Capacidad pronóstica de los microRNAs circulantes en la neumonía adquirida en la comunidad

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 24-109-202

Clinical Ethics Consultation: current European models and novel approaches in Spain

Los Comités de Ética Asistencial (CEAS) han constituido hasta la actualidad el único modelo de resolución de conflictos éticos en el entorno hospitalario en España, aunque su utilidad para mejorar la práctica clínica diaria ha sido puesta en duda. La Consultoría individual en Ética Clínica (CEC) es un modelo complementario al CEAS, eficaz para ayudar a tomar decisiones ético-clínicas complejas a tiempo real. Aunque la CEC está muy extendida en el ámbito estadounidense, todavía goza de poca popularidad en Europa. En el presente trabajo se describen las características generales de los servicios de CEC, remarcando sus ventajas y potenciales riesgos comparándolos con los del modelo basado exclusivamente en los CEAS. En segundo lugar, se recogen las experiencias y modelos de CEC en diversos países europeos, y también presentamos las iniciativas más recientes llevadas a cabo en nuestro país. Tras ello, se propone una estrategia de implantación de un servicio de CEC para un hospital universitario de tamaño medio y se resumen las características mínimas que este servicio de CEC debe tener para poder llevar a cabo eficazmente su labor consultiva: flexibilidad organizativa, composición por profesionales formados en Bioética, con gran experiencia clínica, remunerados específicamente para esta tarea y con dependencia organizativa del CEAS.To date, healthcare ethics committees (HEC) have been the only ethics consultation model in the hospital setting in Spain, though their usefulness for ethical conflict resolution in daily practice has been questioned. Individual clinical ethics consultation (CEC) is a complementary ethics consultation model, which has proved efficacious in real-time ethical problem-solving. Although CEC is widely used in North America, its implementation in Europe is still marginal. In this document we present the general characteristics of CEC services, comparing their potential advantages and risks to those of HECs. We will then share relevant European experiences in CEC, as well as review the few CEC initiatives in Spain. Finally, we will share our recent CEC implementation strategy in a national, medium-sized, teaching hospital. We will summarise the minimum requirements that such a CEC service must meet in order to carry out its consulting activity: organisational flexibility, well-trained professionals, with sufficient clinical experience, economical support, and organisational dependency on HECs

Usefulness of circulating microRNAs miR-146a and miR-16-5p as prognostic biomarkers in community-acquired pneumonia

Introduction Patients with community-acquired pneumonia (CAP) undergo a dysregulated host response that is related to mortality. MicroRNAs (miRNAs) participate in this response, but their expression pattern and their role as biomarkers in CAP have not been fully characterized. Methods A prospective observational study was performed in a cohort of 153 consecutive patients admitted to hospital with CAP. Clinical and analytical variables were collected, and the main outcome variable was 30-day mortality. Small RNA was purified from plasma of these patients obtained on the first day of admission, and miRNA expression was analyzed by RTPCR. Univariate and multivariate analyses were carried out through the construction of a logistic regression model. The proposed model was compared with established prognostic clinical scales using ROC curve analysis. Results The mean age of the patients included was 74.7 years [SD 15.9]. Their mean PSI was 100.9 [SD 34.6] and the mean modified Charlson index was 2.9 [SD 3.0]. Both miR-146a and miR- 16-5p showed statistically significant association with 30-day mortality after admission due to CAP (1.10 vs. 0.23 and 51.74 vs. 35.23, respectively), and this association remained for miR-16-5p in the multivariate analysis adjusted for age, gender and history of bronchoaspiration (OR 0.95, p = 0.021). The area-under-the-curve (AUC) of our adjusted multivariate model (AUC = 0.954 95%CI [0.91–0.99]), was better than those of prognostic scales such as PSI (AUC = 0.799 [0.69–0.91]) and CURB-65 (AUC = 0.722 [0.58–0.86]). Conclusions High levels of miR-146a-5p and miR-16-5p upon admission due to CAP are associated with lower mortality at 30 days of follow-up. Both miRNAs could be used as biomarkers of good prognosis in subjects hospitalized with CAPThis work has been funded by the Carlos III Health Institute (ERDF, European Regional Development Fund), by the Spanish Society of Pneumology and Thoracic Surgery and by the Ministry of Science, Innovation and Universities of Spain

Uso de la pizarra digital interactiva en el PIV-040/11

Esta comunicación retrata una parte del trabajo de un proyecto de investigación educativa, relacionada con la utilización de materiales hechos en las pizarras digitales (PDI). De un lado, aquellos con un enfoque duradero, más generales, en los que se trabaja de forma animada, lúdica y con una componente de retomar, recordar y consolidar diferentes contenidos estudiados a lo largo de las unidades didácticas. Por otro lado, materiales puntuales y producidos a partir de las necesidades de un grupo, bajo un punto de vista más concreto, yendo al centro de la dificultad. Esta doble componente nos permite innovar y entender el uso extenso de los trabajos producidos para las PDI

Desarrollo colaborativo de competencias en la escuela tic 2.0 (PIV-040-11)

Este proyecto de investigación educativa (piv-040-11) pretende desarrollar las competencias básicas en el primer curso de la eso en el marco del programa escuela tic 2.0 y las áreas instrumentales de matemáticas y lengua, mediante el trabajo colaborativo de más de 200 alumnos y alumnas de ocho institutos pertenecientes a cuatro provincias andaluzas, intercomunicados por un aula virtual creada con Moodle y un blog. Para su desarrollo se han usado materiales digitales interactivos y herramientas de la Web 2.0 para la generación de contenidos, difusión de los materiales producidos y de la experiencia, acompañados de una metodología integradora y personalizada que facilite a cada alumno o alumna el desarrollo de sus potenciales

Occurrence of SARS-CoV-2 viremia is associated with genetic variants of genes related to COVID-19 pathogenesis

IntroductionSARS-CoV-2 viral load has been related to COVID-19 severity. The main aim of this study was to evaluate the relationship between SARS-CoV-2 viremia and SNPs in genes previously studied by our group as predictors of COVID-19 severity.Materials and methodsRetrospective observational study including 340 patients hospitalized for COVID-19 in the University Hospital La Princesa between March 2020 and December 2021, with at least one viremia determination. Positive viremia was considered when viral load was above the quantifiable threshold (20 copies/ml). A total of 38 SNPs were genotyped. To study their association with viremia a multivariate logistic regression was performed.ResultsThe mean age of the studied population was 64.5 years (SD 16.6), 60.9% patients were male and 79.4% white non-Hispanic. Only 126 patients (37.1%) had at least one positive viremia. After adjustment by confounders, the presence of the minor alleles of rs2071746 (HMOX1; T/T genotype OR 9.9 p < 0.0001), rs78958998 (probably associated with SERPING1 expression; A/T genotype OR 2.3, p = 0.04 and T/T genotype OR 12.9, p < 0.0001), and rs713400 (eQTL for TMPRSS2; C/T + T/T genotype OR 1.86, p = 0.10) were associated with higher risk of viremia, whereas the minor alleles of rs11052877 (CD69; A/G genotype OR 0.5, p = 0.04 and G/G genotype OR 0.3, p = 0.01), rs2660 (OAS1; A/G genotype OR 0.6, p = 0.08), rs896 (VIPR1; T/T genotype OR 0.4, p = 0.02) and rs33980500 (TRAF3IP2; C/T + T/T genotype OR 0.3, p = 0.01) were associated with lower risk of viremia.ConclusionGenetic variants in HMOX1 (rs2071746), SERPING1 (rs78958998), TMPRSS2 (rs713400), CD69 (rs11052877), TRAF3IP2 (rs33980500), OAS1 (rs2660) and VIPR1 (rs896) could explain heterogeneity in SARS-CoV-2 viremia in our population

Cribado del cáncer en España estado actual y nuevas herramientas no invasivas

En este seminario el José María Galván viene ha presentar metodos para hacer una detección temprana del cáncer en pacientes que aun no manifiestan sintomas, hacer una detección temprana de la enfermedad que permita identificarla y tratarla para mejorar la calidad de vida del paciente y reducir así la mortalidad. Presenta argumentos a favor y en contra de los cribados de cáncer, las caracteristicas que deben presentar los programas de cribado. Los cribado de cáncer son más aceptados a otras intervenciones por: su impacto sobre la mortalidad, su impacto en la calidad de vida, es facil de implementar a nivel poblaciona, permite detectar otras patologías y hay gran predisposición a la colaboración entre la población y el sistema sanitario.N

Gastroenterology: evolution of specialty choice in recent years

Introduction: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. Material and methods: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization. Results: The median consecutive number involved in the choice of Gastroenterology training has decreased year after year, and this specialty is now positioned among the five most commonly selected residency programs in 2015. The median number of hospitals with a higher number of beds, adult liver transplantation activities and dedicated GI bleeding units is significantly lower. This is also true when centers are analyzed according to the presence of specific Gastroenterology on-call shifts for residents or their association with medical schools. Data from the past five years highlight Madrid, Aragón and the Basque Country as the autonomous communities where Gastroenterology is the most popular. Centers selected by candidates with the lowest median consecutive numbers from 2011-2015 included the university hospitals Ramón y Cajal, Santiago de Compostela and Gregorio Marañón. Conclusions: Gastroenterology has gradually escalated in the ranking of residency choices and is now one of the five most popular options. Potential residents prefer larger centers with complex-care patients and more research activity