Enfermedad Celíaca más allá de una enteropatía

Celiac disease (CD) is defined as a gluten-sensitive enteropathy that occurs in genetically predisposed people. In recent years there has been an increase in the prevalence of disorders related to the intake of gluten, a protein found in different cereals such as wheat, barley and rye. Celiac disease is a multisystemic disease that, if not diagnosed in time, can lead to multiple long-term complications.La enfermedad celíaca (EC) se define como una enteropatía sensible al gluten que se da en personas genéticamente predispuestas. En los últimos años se ha visto un incremento en la prevalencia de los trastornos relacionados con la ingesta de gluten, proteína que se encuentra en diferentes cereales como el trigo, la cebada y el centeno. Es una enfermedad multisistémica y si no es diagnosticada a tiempo, puede cursar con múltiples complicaciones a largo plazo

Diagnostic and therapeutic guide for inflammatory bowel disease

La enfermedad inflamatoria intestinal engloba dos grandes patologías principalmente, la enfermedad de Crohn y la colitis ulcerosa. Ambas enfermedades se dan por procesos inflamatorios a nivel intestinal y debido a los cambios en estilos de vida, su prevalencia ha ido en aumento. Si bien es cierto que el tratamiento de la enfermedad inflamatoria no es curativo, tiene como objetivo principal controlar el brote y por medio de este mantener al paciente en remisión.Inflammatory bowel disease encompasses two major etiologies mainly, Crohn's disease and ulcerative colitis. Both diseases are caused by inflammatory bowel processes and due to changes in lifestyles, their prevalence has been increasing. Although it is true that the treatment of Inflammatory bowel disease is not curative, its main objective is to control the outbreak and through this keep the patient in remission

Management of hyperemesis gravidarum according to clinical severity

La mayoría de las embarazadas presentan náuseas y vómitos. Los síntomas suelen iniciar de 2 a 4 semanas posterior a la fertilización y por lo general resuelven a las 22 semanas de gestación. La hiperémesis gravídica se define como la ocurrencia de tres o más vómitos diarios, asociado a cetonuria y pérdida de peso mayor a 3 kilogramos o 5% del peso inicial. Aunque la hiperémesis gravídica presenta una baja mortalidad, sigue siendo una fuente importante de morbilidad por lo que impera un diagnóstico temprano.Nausea and vomiting occur in most pregnant women. Symptoms usually begin 2 to 4 weeks after fertilization and usually resolve by 22 weeks gestation. Hyperemesis gravidarum is defined as the occurrence of three or more vomits daily, associated with ketonuria and weight loss greater than 3 kilograms or 5% of the initial weight. Although hyperemesis gravidarum has a low mortality, it continues to be an important source of morbidity, which is why an early diagnosis prevails

Análisis del prácticum y las sesiones de tutoría en las carreras de odontología, informática y educación de la universidad de Salamanca

Memoria ID-114. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2018-2019

Use of rituximab in pediatric patients with steroid-resistant nephrotic syndrome. A single center study

ABSTRACT: Steroids are the cornerstone of therapy for nephrotic syndrome (NS) with a remission rate as high as 90%. In patients who do not respond to them or are steroid dependent, other immunosuppressive drugs have been used. Although rituximab use in NS is off-label, many authors have published their experience with it. Objective and methods: To describe retrospectively a group of seven children with nephrotic syndrome, either steroid-dependent (SDNS) or steroid-resistant (SRNS), treated with rituximab and mycophenolate, at Pablo Tobón Uribe Hospital, in Medellín, Colombia. Results: Two patients with SDNS and five with SRNS were evaluated; median age at diagnosis was 2 years (p25-75: 1-5); six months after treatment with rituximab there was reduction in proteinuria (93%), in the steroid dose (100%) and in the relapse episodes. However, proteinuria reappeared 12 months after treatment. Conclusion: During the first year after rituximab treatment of NS there is reduction in proteinuria and in the steroid dose, but thereafter there is relapse. It is suggested to carry out another study using a second dose of rituximab one year after the first one.RESUMEN: Los esteroides son el tratamiento de elección del síndrome nefrótico con tasas de éxito hasta del 90%. En pacientes que no responden adecuadamente a ellos, se han usado diferentes esquemas de inmunosupresión. Objetivo y métodos: describir la respuesta terapéutica en un grupo de siete niños con síndrome nefrótico córtico-dependiente (SNCD) o córtico-resistente (SNCR) que recibieron tratamiento con rituximab y micofenolato mofetil en un hospital universitario de la ciudad de Medellín durante los años 2010-2012. Resultados: dos pacientes tenían SNCD y cinco, SNCR; la mediana de edad en el momento del diagnóstico fue de 2 años (p25-75: 1-5); seis meses después de la aplicación del rituximab se encontró disminución de la proteinuria en el 93% de los pacientes; los esteroides se lograron suspender en el 100%; además, disminuyó el número de recaídas; sin embargo, la proteinuria reapareció un año después de dicho tratamiento. Conclusión: con el rituximab disminuyen la proteinuria y la dosis de esteroides, pero la enfermedad recurre 12 meses después de usarlo. Se sugiere hacer otro estudio evaluando el efecto de una segunda dosis de rituximab al año de la primera

a research protocol for a mixed methods study

Funding Information: This work was supported by the European Union under the Horizon Europe Research and Innovation Programme under the grant agreement no 101057825. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2024 Valli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. Aim SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. Methods We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. Discussion The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.publishersversionpublishe

Co-Design Process of a Virtual Community of Practice for the Empowerment of People with Ischemic Heart Disease

Virtual Communities of Practices (vCoP) offer patients the possibility to interact and share tools and knowledge necessary for their empowerment. This paper describes the co-design process of a vCoP for the empowerment of people with ischemic heart disease (IHD). We used a modified experience-based design approach to co-design the vCoP in collaboration with people with IHD and health professionals consisting of two phases: exploratory and development phase. Data collection techniques included listening labs, workshops, and online participation. Twenty-five people with IHD and ten health professionals participated. Experiences and needs for empowerment in IHD were identified in the exploratory phase allowing for the development of a Patient Journey Map. In the development phase, people with IHD prioritized needs to be addressed by the vCoP content framework in addition to content proposals. The Patient Journey Map helped to easily visualize the empowerment needs of people with IHD and it might be transferable for the development of other people-centred interventions. The co-design process also allowed the development of training materials adapted to the priorities of people with IHD. A people-centred co-design process of a vCoP may facilitate the empowerment of people with IHD

Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease : study protocol of a randomised controlled trial

Virtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of the activation and other patient empowerment measures in patients with ischaemic heart disease (IHD). A pragmatic randomised controlled trial will be performed in Catalonia, Madrid and Canary Islands, Spain. Two hundred and fifty patients with a recent diagnosis of IHD attending the participating centres will be selected and randomised to the intervention or control group. The intervention group will be offered participation for 12 months in a VCoP based on a gamified web 2.0 platform where there is interaction with other patients and a multidisciplinary professional team. Intervention and control groups will receive usual care. The primary outcome will be measured with the Patient Activation Measure questionnaire at baseline, 6, 12 and 18 months. Secondary outcomes will include: clinical variables; knowledge (Questionnaire of Cardiovascular Risk Factors), attitudes (Self-efficacy Managing Chronic Disease Scale), adherence to the Mediterranean diet (Mediterranean Diet Questionnaire), level of physical activity (International Physical Activity Questionnaire), depression (Patient Health Questionnaire), anxiety (Hospital Anxiety Scale-A), medication adherence (Adherence to Refill Medication Scale), quality of life (EQ-5D-5L) and health resources use. Data will be collected from self-reported questionnaires and electronic medical records. The trial was approved by Clinical Research Ethics Committee of Gregorio Marañón University Hospital in Madrid, Nuestra Señora de Candelaria University Hospital in Santa Cruz de Tenerife and IDIAP Jordi Gol in Barcelona. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local/international conferences

Informe final del proyecto: Gestión patrimonial y producción responsable como bases para el desarrollo social: implementación de un programa colaborativo de investigación, monitoreo y conservación entre el CURE y el INC

El proyecto dio inicio al programa de cooperación entre el Centro Universitario Regional del Este y el Instituto Nacional de Colonización para implementar programas de investigación, gestión y capacitación que promuevan el desarrollo social y la producción responsable en contextos rurales, compatibilizando la conservación y uso de sus recursos naturales y culturales. Este interés común fue explicitado en un convenio entre ambas instituciones, con el objetivo de promover el desarrollo de un programa de investigación, gestión y monitoreo conjunto del patrimonio cultural y natural que compatibilice su conservación y socialización con el uso productivo del padrón 3406 de la sexta sección catastral del departamento de Rocha. Con este objetivo, las principales acciones del proyecto involucraron: a) delimitación física de tres Unidades de Investigación, Monitoreo y Conservación (UIMC) que comprenden tres conjuntos de cerritos de indios; b) diagnóstico arqueológico y biológico de las UIMC para identificar objetivos e indicadores de conservación; c) monitoreo y evaluación del impacto de diferentes cargas de pastoreo en las UIMC sobre el patrimonio cultural y natural; d) promoción de la conservación patrimonial mediante protección legal y sensibilización social; e) promoción de experiencias asociativas y producciones alternativas como aporte al desarrollo social. Entre los resultados obtenidos se destacan: a) vínculos interinstitucionales fortalecidos; b) primeras UIMC implementadas; c) conocimiento científico inédito producido; d) base de datos con indicadores de conservación para programas de monitoreo a largo plazo; e) metodología de manejo integral del patrimonio en contexto productivo rural; f) propuesta de plan de manejo de las UIMC; g) involucramiento de colonos en la conservación, uso responsable y socialización del patrimonio; h) propuesta de declaración de Monumento Histórico Nacional para las UIMC; i) gestiones para señalización en ruta e integración en circuito turísticos departamentales; j) formación de recursos humanos y amplia socialización del conocimiento (audiovisuales, charlas, talleres, publicaciones, prensa).Agencia Nacional de Investigación e Innovació