Epidemiología de la infección por VIH en mujeres: adicción a drogas vía parenteral vs transmisión heterosexual

Objetivo: Analizar la evolución epidemiológica de la infección por el virus de la inmunodeficiencia humana (VIH) en mujeres y el papel que ha tenido la adicción a drogas vía parenteral (ADVP) en la incidencia de dicha infección.Materiales y método: Estudio retrospectivo transversal que comprende desde 1985 hasta diciembre de 2004. Los datos se han obtenido de la revisión de las Historias Clínicas y de los registros de la Unidad de Atención Farmacéutica a Pacientes Externos (UFPE).Resultados: Se han estudiado los casos de 75 mujeres infectadas por VIH y diagnosticadas entre 1985-2003. Las pacientes han sido divididas en dos grupos en función de la fecha de inicio de la terapia antirretroviral, antes o después de 1997.De las 75 pacientes, 48 iniciaron tratamiento entre 1989-1996, con una edad en el momento del diagnóstico de 26±6.8 años. En cuanto al comportamiento de riesgo, el 58% de las pacientes eran ADVP, mientras que un 37.8% se infectaron por relaciones heterosexuales.Las 27 pacientes restantes iniciaron tratamiento entre 1997-2003, con una edad en el momento del diagnóstico de 32.6±10.7 años. El 29.6% de las pacientes tuvo como comportamiento de riesgo ADVP mientras que el 70.4% se infectaron por relaciones heterosexuales.Discusión: La edad de las pacientes en el momento del diagnóstico es cada vez más elevada. El mayor cambio se ha observado en la vía de infección y prácticas de riesgo, reduciéndose el número de pacientes ADVP y duplicándose el número de pacientes infectadas por mantener relaciones heterosexuales de riesgo

Transcendencia del cocaetileno en el consumo combinado de etanol y cocaína

Cada vez es más frecuente encontrar a nivel asistencial las repercusiones del consumo abusivo de cocaína y etanol.La interacción metabólica del etanol y la cocaína da lugar a un nuevo metabolito denominado cocaetileno, el cual juega un papel importante en el aumento del placer y la toxicidad derivada del consumo de ambas drogas. Este produce un aumento considerable de la euforia y duración de la misma, así como una disminución de la disforia por abstinencia a la cocaína, unido a consumos más compulsivos.Todo esto influye en una mayor pérdida del control del consumo, más problemas sociales y conductas violentas y de riesgo.Gran parte de las diferencias observadas en la acción de ambas sustancias en su administración conjunta, pueden ser explicadas por las modificaciones en la farmacocinética de dichas drogas y por la potencial acción tóxica del cocaetileno, la cual se suma a las respectivas acciones del etanol y la cocaína, pasando a ser la base de los cuadros clínicos de mayor gravedad observados en este tipo de adicción.El objetivo de esta revisión es recoger los efectos psicológicos y somáticos del consumo combinado del etanol y la cocaína, centrándonos en la acción tóxica del cocaetileno sobre el organismo, mediante la revisión de la bibliografía primaria obtenida a través de la base de datos Medline (PubMed 1979-2006), en Índice Médico Español (IME), en datos de la Organización Mundial de la Salud (O.M.S), Revista del Instituto de Investigación de Drogodependencias, datos del Plan Nacional sobre Drogas (PNSD), revista de Adicciones, así como de diversas monografías relacionadas.La compresión de los efectos derivados del consumo de etanol y cocaína así como los mecanismos implicados en la toxicidad directa del cocaetileno, pueden ayudar a resolver los problemas tanto físicos como psicológicos ocasionados en este tipo de toxicomanía

Composition of free amino acids in infant formulas

The relative percentage of the enantiomeric forms of free amino acids threonine, valine, isoleucine, leucine, methionine, phenylalanine, lysine, alanine, glycine, serine, praline, aspartic acid, glutamic acid, taurine and tyrosine in 9 infant formulas containing different whey protein/casein ratio was determined using a gas chromatographic method that allows the determination of the chiral composition Each formula showed different amino acids patterns. Glutamic acid was the major amino acid in most of the formulas; methionine and lysine were not detected in some samples and in others their percentage was very low. It was not possible to establish a relationship between the amino acid patterns and the whey protein/casein ratio. The used method allows a good resolution of the most enantiomeric forms of the analyzed amino acids and therefore, to evaluate their trend to racemization in the infant formulas investigated. D-enantiomeric form was only detected in alanine, the enantiomeric excess was among 48-96%.Peer Reviewe

¿Quieres que te cuente un cuento? : estrategias para el uso de la biblioteca en un centro de educación especial

Este centro de educación especial tiene alumnos con discapacidad psíquica y plurideficiencia, por lo que necesita adaptar los recursos educativos a las necesidades específicas de cada uno. En este caso, el equipo de la biblioteca es uno de los que necesita en mayor medida estas nuevas adaptaciones. Para ello, se llevan acabo actuaciones como el Libromóvil, para hacer más accesible la biblioteca escolar a través de este elemento motivador y aglutinador de la lectura; otros objetivos son adecuar un nuevo espacio de biblioteca en un lugar de mayor accesibilidad y aplicar las nuevas tecnologías a dicho espacio; renovar paulatinamente los fondos bibliográficos y en especial, los álbumes ilustrados, los textos en audio y el material audiovisual. Todas estas mejoras persiguen favorecer la coordinación y la comunicación entre toda la comunidad educativa; dar a conocer las posibilidades de los cuentos y los álbumes ilustrados para el desarrollo de la comprensión y la secuenciación temporal; potenciar la actividad del cuenta cuentos como medio de comunicación, comprensión y expresión de historias; usar el cine como medio motivador y fuente de conocimientos; ayudar a la mejora de las habilidades comunicativas de los alumnos, según sus posibilidades, desde el aprendizaje de la lectoescritura hasta los estímulos más básicos de interacción; utilizar la biblioteca y los medios audiovisuales como fuente de conocimiento y disfrute e implicar a las familias en la lectura conjunta de libros con sus hijos. Se desarrollan actividades con una periodicidad determinada como trabajos creativos en relación a un libro o película relacionada con los contenidos de la programación escolar. También se desarrollan actividades especiales, como celebrar eventos especiales como el Día del Niño, de la Paz o del Libro. Y por último, actividades abiertas que cada profesor propone a sus alumnos, como la representación del Gallo Kiriko, narración de cuentos con ayuda de pictogramas o edición de libros en relación a los conceptos trabajados. La metodología es participativa, basada en la experiencia, y se valora el significado de los contenidos presentados por los alumnos. La evaluación consta de dos partes, la primera, que constata y valora el material elaborado y la segunda que aprecia la cualidad de las enseñanzas impartidas y aprendidas. Como anexo esta memoria adjunta un CD-ROM..Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Mejora de la Calidad de la EnseñanzaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

Delaying surgery for patients with a previous SARS-CoV-2 infection

Not availabl