Cuidados de enfermería al paciente con ECMO en la unidad de cuidados intensivos: Prevención de eventos adversos

Introducción: La Oxigenación por Membrana Extracorpórea (ECMO) es una técnica de soporte cardiopulmonar artificial utilizada para el tratamiento de insuficiencia cardiaca o respiratoria agudas severas. En los últimos años su uso se ha extendido en las Unidades de Cuidados Intensivos, en las que existe un alto riesgo de aparición de eventos adversos y complicaciones secundarias asociadas a la terapia. La enfermera es la encargada de brindar atención continua a estos pacientes, por lo que debe conocer dichos riesgos para poder prevenirlos, identificarlos y abordarlos.Objetivo: Describir los eventos adversos que pueden derivarse de un dispositivo ECMO en pacientes portadores del mismo en relación a los cuidados de enfermería.Metodología: Tras realizar una búsqueda bibliográfica para situar el tema, se planteó la siguiente pregunta de investigación: ¿Qué complicaciones pueden presentar los pacientes adultos de UCI portadores de ECMO en relación a los cuidados de enfermería?. Para responderla, se estableció una estrategia de búsqueda en las bases de datos Scopus, PubMed, Dialnet, Science Direct y Cuiden. De los artículos revisados, 7 fueron incluidos en la revisión.Conclusiones: Las principales complicaciones derivadas del uso del ECMO son desaturación arterial de oxígeno, isquemia de miembros inferiores, hemorragias, eventos trombóticos, insuficiencia renal aguda, infección, decanulación y fallos mecánicos del circuito, entre otras. Para mantener su seguridad, la enfermera debe proporcionar un cuidado integral mediante la monitorización y vigilancia continua tanto del paciente como del circuito, control hemodinámico exhaustivo, manejo de la anticoagulación y estrictas medidas de asepsia.<br /

Programa de educación para la salud para prevenir episiotomías y desgarros vaginales durante el parto

Programa de educación para la salud para prevenir episiotomías y desgarros vaginales durante el parto, dirigido a las gestantes. Debido a las altas tasas que se siguen observando y a las complicaciones a medio y largo plazo que ocurren, se plantea desarrollar tras una revisión bibliográfica, un programa de educación, basado en información vigente y actualizada. Se trabajarán y describirán las intervenciones apropiadas para la prevención de desgarros vaginales en partos normales, ya que el traumatismo perineal es una de las principales causas de morbilidad en el postparto y por ello es importante incidir en la prevención de este, para llegar en situación óptima al parto provocando de esta manera la disminución tanto de episiotomías como de desgarros.<br /

Mesothelial-to-Mesenchymal Transition and Exosomes in Peritoneal Metastasis of Ovarian Cancer

Most patients with ovarian cancer (OvCA) present peritoneal disseminated disease at the time of diagnosis. During peritoneal metastasis, cancer cells detach from the primary tumor and disseminate through the intraperitoneal fluid. The peritoneal mesothelial cell (PMC) monolayer that lines the abdominal cavity is the first barrier encountered by OvCA cells. Subsequent progression of tumors through the peritoneum leads to the accumulation into the peritoneal stroma of a sizeable population of carcinoma-associated fibroblasts (CAFs), which is mainly originated from a mesothelial-to-mesenchymal transition (MMT) process. A common characteristic of OvCA patients is the intraperitoneal accumulation of ascitic fluid, which is composed of cytokines, chemokines, growth factors, miRNAs, and proteins contained in exosomes, as well as tumor and mesothelial suspended cells, among other components that vary in proportion between patients. Exosomes are small extracellular vesicles that have been shown to mediate peritoneal metastasis by educating a pre-metastatic niche, promoting the accumulation of CAFs via MMT, and inducing tumor growth and chemoresistance. This review summarizes and discusses the pivotal role of exosomes and MMT as mediators of OvCA peritoneal colonization and as emerging diagnostic and therapeutic targets

On the characterization of GJ 504: a magnetically active planet-host star observed by the Transiting Exoplanet Survey Satellite (TESS)

We present the results of the analysis of the photometric data collected in long and short-cadence mode by the Transiting Exoplanet Survey Satellite (TESS) for GJ 504, a well studied planet-hosting solar-like star, whose fundamental parameters have been largely debated during the last decade. Several attempts have been made by the present authors to isolate the oscillatory properties expected on this main-sequence star, but we did not find any presence of solar-like pulsations. The suppression of the amplitude of the acoustic modes can be explained by the high level of magnetic activity revealed for this target, not only by the study of the photometric light-curve, but also by the analysis of three decades available of Mount Wilson spectroscopic data. In particular, our measurements of the stellar rotational period Prot=3.4 d and of the main principal magnetic cycle of 12 a confirm previous findings and allow us to locate this star in the early main sequence phase of its evolution during which the chromospheric activity is dominated by the superposition of several cycles before the transition to the phase of the magnetic-braking shutdown with the subsequent decrease of the magnetic activity

Cómo se compra en Valladolid

Producción CientíficaEstudio de los hábitos de consumo en el comercio minorista de la ciudad de ValladolidGeografíaInforme encargado por AVADECO con la colaboración de la Consejería de Industria, Comercio y Turismo de la Junta de Castilla y Leó

Diagnóstico de necesidades de formación para revitalizar el sector comercial

Producción CientíficaEstudio del comercio minorista en las ciudades de Valladolid (incluyendo análisis pormenorizado del centro y varios barrios) y Medina del Campo, basado en el impuesto de actividades económicas y la realización de encuestas a comerciantes y consumidores.Geografí

Link between cognitive polygenic risk scores and clinical progression after a first-psychotic episode

Background Clinical intervention in early stages of psychotic disorders is crucial for the prevention of severe symptomatology trajectories and poor outcomes. Genetic variability is studied as a promising modulator of prognosis, thus novel approaches considering the polygenic nature of these complex phenotypes are required to unravel the mechanisms underlying the early progression of the disorder. Methods The sample comprised of 233 first-episode psychosis (FEP) subjects with clinical and cognitive data assessed periodically for a 2-year period and 150 matched controls. Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, education attainment and cognitive performance were used to assess the genetic risk of FEP and to characterize their association with premorbid, baseline and progression of clinical and cognitive status. Results Schizophrenia, bipolar disorder and cognitive performance PRSs were associated with an increased risk of FEP [false discovery rate (FDR) ⩽ 0.027]. In FEP patients, increased cognitive PRSs were found for FEP patients with more cognitive reserve (FDR ⩽ 0.037). PRSs reflecting a genetic liability for improved cognition were associated with a better course of symptoms, functionality and working memory (FDR ⩽ 0.039). Moreover, the PRS of depression was associated with a worse trajectory of the executive function and the general cognitive status (FDR ⩽ 0.001). Conclusions Our study provides novel evidence of the polygenic bases of psychosis and its clinical manifestation in its first stage. The consistent effect of cognitive PRSs on the early clinical progression suggests that the mechanisms underlying the psychotic episode and its severity could be partially independent

Umbrales de lluvia para el desencadenamiento de inestabilidades de ladera en el norte de Portugal y de España: estado del arte

ES: Gran número de trabajos sobre umbrales de lluvia para el desencadenamiento de inestabilidades de ladera se ha desarrollado en áreas del norte de Portugal y España. Como resultado de una revisión, se han recopilado 103 umbrales. Más del 30% aún no han sido publicados. La comparación de cuatro umbrales regionales pone de manifiesto importantes diferencias ligadas al uso de múltiples metodologías para definir las condiciones críticas de lluvia.A great number of works focused on the calculation of empirical rainfall thresholds for the triggering of landslides have been developed in the northern areas of Portugal and Spain. Because of a review, 103 thresholds have been compiled. More than 30% of them have not yet been published. The comparison of four regional thresholds highlights relevant differences linked to the use of multiple methodologies to define the critical rainfall conditions

Combined Immune Defect in B-Cell Lymphoproliferative Disorders Is Associated with Severe Infection and Cancer Progression

This research received no external funding. K.G.-H is supported by The European Social Fund (ESF) through a Río Ortega Grant for Health Research Projects by the Carlos III Health Institute (ISCIII) (CM20/00098).B cell chronic lymphoproliferative diseases (B-CLPD) are associated with secondary antibody deficiency and other innate and adaptive immune defects, whose impact on infectious risk has not been systematically addressed. We performed an immunological analysis of a cohort of 83 B-CLPD patients with recurrent and/or severe infections to ascertain the clinical relevance of the immune deficiency expression. B-cell defects were present in all patients. Patients with combined immune defect had a 3.69-fold higher risk for severe infection (p = 0.001) than those with predominantly antibody defect. Interestingly, by Kaplan–Meier analysis, combined immune defect showed an earlier progression of cancer with a hazard ratio of 3.21, than predominantly antibody defect (p = 0.005). When B-CLPD were classified in low-degree, high-degree, and plasma cell dyscrasias, risk of severe disease and cancer progression significantly diverged in combined immune defect, compared with predominantly antibody defect (p = 0.001). Remarkably, an underlying primary immunodeficiency (PID) was suspected in 12 patients (14%), due to prior history of infections, autoimmune and granulomatous conditions, atypical or variegated course and compatible biological data. This first proposed SID classification might have relevant clinical implications, in terms of predicting severe infections and cancer progression, and might be applied to different B-CLPD entities.Depto. de Inmunología, Oftalmología y ORLFac. de MedicinaTRUEpu

Relapse, cognitive reserve, and their relationship with cognition in first episode schizophrenia: a 3-year follow-up study

Schizophrenia is frequently characterized by the presence of multiple relapses. Cognitive impairments are core features of schizophrenia. Cognitive reserve (CR) is the ability of the brain to compensate for damage caused by pathologies such as psychotic illness. As cognition is related to CR, the study of the relationship between relapse, cognition and CR may broaden our understanding of the course of the disease. We aimed to determine whether relapse was associated with cognitive impairment, controlling for the effects of CR. Ninety-nine patients with a remitted first episode of schizophrenia or schizophreniform disorder were administered a set of neuropsychological tests to assess premorbid IQ, attention, processing speed, working memory, verbal and visual memory, executive functions and social cognition. They were followed up for 3 years (n=53) or until they relapsed (n=46). Personal and familial CR was estimated from a principal component analysis of the premorbid information gathered. Linear mixed-effects models were applied to analyse the effect of time and relapse on cognitive function, with CR as covariate. Patients who relapsed and had higher personal CR showed less deterioration in attention, whereas those with higher CR (personal and familial CR) who did not relapse showed better performance in processing speed and visual memory. Taken together, CR seems to ameliorate the negative effects of relapse on attention performance and shows a positive effect on processing speed and visual memory in those patients who did not relapse. Our results add evidence for the protective effect of CR over the course of the illness