Anticoncepción poscoital. Características de la demanda

ObjetivoConocer el perfil de las mujeres que demandan anticoncepción poscoital (APC).DiseñoDescriptivo transversal. Emplazamiento. Centro de Orientación Familiar (COF), Área 4 del Instituto Madrileño de Salud. Madrid.ParticipantesTodas las mujeres que acudieron en el año 2000 para requerir APC (n = 404).MedicionesSe realizó una encuesta con variables sociodemográficas relacionadas con la APC y con la vida sexual.ResultadosLa edad media fue de 23,9 años (límites, 14–49); el 9,9% era menor de edad. La media de coitos al mes era de 6,7, el número de años de relaciones sexuales era de 4,9 y el primer coito se produjo, de media, a los 18 años. El 90,9% afirmaba tener pareja estable. Tenía estudios secundarios o universitarios un 75%. El 55,7% manifestaba no haber recibido información sobre anticonceptivos. El 19,5% utilizó APC en otra ocasión. El 6,5% había tenido alguna interrupción voluntaria de embarazo y de éstas, el 36% había utilizado APC anteriormente. Los motivos de consulta fueron: rotura de preservativo (69,3%), preservativo retenido (16,9%) y coito sin protección (12%). El 7% tuvo otros coitos de riesgo en el mismo ciclo. Un 33,2% las remitía su equipo de atención primaria, acudió por conocidos el 19% y desde servicios de urgencias el 16%. Conocía el COF un 26,1%. En el 12,2% no se prescribió APC por mínimo riesgo de embarazo. Realizaron la valoración una enfermera (52,6%), médicos residentes (34,4%) y una ginecóloga (13%).ConclusionesFalta información sobre métodos anticonceptivos. La mayoría de las pacientes son derivadas por otros servicios sanitarios.ObjectiveDefine the profile of the women that ask for emergency contraception (EC).DesignTransversal descriptive investigation.SettingFamiliar Planning Center of 4th Area of Instituto Madrileño de Salud. in Madrid. Participants. All the women that went in the year 2000 requiring EC (n=404).MeasurementsWas carried out a survey with sociodemographic variables, related with the EC and with the sexual life.ResultsThe average age was of 23.9 years (age range 14 to 49) were inquired, 9.9 were under 18. They had an average of 6.7 intercourses per month, the first intercourse when they were 18 years old on average, and 4.9 years of sexual relationships. 90.9% stated to have a couple. 75% were graduated from high school or university, and 55.7% said they had never received information about contraceptives. For 19.5% this was not the first time they asked for EC. 6.5% had interrupted on purpose pregnancy and 36% of them had used EC before. The reasons to demand EC were: condom break (69.3%), held condom (16.9%) and intercourse without any protection (12%). 7% acknowledged other risky intercourses during the same period. 33.2% had been sent by a General Practitioner, 26.1% knew the center, 19% were sent by acquaintances and 16% from Emergency Services. EC was not prescribed in 12.2% of the cases because of minimum risk to pregnancy. The evaluation was made by a nurse (52.6%), by a doctor (34.4%) and by a gynecologist (13%).ConclusionsThere is a lack of information about contraceptive methods. Most of the patients are sent from other sanitary services

Prospective Observational Study of Pazopanib in Patients with Advanced Renal Cell Carcinoma (PRINCIPAL Study)

Background: Real-world data are essential to accurately assessing efficacy and toxicity of approved agents in everyday practice. PRINCIPAL, a prospective, observational study, was designed to confirm the real-world safety and efficacy of pazopanib in patients with advanced renal cell carcinoma (RCC). Subjects, Materials, and Methods: Patients with clear cell advanced/metastatic RCC and a clinical decision to initiate pazopanib treatment within 30 days of enrollment were eligible. Primary objectives included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), relative dose intensity (RDI) and its effect on treatment outcomes, change in health-related quality of life (HRQoL), and safety. We also compared characteristics and outcomes of clinical-trial-eligible (CTE) patients, defined using COMPARZ trial eligibility criteria, with those of non-clinical-trial-eligible (NCTE) patients. Secondary study objectives were to evaluate clinical efficacy, safety, and RDI in patient subgroups. Results: Six hundred fifty-seven patients were enrolled and received ≥1 dose of pazopanib. Median PFS and OS were 10.3 months (95% confidence interval [CI], 9.2–12.0) and 29.9 months (95% CI, 24.7 to not reached), respectively, and the ORR was 30.3%. HRQoL showed no or little deterioration over time. Treatment-related serious adverse events (AEs) and AEs of special interest occurred in 64 (9.7%), and 399 (60.7%) patients, respectively. More patients were classified NCTE than CTE (85.2% vs. 14.8%). Efficacy of pazopanib was similar between the two groups. Conclusion: PRINCIPAL confirms the efficacy and safety of pazopanib in patients with advanced/metastatic RCC in a real-world clinical setting. Implications for Practice: PRINCIPAL is the largest (n = 657) prospective, observational study of pazopanib in patients with advanced/metastatic renal cell carcinoma, to the authors’ knowledge. Consistent with clinical trial results that often contain specific patient types, the PRINCIPAL study demonstrated that the effectiveness and safety of pazopanib is similarly safe and effective in patients with advanced kidney cancer in a real-world clinical setting. The PRINCIPAL study showed that patients with advanced kidney cancer who are treated with first-line pazopanib generally do not show disease progression for approximately 10 months and generally survive for nearly 30 months

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Structural and functional characterisation of the αS1-casein (CSN1S1) gene and association studies with milk traits in Assaf sheep breed

Genetic polymorphisms in genes encoding milk proteins are of interest to the animal breeding and dairy industry due to their effects on production traits, milk composition and milk quality. For this purpose, the total length of the CSN1S1 gene has been sequenced and characterised in Assaf animals with an extreme phenotype for milk protein content. In the present study, some of the polymorphisms were genotyped for association analysis studies with milk protein content in a population of 444 Assaf ewes. Furthermore, the influences of these polymorphisms on the transcription rate of this gene were also evaluated in 45 Churra Tensina ewes. An 18427-bp DNA-sequence of the CSN1S1 gene, including the entire CDS, 5'- and 3'UTR regions, and the promoter region, was analysed, leading to the identification of 61 polymorphisms. Two polymorphisms detected in the 5' flanking region were located within possible trans-acting factor binding sites, modifying the putative CdxA and GATA-1 consensus sites. The SNP (JN560175 g.1123C>A) that modifies a putative CdxA consensus site showed a significant effect on the expression of the CSN1S1 gene (P=0.043), but no effect was found for protein content. A SNP in exon 17 (g.16101C>T) produces a non-conservative substitution of isoleucine to threonine at position 209 in the pre-protein (GenBank accession no. JN560175), but no significant associations with milk protein content were found. Finally, two SNPs located in exons 18 (g.16721C>A) and 19 (g.17826G>A) modify a putative target site for two bovine miRNA (bta-miR-631 and bta-miR-1224, respectively). Only the SNP in exon 18 showed a lightly significant additive genetic effect (PA) were consistent, as the expression of the CSN1S1 gene in animals with the CC genotype was approximately 1.8 times greater than the expression of the GG genotype. Further studies concerning cheese yield and casein content as well as functional studies of transcription factors and miRNA binding activity are needed to elucidate the function of these SNPs and their application to breeding schemes. © 2013 Elsevier B.V

Structural characterisation of the acyl CoA Diacylglycerol acyltransferase 1 (DGAT1) gene and association studies with milk traits in Assaf sheep breed

Because DGAT1 plays a fundamental role in triacylglycerol synthesis, existing SNPs in DGAT1 gene might provide important information in partially explaining, the variation of milk fat content in dairy sheep. Therefore, the main objective of this study was to sequence the complete ovine acyl CoAdiacylglycerol acyltransferase 1 (DGAT1)gene in order to identify polymorphisms and to look for its possible association with milk traits in Assaf sheep breed. Polymorphisms identification in the DGAT1gene was carried out in 50 individuals belonging to five sheep breeds reared in Spain Rasa Aragonesa (n=10), Manchega (n=10), Churra Tensina (n=10), Latxa (n=10) and Spanish Assaf (n=10). The association studies between polymorphisms, and milk traits were carried out using animals belonging to three flocks of Assaf breed (n=402). Four SNPs were detected, one in exon 1 (EU178818 g.358C>A), two in exon 17 (g.8522C>T and g.8539C>T), and one in intron 10 (g.7457C>A). The SNP in exon 1, g.358C>A, generates a non-conservative substitution at position p. Asp53Glu (GenBank ABW24130). The first SNP in exon 17 (g.8522C>T)causes an amino acid change at position p. Arg482Cys. The genotype frequencies were studied in a panel of 9 breed reared in Spain Ansotana (n=50), Latxa (n=36), Romanov (n=33), Rasa aragonesa (n=55), Churra (n=52), Churra tensina (n=57), Churra lebrijana (n=50), Manchega (n=48) and Assaf (n=402). All breeds were in Hardy-Weinberg equilibrium for all SNPs, except for the SNPs g.8522C>T and g.8539C>T SNPs which showed a deficit of heterozygous animals in Ansotana breed. This gene show low variability in a panel of 9 breeds reared in Spain. The only polymorphism not fixed in Assaf breed was the SNP g.8539C>T, and was used to test possible association with milk traits. The allelic frequency of the 8539C allele was 0.96, being 373 animals homozygous for the CC genotype and 29 heterozygous. The association studies showed that lactose, fatty acids C40, C161 c9, and the ratio n-6n-3 were affected by the SNP g.8539C>T. Animals carrying the CC genotype had greater lactose, C4:0 and C16:1 c9 contents and lower ratio of n-6:n-3 compare to the CT ones. Probably the SNP g.8539C>T, is not causative of the variation observed in the lactose content but might be in linkage disequilibrium with the causal mutation located in the same or other closer gene. © 2015 Elsevier B.V. All rights reserved