Efectos adversos de la vacunación contra el virus del papiloma humano

ResumenObjetivoDescribir las reacciones adversas más frecuentes producidas por la vacunación contra el virus del papiloma humano (VPH).DiseñoEstudio descriptivo transversal mediante encuesta telefónica.EmplazamientoSistema Sanitario Público de Andalucía.ParticipantesMujeres vacunadas frente al VPH en Andalucía, seleccionadas por muestreo aleatorio simple con representatividad provincial.MedicionesSe realizaron 3.135 llamadas telefónicas por el servicio público “Salud Responde” dependiente de teleoperadores con supervisión de personal sanitario.Resultados principalesDe las 2.880 llamadas que cumplían criterio de inclusión, se consiguió encuestar a 1.207 personas (41,9% de respuesta). De las 2.124 encuestas realizadas tuvieron algún tipo de reacción adversa (fiebre, inflamación, dolor o enrojecimiento) en 467 dosis (22%): el 6,6% fue fiebre, el 49,5% inflamación, el 72,4% dolor, y el 6% enrojecimiento.ConclusionesSe puede decir que es una vacuna segura, lo que concuerda con lo recogido en su ficha técnica y en la literatura.AbstractObjectiveTo describe the most frequent adverse reactions produced by the human papillomavirus (HPV) vaccine.DesignCross-sectional descriptive study using a telephone survey.SettingA province in the Andalusian Public Health System.ParticipantsFemales vaccinated against HPV in Andalusia, selected by simple random sampling representative of the province.Main measurementsA total of 3,135 telephone calls were made by the public service “Health Answers” using telephone operators supervised by health personnel.ResultsOf the 2,880 calls that fulfilled the inclusion criteria, 1,207 people (41.9% response) took part in the survey. Of the 2,124 surveys made there was some type of adverse reaction (fever, inflammation, pain or rash) in 467 doses (22%): 6.6% was fever, 49.5% inflammation, 72.4% pain, and 6% a rash.ConclusionsIt can be said that HPV vaccine is safe, which is in agreement with that published in the summary of the product characteristics and in the literature

Evaluación de la competencia clínica de tutores de residentes de medicina familiar y comunitaria

ObjetivoDescribir la primera experiencia de una evaluación clínica objetiva y estructurada (ECOE) a tutores de residentes realizada en la comunidad autónoma de AndalucíaDiseñoObservacional descriptivoEmplazamientoUnidad Docente de Medicina Familiar y Comunitaria de HuelvaParticipantesTutores de residentes de medicina familiar y comunitariaMediciones principalesLos componentes competenciales que se consensuaron y ponderaron fueron los siguientes: anamnesis, exploración física, comunicación,habilidades técnicas, manejo, atención a la familia y actividades preventivas. La selección de las 10 situaciones clínicas de las que constaba la prueba se realizó utilizando unos criterios de priorización según la prevalencia, gravedad clínica, importancia de la prevención y del diagnóstico precoz, complejidad del caso, evaluación de la capacidad resolutiva del médico y simplicidad evaluativaResultadosRealizaron la ECOE 13 tutores. La edad media ± desviación estándar de los participantes fue de 42,8 ± 3,64 años. La prueba tuvo un coeficiente de fiabilidad (alfa de Cronbach) de 0,73. Por lo que se refiere a los resultados por participantes, la media global fue de 73 ± 6,2. Al analizar los resultados para los diferentes componentes competenciales, los mejores resultados se obtuvieron en la atención a la familia, la comunicación y las habilidades técnicasConclusionesLas pruebas de evaluación clínica objetiva y estructurada pueden ser útiles para la valoración de los tutores, con el objetivo de orientar su formación en los puntos débiles e incluso para, en un futuro no muy lejano, servir como instrumento para acreditar y reacreditar a los tutores de residentes de medicina familiar y comunitariaObjectivesWe show the first experience of the application of an objetive and structured clinical evaluation (OSCE) procedure to family medicine trainers, that has been carried out in Andalucia. The objective is to use a competence evaluation instrument that, in the short term, will be used not only for trainer accreditation but also for other public sanitary professionalsParticipantsTutors of family and commnity medicine residentsDesignObservational descriptiveSettingEducational unity of family medicinePrincipal measurementsThe competencial components to be assessed are the following: anamnesis, physical exploration, communication, technical skill, management, family attention y preventive activities. The clinical situations were selected using the following priority criteria: prevalence, clinical gravity, prevention and early diagnosis importance, case complexity, doctor's capacity of evaluation and simplicityResultsThirteen family medicine trainers took part in the OSCE. Their average age was 42.8±3.6 years. The test had an overall reliability coefficient (Cronbach's alpha) of 0.73. The overall mean score of the participants was 73±6.2. The best results about the competencial components were family attention, communication and technical skillConclusionsThe OSCE can be a convenient tool for family medical trainer evaluation, helping to orientate their education in the weak points and, in the near future, it can also be used as an instrument do accredit family medicine trainer

A Novel Role For Nanog As An Early Cancer Risk Marker In Patients With Laryngeal Precancerous Lesions

NANOG is a master regulator of embryonic stem cell pluripotency, found to be frequently aberrantly expressed in a variety of cancers, including laryngeal carcinomas. This study investigates for the first time the role of NANOG expression in early stages of laryngeal tumourigenesis and its potential utility as cancer risk marker. NANOG protein expression was evaluated by immunohistochemistry using two large independent cohorts of patients with laryngeal precancerous lesions, and correlated with clinicopathological parameters and laryngeal cancer risk. NANOG expression was detected by immunohistochemistry in 49 (60%) of 82 laryngeal dysplasias, whereas expression was negligible in patient-matched normal epithelia. Strong NANOG expression was found in 22 (27%) lesions and was established as cut-off point, showing the most robust association with laryngeal cancer risk (P = 0.003) superior to the histological classification (P = 0.320) the current gold standard in the clinical practice. Similar trends were obtained using a multicenter validation cohort of 86 patients with laryngeal dysplasia. Our findings uncover a novel role for NANOG expression in laryngeal tumourigenesis, and its unprecedented application as biomarker for cancer risk assessment

Integrated Ugi-Based Assembly of Functionally, Skeletally, and Stereochemically Diverse 1,4-Benzodiazepin-2-ones

A practical, integrated and versatile U-4CR-based assembly of 1,4-benzodiazepin-2-ones exhibiting functionally, skeletally, and stereochemically diverse substitution patterns is described. By virtue of its convergence, atom economy, and bond-forming efficiency, the methodology documented herein exemplifies the reconciliation of structural complexity and experimental simplicity in the context of medicinal chemistry projects.This work was financially supported by the Galician Government (Spain), Projects: 09CSA016234PR and GPC-2014-PG037. J.A. thanks FUNDAYACUCHO (Venezuela) for a predoctoral grant and Deputación da Coruña (Spain) for a postdoctoral research grant. A.N.-V. thanks the Spanish government for a Ramón y Cajal research contract

Large-scale unit commitment under uncertainty: an updated literature survey

The Unit Commitment problem in energy management aims at finding the optimal production schedule of a set of generation units, while meeting various system-wide constraints. It has always been a large-scale, non-convex, difficult problem, especially in view of the fact that, due to operational requirements, it has to be solved in an unreasonably small time for its size. Recently, growing renewable energy shares have strongly increased the level of uncertainty in the system, making the (ideal) Unit Commitment model a large-scale, non-convex and uncertain (stochastic, robust, chance-constrained) program. We provide a survey of the literature on methods for the Uncertain Unit Commitment problem, in all its variants. We start with a review of the main contributions on solution methods for the deterministic versions of the problem, focussing on those based on mathematical programming techniques that are more relevant for the uncertain versions of the problem. We then present and categorize the approaches to the latter, while providing entry points to the relevant literature on optimization under uncertainty. This is an updated version of the paper "Large-scale Unit Commitment under uncertainty: a literature survey" that appeared in 4OR 13(2), 115--171 (2015); this version has over 170 more citations, most of which appeared in the last three years, proving how fast the literature on uncertain Unit Commitment evolves, and therefore the interest in this subject

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted