Eficacia de un Programa Multidisciplinar de Gestión de Cuidados en Pacientes que Ingresan por Insuficiencia Cardiaca (ProMIC)

Objetivo: Evaluar la eficacia de « ProMIC » , programa multidisciplinar de atención a pacientes con insuficiencia cardiaca (IC), para reducir de la tasa de reingresos por IC. Dise ̃ no: Ensayo cuasiexperimental multicéntrico con grupo control. Emplazamiento: Doce centros de salud y 3 hospitales del País Vasco. Participantes: Pacientes mayores de 40 a ̃ nos ingresados por IC en situación funcional ii-iv de la New York Heart Association. Intervenciones: En los pacientes ProMIC se realizó una intervención clínica estructurada basada en las guías de práctica clínica y en el modelo de atención a la cronicidad. Los pacientes control recibieron cuidados habituales. Mediciones principales: Tasa de reingresos por IC y calidad de vida relacionada con la salud.Objective: To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate. Desing: Quasi-experimental research with control group. Settings: Twelve primary health care centres and 3 hospitals from the Basque Country. Participants: Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV. Interventions: Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care. Main measurements: The rate of readmission for HF and health-related quality of life Results: One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio=0.59, CI 95%:0.36-0.98; P=.049). There were significant differences in specific quality of Life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up. Conclusions: ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables (C) 2018 The Authors. Published by Elsevier Espana, S.L.U.Departamento de salud del Gobierno Vasco: N. o de expe- diente 2010111182 Bizkaia y N. o de expediente 2010111088 Araba. Fundación Vasca de Innovación e investigación sani- taria BIOEF: Expediente BIO10/EC/004

Filaggrin and cytokines in respiratory samples of preterm infants at risk for respiratory viral infection

Respiratory viral infections (RVIs) are frequent in preterm infants possibly inducing long-term impact on respiratory morbidity. Immune response and respiratory barriers are key defense elements against viral insults in premature infants admitted to Neonatal Intensive Care Units (NICUs). Our main goals were to describe the local immune response in respiratory secretions of preterm infants with RVIs during NICU admission and to evaluate the expression and synthesis of lung barrier regulators, both in respiratory samples and in vitro models. Samples from preterm infants that went on to develop RVIs had lower filaggrin gene and protein levels at a cellular level were compared to never-infected neonates (controls). Filaggrin, MIP-1α/CCL3 and MCP-1 levels were higher in pre-infection supernatants compared to controls. Filaggrin, HIF-1α, VEGF, RANTES/CCL5, IL-17A, IL-1β, MIP-1α and MIP-1β/CCL5 levels were higher during and after infection. ROC curve and logistic regression analysis shows that these molecules could be used as infection risk biomarkers. Small airway epithelial cells stimulated by poly:IC presented reduced filaggrin gene expression and increased levels in supernatant. We conclude that filaggrin gene and protein dysregulation is a risk factor of RVI in newborns admitted at the NICU.This study has been partially supported by ISCIII – Instituto de Salud Carlos III, FIS (Fondo de Investigación Sanitaria—Spanish Health Research Fund) grants FI19/00067, PI18/00167, PI21/00896, PI18CIII/00009 and FEDER funds (Fondo Europeo de Desarrollo Regional); Sociedad Española de Alergología e Inmunología Clínica (SEAIC)Beca19A04_Valverde; Alfonso X El Sabio University Grant: VIII Convocatoria Santander-UAX; CIBER de Enfermedades Respiratorias (CIBERES), a Carlos III Institute of Health Initiative.S

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain

Background: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. Methods: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. Results: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. Conclusions: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).The data of the study was originally collectedas part of the following projects run by the European Centre for Disease Prevention and Control:“Establishing Severe Acute Respiratory Infections (SARI) surveillance and performing hospital-based COVID-19 transmission studies”, “Developing an infrastructure and performing vaccine effectiveness studies for COVID-19 vaccines in the EU/EEA”, and the “Vaccine Effectiveness, Burden and Impact Studies(VEBIS) of COVID-19 and Influenza".S

Biorefinery: the paper mill of tomorrow

Peer Reviewe

Diseño de infografías científicas en el aula a través de herramientas web 3.0 y recursos en abierto

El proyecto que se presenta pretende instruir a estudiantes y profesores en las competencias necesarias para el diseño y elaboración de infografías científicas de contenidos académicos, utilizando para ello herramientas de la web 3.0 disponibles en abierto. Exponer ideas científicas mediante la elaboración de infografías es una realidad que ha llegado ya a todos los hogares gracias a los medios de comunicación: al exponer noticias en papel o en web, los redactores ya no recurren únicamente al texto con imágenes, sino que se valen de elementos infográficos explicativos que ayudan a que el público comprenda mejor la noticia en su dimensión más técnica. Aplicar la metodología de realización de infografías científicas a la práctica docente en Humanidades y Ciencias Sociales (Historia del Arte, Historia Moderna, Educación, Psicología, Bellas Artes y Documentación) se presenta no solo como una estrategia útil para que los estudiantes sinteticen las claves de determinados temas, sino también como una herramienta interesante para dotar de competencias de difusión científica a los alumnos, facilitando así su inserción laboral. Asimismo, esta proyecto ha facilitado la conformación de un equipo innovador profundamente interdisciplinar (Historia, Historia del Arte, Psicología, Tecnologías y Bellas Artes) e interinstitucional (UCM, UNED y URJC) con un enorme potencial de cara a futuras propuestas de innovación docente

INFOTIC. Infografías académicas y herramientas de visualización de datos científicos con herramientas TIC: formación docente, diseño de recursos multimedia y experiencias didácticas para la enseñanza semipresencial

El proyecto ha gravitado en torno al uso didáctico de las infografías científicas como una herramienta destinada a la enseñanza semipresencial y telemática, aportando nuevos recursos para estudiantes y docentes y permitiendo implementar dinámicas adaptadas a las nuevas tecnologías. En este sentido, una infografía se puede definir como un conjunto de ideas complejas representadas mediante palabras, imágenes, gráficos, etc., que les confieren un aspecto visualmente atractivo. Las infografías conforman un hilo comunicativo de transmisión de estas ideas gracias al uso de textos informativos, que refuerzan su carácter pedagógico, e imágenes ilustrativas para potenciar la claridad y el dinamismo del mensaje. La visualidad de los datos integrados en las infografías es la característica más destacable de estos recursos, haciéndolas interesantes para su aplicación en la enseñanza y divulgación académica. En el marco de este proyecto, poseen una finalidad eminentemente didáctica, ayudando a que temas complejos puedan ser entendidos por un público no especializado

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Actualidad de la renovación pedagógica en la Comunidad de Madrid: un estudio a través de centros escolares representativos

Resumen La historia de la renovación pedagógica española alberga una extensa y plural actividad que constata la búsqueda de una escuela configurada no solo con finalidad académica, sino también entendida como motor de transformación personal, cultural y social. Son numerosos los centros educativos que a lo largo de la historia española evidencian esta búsqueda, construyendo una mirada socio-educativa crítica e innovadora sobre la educación. A lo largo del artículo se estudian once centros escolares de educación primaria, representativos de la renovación pedagógica, que estaban activos durante el curso académico 2012-2013 en la Comunidad de Madrid. La investigación se ha realizado a través del estudio de bibliografía destacada, entrevistas a miembros significativos, observaciones de centros y análisis de contenido de proyectos educativos. Se establecen dos ejes de análisis: metodología e ideario pedagógico de los centros y principales dificultades en la realización de su proyecto educativo. Los resultados muestran que cada uno de los centros refleja una singularidad educativa propia. Sin embargo, todos revelan múltiples aspectos educativos comunes que ponen en cuestión elementos muy arraigados en la cultura pedagógica española, a saber: libro de texto como material exclusivo de trabajo, escasa participación de padres y madres, y por último, clase magistral como único método de relación pedagógica

Development and Evaluation of an NTM-IGRA to Guide Pediatric Lymphadenitis Diagnosis

Background: Diagnosis of nontuberculous mycobacteria (NTM) infections remains a challenge. In this study, we describe the evaluation of an immunological NTM-interferon (IFN)-γ release assay (IGRA) that we developed using glycopeptidolipids (GPLs) as NTM-specific antigens. Methods: We tested the NTM-IGRA in 99 samples from pediatric patients. Seventy-five were patients with lymphadenitis: 25 were NTM confirmed, 45 were of unknown etiology but compatible with mycobacterial infection and 5 had lymphadenitis caused by an etiologic agent other than NTM. The remaining 24 samples were from control individuals without lymphadenitis (latently infected with M.Tuberculosis, uninfected controls and active tuberculosis patients). Peripheral blood mononuclear cells were stimulated overnight with GPLs. Detection of IFN-γ producing cells was evaluated by enzyme-linked immunospot assay. Results: NTM culture-confirmed lymphadenitis patient samples had a significantly higher response to GPLs than the patients with lymphadenitis of unknown etiology but compatible with mycobacterial infection (P < 0.001) and lymphadenitis not caused by NTM (P < 0.01). We analyzed the response against GPLs in samples from unknown etiology lymphadenitis but compatible with mycobacterial infection cases according to the tuberculin skin test (TST) response, and although not statistically significant, those with a TST ≥5 mm had a higher response to GPLs when compared with the TST <5 mm group. Conclusions: Stimulation with GPLs yielded promising results in detecting NTM infection in pediatric patients with lymphadenitis. Our results indicate that the test could be useful to guide the diagnosis of pediatric lymphadenitis. This new NTM-IGRA could improve the clinical handling of NTM-infected patients and avoid unnecessary misdiagnosis and treatments

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research