Análisis de la relación entre microbiota intestinal, permeabilidad intestinal y niveles de glucemia, en niños con Diabetes Mellitus tipo 1 comparados con niños con diabetes tipo MODY 2 y controles sanos

La Diabetes Mellitus tipo 1 (DM1) es una enfermedad inmunomediada de origen multifactorial que está sufriendo un aumento de incidencia en las últimas décadas. Esta enfermedad presenta una elevada morbilidad, precisando un tratamiento farmacológico intensivo. Por otro lado, la diabetes MODY2 es de origen monogénico y produce una hiperglucemia moderada mantenida, que no precisa tratamiento. Previamente en estudios murinos y recientemente en humanos, la relación entre las bacterias intestinales y DM1 ha sido demostrada, sin embargo cómo influyen y por qué mecanismo continúa siendo motivo de estudio. También se han relacionado cambios en la microbiota con otras enfermedades autoinmunes y con alteraciones metabólicas como la DM2, pero hasta el momento la microbiota de los pacientes con MODY2 no ha sido estudiada. Por otra parte, se ha observado un aumento de la permeabilidad intestinal en relación con la flora intestinal hallada en DM1. El objetivo de este estudio es analizar la composición de la microbiota intestinal de los niños afectos de DM1, MODY2 y controles sanos mediante pirosecuenciación masiva y compararla entre los tres grupos, así como analizar la permeabilidad intestinal mediante zonulina

31 visiones actuales de la transparencia

Treinta y una aportaciones de autores nacionales y extranjeros sobre la transparencia de las instituciones públicas y de los sujetos obligados por la Ley 19/2013 de 9 de diciembre y el derecho de acceso a la información pública

Proyecto de talleres de EGB

Se trata de desarrollar el área de Expresión a través de los talleres, los cuales no funcionarán de forma aislada, sino dentro de la programación de los diferentes cursos. Se celebrarán asambleas de clase periódicas, de profesores y alumnos, donde se propondrán centros de interés o conjunto de actividades sobre un mismo asunto, que motive al niño y que sea aplicable a diferentes áreas educativas. Habrá dos tipos de talleres: Libres, en el que el niño realiza labores orientadas a cumplir los objetivos del área de Expresión, y Obligatorios, en el que desarrolla facetas en las materias de Expresión Artística y Dinámica. No adjunta memoria. En un anexo se describe el funcionamiento de la experiencia, detallando objetivos y actividades de cada taller..Madrid (Comunidad Autónoma). Consejería de Educación y CulturaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Proyecto de educación para la salud

Los objetivos son analizar la incidencia del entorno en la concepción de la sexualidad infantil; adecuar y organizar el centro con medidas de seguridad; adquirir hábitos de alimentación equilibrada y costumbres saludables de higiene; saber defender derechos como consumidores; conocer, aceptar y valorar los órganos sexuales; entender la sexualidad como una opción personal y respetar las distintas conductas; y conocer técnicas de reproducción y control de natalidad. Para desarrollarlo se trabaja la educación afectivo-sexual en educación infantil; los riesgos y acciones en primer y segundo ciclo de Primaria; la nutrición en el tercer ciclo; y la educación sexual en el primer ciclo de Secundaria. También se desarrolla un taller de cocina y charlas de sexualidad con alumnos y padres. Mediante reuniones periódicas de ciclos, se pone en común los logros y dificultades encontradas..Madrid (Comunidad Autónoma). Consejería de SanidadMadridNo disponibleES

Gut Microbiota Differs in Composition and Functionality Between Children With Type 1 Diabetes and MODY2 and Healthy Control Subjects: A Case-Control Study.

Type 1 diabetes is associated with compositional differences in gut microbiota. To date, no microbiome studies have been performed in maturity-onset diabetes of the young 2 (MODY2), a monogenic cause of diabetes. Gut microbiota of type 1 diabetes, MODY2, and healthy control subjects was compared. This was a case-control study in 15 children with type 1 diabetes, 15 children with MODY2, and 13 healthy children. Metabolic control and potential factors modifying gut microbiota were controlled. Microbiome composition was determined by 16S rRNA pyrosequencing. Compared with healthy control subjects, type 1 diabetes was associated with a significantly lower microbiota diversity, a significantly higher relative abundance of Bacteroides, Ruminococcus, Veillonella, Blautia, and Streptococcus genera, and a lower relative abundance of Bifidobacterium, Roseburia, Faecalibacterium, and Lachnospira. Children with MODY2 showed a significantly higher Prevotella abundance and a lower Ruminococcus and Bacteroides abundance. Proinflammatory cytokines and lipopolysaccharides were increased in type 1 diabetes, and gut permeability (determined by zonulin levels) was significantly increased in type 1 diabetes and MODY2. The PICRUSt analysis found an increment of genes related to lipid and amino acid metabolism, ABC transport, lipopolysaccharide biosynthesis, arachidonic acid metabolism, antigen processing and presentation, and chemokine signaling pathways in type 1 diabetes. Gut microbiota in type 1 diabetes differs at taxonomic and functional levels not only in comparison with healthy subjects but fundamentally with regard to a model of nonautoimmune diabetes. Future longitudinal studies should be aimed at evaluating if the modulation of gut microbiota in patients with a high risk of type 1 diabetes could modify the natural history of this autoimmune disease

Diez meses en las cañadas verdes

Se desarrolla un proyecto de innovación educativa que pretende integrar la Educación Ambiental en el currículo del centro para Educación Infantil, Educación Primaria y Educación Secundaria. Se pretende concienciar a la comunidad escolar sobre la necesidad de mantener una relación sostenible con el medio cercano. Se trata de conocer la acciones positivas del centro y los aspectos de mejora en temas medioambientales, para poner en práctica las propuestas de mejora diseñadas y armonizar la relación con el entorno y hacerlo más agradable y humano. Se potencia la sensibilización de la comunidad escolar sobre el respeto, cuidado y recuperación del medio ambiente aportando valores positivos útiles para el futuro. A través del proyecto de innovación educativa se crea una red de centros comprometidos con el medio ambiente para mejorar la calidad educativa en los diferentes niveles educativos a través de los materiales generados. En cuanto a la metodología empleada, el proyecto parte de del nivel de desarrollo de cada niño, adaptándose a sus características madurativas y desde de todas las áreas educativas. El proyecto incita a la reflexión personal y a la comunicación entre los diferentes agentes implicados. La participación del alumnado y del profesorado es activa en todo momento, procurando situaciones de aprendizaje a partir del medio más inmediato y concreto, facilitando su extrapolación al conocimiento de otras realidades ambientales más complejas.Castilla y LeónConsejería de Educación. Dirección General de Universidades e Investigación; Monasterio de Nuestra Señora de Prado, Autovía Puente Colgante s. n.; 47071 Valladolid; +34983411881; +34983411939ES

Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trialResearch in context

Summary: Background: Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. Methods: We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. Findings: 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, −3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; −9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. Interpretation: Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. Funding: Grifols

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care