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

Biomarcadores en cirugía de revascularización coronaria : valor prónostico a corto plazo / José María Arribas Leal; director, José Antonio Ruipérez Abizanda.

Texto en español e inglés.Tesis-Universidad de Murcia.Consulte la tesis en: BCA. GENERAL. ARCHIVO UNIVERSITARIO. T.M. 3330

Evidence for a lack of inotropic and chronotropic effects of glucagon and glucagon receptors in the human heart

Abstract Background Glucagon is thought to increase heart rate and contractility by stimulating glucagon receptors and increasing 3′,5′-cyclic adenosine monophosphate (cAMP) production in the myocardium. This has been confirmed in animal studies but not in the human heart. The cardiostimulatory effects of glucagon have been correlated with the degree of cardiac dysfunction, as well as with the enzymatic activity of phosphodiesterase (PDE), which hydrolyses cAMP. In this study, the presence of glucagon receptors in the human heart and the inotropic and chronotropic effects of glucagon in samples of failing and nonfailing (NF) human hearts were investigated. Methods Concentration‒response curves for glucagon in the absence and presence of the PDE inhibitor IBMX were performed on samples obtained from the right (RA) and left atria (LA), the right (RV) and left ventricles (LV), and the sinoatrial nodes (SNs) of failing and NF human hearts. The expression of glucagon receptors was also investigated. Furthermore, the inotropic and chronotropic effects of glucagon were examined in rat hearts. Results In tissues obtained from failing and NF human hearts, glucagon did not exert inotropic or chronotropic effects in the absence or presence of IBMX. IBMX (30 µM) induced a marked increase in contractility in NF hearts (RA: 83 ± 28% (n = 5), LA: 80 ± 20% (n = 5), RV: 75 ± 12% (n = 5), and LV: 40 ± 8% (n = 5), weaker inotropic responses in the ventricular myocardium of failing hearts (RV: 25 ± 10% (n = 5) and LV: 10 ± 5% (n = 5) and no inotropic responses in the atrial myocardium of failing hearts. IBMX (30 µM) increased the SN rate in failing and NF human hearts (27.4 ± 3.0 beats min −1 , n = 10). In rat hearts, glucagon induced contractile and chronotropic responses, but only contractility was enhanced by 30 µM IBMX (maximal inotropic effect of glucagon 40 ± 8% vs. 75 ± 10%, in the absence or presence of IBMX, n = 5, P  0.05). Glucagon receptors were not detected in the human heart samples. Conclusions Our results conflict with the view that glucagon induces inotropic and chronotropic effects and that glucagon receptors are expressed in the human heart

Hematic Antegrade Repriming: A Reproducible Method to Decrease the Cardiopulmonary Bypass Insult

The current practice of cardiopulmonary bypass (CPB) requires a preoperative priming of the circuit that is frequently performed with crystalloid solutions. Crystalloid priming avoids massive embolism but is unable to eliminate all microbubbles contained in the circuit. In addition, it causes a sudden hemodilution which is correlated with transfusion requirements and an increased risk of cognitive impairment. Several repriming techniques using autologous blood, collectively termed retrograde autologous priming (RAP), have been demonstrated to reduce the hemodilutional impact of CPB. However, the current heterogeneity in the practice of RAP limits its evidence and benefits. Here, we describe hematic antegrade repriming as an easy and reliable method that could be applied with any circuit in the market to decrease transfusion requirements, emboli, and inflammatory responses, reducing costs and the impact of CPB on postoperative recovery

Educación física (2). Cuarto curso

Este material pretende facilitar el desarrollo curricular del área de educación física, proporcionándoles sugerencias de programación y unidades didácticas que les ayuden en su trabajo. Son materiales preparados para el momento de tránsito de la anterior a la nueva ordenación y contiene, sobre todo, la información imprescindible sobre distribución y secuencia de contenidos.MadridBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

Materiales didácticos : Educación Física (cuarto Curso Secundaria Obligatoria)

Orientar a los profesores ante la implantación anticipada de la reforma educativa en el área de Educación Física. Facilitar la aplicación y desarrollo del nuevo curriculum en la práctica docente, proporcionando sugerencias de programación y unidades didácticas. 3204 alumnos de tres institutos de Valladolid, dos de ellos de Bachillerato y uno de FP. Análisis de la situación inicial, intercambio entre los participantes del Seminario de investigación-acción de la información recogida en las clases, elaboración de estrategias teóricas que permitan resolver los problemas observados inicialmente, puesta en práctica del programa elaborado y recogida de datos, actividades relacionadas con el análisis de datos y elaboración de teorías. Diario del profesor, diarios de los alumnos, observación, estudios de casos, triangulación. Dentro del paradigma naturalista-cualitativo, se encuentra la investigación-acción, como un instrumento metodológico que parte de un proceso de: revisión, diagnóstico, planificación, puesta en acción y control de los efectos producidos, en relación con una situación problemática del aula o la escuela, con objeto de mejorar la calidad de enseñanza y promover el desarrollo profesional del equipo docente. Aunque esta propuesta tenía inicialmente como finalidad dar respuestas didácticas a los problemas del aula, dicho proyecto de formación no sólo atiende esas necesidades técnicas, sino tambien a una mejora profesional, actuando sobre diversos aspectos como: reflexión sobre su actividad docente, trabajo colaborativo, elaboración de materiales curriculares según la reforma del sistema educativo, mayor autonomía profesional, consideración del curriculum como base de su formación permanente.Castilla y LeónES

Recomendaciones de la SECTCV para la cirugía cardiovascular. 2019 actualización de los estándares en organización, actividad profesional, calidad asistencial y formación en la especialidad

Resumen: La cirugía cardiovascular es la especialidad médica que se ocupa de la prevención, diagnóstico y tratamiento quirúrgico de los trastornos y enfermedades del sistema cardiocirculatorio. Los continuos y rápidos avances en el diagnóstico y tratamiento de las enfermedades cardiovasculares justifican la necesidad de llevar a cabo una actualización de los principales aspectos definitorios y organizativos de la especialidad, relacionados con la profesión (de la práctica, calidad asistencial), con el programa docente de la especialidad, la formación continuada de los cirujanos, los procesos de acreditación desde la Sociedad Española de Cirugía Torácica-Cardiovascular, entre otros.Este documento, elaborado por expertos de la cirugía cardiovascular, representa la opinión de la Sociedad Española de Cirugía Torácica-Cardiovascular y actualiza los principales aspectos de la especialidad en nuestro país. Abstract: Cardiovascular surgery is the medical specialty that deals with the prevention, diagnosis, and surgical treatment of disorders and diseases of the circulatory system. The continuous and rapid advances in the diagnosis and treatment of cardiovascular diseases justify the need to update the main, defining, and organisational aspects of the specialty, related to the profession (its practice, quality care), aspects on the teaching program of the specialty, the continuing education program of the surgeons, the processes of accreditation from the Spanish Society of Thoracic-Cardiovascular Surgery, etc.This document, prepared by experts in cardiovascular surgery, represents the opinion of the Spanish Society of Thoracic-Cardiovascular surgery and updates the main aspects of the specialty in our country. Palabras clave: Cirugía cardiovascular, Cirugía cardíaca, Cirugía torácica, Cirugía vascular, Recomendaciones, Keywords: Cardiovascular surgery, Cardiac surgery, Thoracic surgery, Vascular surgery, Recommendation

Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort : 2004-2013

To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004-2013). Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS. Of 7165 new HIV diagnoses, 46.9% (CI:45.7-48.0) were LP, 240 patients died.First-year mortality was the highest (aHR = 10.3[CI:5.5-19.3]); between 1 and 4 years post-diagnosis, aHR = 1.9(1.2-3.0); an

Prediction of long-term outcomes of HIV-infected patients developing non-AIDS events using a multistate approach

Outcomes of people living with HIV (PLWH) developing non-AIDS events (NAEs) remain poorly defined. We aimed to classify NAEs according to severity, and to describe clinical outcomes and prognostic factors after NAE occurrence using data from CoRIS, a large Spanish HIV cohort from 2004 to 2013. Prospective multicenter cohort study. Using a multistate approach we estimated 3 transition probabilities: from alive and NAE-free to alive and NAE-experienced ("NAE development"); from alive and NAE-experienced to death ("Death after NAE"); and from alive and NAE-free to death ("Death without NAE"). We analyzed the effect of different covariates, including demographic, immunologic and virologic data, on death or NAE development, based on estimates of hazard ratios (HR). We focused on the transition "Death after NAE". 8,789 PLWH were followed-up until death, cohort censoring or loss to follow-up. 792 first incident NAEs occurred in 9.01% PLWH (incidence rate 28.76; 95% confidence interval [CI], 26.80-30.84, per 1000 patient-years). 112 (14.14%) NAE-experienced PLWH and 240 (2.73%) NAE-free PLWH died. Adjusted HR for the transition "Death after NAE" was 12.1 (95%CI, 4.90-29.89). There was a graded increase in the adjusted HRs for mortality according to NAE severity category: HR (95%CI), 4.02 (2.45-6.57) for intermediate-severity; and 9.85 (5.45-17.81) for serious NAEs compared to low-severity NAEs. Male sex (HR 2.04; 95% CI, 1.11-3.84), ag