Sarcopenia en pacientes VIH: prevalencia y factores asociados

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 17 de Abril de 201

Cetoacidosis diabética en un paciente: error diagnóstico y mala praxis

Occasionally, type 2 diabetes mellitus (T2DM) is diagnosed in patients with type 1 diabetes mellitus (T1DM), especially in obese subjects without diabetic ketoacidosis (DKA). This can be serious, among other things, because the type 2 sodium-glucose transporter inhibitors used in T2DM are associated with euglycemic DKA. We present the case of a 42-year-old male with 13-year-old T2DM who presented severe DKA due to dapagliflozin, as well as a severe intrahospital ketosis due to omission of subcutaneous insulin doses. Finally, the diagnosis of T1DM was made.En ocasiones se diagnostica como diabetes mellitus tipo 2 (DM2) a pacientes con diabetes mellitus tipo 1 (DM1), especialmente en sujetos obesos sin cetoacidosis diabética (CAD). Esto puede ser grave, entre otras cosas, debido a que los inhibidores del transportador sodio-glucosa tipo 2 empleados en DM2 se asocian a CAD euglucémica. Presentamos el caso de un varón de 42 años con DM2 de 13 años de evolución, que presentó CAD severa por dapagliflozina, así como un cuadro de cetosis severa intrahospitalaria por omisión de dosis subcutánea de insulina. Finalmente, se realizó el diagnóstico de DM1

Mid and late Holocene forest fires and deforestation in the subalpine belt of the Iberian range, northern Spain

26 Pags.- 6 Figs.- 2 Tabls. The definitive version is available at: http://link.springer.com/journal/11629The conversion of subalpine forests into grasslands for pastoral use is a well-known phenomenon, although for most mountain areas the timing of deforestation has not been determined. The presence of charcoal fragments in soil profiles affected by shallow landsliding enabled us to date the occurrence of fires and the periods of conversion of subalpine forest into grasslands in the Urbión Mountains, Iberian Range, Spain. We found that the treeline in the highest parts of the northwestern massifs of the Iberian Range (the Urbión, Demanda, Neila, and Cebollera massifs) is currently between 1500 and 1600 m a.s.l., probably because of pastoral use of the subalpine belt, whereas in the past it would have reached almost the highest divides (at approximately 2100–2200 m a.s.l.). The radiocarbon dates obtained indicate that the transformation of the subalpine belt occurred during the Late Neolithic, Chalcolithic, Bronze Age, Iron Age, and Middle Ages. Forest clearing was probably moderate during fires prior to the Middle Ages, as the small size of the sheep herds and the local character of the markets only required small clearings, and therefore more limited fires. Thus, it is likely that the forest recovered burnt areas in a few decades; this suggests the management of the forest and grasslands following a slash-and-burn system. During the Middle and Modern Ages deforestation and grassland expansion affected most of the subalpine belt and coincided with the increasing prevalence of transhumance, as occurred in other mountains in the Iberian Peninsula (particularly the Pyrenees). Although the occurrence of shallow landslides following deforestation between the Neolithic and the Roman Period cannot be ruled out, the most extensive shallow landsliding processes would have occurred from the Middle Ages until recent times.Support for this research was provided by the projects INDICA (CGL2011- 27753-C02-01 and -02) and DINAMO2 (CGL2012-33063), funded by the Spanish Ministry of Economy and Competitiveness.Peer reviewe

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Glycemic variability : prognostic impact on acute ischemic stroke and the impact of corrective treatment for hyperglycemia. The GLIAS-III translational study

Glycemic variability (GV) represents the amplitude of oscillations in glucose levels over time and is associated with higher mortality in critically ill patients. Our aim is to evaluate the impact of GV on acute ischemic stroke (IS) outcomes in humans and explore the impact of two different insulin administration routes on GV in an animal model. This translational study consists of two studies conducted in parallel: The first study is an observational, multicenter, prospective clinical study in which 340 patients with acute IS will be subcutaneously implanted a sensor to continuously monitor blood glucose levels for 96 h. The second study is a basic experimental study using an animal model (rats) with permanent occlusion of the middle cerebral artery and induced hyperglycemia (through an intraperitoneal injection of nicotinamide and streptozotocin). The animal study will include the following 6 groups (10 animals per group): sham; hyperglycemia without IS; IS without hyperglycemia; IS and hyperglycemia without treatment; IS and hyperglycemia and intravenous insulin; and IS and hyperglycemia and subcutaneous insulin. The endpoint for the first study is mortality at 3 months, while the endpoints for the animal model study are GV, functional recovery and biomarkers. The GLIAS-III study will be the first translational approach analyzing the prognostic influence of GV, evaluated by the use of subcutaneous glucose monitors, in acute stroke. Trial registration (NCT04001049

Punto de fuga. Punto de encuentro : aproximación interdisciplinar a las Vanguardias Artísticas de la segunda mitad del siglo XX

Resumen basado en el del proyecto. Premiado en la convocatoria: Premios para proyectos de innovación concluidos durante el curso 2007-2008, en los centros educativos no universitarios sostenidos con fondos públicos de la Comunidad Autónoma de Castilla-La Mancha (Orden 12-12-2008, de la Consejería de Educación y Ciencia de la Junta de Comunidades de Castilla-La Mancha. Resolución de 5-5-2009, de la Viceconsejería de Educación)El proyecto se desarrolla entre cinco centros: la Escuela de Arte de Guadalajarara, la Escuela de Hostelería y Turismo del IES Antonio Buero Vallejo de Guadalajara, el Conservatorio Provincial de Música de Guadalajara, el IES Profesor Domínguez Ortiz de Azuqueca de Henares y el Colegio Infantil y Primaria Castillo de Pioz. La idea central es la de abordar de forma interdisciplinar un tema común entre centros de distinta naturaleza armonizando el calendario de realización. Se buscan elementos integradores que permitan que el alumno se involucre activamente en un aprendizaje significativo con uno de los elementos clave en la educación, la motivación. Los objetivos son: fomentar la idea de que todas las áreas de conocimiento y creación humanas son producto de épocas y situaciones concretas englobadas en un todo; fomentar la participación activa en el proceso educativo; descubrir que el arte es algo vivo y que puede formar parte de la propia personalidad; fomentar el espíritu colectivo, la relevancia en el cumplimiento de los plazos y la valoración de la mirada del espectador sobre lo realizado; descubrir nuevos modos de comunicación y de relación; promover la reflexión anti-racista, anti-sexista, pacifista y solidaria. El tema elegido, la segunda mitad del siglo XX, especialmente las décadas de los 50, 60 y 70. Años de grandes transformaciones sociales y económicas en Europa. Su aproximación es multidisciplinar, desde la música, las artes plásticas, la literatura, la gastronomía, y el desarrollo del turismo como una industria potente que contribuirá además económicamente a sacar del ostracismo al pais.Castilla La ManchaConsejería de Educación, Ciencia y Cultura. Viceconsejería de Educación y Cultura. Servicio de Documentación; Bulevar del Río Alberche, s. n. - 1 Planta; 45071 Toledo; Tel. +34925286045; Fax +34925247410; [email protected]

ICU-Acquired Pneumonia Is Associated with Poor HealthPost-COVID-19 Syndrome

Background. Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. Methods: This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Conclusions: Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-1

Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.

Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment ( Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p  Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful

Methodology of a Large Multicenter Observational Study of Patients with COVID-19 in Spanish Intensive Care Units.

The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs