Tratamiento quirúrgico de las metátasis pulmonares. Factores de supervivencia

La metastectomía pulmonar ha demostrado ser un tratamiento curativo en pacientes seleccionados con metástasis pulmonares, incrementando la supervivencia. La toracotomía abierta (OT) es el procedimiento quirúrgico estándar en estos pacientes. No obstante, en los últimos años, la cirugía torácica video-asistida (VATS) ha adquirido mayor relevancia, planteándose como una posible alternativa al anterior procedimiento, menos invasiva y con una mayor conservación del parénquima pulmonar. Sin embargo, su seguridad y eficacia es todavía objeto de estudio y controversia, por lo que serían necesarios ulteriores estudios randomizados para aclarar dichas cuestiones. El objetivo de esta revisión bibliográfica es analizar los resultados del tratamiento quirúrgico de las metástasis pulmonares, centrándose en tres aspectos: la supervivencia obtenida tras la metastectomía y los factores que condicionan dicha supervivencia; la comparación de las diferentes técnicas quirúrgicas utilizadas actualmente; y algunas consideraciones especiales, como la recurrencia de las metástasis y la remetastectomía, aspectos todos ellos que influyen y condicionan dicha supervivencia. Hemos concluido que VATS es una alternativa viable, con tasas de supervivencia similares a la toracotomía abierta, e incluso con ventajas en el caso de recurrencia metastásica. Son factores importantes para el resultado: la experiencia quirúrgica, y una correcta selección de pacientes que, en su caso, pueden beneficiarse al máximo de una técnica menos invasiva.OtroGrado en Medicin

PhDay Educación 2020. VI Jornadas de Investigación. Libro de Actas

Todas las contribuciones presentadas en este Libro de Actas forman parte de la evaluación de seguimiento de los doctorandos de segundo año a tiempo completo y tercer año a tiempo parcial del Programa de Doctorado en Educación de la Universidad Complutense de Madrid. Cada trabajo ha sido revisado formalmente por el comité organizador y valorado por los directores y tutores de tesis. Asimismo, cada doctorando ha recibido mejoras por otros estudiantes del programa que han podido incluir antes de la finalización del presente documento

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Examining the immune signatures of SARS-CoV-2 infection in pregnancy and the impact on neurodevelopment: Protocol of the SIGNATURE longitudinal study

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women.This work has received support from the Fundación Alicia Koplowitz to realize the epigenetic wide association study and to the clinical assessment to the children. This work has also received public support from the Consejería de Salud y Familias para la financiación de la investigación, desarrollo e innovación (i + d + i) biomédica y en ciencias de la salud en Andalucía (CSyF 2021 - FEDER). Grant Grant number PECOVID- 0195-2020. Convocatoria financiada con Fondo Europeo de Desarrollo Regional (FEDER) al 80% dentro del Programa Operativo de Andalucía FEDER 2014-2020. Andalucía se mueve con Europa. NG-T received payment under Rio Hortega contract CM20-00015 with the Carlos III Health Institute.Peer reviewe

El huerto-invernadero escolar : memoria 1997-1998

Ayudas concedidas a proyectos de innovación educativa para el curso 1997-1998. Anexo Memoria en C-Innov.7Proyecto realizado por un grupo de profesores del Colegio Público María Teresa Iñigo de Toro de Valladolid con el apoyo de la Asociación de Padres y Madres del Colegio y realizado con niños de educación infantil y de educación primaria, y dado que el Centro es de integración hay alumnos con necesidades educativas especiales: síndrome de down, minorías étnicas y con desventaja social. Los objetivos del proyecto son: que el alumnado conozca, descubra, valore y respete las plantas, favoreciendo su desarrollo en el campo o en el huerto escolar, acercar al niño al medio agrícola, crear hábitos de limpieza, fomentar la colaboración y el trabajo en equipo, manejar las herramientas utilizadas en el huerto, desarrollar la observación global y progresiva de las plantas, descubrir la importancia de las plantas en la alimentación del hombre, conocer el ciclo vital de las plantas hortícolas y conocer y respetar el medio ambiente. Tras una primera fase de formación y asesoramiento del profesorado a través del centro de Profesores y Recursos y la bibliografía adecuada, se inicia la segunda fase con el desarrollo del huerto-invernadero con una planificación exhaustiva dirigida hacia unas delimitaciones y parcelación del terreno en relación con los cultivos. Las plantaciones serán de hortícolas, hierbas medicinales y flores. Y la tercera fase con el cuidado de los cultivos y la recolección de los primeros frutos y actividades derivadas de la misma. En la evaluación se utilizan cuestionarios, escalas, fichas de evaluación inicial, de seguimiento y de evaluación final, observación directa del trabajo en el huerto-invernadero y observación directa de fichas personales y de los cuadernos de trabajo del alumnado y se evaluarán las actividades propuestas, los materiales, el papel del profesorado y la actuación individualizada y en equipo del alumnado.Ministerio Educación CIDEBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; Fax +34917748026; [email protected]

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis.

The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, -216.8 defined daily doses per 1000 OBDs; 95% confidence interval, -347.5 to -86.1), and was sustained during subsequent years (average reduction, -19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, -.003 to .039) reverted toward a decreasing trend of -0.130 per quarter (change in slope, -0.029; -.051 to -.008), and so did the mortality rate (change in slope, -0.015; -.021 to -.008). This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use