Diseño de una app para diabéticas gestacionales

La diabetes gestacional, con una prevalencia de un 12%, puede conllevar a importantes complicaciones obstétricas y perinatales como abortos, malformaciones fetales, macrosomía fetal o preeclamsia, si no se consigue un correcto control glucémico. Las pacientes requieren un tratamiento basado en un autocontrol de la glucemia, una dieta equilibrada y la realización de ejercicio físico. El auge de las tecnologías de la información y la comunicación (TIC) en el área de la salud ha sido espectacular, al igual que el acceso a Internet desde los smartphones. El objetivo fue crear una aplicación (App) de software que se instala en móviles o en tablets para un correcto control de la diabetes gestacional. Nuestro método es el diseño de la App con el programa “Mobincube”, que incluye diferentes partes: información sobre la paciente (edad, peso, talla, semanas de gestación…), diario de glucemias, plan de alimentación y rutina de ejercicio. Se obtuvo una App “GESTADIA” de fácil uso para embarazadas y para profesionales de enfermería, que realizan los controles de seguimiento de la diabetes gestacional. Además, se acompaña de un vídeo explicativo sobre su uso. El proyecto proporciona una ayuda para el control y tratamiento de estas pacientes y puede apoyar a la atención y los cuidados de enfermería. Los profesionales de la salud a través de la comunicación digital, como es la creación de un diseño de aplicación de móvil (App), sencilla y con información verídica, pueden utilizar esta herramienta para las dudas y seguimiento de las diabéticas gestacionales. La aplicación fue diseñada desde los cuidados de enfermería, para incluir el control de glucemias, un plan de alimentación y unas recomendaciones de actividad física en las pacientes con diabetes gestacional.Grado en Enfermerí

Tendencias de la investigación sobre educación en los posgrados médicos

RESUMEN: Este estudio se enmarcó en la investigación: Caracterización del modelo en competencias profesionales de educación médica desarrollado en doce especializaciones clínicas y nueve quirúrgicas de la Facultad de Medicina, Universidad de Antioquia. Su objetivo fue indagar el estado del arte de la formación médica en los posgrados. La pregunta orientadora fue la siguiente: ¿hacia dónde se dirige actualmente la investigación en educación médica de posgrado? Se hizo un estudio descriptivo, no experimental, para el que se revisaron 12 bases de datos y se seleccionaron 28 artículos relacionados con la formación médica de posgrado. Se compararon, analizaron e interpretaron los hallazgos. Se evidenció un aumento del número de publicaciones sobre educación en las especialidades médicas. La tendencia investigativa en educación médica de posgrado apunta a la necesidad de hacer propuestas multi-intertransdisciplinarias y humanísticas basadas en el constructivismo; situar la evaluación como proceso haciendo énfasis en el aprendizaje y la participación de los estudiantes y construir sistemas de formación pedagógica de tutores y currículos interactivos y flexibles; es notoria la ausencia de estudios que promuevan la formación por competencias en los posgrados médicos.ABSTRACT: This study was framed in the research: Characterization of professional competency-based model in medical education developed in twelve clinical and nine surgical specializations at the Faculty of Medicine, University of Antioquia. Its aim was to inquire about the state of the art in medical postgraduate education. The guiding question was: Where is present-day research headed in medical postgraduate education. For this descriptive, nonexperimental work, 12 bibliographic databases were reviewed and 28 research articles related to graduate medical formation were selected. The findings were compared, analyzed and interpreted. The tendency in research on graduate medical education points to the need of having multi-inter-trans-disciplinary and humanistic proposals based on constructivism; to consider evaluation as a process emphasizing on learning and the participation of students, and to build systems of pedagogical formation of tutors and interactive and flexible curricula. The lack of studies that promote competencies-based training in postgraduate medical education is notorious

Cancer-associated fibroblast-derived gene signatures determine prognosis in colon cancer patients

© The Author(s)Paracrine communication between tumor and surrounding stroma arbitrates the malignant behavior of cancer progression [1]. Fibroblasts, which are the main cell type within the stroma and are called cancer-associated fibroblasts (CAFs), orchestrate the crosstalk with cancer cells [2, 3] and express several markers associated with prognosis [4]. There is increasing evidence that a stroma-specific signature could be used for risk assessment in colon cancer (CC). According to the Consensus Molecular Subtype classification (CMS) in CC, the mesenchymal or CMS4 group is characterized by stromal invasion, extracellular matrix remodeling and TGF-β signaling activation. It is associated with the worst prognosis rates [5, 6]. Genes correlating with the mesenchymal subtype are mostly expressed by CAFs and other stromal cells, rather than by tumor cells [7]. Accordingly, our group defined a gene expression profile associated with CAFs with high pro-migratory effects on colon tumor cells, which was associated with patients’ poor prognosis. These were mostly advanced-stage patients [8].This research is supported by PI17/01847, PI18/01020 and PI20/00602 from the Instituto de Salud Carlos III and co-financed by the European Development Regional Fund (FEDER) “A way to achieve Europe” (ERDF); by “CIBER de Cáncer”, CB16/12/00273, CB16/12/00301 and CB16/12/00446, from the Instituto de Salud Carlos III-FEDER; and by the Fundación Científica AECC (a multifaceted approach to targeting pancreatic cancer). The JDLR group also acknowledges the funding provided by the Instituto de Salud Carlos III (ISCiii, AES) in grants PI18/00591 and PT17/0009/0008, co-financed by the European Development Regional Fund (FEDER)

Plurilingüismo y aprendizaje cooperativo en el diseño de prácticas de Lingüística

Este artículo presenta el trabajo realizado desde el área de Lingüística General de la Universidad de Alicante para ofertar sus prácticas de la asignatura “Lingüística General II”, común a todas las especialidades de lenguas modernas de la Facultad de Filosofía y Letras, en los tres idiomas en que tiene lugar la docencia de dichas clases: castellano, valenciano e inglés. A fin de armonizar los contenidos prácticos de una enseñanza trilingüe, por un lado, y de fomentar la implicación del alumnado en las actividades prácticas y contribuir al desarrollo del aprendizaje colaborativo en el aula, por otro, los profesores de este área de conocimiento, junto con la participación de dos estudiantes, han diseñado veinte prácticas que van desde el análisis del signo lingüístico hasta la Pragmática, pasando por la Fonética, la Morfología, la Sintaxis y el Análisis del Discurso

Long or complicated mpox in patients with uncontrolled HIV infection

To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive

Monkeypox virus genomic accordion strategies

The 2023 monkeypox (mpox) epidemic was caused by a subclade IIb descendant of a monkeypox virus (MPXV) lineage traced back to Nigeria in 1971. Person-to-person transmission appears higher than for clade I or subclade IIa MPXV, possibly caused by genomic changes in subclade IIb MPXV. Key genomic changes could occur in the genome's low-complexity regions (LCRs), which are challenging to sequence and are often dismissed as uninformative. Here, using a combination of highly sensitive techniques, we determine a high-quality MPXV genome sequence of a representative of the current epidemic with LCRs resolved at unprecedented accuracy. This reveals significant variation in short tandem repeats within LCRs. We demonstrate that LCR entropy in the MPXV genome is significantly higher than that of single-nucleotide polymorphisms (SNPs) and that LCRs are not randomly distributed. In silico analyses indicate that expression, translation, stability, or function of MPXV orthologous poxvirus genes (OPGs), including OPG153, OPG204, and OPG208, could be affected in a manner consistent with the established "genomic accordion" evolutionary strategies of orthopoxviruses. We posit that genomic studies focusing on phenotypic MPXV differences should consider LCR variability.We would like to thank the work of the Rapid Response Unit of the National Center for Microbiology, especially MªJosé Buitrago, and Cristobal Belda, ISCIII General Director. We also thank Anya Crane (Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health) for critically editing the manuscript and Jiro Wada (Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health) for helping with figure preparation. The work for this study performed at Instituto de Salud Carlos III was partially funded by Acción Estratégica “Impacto clínico y microbiológico del brote por el virus de la viruela del mono en pacientes en España (2022): proyecto multicéntrico MONKPOX-ESP22” (CIBERINFEC) (M.P.S.S.). The work for this study done at the Icahn School of Medicine at Mount Sinai Department of Microbiology as part of Global Health Emerging Pathogen Institute activities was funded by institutional funds (G.P.) from the Icahn School of Medicine at Mount Sinai Department of Microbiology in support of Global Health Emerging Pathogen Institute activities. This work was also supported in part through Laulima Govern ment Solutions, LLC, prime contract with the U.S. National Institute of Allergy and Infectious Diseases (NIAID) under Contract No. HHSN272201800013C. J.H.K. performed this work as an employee of Tunnell Government Services (TGS), a subcontractor of Laulima Government Solutions, LLC, under Contract No. HHSN272201800013C. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Army. The views and conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or implied, of the U.S. Department of Health and Human Services or of the institutions and companies affiliated with the authors, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.S

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women