Tratamiento de la depresión en pacientes oncológicos: influencia sobre la calidad de vida al año de seguimiento

Tesis inédita realizada en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Psiquiatría. Fecha de Lectura: 24 de Junio de 2010

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

SARS-CoV-2 Infection in Multiple Sclerosis

To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal diseas

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

Famílies botàniques de plantes medicinals

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia, Assignatura: Botànica Farmacèutica, Curs: 2013-2014, Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són els recull de 175 treballs d’una família botànica d’interès medicinal realitzats de manera individual. Els treballs han estat realitzat per la totalitat dels estudiants dels grups M-2 i M-3 de l’assignatura Botànica Farmacèutica durant els mesos d’abril i maig del curs 2013-14. Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pel professor de l’assignatura i revisats i finalment co-avaluats entre els propis estudiants. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Efectividad de un programa formativo en enfermería transcultural sobre aspectos de la salud mental en hijos de inmigrantes entre 12 y 17 años diagnosticados de síndrome de estrés por traslado

Objectives: To value the efficiency of a formative program for Transcultural Nursing on the level of anxiety, emotional balance and social implication for children of immigrant population diagnosed of Syndrome of Stress for Movement. Methodology: Clinical random Essay with assignment for groups. There will be realized in the Area 6 of the Community of Madrid, the selection of the participants will realize in the centers of Primary care selected as group control and experimentally. An evaluation will be realized in the center of Mental Health of all the participants and the results will be compared after six months in health of all the participants (group control and experimental), as well as the nursing aims and the interventions realized in every center. The evaluation of every variable will carry out by means of validated instruments and by means of the utilization of nursing taxonomy. The population size belongs 14000 individuals and there will select a sample of 156 children, calculated for a mistake alpha of 0,05 a power of 0,8 and an estimated effect of 0,4. The analysis of information will be realized by comparison pre and post, as well as intergroups, besides the descriptive analysis of the variables.Objetivos: Valorar la eficacia de un programa formativo en Enfermería Transcultural sobre el nivel de ansiedad, equilibrio emocional e implicación social en hijos de población inmigrante diagnosticados de Síndrome de Estrés por Traslado. Metodología: Ensayo clínico aleatorio con asignación por grupos. Se realizará en el Área 5 de la Comunidad de Madrid, la selección de los participantes se realizará en los centros de Atención Primaria seleccionados como grupo control y experimental. Se realizará una evaluación en el centro de Salud Mental de todos los participantes y se compararán tras seis meses los resultados en salud de todos los participantes (grupo control y experimental), así como los objetivos de enfermería y las intervenciones realizadas en cada centro. La evaluación de cada variable se realizará mediante instrumentos validados y mediante la utilización de taxonomía enfermera. El tamaño poblacional es de 14000 individuos y se seleccionará una muestra de 156 niños, calculada para un error alfa de 0,05, un poder de 0,8 y un efecto estimado de 0,4. El análisis de datos se realizará por comparación pre y post, así como intergrupos, además del análisis descriptivo de las variables

Effectiveness of a formative program about transcultural nursing on aspects of the mental health on immigrants children between 12 and 17 years old diagnosed of stress for movement syndrome

Objectives: To value the efficiency of a formative program for Transcultural Nursing on the level of anxiety, emotional balance and social implication for children of immigrant population diagnosed of Syndrome of Stress for Movement.Methodology: Clinical random Essay with assignment for groups. There will be realized in the Area 6 of the Community of Madrid, the selection of the participants will realize in the centers of Primary care selected as group control and experimentally.An evaluation will be realized in the center of Mental Health of all the participants and the results will be compared after six months in health of all the participants (group control and experimental), as well as the nursing aims and the interventions realized in every center.The evaluation of every variable will carry out by means of validated instruments and by means of the utilization of nursing taxonomy.The population size belongs 14000 individuals and there will select a sample of 156 children, calculated for a mistake alpha of 0,05 a power of 0,8 and an estimated effect of 0,4.The analysis of information will be realized by comparison pre and post, as well as intergroups, besides the descriptive analysis of the variables

Efectividad de un programa formativo en enfermería transcultural sobre aspectos de la salud mental en hijos de inmigrantes entre 12 y 17 años diagnosticados de síndrome de estrés por traslado

Objetivos: Valorar la eficacia de un programa formativo en Enfermería Transcultural sobre el nivel de ansiedad, equilibrio emocional e implicación social en hijos de población inmigrante diagnosticados de Síndrome de Estrés por Traslado. Metodología: Ensayo clínico aleatorio con asignación por grupos. Se realizará en el Área 5 de la Comunidad de Madrid, la selección de los participantes se realizará en los centros de Atención Primaria seleccionados como grupo control y experimental. Se realizará una evaluación en el centro de Salud Mental de todos los participantes y se compararán tras seis meses los resultados en salud de todos los participantes (grupo control y experimental), así como los objetivos de enfermería y las intervenciones realizadas en cada centro. La evaluación de cada variable se realizará mediante instrumentos validados y mediante la utilización de taxonomía enfermera. El tamaño poblacional es de 14000 individuos y se seleccionará una muestra de 156 niños, calculada para un error alfa de 0,05, un poder de 0,8 y un efecto estimado de 0,4. El análisis de datos se realizará por comparación pre y post, así como intergrupos, además del análisis descriptivo de las variables.   Abstract: Objectives: To value the efficiency of a formative program for Transcultural Nursing on the level of anxiety, emotional balance and social implication for children of immigrant population diagnosed of Syndrome of Stress for Movement. Methodology: Clinical random Essay with assignment for groups. There will be realized in the Area 6 of the Community of Madrid, the selection of the participants will realize in the centers of Primary care selected as group control and experimentally. An evaluation will be realized in the center of Mental Health of all the participants and the results will be compared after six months in health of all the participants (group control and experimental), as well as the nursing aims and the interventions realized in every center. The evaluation of every variable will carry out by means of validated instruments and by means of the utilization of nursing taxonomy. The population size belongs 14000 individuals and there will select a sample of 156 children, calculated for a mistake alpha of 0,05 a power of 0,8 and an estimated effect of 0,4. The analysis of information will be realized by comparison pre and post, as well as intergroups, besides the descriptive analysis of the variables.   Centro de Trabajo: (1) Enfermera y Antropóloga. Centro Salud Mental Colmenar Viejo (Madrid, España); (2) Enfermera y Antropóloga; (3) Psicóloga. Centro Salud Mental Colmenar Viejo (Madrid, España); (4) Enfermera. Centro Salud Pavones (Madrid, España). Fecha del Trabajo: 15/12/2009 Palabra Clave: Enfermería Transcultural; Estudios de Intervención; Migración Internacional; Salud Mental; Estrés Psicológico. Key Words: Transcultural Nursing; Intervention Studies; Emigration and Immigration; Mental Health; Stress, Phsichological