Técnicas de reproducción asistida humana: apoyo psicológico y calidad asistencial

Describir aspectos psicosociales implicados en las Técnicas de Reproducción Asistida Humana (TRA), en base a la satisfacción, apoyo psicológico e información recibidos por sus usuarias. Estudio transversal descriptivo de tipo encuesta-cuestionario. La encuesta se facilitó por foros de Internet consistentes en grupos de apoyo de usurarias de TRA. Se distinguió entre las usuarias de la Sanidad Pública, la Privada y un grupo mixto (si acudieron a ambos servicios). Las variables se presentan según su distribución de frecuencias. Mediante el test Chi-cuadrado de Pearson, se ha analizado la asociación de las variables cualitativas. Los datos han sido analizados con el programa estadístico IBM SPSS Statistics versión 20.0 para Windows. El nivel de significación establecido fue de p<0,05. La asistencia integral a la pareja estéril debe incluir la evaluación y el apoyo psicológico profesional, que debiera ser ofrecido sistemáticamente en los Servicios de Reproducción Humana Asistida y cualquier miembro del equipo debería ser capaz de proporcionarlo. La satisfacción de la calidad asistencial está determinada en gran medida por la información que reciben los pacientes, por lo que habría que proporcionarla de manera clara, sin tecnicismos y adecuada; por personal sanitario debidamente cualificado, de cara a reducir el porcentaje de pacientes que acuden en busca de información a fuentes no sanitarias.Grado en Medicin

Estudio de las arcillas de Santa Cruz de Mudela (Ciudad Real) y de su comportamiento cerámico con adición de escorias de la Central Térmica GICC de Puertollano

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Ciencias Geológicas, Departamento de Cristalografía y Mineralogía, leída el 22/09/2010.Depto. de Mineralogía y PetrologíaFac. de Ciencias GeológicasTRUEProQuestpu

Recycling of residual IGCC slags and their benefits as degreasers in ceramics

This work studies the evolution of IGCC slag grains within a ceramic matrix fired at different temperatures to investigate the effect of using IGCC slag as a degreaser. Pressed ceramic specimens from two clay mixtures are used in this study. The M1 mixture is composed of standard clays, whereas the M2 mixture is composed of the same clay mixture as M1 mixture but contains 15% by weight IGCC slag. The amount of IGCC slag added coincides with the amount of slag typically used as a degreaser in the ceramic industry. Specimens are fired at 950 ºC, 1000 ºC, 1050 ºC, 1100 ºC and 1150 ºC. The mineralogical composition and the IGCC slag grain shape within the ceramic matrix are determined by X-ray diffraction, polarized light microscopy and scanning electron microscopy. The results reveal that the surface of the slag grains is welded to the ceramic matrix while the quartz grains are separated, which causes increased water absorption and reduces the mechanical strength. IGCC slag, however, reduces water absorption. This behaviour is due to the softening temperature of the slag. This property is quite important from an industrial viewpoint because IGCC slag can serve as an alternative to traditional degreasing agents in the ceramic building industry. Additionally, using IGCC slag allows for the transformation of waste into a secondary raw material, thereby avoiding disposal at landfills; moreover, these industrial wastes are made inert and improve the properties of ceramics

Dynamic Secondary Electron Emission in Rough Composite Materials

The interaction of ionizing radiation with matter is of critical importance in numerous areas of science and technology like space and vacuum technology and even medicine and biotechnology. Secondary electron emission is a consequence of electron irradiation on materials. We achieve extremely low secondary electron emission yield values smaller than 0.2, even up to incident electron energies ~1 keV, due to an undocumented synergy between neighbouring metal and dielectric domains in composite samples. To investigate this experimental discovery, we propose a simple 3D model where the dielectric and metallic domains are arranged in parallel and interleaved. The proposed surface profile has a triangular shape to model the surface roughness. We obtain a continuous equation to describe the electric field that arises between grounded conductors and charged dielectrics domains. The calculated trajectories of secondary electrons in this 3D geometry are used to predict dynamic secondary emission yield, which strongly depends on the charge accumulated in the dielectric domains. This research paves the way to design new materials of low secondary emission yield, addressing the technological problem not yet resolved to inhibit the electron avalanche in RF equipment that limit their maximum working power

Late HIV Diagnosis but Earlier Antiretroviral Treatment Initiation in Northwest Spain: Impact of Current Treatment Guidelines

[Abstract] Background: Current HIV treatment guidelines recommend antiretroviral treatment (ART) initiation for all HIV-infected individuals regardless of CD4 count. This study evaluates the immunological and virological status and the clinical characteristics of patients who have started ART in the last 8 years in the Northwest of Spain. Methods: All HIV-infected patients who have started ART between January 2009 and December 2016 at a reference hospital in the Northwest of Spain were included in this retrospective observational study. Epidemiological, clinical, and immunovirological features and antiretroviral drugs used for initiation were recorded. A statistical analysis was performed using SPSS version 19 software. Categorical and continuous variables were compared by the specific statistical tests, and a logistic regression model was used to identify time associated with Center for Disease Control and Prevention (CDC) categories change. Results: A high proportion of HIV-infected patients (66.7%) had initiated ART with CD4 counts <350 cells/mm3 in the last 8 years. From these, most of them (68.3%) had <350 CD4 counts at first contact with HIV specialist medical team, 12.2% had no indications for ART initiation in the last clinic visit before ART initiation according to the national guidelines at that moment, 11.0% were lost to follow-up because of lack of compliance with scheduled visits and 8.5% of patients refused treatment. A logistic regression model showed that a delay of one month since the first contact with HIV specialist medical team to ART initiation involves a risk of worsening in the CDC clinical category (odds ratio: 1.02 [95% confidence interval: 1.012-1.029]; P < .001). A trend towards an earlier start of ART was observed during 2015 and 2016, likely influenced by the last treatment guidelines recommendations. Conclusion: High proportion of HIV-infected patients (66.7%) had initiated ART with CD4 counts <350 cells/mm3 in the last 8 years. The main reasons for this problem were analyzed and an important rate of late diagnosis was identified. However, a trend towards an earlier start of ART was observed during 2015 and 2016, likely influenced by the last treatment guidelines recommendations. These findings highlight the need to promote and facilitate HIV testing to reduce the late diagnosis as well as counseling on HIV prevention, treatment, and linkage care

Balance y perspectivas del Registro de Paisajes de Interés Cultural de Andalucía

El Convenio Europeo del Paisaje (Consejo de Europa, 2000), en vigor en España desde el 1 de marzo de 2008, detalla en su capítulo II (‘Medidas nacionales’) una serie de obligaciones para los distintos estados firmantes entre las que relacionan (art. 6) la identificación y cualificación de paisajes, mediante el análisis de sus características (caracterización) y la consideración de los valores particulares que les atribuyen las Partes y la población interesadas (en nuestro caso, sus valores como patrimonio cultural).El Registro de Paisajes de Interés Cultural de Andalucía (R-PICA) es un cuerpo de datos homogéneo y normalizado que recoge una completa y diversa información sobre áreas territoriales que han sido seleccionadas por ser depositarias de valores patrimoniales, culturales e históricos, que han participado y son testigos actuales de su formación como un paisaje cultural reconocible y significativo de Andalucía. Con la primera caracterización de cobertura regional de una selección de paisajes culturales, más de 100 por el momento, se habrá consolidado una metodología innovadora con la que se consigue la integración de diferentes fuentes de información y disciplinas científicas

His452Tyr polymorphism in the human 5-HT2A receptor affects clozapine-induced signaling networks revealed by quantitative phosphoproteomics

Antipsychotic drugs remain the current standard for schizophrenia treatment. Although they directly recognize the orthosteric binding site of numerous monoaminergic G protein-coupled receptors (GPCRs), these drugs, and particularly second-generation antipsychotics such as clozapine, all have in common a very high affinity for the serotonin 5-HT receptor (5-HTR). Using classical pharmacology and targeted signaling pathway assays, previous findings suggest that clozapine and other atypical antipsychotics behave principally as 5-HTR neutral antagonists and/or inverse agonists. However, more recent findings showed that antipsychotics may also behave as pathway-specific agonists. Reversible phosphorylation is a common element in multiple signaling networks. Combining a quantitative phosphoproteomic method with signaling network analysis, we tested the effect of clozapine treatment on the overall level of protein phosphorylation and signal transduction cascades in vitro in mammalian cell lines induced to express either the human 5-HTR or the H452Y variant of the gene encoding the 5-HTR receptor. This naturally occurring variation within the 5-HTR gene was selected because it has been repeatedly associated with schizophrenia patients who do not respond to clozapine treatment. Our data show that short time exposure (5 or 10 min) to clozapine (10 M) led to phosphorylation of numerous signaling components of pathways involved in processes such as endocytosis, ErbB signaling, insulin signaling or estrogen signaling. Cells induced to express the H452Y variant showed a different basal phosphoproteome, with increases in the phosphorylation of mTOR signaling components as a translationally relevant example. However, the effect of clozapine on the functional landscape of the phosphoproteome was significantly reduced in cells expressing the 5-HTR-H452Y construct. Together, these findings suggest that clozapine behaves as an agonist inducing phosphorylation of numerous pathways downstream of the 5-HTR, and that the single nucleotide polymorphism encoding 5-HTR-H452Y affects these clozapine-induced phosphorylation-dependent signaling networks

Influence of drug–drug interactions on effectiveness and safety of direct-acting antivirals against hepatitis C virus

[Abstract] Objectives Direct-acting antivirals are the recommended treatment for hepatitis C-infected patients. Drug–drug interactions with concomitant treatments can cause lack of effectiveness and/or safety. The objective of this study is to characterise drug–drug interactions of direct-acting antivirals and to analyse their influence both on the effectiveness of antiviral treatment and on the overall safety of pharmacological treatment in hepatitis C-infected patients. Methods Observational and prospective cohort study for 3 years in the pharmaceutical care outpatient consultation of a general hospital, undertaking detection, evaluation and management of drug–drug interactions by clinical pharmacists and physicians. The main outcome measures were sustained virologic response at week 12 for effectiveness and serious drug-related adverse events for safety. Multivariate statistical analysis applied to: (a) patient basal characteristics related to presence of drug–drug interactions; (b) previous antiviral treatments, viral genotype, cirrhosis, decompensations and presence of drug–drug interactions related to the effectiveness of direct-acting antivirals. Results Of a total of 1092 patients, the majority of them were men, around 60 years old and HCV-genotype 1 mono-infected, with a high basal viral load, naive to antiviral treatment, treated with ledipasvir/sofosbuvir and without cirrhosis. 24.5% had drug–drug interactions. Proton pump inhibitors were the concomitant drugs that caused the most drug–drug interactions. Age ≥65 years and direct-acting antivirals based on protease inhibitors were independently related to the presence of drug-drug interactions (p≤0.012). All (100%) of the therapeutic recommendations based on detected drug–drug interactions were implemented; 97.7% of patients with interactions versus 99.0% without them reached sustained virologic failure (p=0.109). The serious adverse events rates were 1.5% and 1.3% in patients with and without drug-drug interactions, respectively (p=0.841). Conclusions Drug–drug interactions are frequent among hepatitis C-infected patients receiving treatment with direct-acting antivirals. However, the collaboration between physicians and clinical pharmacists makes it possible to detect, evaluate, avoid or clinically manage these drug–drug interactions, in order to maintain whole treatment therapeutic safety and the effectiveness of direct-acting antivirals

Clinical experience with the integrase inhibitors Dolutegravir and Elvitegravir in HIV-infected patients: efficacy, safety and tolerance

[Abstract] Two integrase inhibitors (INSTIs), dolutegravir (DTG) and elvitegravir/cobicistat (EVG/COBI), have joined recently the pharmacotherapy arsenal against HIV. This study evaluated the efficacy and tolerability of these INSTIs in the last two years. A retrospective observational study in patients who started DTG or EVG/COBI from January 2015 to January 2017 at a reference hospital in north-western Spain was done. Epidemiological, clinical and immunovirological data were recorded. A statistical analysis was performed with SPSS software. A total of 542 DTG (n = 275)- or EVG/COBI (n = 267)-based therapies were initiated during the study period. Overall, more than 90% of naïve and pre-treated patients had virological suppression in both groups after 48 weeks of initiation of treatment per-protocol snapshot analysis. During follow-up, 10.2% of patients were treated with DTG and 4.5% of those treated with EVG discontinued due to adverse events (AE). In the case of DTG mainly related to neuropsychiatric disturbances (70.4%) and for EVG/COBI with gastrointestinal discomfort (50%). Female sex [HR 2.255 (95%CI 1.121–4.535), p = 0.023] and DTG treatment [HR 2.453 (95%CI 1.221–4.931), p = 0.012] were associated with AE discontinuations. Specifically for neuropsychiatric events, DTG treatment [HR 5.906 (95%CI 1.954–17.846), p = 0.002] and receiving abacavir/lamivudine/DTG [HR 4.380 (95%CI 1.348–14.233), p = 0.014] were identified as predictive risk factors for treatment discontinuations in two different multivariate analyses. A high percentage of AE discontinuations not previously described in clinical trials has been observed, especially with DTG. Female gender and DTG treatment were identified as risk factors for AE discontinuation. DTG-based therapies, especially in combination with abacavir/lamivudine, were associated with an increased risk of treatment discontinuation due to neuropsychiatric AE.Instituto de Salud Carlos III; CPII14/00014Instituto de Salud Carlos III; PI10/02166Instituto de Salud Carlos III; PI13/02266Instituto de Salud Carlos III; CM13/00328Instituto de Salud Carlos III; CM15/00233Instituto de Salud Carlos III; PI16/0215