inefficient and a better understanding of its basic biology is required. The mesenchymal-to-epithelial transition (MET) has been recognized as a crucial step for the successful reprogramming of fibroblasts into iPSCs. It has been reported that the p53 tumor suppressor gene acts as a barrier of this process, while its homolog p63 acts as an enabling factor. In this regard, the information concerning the role of the third homolog, p73, during cell reprogramming is limited. Here, we derive total Trp73 knockout mouse embryonic fibroblasts, with or without Trp53, and examine their reprogramming capacity. We show that p73 is required for effective reprogramming by the Yamanaka factors, even in the absence of p53. Lack of p73 affects the early stages of reprogramming, impairing the MET and resulting in altered maturation and stabilization phases. Accordingly, the obtained p73-deficient iPSCs have a defective epithelial phenotype and alterations in the expression of pluripotency markers. We demonstrate that p73 deficiency impairs the MET, at least in part, by hindering BMP pathway activation. We report that p73 is a positive modulator of the BMP circuit, enhancing its activation by DNp73 repression of the Smad6 promoter. Collectively, these findings provide mechanistic insight into the MET process, proposing p73 as an enhancer of MET during cellular reprogramming.S

Use of Shockwave intravascular lithotripsy for the treatment of symptomatic and severely calcified superior mesenteric artery stenosis

Abstract Background We present the use of intravascular lithotripsy as a treatment for highly calcified superior mesenteric artery stenosis. Case presentation A 67-year-old diabetic man had chronic postprandial abdominal pain and weight loss. Computed tomography angiography revealed highly calcified stenosis of the superior mesenteric artery. Selective angiography confirmed severe stenosis. A Shockwave lithotripsy balloon catheter was successfully used via brachial access to modify calcified plaque and increase vascular lumen. After 12 months of follow-up the patient had gained weight and had no abdominal postprandial pain. Conclusion Intravascular lithotripsy could be considered a new treatment modality to modify calcified lesions in the visceral arteries. More controlled studies are needed to demonstrate the efficacy, safety and feasibility of this new technology. Level of evidence 4, Case Repor

Sermones predicados en la Beatificacion de la B.M. Teresa de Iesus Virgen fundadora de la Reforma de los Descalcos [sic] de N. Señora del Carmen

Copia digital. Valladolid : Junta de Castilla y León. Consejería de Cultura y Turismo, 2013Colofón (en el recto de la h. 3L4)Sign. : [ ]1, *4, A-Z8, 2A-2Z8, 3A-3I8, 3K-3L4.La h. 16 en bl.Esc. xil. de los Carmelitas en el verso de la h. 3L4.Port. grab. calc. : "P.P.f."La h. de grab. calc. : "Lt á Palomº. inn del. et sculp. Mti", representa a Santa Teresa

Changes in the Hyperreflective Bands of Outer Retinal Layers after Idiopathic Epiretinal Membrane Surgical Removal

Purpose: The purpose of this study was to describe the relationship between the outer retinal hyperreflective bands and visual acuity recovery after idiopathic epiretinal macular membrane (ERM) surgical removal. Methods: A prospective longitudinal non-comparative study was conducted that included a total of 68 patients with idiopathic ERM, who underwent consecutive 23 G pars plana vitrectomy (PPV) at San Juan University Hospital (Alicante, Spain) from January 2019 to January 2021. All patients underwent a complete preoperative standard ophthalmic examination, including measurement of best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) examination. This protocol was repeated at 1 and 3 months after surgery. Results: Mean preoperative decimal BCVA was 0.30 ± 0.13 and disruption of the first, second, third and fourth outer retinal hyperreflective bands was observed by SD-OCT in 9 (27.9%), 27 (39.7%), 33 (48.5%) and 17 patients (25%), respectively. BCVA improved after ERM peeling at 1 and 3 months in all patients, regardless of the presence of disruption in any hyperreflective band. Significantly larger improvement of BCVA was found at 3 months after surgery in patients not showing disruption of hyperreflective bands 1 and 4 (p = 0.048 and 0.001, respectively). Conclusions: The integrity of the outer retinal hyperreflective bands by SD-OCT in patients with idiopathic ERM is a valuable tool to determine the visual prognosis of the surgical treatment of this condition. A successful recovery of hyperreflective bands 1 and 4 with ERM surgery may be a potential biomarker of the visual improvement achieved due to their important anatomical relation with cone photoreceptors at the foveal level.The author David P Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

El marido más firme

Nom del imp. i data d'imp. preses del colofóMarca tip. en portText a 1 i a 2 col. - ReclamsSign.: [calderó]4, A-Oo8, Pp2. - Errates tip. en la folFrisos, caplletres ornades, vinyetesLa discreta vengança ; Lo cierto por lo dudoso ; Pobreza no es vileza ; Arauco domado ; La ventura sin buscalla ; El valiente Cespedes ; El hombre por su palabra ; Roma abrasada ; Virtud, pobreza y muger ; El rey sin reyno ; El meior mozo de España ; El marido mas firm

Incidence of cardiovascular events and associated risk factors in kidney transplant patients: a competing risks survival analysis

BACKGROUND: The high prevalence of cardiovascular risk factors among the renal transplant population accounts for increased mortality. The aim of this study is to determine the incidence of cardiovascular events and factors associated with cardiovascular events in these patients. METHODS: An observational ambispective follow-up study of renal transplant recipients (n = 2029) in the health district of A Coruña (Spain) during the period 1981–2011 was completed. Competing risk survival analysis methods were applied to estimate the cumulative incidence of developing cardiovascular events over time and to identify which characteristics were associated with the risk of these events. Post-transplant cardiovascular events are defined as the presence of myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances, peripheral vascular disease and cardiovascular disease and death. The cause of death was identified through the medical history and death certificate using ICD9 (390–459, except: 427.5, 435, 446, 459.0). RESULTS: The mean age of patients at the time of transplantation was 47.0 ± 14.2 years; 62% were male. 16.5% had suffered some cardiovascular disease prior to transplantation and 9.7% had suffered a cardiovascular event. The mean follow-up period for the patients with cardiovascular event was 3.5 ± 4.3 years. Applying competing risk methodology, it was observed that the accumulated incidence of the event was 5.0% one year after transplantation, 8.1% after five years, and 11.9% after ten years. After applying multivariate models, the variables with an independent effect for predicting cardiovascular events are: male sex, age of recipient, previous cardiovascular disorders, pre-transplant smoking and post-transplant diabetes. CONCLUSIONS: This study makes it possible to determine in kidney transplant patients, taking into account competitive events, the incidence of post-transplant cardiovascular events and the risk factors of these events. Modifiable risk factors are identified, owing to which, changes in said factors would have a bearing of the incidence of events

Integrate and learn. Building a farm-to-table blockchain

DecanatoFac. de VeterinariaFALSEsubmitte