Evaluation of first resection of synchronous liver metastases of colorectal cancer (liver first)

RESUMEN: Dos de cada tres muertes relacionadas con el cáncer colorrectal son atribuibles a las metástasis hepáticas. Conceptualmente, la estrategia Liver first permitiría el rescate de pacientes con metástasis sincrónicas mejor que la resección del tumor colorrectal en primer lugar. El objetivo será comparar en términos de morbimortalidad postoperatoria, supervivencia libre de enfermedad y supervivencia global los pacientes pertenecientes a los distintos protocolos (CF, LF y S). Para ello se realizará un análisis retrospectivo, por intención de tratar, de los pacientes intervenidos por metástasis hepáticas en el HUMV entre 2012 y 2018. En el estudio comparativo se encontró un TBS significativamente mayor en los pacientes con protocolo LF, media de 7,75 (DT:3,87). La supervivencia libre de enfermedad media fue de 12, 9 meses (10,02-15,81, IC 95%), en el caso del protocolo LF la media fue de 5,82 meses (3,81-7,83, IC 95%). La media de supervivencia global fue de 30,2 meses (22,05-38,34, IC 95%). No se encontraron diferencias significativas en cuanto a morbimortalidad postoperatoria. Los pacientes pertenecientes al protocolo LF presentaron un TBS significativamente mayor, y su supervivencia libre de enfermedad fue significativamente menor, aunque esto no se tradujo en una menor supervivencia global.ABSTRACT: Two out of three colorectal cancer-related deaths are attributable to liver metastases. Conceptually, the Liver First strategy would allow the rescue of patients with synchronous metastases better than resection of the colorectal tumour in the first place The objective will be to compare in terms of postoperative morbidity and mortality, disease-free survival and overall survival the patients belonging to the different protocols (CF, LF, and S). For this purpose, we will perform a retrospective analysis, by intention to treat, patients intervened by liver metastases in HUMV between 2012 and 2018. In the comparative study a significantly higher TBS was found in patients with LF protocol, mean of 7,75 (DT:3,87). The mean disease-free survival was 12.9 months (10.02-15.81, 95% CI), in the case of the LF protocol the mean was 5.82 months (3.81-7.83, 95% CI). The mean overall survival was 30.2 months (22.05- 38.34, 95% CI). No significant differences in postoperative morbidity and mortality were found. Patients belonging to the LF protocol had significantly higher TBS, and their disease-free survival was significantly lower, although this did not translate into lower overall survival.Grado en Medicin

Instalar y configurar Zentyal Server como sistema operativo base para disponer de los servicios de infraestructura IT

En este artículo se busca abordar la importancia de Zentyal Server como plataforma para la administración de la Infraestructura IT dentro de una organización que quiera estar a la vanguardia tecnológica, donde se explicará de manera técnica la implementación de esta importante herramienta, desde la descarga e instalación hasta la validación de funcionamientos de sus módulos en los servicios de gestión IT.This article looks for approaching importance of Zentyal Server as a platform for the administration of IT Infrastructure within an organization that wants to be at the forefront of technology, where the implementation of this important tool will be explained technically, from the download and installation until the validation of the functions of its modules in the IT management services

Correction : Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885

The authors wish to make the following corrections to this paper [...]

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain : Large-Scale Epidemiological Study

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Guía Mexicana para el Diagnóstico y el Tratamiento de la Urticaria

La urticaria es una enfermedad que padece una quinta parte de la población en algún momento de su vida. Las guías inter- nacionales recientes han propuesto unos cambios de fondo en su diagnóstico y tratamiento, por lo que había la necesidad de crear una guía nacional y multidisciplinaria, con base amplia en los gremios de especialistas y médicos de primer contacto en México. ABSTRACT Urticaria is a disease that a fifth of the population shall suffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups –both specialists and primary health care workers–, necessary in Mexico

Evaluation of survival of Actinobacillus pleuropneumoniae and Haemohilus parasuis in four liquid media and two swab specimen transport systems

P. 1176-1180The aim of this study is determine duration and rates of recov- ery of Actinobacillus pleuropneumoniae and Haemophilus parasuis from 4 liquid media and 2 swab specimen transport systems and compare findings with those of Escherichia coliS

Una estrategia poco utilizada en el cuidado de pacientes con enfermedad renal crónica: la educación en grupo y multidisciplinar de pacientes y sus familiares

Los equipos multidisciplinares, son una estrategia sugerida hace ya más de un decenio por grupos canadienses. Los pacientes tratados en un ámbito multidisciplinar demuestran un mejor conocimiento de la enfermedad renal crónica y mejores parámetros bioquímicos. Los objetivos fueron, aumentar los conocimientos, en nuestros pacientes con enfermedad renal crónica avanzada y su familia, sobre su enfermedad, su correcto cuidado y sobre el tratamiento renal sustitutivo, a través de la educación en grupo. Valorar si la información aumenta el nivel de ansiedad de los pacientes. Valorar el grado de satisfacción con la intervención educación en grupo. Estudio retrospectivo que contó con 19 pacientes, asistentes a los dos cursos. Se realizaron dos cuestionarios al inicio y al final del curso sobre nivel de conocimientos y el nivel de ansiedad (Inventario de Ansiedad Estado-Rasgo). Al final de cada edición, se realizó un cuestionario de evaluación. Las variables estudiadas fueron el sexo, edad, nivel de estudios y asistencia de un familiar. El nivel de conocimientos alcanzó una diferencia estadísticamente significativa entre ambos cuestionarios (inicial-final) (p = 0,013). Los resultados obtenidos en la evaluación del nivel de ansiedad mostraron un ligero incremento en la ansiedad. El cuestionario de satisfacción mostró una valoración muy positiva de la intervención. Podemos concluir, que la mayoría de los pacientes han aumentado sus conocimientos sobre enfermedad renal crónica avanzada y técnicas de sustitución, han demostrado una alta satisfacción con la experiencia de esta intervención y la mayoría han experimentado un ligero aumento de ansiedad

Trastorno mental grave : proceso asistencial integrado. 2ª ed

YesTranscurridos doce años de la publicación del Proceso Asistencial Integrado Trastorno Mental Grave (PAI TMG)1 se hace necesaria su revisión, tal como establece el III Plan Integral de Salud Mental de Andalucía 2016-2020 (PISMA III)2. Una revisión que responde, como recoge el Plan, al desarrollo de un modelo de recuperación centrado en la persona que sufre un TMG. Este enfoque implica la participación plena de las personas afectadas y sus allegados, que va desde la evaluación hasta las distintas intervenciones que pudieran estar indicadas. En este contexto, el modelo de decisiones compartidas resulta válido para garantizar tanto la eficacia como el respeto a los derechos fundamentales de las personas. Desde otro marco de referencia se ha procedido a la actualización de conocimientos basados en la mejor evidencia científica disponible, atendiendo a uno de los principios transversales del Plan de Acción de la OMS3. Así, se han mejorado notablemente los aspectos metodológicos de búsqueda de evidencia disponible y como consecuencia, una serie de recomendaciones clave - que figuran al principio - referente a aquéllas características de calidad que aportan más valor, según se desprende de las evidencias halladas en las diferentes búsquedas