Adherencia de "streptococcus pneumoniae" a poliestireno, patogenicidad e interferencia de antibióticos e ibuprofeno

Tesis de la Universidad Complutense de Madrid, Facultad de Farmacia, Departamento de Microbiología II, leída el 03-10-2008Depto. de Microbiología y ParasitologíaFac. de FarmaciaTRUEpu

Valor del hemograma en el pronóstico del shock séptico

El shock séptico es una patología de gran complejidad causante de la mayoría de las muertes en las Unidades de Cuidados Intensivos. En la actualidad su incidencia y mortalidad continúan incrementándose, superando incluso las de otras enfermedades de gran impacto social como el sida o el cáncer de mama. En España la letalidad por shock séptico alcanza el 45,8% de los casos. Los actuales estudios sobre sepsis centran sus esfuerzos en la búsqueda de biomarcadores diagnósticos y pronósticos, cuya medición es cara y está basada en tecnología compleja, que permitan una mayor celeridad en el diagnóstico y en el tratamiento. Parece evidente, por tanto, la necesidad de identificar aquellos pacientes con más riesgo de mortalidad lo antes posible para iniciar una monitorización precoz y un tratamiento rápido. Para ello se realizó un estudio observacional prospectivo donde se analizaron los datos de 195 pacientes postquirúrgicos que ingresaron en la Unidad de Reanimación del Hospital Clínico Universitario de Valladolid entre los años 2008-2013 y que fueron diagnosticados de shock séptico. El objetivo de este estudio es analizar la influencia de las subpoblaciones leucocitarias del hemograma en el pronóstico de muerte del shock séptico. Metodológicamente se hizo un análisis descriptivo de los factores de riesgo de mortalidad de los pacientes seleccionados, un análisis de regresión de Cox univariante y multivariante y análisis de supervivencia con las curvas de Kaplan-Meier. La conclusión del trabajo fue que el número absoluto de las subpoblaciones leucocitarias en sangre se considera una herramienta valiosa y accesible para predecir la evolución de los pacientes con shock séptico.Departamento de Cirugía, Oftalmología,Otorrinolaringología y Fisioterapi

Projeto e validação de um questionário de saúde oral para avaliação pré‐anestésica no pré‐operatório

BACKGROUND AND OBJECTIVES: Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS: Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS: The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS: The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.S

Estrategias para la consecución del trabajo decente y sostenible en la empresa

La presente obra surge de la labor desarrollada en el grupo de cooperación "Trabajo decente y sostenible"; de la Universidad Carlos III de Madrid. Este grupo tiene como objetivo principal analizar, desde un enfoque interdisciplinar, la situación y perspectivas del trabajo decente como Objetivo de Desarrollo Sostenible en el marco de la Agenda 2030, así como formular propuestas para su consecución. Dentro de los proyectos promovidos por el grupo se encuentra la "Escuela de trabajo decente: formación online para el apoyo de la acción sindical en Colombia para erradicar el trabajo informal". El objetivo ha sido dotar de herramientas de aplicación del concepto de trabajo decente, en colaboración con los trabajadores y con las empresas, desde las prioridades marcadas desde la OIT. Así pues, el lector encontrará aquí una colección de estudios que desde una perspectiva mixta docente-investigadora han pretendido abordar el fenómeno del trabajo decente desde sus muy diversas manifestaciones.This book is based on the work carried out in the “Decent and sustainable work” cooperation group of the Carlos III University of Madrid. The main objective of this group is to analyze, from an interdisciplinary approach, the situation and perspectives of decent work as a Sustainable Development Goal within the framework of the 2030 Agenda, as well as to formulate proposals for its achievement. Among the projects promoted by the group, it has carried out the "Decent Work School: online training for the support of collective action in Colombia to eradicate informal work". The target has been to provide tools for applying the concept of decent work, in collaboration with workers and companies, a one of the priorities set by the ILO. Thus, the reader will find here a collection of studies that, from a mixed teaching-research perspective, have sought to address the phenomenon of decent work from its very diverse manifestations.Prólogo / Eva María Blázquez Agudo y Daniel Pérez del Prado (pp. 11-13). -- Estrategias de prevención de la pobreza laboral / Magdalena Díaz Gorfinkiel y María Gema Quintero Lima (pp. 15-45). -- Aproximación al trabajo forzoso e infantil desde una perspectiva interdisciplinar e internacional / Tania García-Sedano, Vanesa Zorrilla-Muñoz y María Silveria Agulló-Tomás (pp. 47-75). -- El incremento de los niveles educativos de las personas con discapacidad como factor de empleabilidad / Patricia Nieto Rojas (pp. 77-102). -- Derechos fundamentales en el plano internacional: una introducción / Ana Belén Muñoz Ruiz (pp. 103-117). -- Las cláusulas laborales como herramienta para lograr el objetivo del trabajo decente / Daniel Pérez del Prado (pp. 119-141). -- Una estrategia global para la formalización empresarial y laboral / Marta García Mandaloniz (pp. 143-169). -- Trabajo decente e igualdad de género. Déficits de trabajo decente y acción sindical / Ofelia de Felipe Vila (pp. 171-182)

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Comparative efficacy of novobiocin and amoxicillin in experimental sepsis caused by β-lactam-susceptible and highly resistant pneumococci.

[EN]Manuscript accepted version for publication. [ES]Versión aceptada del manuscrito para su publicación.Therapeutic alternatives are needed against infections caused by highly multidrug-resistant Streptococcus pneumoniae. Novobiocin, an old antibiotic, was tested in vitro and in a murine sepsis model against one amoxicillin-susceptible and three amoxicillin-resistant strains [minimum inhibitory concentrations (MICs) 8–64mg/L]. Novobiocin MICs for all strains were 0.25–0.5mg/L. In sepsis, novobiocin and amoxicillin were evaluated at 25, 50, 100 and 200mg/kg given at 1, 5, 24 and 48h post bacterial challenge. The most effective regimens in animals infected with the amoxicillin-susceptible strain were 200mg/kg novobiocin and 25mg/kg amoxicillin, achieving 100% survival and undetectable organisms in the peritoneum. Among mice infected with amoxicillin-resistant S. pneumoniae, 200mg/kg novobiocin gave the highest protection (90–100% survivors), followed by 200mg/kg amoxicillin (60–100%), 100mg/kg novobiocin (50–87.5%) and 50mg/kg amoxicillin (14.3–25%). The killing effect of antibiotics in the peritoneum (mean Δlog10 colony-forming units/mL between treated and control mice) was as follows: 200mg/kg novobiocin (−6.6)>200mg/kg amoxicillin (−5.6)>100mg/kg novobiocin (−3.7)>50mg/kg amoxicillin (−0.7). Total plasma and ultrafiltrate pharmacokinetics of novobiocin (200mg/kg, single dose) in non-infected mice showed, respectively, half-lives of 151min and 215min, area under the concentration–time curves (AUCs) of 945.0mg h/L and 136.6mg h/L and maximal concentrations of 147mg/L and 18mg/L. Novobiocin may be a promising agent for therapy of highly β-lactam-resistant pneumococcal infections.Research contracts were received by VR-C (COMBACT-CM, S-BIO-0260/2006) and by GdP (CPI/0305/2 007 attached to COMBACT-CM), both from Comunidad Autónoma de Madrid, Spain. VR-C is currently supported by a research contract from the Subprogram Juan de La Cierva (JCI-2008-02690; Ministerio de Ciencia e Innovación Tecnológica, Spain). LH received a grant from the Fundación Conchita Rábago (Madrid, Spain), and PN from the Alan program (European Union). This work was performed under the Research Collaboration Agreement between the Consejo Superior de Investigaciones Científicas and the Fundación Jiménez Díaz.Peer reviewe