Estudio descriptivo del manejo del ductus arterioso persistente en una unidad de neonatología de tercer nivel y su adecuación a la evidencia actual

El DAP es una de las co-morbilidades más frecuentes en la prematuridad, sobre todo de los niños menores de 32 semanas de gestación y/o 1500 g al nacer, y especialmente en los prematuros extremos, es decir, los nacidos antes de las 28 semanas, con un peso de menos de 1000 g. A pesar de que existen varios estudios que relacionan el DAP con el desarrollo de morbimortalidad, hay un gran debate en torno a que el DAP sea el responsable directo, ya que la evidencia científica no avala ninguna de las estrategias encaminadas a cerrar el DAP, entre otras cosas porque muchos de los estudios disponibles son antiguos y difícilmente extrapolables a la práctica clínica actual, no existen muchos estudios de calidad, así como por la heterogenicidad de los pacientes seleccionados y de las estrategias adoptadas en los diversos estudios. Por tanto, se sigue buscando cuál es la mejor estrategia terapéutica para manejar los prematuros con un DAP. Además, en los últimos años están surgiendo nuevas opciones diagnósticas y terapéuticas, como los biomarcadores, el uso del paracetamol, o los dispositivos intravasculares para el cierre del DAP. Todo esto hace que sea de especial interés la recogida de datos en una UCIN de tercer nivel con respecto al manejo del DAP en el contexto de la práctica clínica actual, tanto para aportar datos a la comunidad científica como para conocer los datos propios. Esto permitirá hacer comparaciones de nuestros resultados con los de otras estrategias, nos sirve como punto de partida para valorar la necesidad de implantar nuevas medidas diagnóstico-terapéuticas en la práctica diaria y valorar las eventuales mejoras aportadas, y finalmente, para proponer estudios de cara al futuro. Los resultados más relevantes de nuestro trabajo son que el DAP-HS y su tratamiento se asocia con la HIV y con una peor evolución respiratoria, medida en términos de días de VM y de DBP, y que en los últimos años el aumento del uso de los tratamientos médico y quirúrgico para el DAP han coincidido con un aumento de perforación intestinal, uso de iNO y DBP. Se proponen como elementos de mejora en el manejo del DAP el uso más restrictivo del tratamiento

Antenatal Betamethasone Every 12 Hours in Imminent Preterm Labour

Background: Benefits of antenatal corticosteroids have been established for preterm infants who have received the full course. In imminent preterm labours there is no time to administer the second dose 24 h later. Objective: To determine whether the administration of two doses of betamethasone in a 12 h interval is equivalent to the effects of a full maturation. Methods: We performed a retrospective cohort study including preterm infants ≤34 weeks gestational age at birth and ≤1500 g, admitted to an NICU IIIC level in a tertiary hospital from 2015 to 2020. The population was divided into two cohorts: complete maturation (CM) (two doses of betamethasone 24 h apart), or advanced maturation (AM) (two doses of betamethasone 12 h apart). The primary outcomes were mortality or survival with severe morbidities. The presence of respiratory distress syndrome and other morbidities of prematurity were determined. These variables were analysed in the neonates under 28 weeks gestational age cohort. Neurodevelopment at 2 years was evaluated with the validated Ages and Stages Questionnaires®, Third Edition (ASQ®-3). Multiple regression analyses were performed and adjusted for confounding factors. Results: A total of 275 preterm neonates were included. Serious outcomes did not show differences between cohorts, no increased incidence of morbidity was found in AM. A lower percentage of hypotension during the first week (p = 0.04), a tendency towards lower maximum FiO2 (p = 0.14) and to a shorter mechanical ventilation time (p = 0.14) were observed for the AM cohort. Similar results were found in the subgroup of neonates under 28 weeks gestational age. There were no differences in cerebral palsy or sensory deficits at 24 months of corrected age, although the AM cohort showed a trend towards better scores on the ASQ3 scale. Conclusions: Administration of betamethasone every 12 h showed similar results to the traditional pattern with respect to mortality and severe morbidities. (...)This research received no external funding. Partial funding for open access charge: Universidad de Málag

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission

Risk Factors for COVID-19 in Inflammatory Bowel Disease: A National, ENEIDA-Based Case–Control Study (COVID-19-EII)

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case-control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March-July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3-5.9), occupational risk (OR: 2.9; 95%CI: 1.8-4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2-2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09-0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution

Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response

La grabación sonora: un recurso pedagógico multidisciplinar para la reinterpretación de la Historia

Mediante el presente proyecto se ha pretendido abordar un nuevo acercamiento a la historia de la música, en tanto manifestación cultural, basado en una metodología de reciente creación que entronca directamente con los estudios sobre la praxis interpretativa. Para ello hemos profundizado en el correcto manejo de los software informáticos que permiten el análisis de estas fuentes sonoras (fundamentalmente visualizadores de ondas y editores de sonido). Como resultado, hemos constituido un grupo de trabajo abierto a profesores y alumnos, ubicado físicamente en la Facultad de Geografía e Historia de la UCM

La influencia de la tecnología en los procesos de producción musical: análisis de la grabación sonora y sus aplicaciones en el ámbito docente

Memoria de las actividades del proyecto de Innova-Docencia nº256, coordinado por el Dr. Marco Antonio Juan de Dios Cuartas, profesor del Departamento de Musicología de la Universidad Complutense de Madrid

INNOVASONORA: gestión de archivos sonoros, sonido inmersivo y realidad virtual en plataformas LMS

Memoria del proyecto de innovación docente "Innovasonora" (Curso 2021-2022

INNOVASONORA: desarrollo de recursos para la transmisión digital de los archivos sonoros y la aplicación de la realidad virtual como complemento de la enseñanza presencial

Memoria del proyecto de innovación docente nº 208 (curso 2020-2021