Time to desaturation in the 6-min walking distance test predicts 24-hour oximetry in COPD patients with a PO2 between 60 and 70mmHg

SummaryBackgroundThe 6-min walking distance (6MWD) test is a useful tool for assessing patients with chronic obstructive pulmonary disease (COPD), but little is known about the changes in oxygen saturation that occur during the test.ObjectiveTo predict the oximetry profile during daily living activities by the time to desaturation in the 6MWD test in COPD-affected patients.Patients and methodsWe studied 67 COPD patients with moderate hypoxemia performing a 6MWD test and a 24-hour ambulatory pulse oximetry (24-hr PO). We determined the time to desaturation (SatO2⩽90%) in the 6MWD test, in the daytime, nighttime and 24-hr PO. We then estimated the time to desaturation that better predicts desaturation in diurnal, nocturnal and 24-hour oximetries using the ROC type II analysis.ResultsThe patients who desaturated after 3′30min have a 100% probability not to desaturate during diurnal, nocturnal and 24-hr PO. Those patients who desaturated during the first minute of the 6MWD test have a 74% probability to desaturate in these oximetries.ConclusionsThe time to desaturation in the 6MWD test can discriminate early desaturators who desaturate during their daily living activities and late desaturators who do not desaturate. Ambulatory oximetry would thus only be necessary in patients with a time to desaturation that ranges between 1 and 3′30″

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

Volteando la tortilla. Género y maíz en la alimentación actual de México.

Ante escenarios complejos, patriarcales y desoladores que dejan ver el neoliberalismo, la globalización agroalimentaria, el calentamiento global y las contaminaciones de granos nativos por la imposición de transgénicos, nos cuestionamos si existen algunas alternativas para preservar el maíz nativo como un recurso multiestratégico (alimentario, económico, cultural, ecológico y tecnológico) tomando en cuenta las condiciones actuales de desigualdades sociales de género, etnia, clases y edad que predominan en el campo mexicano. Para responder a algunos cuestionamientos, este libro presenta algunas alternativas a través de diversas experiencias femeninas y de relaciones de género en torno al maíz y la alimentación. Todas ellas muestran que es posible construir una masa crítica para salvaguardar el maíz nativo bajo esas condiciones desoladoras, pero siempre y cuando se “voltee la tortilla”, metáfora que da pie al inicio de otra realidad humanizada y en sincronía con la naturaleza.Proyecto realizado con financiamiento Conacy

Rehabilitación pulmonar en la enfermedad pulmonar obstructiva crónica: eficacia clínica : parámetros predictivos de respuesta

Tesis doctoral inédita leída el 29 de Octubre de 1992 Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicin

Free access interactive audiovisual material to support veterinary clinical practices

En el Hospital Veterinario de la Universidad de Murcia se desarrollan prácticas clínicas en entorno real de muchas asignaturas del Grado en Veterinaria. La confluencia de estudiantes de diversos niveles formativos motiva que pueda darse tanto su participación en procedimientos clínicos que aún no han estudiado como el acceso improbable a otros menos cotidianos. El objetivo del proyecto era generar material audiovisual clínico ligado a códigos bidi de acceso abierto y libre en las consultas del Hospital Veterinario y evaluar su impacto docente. Se elaboraron presentaciones audiovisuales con diversos grados de interactividad que recopilaban procedimientos clínicos, síntomas de enfermedades y casos clínicos mediante el uso de las herramientas Genially, LUMI y Power-Point. Se generaron códigos bidi cuya captura permitía el acceso libre directo al material y se pusieron a disposición de los estudiantes en general y a un grupo de 14 voluntarios en particular. Al final del estudio, se realizó un estudio de utilidad, factibilidad e interés mediante encuestación ad hoc (cuestiones graduadas 1-10). Se recopilaron 114 encuestas cuyo análisis demostró cómo el sistema empleado permitía un acceso rápido (9.4/10) y técnicamente sencillo (9.5/10) a un material que en general fue considerado de muy buena calidad técnica (8.9/10) y gran utilidad docente (8.7/10). Los materiales realizados mediante Genially o Lumi, tuvieron comparativamente mejores puntuaciones medias en grado de interactividad que los de acceso a Youtube que solo permiten navegación pero menos interacción (8.75/10 vs 3.65/10). Los materiales Genially y Lumi obtuvieron también mejores valores medios en estimación de utilidad docente (9.3/10 vs 7.8/10). La generación de material audiovisual de acceso rápido y sencillo, sin necesidad de instalar aplicaciones o programas especiales es de gran utilidad y rentabilidad docente. Los materiales que incorporan interactividad aportan claramente un valor añadido que se traduce en mejor aceptación por parte del estudiante y mayor aprovechamiento en términos de aprendizaje.In the Veterinary Hospital, clinical practices are developed in a real environment of many subjects of the Degree in Veterinary Medicine. The confluence of students from different educational levels generates a reality in which participation in clinical procedures that they have not yet studied can occur, as well as unlikely access to other less common procedures. The objective of the project was to generate clinical audiovisual material linked to free and open access bidi codes in the Veterinary Hospital consultations and to evaluate its teaching impact.Audiovisual presentations with varying degrees of interactivity were produced, including clinical proce-dures, disease symptoms, and clinical cases using the Genially, LUMI, and Power-Point tools. Bidi codes were generated whose capture allowed direct free access to the material and were made available to students in gen-eral and to a group of 14 volunteers in particular. A utility, feasibility and interest study was carried out through ad hoc surveys (graded questions 1-10).One hundred and fourteen surveys were collected, the analysis of which showed how the system used al-lowed quick (9.4/10) and technically simple (9.5/10) access to material that was generally considered to be of very good technical quality (8.9/10) and highly useful for teaching. (8.7/10). The materials made using Genially or Lumi had comparatively better average scores in the degree of interactivity than those for access to YouTube that only allow navigation but less interaction (8.75/10 vs 3.65/10). The Genially and Lumi materials also ob-tained better mean values in estimation of teaching utility (9.3/10 vs 7.8/10).The generation of audiovisual material with quick and easy access, without the need to install applications or special programs, is highly useful and profitable for teaching. Materials that incorporate interactivity clearly provide added value that translates into better acceptance by the student and greater use in terms of learnin

Evaluation of the multimorbidity network and its relationship with clinical phenotypes in chronic obstructive pulmonary disease: The GALAXIA study

Abstract Background Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition, in which taking into consideration clinical phenotypes and multimorbidity is relevant to disease management. Network analysis, a procedure designed to study complex systems, allows to represent connections between the distinct features found in COPD. Methods Network analysis was applied to a cohort of patients with COPD in order to explore the degree of connectivity between different diseases, taking into account the presence of two phenotypic traits commonly used to categorize patients in clinical practice: chronic bronchitis (CB+/CB−) and the history of previous severe exacerbations (Ex+/Ex−). The strength of association between diseases was quantified using the correlation coefficient Phi (ɸ). Results A total of 1726 patients were included, and 91 possible links between 14 diseases were established. Although the four phenotypically defined groups presented a similar underlying comorbidity pattern, with special relevance for cardiovascular diseases and/or risk factors, classifying patients according to the presence or absence of CB implied differences between groups in network density (mean ɸ: 0.098 in the CB− group and 0.050 in the CB+ group). In contrast, between‐group differences in network density were small and of questionable significance when classifying patients according to prior exacerbation history (mean ɸ: 0.082 among Ex− subjects and 0.072 in the Ex+ group). The degree of connectivity of any given disease with the rest of the network also varied depending on the selected phenotypic trait. The classification of patients according to the CB−/CB+ groups revealed significant differences between groups in the degree of conectivity between comorbidities. On the other side, grouping the patients according to the Ex−/Ex+ trait did not disclose differences in connectivity between network nodes (diseases). Conclusions The multimorbidity network of a patient with COPD differs according to the underlying clinical characteristics, suggesting that the connections linking comorbidities between them vary for different phenotypes and that the clinical heterogeneity of COPD could influence the expression of latent multimorbidity. Network analysis has the potential to delve into the interactions between COPD clinical traits and comorbidities and is a promising tool to investigate possible specific biological pathways that modulate multimorbidity patterns