Calidad del sistema de dispensación de antimicrobianos por dosis unitaria, en niños de 4 a 10 años. Hospital Infantil Manuel de Jesús Rivera La mascota, Septiembre-Diciembre, 2016

Este estudio se basa en la evaluación del Sistema de Dispensación de Medicamentos por Dosis Unitaria (SDMDU) en antimicrobianos en el Hospital Infantil Manuel de Jesús Rivera (HIMJR) “La Mascota”; donde se verifica el nivel de cumplimiento de los procedimientos del mismo, además se identifican los problemas y se detectan los errores. La presente investigación es de tipo descriptivo, corte transversal, prospectivo, la muestra es seleccionada en base a los objetivos específicos, criterios de exclusión e inclusión con un límite confianza del 95% aceptando un error de estimación del 10%, la información se recopila mediante formatos de evaluación, encuestas y entrevistas. Los resultados respecto a la capacidad física instalada reflejan un porcentaje promedio de cumplimiento del 77,45% en cuanto a los requisitos de personal, materiales, equipos y mobiliarios, e instalaciones y un 22,55% de incumplimiento. En el grado de cumplimiento de los procedimientos por parte del personal, éste efectúa siempre las acciones establecidas por el SDMDU en un 83,45%, a veces 6,4% y nunca 10,15%. En el llenado del perfil farmacoterapéutico del paciente se cumple con un promedio de 79,5%. Para la preparación de las bandejas de medicación se da un cumplimiento del 100% de este procedimiento. Respecto a la Identificación de problemas causantes de un inadecuado funcionamiento del sistema se destaca con el 34,1% el desabastecimiento de insumos médicos y como resultado negativo de mayor relevancia se identifica la omisión de la dosis o cambio en el tratamiento con un 37% y la resistencia microbiana en un 36%. Finalmente, el SDMDU del Hospital Infantil Manuel de Jesús Rivera obtuvo un nivel de calidad bueno. Palabras Claves. Dispensación, Dosis unitaria, Antimicrobianos, calida

Manual descriptivo de puestos basado en competencias : Promotora del Comercio Exterior de Costa Rica.

Proyecto de Graduación (Bachillerato en Administración de Empresas) Instituto Tecnológico de Costa Rica, 2007.La promotora del comercio exterior de Costa Rica es una institución comprometida con el cumplimiento de estándares de calidad, es por esta razón que a la institución le interesa contar con herramientas útiles para los procesos de toma de decisiones en todas las áreas de la institución. PROCOMER, ha experimentado cambios como el surgimiento de nuevos puestos; además de querer implementar el sistema de gestión por competencias dentro de la institución, esto ha provocado que el manual descriptivo de puestos con el que se cuenta se encuentre desactualizado y además de que el mismo no cumpla con los requerimientos necesarios. Lo anterior, trae como consecuencia que los futuros colaboradores puedan no cumplir a cabalidad tanto con las exigencias como con las responsabilidades exigidas por determinado puesto de trabajo. Esto genera que la institución se vea afectada en el campo laboral y que se presenten conflictos dentro de la organización, ya que al contar con un manual descriptivo de puestos desactualizado no se tiene la certeza de que los colaboradores sean los idóneos para cada uno de los cargos que desempeñan; además de producir problemas en el proceso de selección del nuevo personal. PROCOMER es una institución que conoce la importancia que tiene contar con un manual de puestos actualizado Lo anterior es lo que impulsa a la institución a iniciar el proceso de actualización del mismo. El propósito de dicha investigación es el actualizar y diseñar un manual descriptivo basado en competencias que cumpla a cabalidad con los requerimientos necesarios para lograr obtener el personal idóneo para la Promotora de Comercio Exterior de Costa Rica. Los servicios ofrecidos por PROCOMER, están orientados a satisfacer las necesidades de las empresas costarricenses que desean incursionar exitosamente en los mercados internacionales. Esto abarca compañías que poseen ya una basta experiencia exportadora, así como otras que apenas inician sus esfuerzos de internacionalización. Puesto que PROCOMER tiene como política de calidad satisfacer y exceder permanentemente las necesidades y expectativas de sus clientes, mediante un sistema de gestión de calidad orientado bajo principios de competitividad, servicio al cliente y mejora continua. Lo anterior, obliga a la institución a hallar el personal idóneo para cumplir con estándares de calidad. Sus principales actividades son identificar oportunidades comerciales, desarrollar actividades de promoción e inteligencia comercial, detectar potenciales compradores y promover el aprovechamiento de los beneficios de los Tratados de Libre Comercio suscritos por Costa Rica. Las oficinas de Promoción Regional tienen como propósito fomentar el desarrollo productivo de las pequeñas y medianas empresas (PYMES), en las regiones Huetar Norte, Chorotega, Brunca, Vertiente Caribe y Pacífico y Central, mediante acciones que agreguen valor a las principales actividades productivas de la región en el sector agrícola, agroindustrial, de manufactura industrial, artesanía y turismo. PROCOMER tiene presencia tanto a nivel internacional como a nivel local. Para la primera, se cuenta con Oficinas de Promoción Comercial en diversos puntos, para apoyar la gestión de la institución en Costa Rica. Asimismo, cuenta con oficinas en los principales puestos de aduanas del país.Instituto Tecnológico de Costa Rica. Escuela de Administración de Empresas

Enfermedad pulmonar intersticial difusa clínica en pacientes diagnosticados de artritis reumatoide

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 15-12-202

A convergent numerical scheme for integrodifferential kinetic models of angiogenesis

We study a robust finite difference scheme for integrodifferential kinetic systems of Fokker-Planck type modeling tumor driven blood vessel growth. The scheme is of order one and enjoys positivity features. We analyze stability and convergence properties, and show that soliton-like asymptotic solutions are correctly captured. We also find good agreement with the solution of the original stochastic model from which the deterministic kinetic equations are derived working with ensemble averages. A numerical study clarifies the influence of velocity cut-offs on the solutions for exponentially decaying data

Frequency of Th17 CD4+ T cells in early rheumatoid arthritis: A marker of anti-CCP seropositivity

Objective: To examine the frequency and phenotype of Th17 cells in the peripheral blood of early RA (eRA) patients. Methods: CD4+ T cells were isolated from the peripheral blood of 33 eRA patients, 20 established RA patients and 53 healthy controls (HC), and from the synovial fluid of 20 established RA patients (RASF), by ficoll-hypaque gradient and magnetical negative selection. After polyclonal stimulation, the frequency of Th17 and Th1 cells was determined by flow cytometry and concentrations of IL-17, IFN-γ, TNF-α and IL-10 were measured by ELISA in cell-free supernatants. Results: When all of our eRA patients were analyzed together, a significantly lower percentage of circulating Th17 cells and a lower CD4-derived IL-17 secretion were observed in comparison with HC. However, after stratifying by anti-CCP antibody status, circulating Th17 cells were decreased in anti-CCP(+) but not in anti-CCP(-)-eRA. All Th17 cells were CD45RO+CD45RA- and CCR6+. Dual Th17/Th1 cells were also exclusively decreased in anti-CCP(+)-eRA. Circulating Th17 and Th17/Th1 cells were negatively correlated with anti-CCP titres. When anti-CCP(+)-eRA patients were retested one year after initiating treatment with oral methotrexate, their circulating Th17 frequency was no longer different from HC. Of note, the percentage of circulating Th1 cells and the secretion of CD4-derived IFN-γ, TNF-α and IL-10 were not different between eRA patients and HC. In established RA patients, circulating Th17 and T17/Th1 cell frequencies were comparable to HC. In RASF, both Th17 and Th1 cells were increased when compared with blood of eRA patients, established RA patients and HC. Conclusion: Decreased circulating Th17 levels in eRA seem to be a marker of anti-CCP seropositivity, and return to levels observed in healthy controls after treatment with methotrexateThis work was supported by Ministerio de Ciencia e Innovación grant SAF 2009-07100, (http://www.idi.mineco.gob.es/portal/site/MICINN) and by RETICS Program, RD08/0075 (RIER) from ‘‘Instituto de Salud Carlos III’’ (ISCIII) (http://www.isciii.es/

Nasopharyngeal swab for the diagnosis of COVID-19

RESUMEN Introducción y objetivo: La prueba de diagnóstico directo del COVID-19 de mayor sensibilidad es la toma de muestras de nasofaringe mediante un hisopo para estudio posterior mediante RT-PCR. El objetivo de nuestro trabajo es exponer pormenoriza-damente la forma más adecuada de realizar dicha técnica. Método: Descripción de los diferentes pasos necesarios para la toma de muestras nasofaríngeas en pacientes con COVID-19. Resultados: Los pasos a tener en cuenta son: 1. Previamente se des-carta que no existan contraindicaciones para la toma de muestra. 2.Etiquetado de la muestra y preparación del volante de petición. 3. Colocación de EPI según los están-dares de la institución en la que se trabaja. 4. Explicación al paciente del proceso a realizar. 5. Técnica para la toma de muestra nasofaríngea 6. Retirada del EPI. 7. Mani-pulación y transporte de la muestra al laboratorio. Discusión/Conclusiones: Dado que la sensibilidad de las muestras nasofaríngeas para diagnóstico de COVID-19 depen-de en gran parte de una adecuada técnica, es muy importante la formación adecuada del personal implicado en la recogida de esta. La persona formada a tal efecto debe conocer el objetivo claro de la misma, como se debe poner y quitar el EPI, conocer cómo se realiza la técnica y como se manipula la muestra.Introduction and objective: The diagnostic test of COVID-19 with the highest sensitivity is a nasopharyngeal sample using a swab for subsequent study using RT-PCR. The objective of our work is to explain in detail the most appropriate way to perform this technique. Method: Description of the different steps necessary for taking a nasopharyngeal sample in patients with covid-19. Results: The steps to take into account to get a nasopharyngeal sample in a patient with COVID-19 are: 1- Previously, it is necessary to rule out that there are no contraindications for sampling2. Sample labeling and preparation of the petition form. 3. Placement of PPE according to the institution rules4. Explanation to the patient of the process to be performed 5. Procedure for taking a nasopharyngeal sample. &. Withdrawal of the EPI. /. Handling and tranportation of the sample to the laboratory. Discussion/Conclusions: Given that the sensitivity of the nasopharyngeal simples for the diagnosis of COVID-19 depends largely on a correct technique, the adequate training of the personnel involved in this collection is very important. The examiner must know the objetive of the procedure, how top ut on and take off the PPE, know how the technique is performed and how the sample is handled

Role of targeted therapies in rheumatic patients on COVID-19 outcomes: results from the COVIDSER study

Objectives: To analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases. Methods: The COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed. Results: A total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients' hospitalisation. Conclusions: The use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.This Project has been financed by Bristol-Myers Squibb, Galapagos Biopharma Spain SLU, Gebro Pharma, Roche Farma and Sanofi Aventis

Relevance of gastrointestinal manifestations in a large Spanish cohort of patients with systemic lupus erythematosus: what do we know?

SLE can affect any part of the gastrointestinal (GI) tract. GI symptoms are reported to occur in >50% of SLE patients. To describe the GI manifestations of SLE in the RELESSER (Registry of SLE Patients of the Spanish Society of Rheumatology) cohort and to determine whether these are associated with a more severe disease, damage accrual and a worse prognosis. METHODS: We conducted a nationwide, retrospective, multicentre, cross-sectional cohort study of 3658 SLE patients who fulfil =4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SLEDAI-2K or BILAG), damage (SLICC/ACR/DI) and therapies were collected. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease. RESULTS: From 3654 lupus patients, 3.7% developed GI damage. Patients in this group (group 1) were older, they had longer disease duration, and were more likely to have vasculitis, renal disease and serositis than patients without GI damage (group 2). Hospitalizations and mortality were significantly higher in group 1. Patients in group 1 had higher modified SDI (SLICC Damage Index). The presence of oral ulcers reduced the risk of developing damage in 33% of patients. CONCLUSION: Having GI damage is associated with a worse prognosis. Patients on a high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers appear to decrease the risk of GI damage. © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology

Role of MUC1 rs4072037 polymorphism and serum KL-6 levels in patients with antisynthetase syndrome

Mucin 1/Krebs von den Lungen-6 (KL-6) is proposed as a serum biomarker of several interstitial lung diseases (ILDs), including connective tissue disorders associated with ILD. However, it has not been studied in a large cohort of Caucasian antisynthetase syndrome (ASSD) patients. Consequently, we assessed the role of MUC1 rs4072037 and serum KL-6 levels as a potential biomarker of ASSD susceptibility and for the differential diagnosis between patients with ILD associated with ASSD (ASSD-ILD?+) and idiopathic pulmonary fibrosis (IPF). 168 ASSD patients (149 ASSD-ILD?+), 174 IPF patients and 523 healthy controls were genotyped for MUC1 rs4072037 T?>?C. Serum KL-6 levels were determined in a subgroup of individuals. A significant increase of MUC1 rs4072037 CC genotype and C allele frequencies was observed in ASSD patients compared to healthy controls. Likewise, MUC1 rs4072037 TC and CC genotypes and C allele frequencies were significantly different between ASSD-ILD+ and IPF patients. Additionally, serum KL-6 levels were significantly higher in ASSD patients compared to healthy controls. Nevertheless, no differences in serum KL-6 levels were found between ASSD-ILD+ and IPF patients. Our results suggest that the presence of MUC1 rs4072037 C allele increases the risk of ASSD and it could be a useful genetic biomarker for the differential diagnosis between ASSD-ILD+ and IPF patients

HLA association with the susceptibility to anti-synthetase syndrome

Objective: To investigate the human leukocyte antigen (HLA) association with anti-synthetase syndrome (ASSD). Methods: We conducted the largest immunogenetic HLA-DRB1 and HLA-B study to date in a homogeneous cohort of 168 Caucasian patients with ASSD and 486 ethnically matched healthy controls by sequencing-based-typing. Results: A statistically significant increase of HLA-DRB1*03:01 and HLA-B*08:01 alleles in patients with ASSD compared to healthy controls was disclosed (26.2% versus 12.2%, P=1.56E-09, odds ratio-OR [95% confidence interval-CI]=2.54 [1.84-3.50] and 21.4% versus 5.5%, P=18.95E-18, OR [95% CI]=4.73 [3.18-7.05]; respectively). Additionally, HLA-DRB1*07:01 allele was significantly decreased in patients with ASSD compared to controls (9.2% versus 17.5%, P=0.0003, OR [95% CI]=0.48 [0.31-0.72]). Moreover, a statistically significant increase of HLA-DRB1*03:01 allele in anti-Jo-1 positive compared to anti-Jo-1 negative patients with ASSD was observed (31.8% versus 15.5%, P=0.001, OR [95% CI]=2.54 [1.39-4.81]). Similar findings were observed when HLA carrier frequencies were assessed. The HLA-DRB1*03:01 association with anti-Jo-1 was unrelated to smoking history. No HLA differences in patients with ASSD stratified according to the presence/absence of the most representative non-anti-Jo-1 anti-synthetase autoantibodies (anti-PL-12 and anti-PL-7), arthritis, myositis or interstitial lung disease were observed. Conclusions: Our results support the association of the HLA complex with the susceptibility to ASSD