57 research outputs found
Una facultad llena de posibilidades
Con cierta frecuencia,
los estudiantes acostumbramos a quejarnos (muchas veces con razón) acerca de lo que necesitamos,
lo que nos falta y que la
universidad no es capaz de
ofrecernos. Sin embargo,
muchas veces desconocemos la gran cantidad de
actividades y posibilidades
que emanan de ésta, y no
somos capaces de aprovecharlas por falta de información.
El caso de la Facultad de
Medicina de la Universidad
de Granada es un perfecto
ejemplo de ello, y fruto del
intenso trabajo y preclaras ideas que proceden de
la motivación y ganas de
mejoría del colectivo estudiantil, nuestra facultad
goza de una incuestionable
“red” de asociaciones, actividades y, por tanto, posibilidades
Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain
This work was supported by the ‘Artificial Intelligence for the
diagnosis and prognosis of COVID-19’ project (CV20-29480),
funded by the Consejería de Transformación Económica, In-
dustria, Conocimiento y Universidades, Junta de Andalucía,
and the FEDER funds.Several studies have been published showing a significant increase in thrombotic complications in coronavirus disease 2019 (COVID-19) patients, including acute pulmonary embolism (PE). However, there is significant variability regarding published data on the number of computed tomography pulmonary angiography (CTPA) orders to rule out PE, frequency and characteristics of PE, and other factors that could have magnified the actual incidence of PE. The aim of this work is to analyze these factors during the first year of the pandemic. A longitudinal retrospective observational study was designed comparing two cohorts (preCOVID and COVID) of patients for whom an emergency CTPA was requested to rule out PE at the emergency department of our institution. Information was collected regarding the number of CTPAs requested, patient demographics, presence and extension of PE, and radiological signs of right ventricle strain/pulmonary hypertension (RVS/PH). Univariate and bivariate analyses were performed, with stratification by time intervals according to different pandemic waves in the COVID cohort. A total of 1905 patients (530 in the pre-COVID cohort and 1375 in the COVID cohort), with a mean age of 68.3 years (standard deviation, 16.5) and 981 (51.5%) women were included. No significant differences were observed regarding the incidence of PE between both cohorts. In patients with PE, no significant differences regarding age or sex were found, but a significantly higher frequency of peripheral PE was observed in the COVID cohort (42.0% vs. 6.5%, p < 0.001). Regarding signs of RVS/PH, a lower degree of septal deviation and contrast reflux to the inferior vena cava was observed in the COVID cohort, but no significant differences were observed in the right-to-left ventricular ratio. For the COVID cohort, the distribution of central vs. peripheral PE was similar in patients without laboratory-confirmed COVID-19 infection. Finally, the analysis of signs of RVS/PH stratifying by pandemic waves showed a lower frequency of RVS/PH signs in the 2nd and 3rd pandemic waves. In conclusion, despite a significantly higher number of CTPAs were performed during the pandemic, the incidence of PE was similar to that of the pre-pandemic period. A higher number of peripheral PE and less radiological signs of RVS/PH were observed during the pandemic. These findings could be explained by an increased incidental detection of PE during the pandemic. Our study has some limitations, mainly derived from its retrospective and single-center nature, which should be overcome in future research.Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades
CV20-29480Junta de AndaluciaEuropean Commissio
Synthesis and characterization of a cartilage model using hydroxyapatite, chitosan and polycaprolactone
El presente estudio se ha realizado en el marco del
trabajo de fin de grado del autor principal. Agradecemos
profundamente el trato y la ayuda prestada por los miembros
del departamento de Histología de la facultad de Medicina
de Granada.Introducción: El cartílago es una estructura clave que permite el deslizamiento de los huesos evitando la fricción y su
desgaste. Sus propiedades biomecánicas vienen determinadas por la interacción entre sus componentes principales.
La elevada incidencia de lesiones condrales ha originado un amplio número de estudios con objeto de tratar los defectos
del cartílago articular. Las estrategias terapéuticas ensayas incluyen la terapia celular, el uso de biomateriales y,
especialmente, la ingeniería tisular, que ha demostrado un gran potencial para tratar estos defectos. Se han ensayado
diversos biomateriales para constructos tisulares e hidrogeles, incluyendo polímeros naturales y sintéticos.
Objetivos: El objetivo de este trabajo es presentar un método de obtención de cartílago articular basado en quitosano
(CS), policaprolactona (PCL) e hidroxiapatita (HA).
Material y métodos: Se utilizaron como biomateriales de base el quitosano, policaprolactona y la hidroxiapatita. Se
sintetizó una biomatriz de quitosano y policaprolactona mediante el método de disolución en medio ácido y la hidroxiapatita
con productos químicos habituales. Se realizaron varias mezclas con distintas proporciones de quitosano, policaprolactona
e hidroxiapatita y se evaluó su capacidad de absorción de agua, humedad, densidad, porosidad volumétrica
y propiedades de procesamiento histológico, comparándose con los valores respectivos del cartílago articular normal.
Resultados: De las mezclas ensayadas, la mezcla 80CS/15PCL/5HA mostró una mayor similitud al cartílago normal en
los parámetros medidos. Asimismo, esta mezcla presentó unas características aptas para el procesamiento histológico
habitual.
Discusión: En este estudio se presenta un método sencillo y económico para obtener biomatrices basadas en quitosano,
policaprolactona e hidroxiapatita. Para las proporciones ensayadas, la mezcla 80CS/15PCL/5HA presenta unas propiedades
de gran interés para ser utilizada como modelo de cartílago articular artificial. En un futuro se caracterizarán
otras propiedades biomecánicas y biológicas.Introduction: Articular cartilage (AC) is a key structure in bone displacement that limits its friction and subsequent
erosion. The biochemical properties of AC are determined by the interaction of its constituents. The high incidence of
chondral lesions has led to a number of studies aimed to developing therapies to heal cartilage defects. These include
cell therapy, use of biomaterials and, especially, tissue engineering, which has shown promising results. Many biomaterials,
including natural and synthetic polymers, have been explored to develop tissue constructs and hydrogels.
Objectives: The present study aims to synthesize and evaluate bioscaffolds for articular cartilage made of chitosan (CS),
polycaprolactone (PCL) and hyroxyapatite (HA).
Materials and methods: CS, PCL and HA were used as biomaterials. CS-PCL bioscaffold was synthesized by acid solution
method and HA with common chemicals. Several blends were prepared with varying percentages of CS, PCL and HA.
Water uptake capability, humidity, density, volumetric porosity and properties of histological processing were assessed
and compared to the values of normal AC.
Results: For the assessed parameters and melts, the melt 80CS/15PCL/5HA showed the most similar values in comparison
with normal cartilage. This melt also showed correct characteristics for standard histological processing.
Discussion: In this study we present a simple and inexpensive method to obtain bioscaffolds based on CS, PCL and
HA. For the percentages explored, the melt 80CS/15PCL/5HA showed promising properties to be used as artificial AC
model. More biomechanical and biological properties shall be assessed in the future
Factors associated with mortality and sequelae in patients living in long-term facilities hospitalized for COVID-19: a longitudinal 6-month follow-up study
Objetivos: Evaluar los principales factores asociados al pronóstico (mortalidad, secuelas a los 6 meses
y reingresos) de pacientes ingresados por COVID-19 en el Hospital Clínico San Cecilio que viven en una
residencia para personas mayores.
Métodos: Estudio observacional longitudinal realizado sobre la cohorte de 441 pacientes ingresados
por COVID-19 confirmada por PCR en el Hospital Clínico San Cecilio entre los días 01/03/20 y 15/04/20.
Dichos pacientes fueron seguidos, a través de sus historias clínicas, los 6 meses posteriores a su alta.
Se recogieron variables sociodemográficas, de ingreso, clínicas, terapéuticas y secuelas. Se realizaron
análisis descriptivos, bivariantes y modelos de regresión logística multivariante con el software
estadístico R, a través de su herramienta R Commander.
Resultados: La edad media de la cohorte fue de 66,4 años (s=15,3), con un 55,1% de varones. La mortalidad
intrahospitalaria fue del 18,1%. Los pacientes que vivían en residencias de mayores tuvieron mayor
edad media y mayores frecuencias de comorbilidades, mortalidad y reingresos hospitalarios. Durante
los 6 meses posteriores al alta presentaron una alta frecuencia de secuelas (59%), y mayor frecuencia
de confusión, problemas hematológicos, nefrológicos y sobreinfecciones. Los principales factores
asociados a la mortalidad fueron la edad avanzada, sexo masculino, ingreso en UCI y vulnerabilidad al
ingreso medida con escalas pronósticas clínicas.
Conclusiones: Vivir en una residencia no constituyó un factor independiente de mortalidad, pero sí reunió
a un grupo de especial vulnerabilidad frente a la COVID-19. Las causas de mortalidad analizas en este
estudio podrían ser similares a las causas de mortalidad de las personas mayores en las residencias
durante los primeros meses de la pandemia. Estos datos deben servir para optimizar las estrategias de
manejo intrahospitalario y de seguimiento de personas mayores durante los meses posteriores al alta
hospitalaria, e intentar disminuir la mortalidad no registrada por COVID-19 en esta población.Objectives: To evaluate the main factors associated with prognosis (mortality, sequelae at 6 months
and readmissions) of patients admitted for COVID-19 at the Hospital Clínico San Cecilio who live in a
long-term care facility.
Methods: Longitudinal observational study carried out on the cohort of 441 patients admitted for
COVID-19 confirmed by PCR at the Hospital Clínico San Cecilio between 01/03/20 and 15/04/20. These
patients were followed up, through their medical records, for 6 months after discharge. Sociodemographic,
admission, clinical, therapeutic and sequelae variables were collected. Descriptive and bivariate analyses
and multivariate logistic regression models were performed with R statistical software, through its R
Commander tool.
Results: The mean age of the cohort was 66.4 years (s=15.3), with 55.1% male. In-hospital mortality was
18.1%. Patients living in nursing homes had higher mean age and higher frequencies of comorbidities,
mortality and hospital readmissions. During the 6 months after discharge, they had a high frequency
of sequelae (59%), and a higher frequency of confusion, hematologic and nephrological problems, and superinfections. The main factors associated with mortality were advanced age, male sex, admission to
the ICU and vulnerability at admission measured with clinical prognostic scales.
Conclusions: Living in a long-term care facility was not an independent factor of mortality, but it did
bring together a group of special vulnerability to COVID-19. The causes of mortality analysed in this
study could be similar to the causes of mortality of elderly people in nursing homes during the first
months of the pandemic. These data should serve to optimize strategies for in-hospital management
and follow-up of the elderly during the months following hospital discharge, and to try to reduce the
unrecorded mortality due to COVID-19 in this population
Factors associated with readmission to the Emergency Department in a cohort of COVID-19 hospitalized patients
This work was supported by the 'Artificial Intelligence for the diagnosis and prognosis of COVID-19' project (CV20-29480), funded by the Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades, Junta de Andalucia, and the FEDER funds. We acknowledge the Faculty of Medicine, University of Granada, for the successful organization of the final degree projects, since this work was designed and conducted during the project of Alvaro Romero-Duarte. We also acknowledge all the healthcare workers from the Department of Preventive Medicine and Public Health, San Cecilio University Hospital for their restless commitment during the pandemic of COVID-19 and their continuous efforts for investigating and communicating their results to the scientific community. Finally, we thank the SEMERGEN-UGR Chair of Teaching and Research in Family Medicine for being an example of support and encouragement in Primary Care research.Introduction: The aim of this study was to describe the symptomatology and main
factors associated with readmission to the Emergency Department (ED) in COVID-19
patients discharged from hospital during the first wave of the pandemic at the San Cecilio
University Hospital, Granada, Spain.
Methods: An observational longitudinal study was conducted in a cohort of 441 patients
admitted to our hospital with confirmed SARS-CoV-2 polymerase chain reaction (PCR)
from 1 March to 15 April 2020. Patients were followed up through medical records
6 months after discharge. Sociodemographic, clinical and symptomatologic variables
were collected. Descriptive, bivariate and multivariate logistic regression analyses were
performed.
Results: The mean age of patients in the cohort was 66.4 years (s = 15.3), with 55.1%
men. In-hospital mortality was 18.1%. The presence of persistent symptomatology
was high (64.5%), especially respiratory (53.2%), systemic (46.3%) and neurological
(31.0%). A total of 75 (20.8%) patients were readmitted to the ED during the 6 months
following hospital discharge. The main factors associated with readmission to the
ED were polymedication (P = 0.031), living in a care home (P = 0.014), fever (P =
0.047), general malaise (P < 0.001), thoracic pain (P < 0.001), headache (P = 0.012),
hematological symptoms (P = 0.011), nephrological symptoms (P = 0.047), depressive
symptoms (P = 0.009), syncope or hypotension (P = 0.006) and superinfection (P =
0.018). After multivariate adjustment analysis, thoracic pain (OR: 4.45, 95% CI: 1.88–
10.52), general malaise and hematological symptoms (OR: 3.95, 95% CI: 1.12–13.89)
remained as risk factors.
Conclusions: The presence of persistent symptomatology after hospital discharge in our
cohort was common and varied. Polymedication and living in a care home made up the
most vulnerable profile of COVID-19 patients for returning to the ED. Thoracic pain,
general malaise and hematological symptoms were identified as potential markers of
severity, along with others predictors. These findings might be useful for optimizing
follow-up strategies. Future studies conducted in other geographical areas are necessary
to corroborate our results.'Artificial Intelligence for the diagnosis and prognosis of COVID-19' project - Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades CV20-29480Junta de Andalucia
European Commissio
Shift Work and Prostate Cancer: An Updated Systematic Review and Meta-Analysis
The International Agency of Research in Cancer (IARC) has recently confirmed shift work as
a type 2A carcinogen. The results presented in published epidemiological studies regarding prostate
cancer are inconsistent and the association remains controversial. The aims of this study were: (a) to
investigate the possible association between shift work and prostate cancer incidence, identifying
possible sources of heterogeneity; and (b) to analyze the potential effect of publication bias. A search
for cohort and case-control studies published from January 1980 to November 2019 was conducted.
The quality of the articles was assessed using the Newcastle–Ottawa Scale. Pooled OR were calculated
using random-effects models. Heterogeneity was evaluated using Cochran’s Q test and data were
stratified by potential sources of heterogeneity. Publication bias was analyzed. Eighteen studies
were included. No association was found between rotating/night-shift work and prostate cancer,
pooled OR 1.07 (95%CI 0.99 to 1.15), I2 = 45.7%, p = 0.016. Heterogeneity was eliminated when only
cohort studies (pooled OR 1.03; 95%CI 0.96 to 1.10; I2 = 18.9%, p = 0.264) or high-quality studies
(pooled OR 0.99; 95%CI 0.89 to 1.08; I2 = 0.0%, p = 0.571) were considered. A publication bias was
detected. An association between shift work and prostate cancer cannot be confirmed with the
available current data. Future analytical studies assessing more objective homogeneous exposure
variables still seem necessary
Prevalence and Risk Factors Associated with Tumors and Other Structural Anomalies in Brain MRI Performed to Rule out Secondary Headache: A Multicenter Observational Study
This research was funded by MCIN/AEI/10.13039/501100011033, grant number PID2020118224RB-I00.Headache disorders (HDs) are among the most common conditions of the central nervous
system, with an estimated prevalence of 50% in adult population. The aim of this work is to analyze
the prevalence of structural anomalies that may explain HDs in MRI exams performed to rule out
secondary headache in real-world practice, as well as risk factors associated with these lesions. We
conducted a retrospective observational study based on a consecutive case series of all patients that
underwent brain MRI due to headache from 1 January 2019 to 31 May 2019. We included patients from
six MRI diagnostic centers accounting for four provinces of Andalusia (southern Spain). Bivariate
and multivariate logistical regression models were performed to identify risk factors associated
with the outcomes (1) presence of a structural finding potentially explaining headache, (2) presence
of intracranial space-occupying lesions (SOLs), and (3) presence of intracranial tumors (ITs). Of
the analyzed sample (1041 patients), a structural finding that could explain headache was found
in 224 (21.5%) patients. SOLs were found in 50 (6.8%) patients and ITs in 12 (1.5%) patients. The
main factors associated with structural abnormalities were female sex (OR, 1.35; 95% CI, 1.02–1.85),
accompanying symptoms (OR, 1.34; 95% CI, 1.05–1.89), use of gadolinium-based contrast agents
(OR, 1.89; 95% CI, 1.31–2.72) and previously known conditions potentially explaining headache
(OR, 2.44; 95% CI, 1.55–3.84). Female sex (p = 0.048) and accompanying symptoms (p = 0.033) were
also associated with ITs in bivariate analyses. Our results may be relevant for different medical
specialists involved in the diagnosis, management and prevention of headache. Moreover, the risk
factors identified in our study might help the development of public health strategies aimed at early
diagnosis of brain tumors. Future studies are warranted to corroborate our findings.MCIN/AEI/10.13039/501100011033
PID2020118224RB-I0
Cycling area can be a confounder and effect modifier of the association between helmet use and cyclists’ risk of death after a crash
The effect of helmet use on reducing the risk of death in cyclists appears to be distorted by some
variables (potential confounders, effect modifiers, or both). Our aim was to provide evidence for or
against the hypothesis that cycling area may act as a confounder and effect modifier of the association
between helmet use and risk of death of cyclists involved in road crashes. Data were analysed for
24,605 cyclists involved in road crashes in Spain. A multiple imputation procedure was used to
mitigate the effect of missing values. We used multilevel Poisson regression with province as the group
level to estimate the crude association between helmet use and risk of death, and also three adjusted
analyses: (1) for cycling area only, (2) for the remaining variables which may act as confounders, and
(3) for all variables. Incidence–density ratios (IDR) and their 95% confidence intervals were calculated.
Crude IDR was 1.10, but stratifying by cycling area disclosed a protective, differential effect of helmet
use: IDR = 0.67 in urban areas, IDR = 0.34 on open roads. Adjusting for all variables except cycling area
yielded similar results in both strata, albeit with a smaller difference between them. Adjusting for
cycling area only yielded a strong association (IDR = 0.42), which was slightly lower in the adjusted
analysis for all variables (IDR = 0.45). Cycling area can act as a confounder and also appears to act as an
effect modifier (albeit to a lesser extent) of the risk of cyclists’ death after a crash
Hospitalisation by tick-borne diseases in the last 10 years in two hospitals in South Spain: analysis of tick exposure data collected in the Emergency Department
Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation,
but they often go unnoticed in the Emergency Department (ED). The aim of this
study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to
evaluate the data collected in the medical records from the ED in order to analyse their potential
clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the
ED records were identified and analysed. These corresponded to all the hospitalisations by
TBDs in the last 10 years (2009–2019) in two tertiary hospitals in Granada, Spain.
Statistical analyses were made using RStudio. Coinciding with the absence of patient’s report
of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission
was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases
showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation
of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with
TBDs are highly non-specific. In the absence of explicit information related to potential tick
exposure, TBDs are not initially suspected. As a consequence, elective treatment administration
is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the
importance of addressing potential exposure to ticks during the ED contact with patients presenting
with febrile syndrome
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