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

Estudio de los factores pronósticos implicados en la supervivencia del paciente con enfermedad neoplásica progresiva: propuesta de un modelo predictivo

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina. Departamento de Medicina Fecha de lectura: 27 de Septiembre de 200

Actividad laboral en una cohorte de pacientes con carcinoma de pulmón Employment in a cohort of lung cancer patients

Introducción: La actividad laboral en el cáncer de pulmón es un aspecto psicosocial que ha recibido poca atención hasta el momento actual por distintos motivos, a pesar de considerarse una dimensión de la calidad de vida para todo paciente oncológico. Objetivos: Analizar la reinserción y adaptación al entorno laboral en una cohorte de pacientes con un carcinoma de pulmón para describir los factores que influyen en la vuelta al trabajo de estos enfermos. Pacientes y métodos: El estudio incluyó 35 pacientes consecutivos diagnosticados de un cáncer de pulmón y que estaban empleados en el momento del diagnóstico. El cuestionario incluyó aspectos epidemiológicos, clínicos y laborales (32 variables en total) que se relacionaron con la reincorporación al mundo laboral. También se incluyeron percepciones subjetivas de los enfermos respecto a este tema. Resultados: El 96,9% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 85,7% lo seguían estando tras éste. La presencia de secuelas fue la variable con mayor influencia en la inactividad laboral. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de un carcinoma de pulmón.Background: Cancer affects many dimensions determining quality of life, including work. However, the importance of work to cancer survivors has received little attention. Aim: Employment and work-related disability were investigated in a cohort of lung cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 35 lung cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face and 32 variables were recorded. Results: 96,9 per cent of patients were unable to work after diagnosis, but 85,7% returned to work at the end of treatment. Most of the problems reported in the study were linked to the sequelae of their disease and related treatments. Conclusions: This is the first exploratory study in Spain about labour reintegration in lung cancer patients. Further studies are necessary

Current evidence for cancer stem cells in gastrointestinal tumors and future research perspectives

Cancer stem cells (CSCs) are a very heterogeneous subpopulation of “stem-like” cancer cells that have been identified in many cancers, including leukemias and solid tumors. It is believed that CSCs drive tumor growth, malignant behavior and are responsible for the initiation of metastatic spread. In addition, CSCs have been implicated in chemotherapy and radiotherapy resistance. Current evidence supports the theory that CSCs share at least two main features of normal stem cells: self-renewal and differentiation, properties that contribute to tumor survival even in the presence of aggressive chemotherapy; however, the mechanism(s) governing the unique biology of CSCs remain unclear. In the field of gastrointestinal cancer, where we face very low survival rates across different tumor types, unraveling the role of CSCs in gastrointestinal tumors should improve our knowledge of cancer biology and chemoresistance, ultimately benefiting patient survival. Towards this end, much effort is being invested in the characterization of CSCs as a means of overcoming drug resistance and controlling metastatic spread. In this review we will cover the concept of CSCs, the current evidence for CSCs in gastrointestinal tumors and future research directions.This work was supported by a Ramon y Cajal Merit Award from the Ministerio de Economía y Competitividad, Spain (B.S. Jr) and a Clinic and Laboratory Integration Program (CLIP) grant from the Cancer Research Institute, NY (B.S. Jr)

Epidemiological analysis of SARS-CoV-2 virus infection in patients with solid tumors: The experience of Infanta Sofía University Hospital (HUIS)

Background The global SARS-CoV-2 outbreak has significantly affected hospital assistance to cancer patients. Diagnostic and treatment paradigms have been challenged with an urgent need for patient protection. In the abscence of data to balance clinical decissions we aimed to analyze HUIS experience during the peak of the outbreak. Methods Cancer pts atended at HUIS since February 24th to April 24th were collected. Clinical management was adapted according to evolving international consensus. All PCR+ COVID-19 pts have been included in a database. Oncological and COVID-19 diseases characteristics as well as cancer management have been collected. The main objective of this analysis was to know the risk of SARS-CoV-2 infection, hospitalization rate and mortality of cancer patientes in our center during the outbreak and to identify potential predictive factors. Results Overall, 853 cancer pts had been attended at our department during this period of time. Twenty-six pts (3.05%) were hospitalized with confirmed COVID-19 diagnosis. Underlying solid tumors were the following: breast (256, 30.01%), GI (312, 36.8%), lung (100, 11.72%) and others (185, 21.47%). 322 pts (37.75%) had metastatic cancer and 531 (62.25%) had early stage diseases. 395 pts (46.31%) were treated with antineoplastic agents: 62,63% received treatment as adjuvant therapy, 18. 92% as first line (or maintenance) treatment in advanced diseases and 12.81% second or following lines of treatment in advaced diseases. 10 pts (32.26%) with COVID-19 died. Futher analysis regarding clinical, laboratory and hospital risk factors – such as diagnostic procedures, type and length of treatments, number of hospital visits, etc will be reported in the final presentation. Conclusions COVID-19 hospitalization rate was 3.05%, and mortality rate was 32.26%. Adequate testing and protective measures are mandatory to warrant an optimal managment of cancer pts during the global SARS-CoV-2 outbreak.Sin financiación18.274 JCR (2019) Q1, 9/244 Oncology1.039 SJR (2019) Q1, 483/2754 Medicine (miscellaneous)No data IDR 2019UE

Nuevos escenarios para la innovación educativa : el Grupo CREA (Centros en Red para las Enseñanza Activas) y la renovación metodológica de los centros educativos

Convocatoria Proyectos de innovación de Extremadura 2018/2019Proyecto que agrupa a cinco centros educativos: el IES Jaranda (Jarandilla de la Vera, Cáceres), el IESO Sierra la Mesta (Santa Amalia, Badajoz), el IES Albarrega (Mérida, Badajoz), el IESO Val de Xálima (Valverde del Fresno, Badajoz), IESO Matías Ramón Martínez (Burguillos del Cerro, Badajoz) que conforman el Grupo CREA y que comparten una trayectoria común: el uso de metodologías educativas activas. A las iniciativas innovadoras llevadas a cabo colectivamente se suman las individuales de cada centro debido a la particularidad de cada uno de ellos. Los objetivos principales del proyecto son: la creación de una estructura organizativa y de coordinación entre los distintos centros participantes que permita la planificación y puesta en marcha de acciones educativas conjuntas; la introducción de cambios organizativos, funcionales, espaciales y metodológicos para llevar a cabo aprendizajes basados en proyectos, orientados al servicio a la comunidad y a los problemas sociales, centrados en el aprendizaje cooperativo, etc.; el diseño y desarrollo de programas de innovación coordinados entre los distintos centros educativos participantes; el establecimiento de mecanismos de coordinación para hacer efectiva la comunicación, el intercambio de información, el análisis y la reflexión del profesorado participante en los programas de innovación de cada uno de los centros; la formación conjunta del profesorado; el desarrollo de proyectos conjuntos para los alumnos participantes, su conexión en entornos virtuales, el intercambio de experiencias en encuentros periódicos, etc. y la generación y fomento de una nueva red creando un portal web y un espacio de comunicación e intercambio de documentaciónExtremaduraES

Aspectos fisiológicos de la remolacha azucarera de siembra otoñal

Conceptos generales del metabolismo; crecimiento y desarrollo; actividades enzimáticas; niveles de adenilatos; efecto del nitrógeno; actividad nitrato reductasa en relación con la nutrición nitrogenada; la fosfoenolpiruvato piruvato carboxilasa; inhibición del espigado; niveles de prolina; respuesta varietal al estrés hídrico e identificación y cuantificación de azúcares

Standardization and Chemical Characterization of Intravenous Therapy in Adult Patients: A Step Further in Medication Safety.

Intravenous drug administration is associated with potential complications, such as phlebitis. The physiochemical characteristics of the infusate play a very important role in some of these problems. The aim of this study was to standardize the dilutions of intravenous drugs most commonly used in hospitalized adult patients and to characterize their pH, osmolarity and cytotoxic nature to better guide the selection of the most appropriate vascular access. The project was conducted in three phases: (i) standardization of intravenous therapy, which was conducted using a modified double-round Delphi method; (ii) characterization of the dilutions agreed on in the previous phase by means of determining the osmolarity and pH of each of the agreed concentrations, and recording the vesicant nature based on the information in literature; and (iii) algorithm proposal for selecting the most appropriate vascular access, taking into account the information gathered in the previous phases. In total, 112 drugs were standardized and 307 different admixtures were assessed for pH, osmolarity and vesicant nature. Of these, 123 admixtures (40%), had osmolarity values >600 mOsm/L, pH 600 mOsm/L, pH 9, or were classified as vesicants. In these cases, selection of the most suitable route of infusion and vascular access device is crucial to minimize the risk of phlebitis-type complications. Increasing safety of intravenous therapy should be a priority in the healthcare settings. Knowing the characteristics of drugs to assess the risk involved in their administration related to their physicochemical nature may be useful to guide decision making regarding the most appropriate vascular access and devices

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved