Aspectos biológicos y clínicos de la alfa-1-antitripsina con especial referencia a los procesos tumorales malignos

Tesis Univ. Complutense.Fac. de MedicinaTRUEProQuestpu

Influence of the COVID-19 Pandemic on Medical Training

The COVID-19 pandemic has shown an inmediate response in health services. But this feature required an inmediate change in the traditional medical education: educational resources, teaching activities, personal attitude, knowledge in new tecnologies, … for both students and professors. These could be considere as a optional frame for transformation of medical education. For all agents implicated in medical eductaion is an opportunity to improve the natural dynamic to learn medical knowledge. This time force to students and teachers to transform the medical education in the future. Some of the main aspects of this transformation has been included in this paper under the visión of the authorLa pandemia por COVID-19 ha mostrado una respuesta inmediata en los servicios sanitarios. Pero este hecho ha requerido también un cambio inmediato en la educación médica tradicional: recursos educativos, actividades docentes, actitudes personales, conocimiento de las nuevas tecnologías… tanto para estudiantes como para profesores. Esta situación puede proporcionar un escenario propicio para la transformación de la educación médica. Para todos los agentes implicados en la educación médica es una oportunidad para implementar la dinámica natural del aprendizaje de los conocimientos. Esta época ha forzado a estudiantes y educadores a transformar la educación médica en el futuro. Algunos de los principales aspectos de esta transformación son los que se han incluido en este trabajo, bajo la visión personal del autor

Aspectos biológicos y clínicos de la alfa-1-antitripsina con especial referencia a los procesos tumorales malignos

Tesis Univ. Complutense.Fac. de MedicinaTRUEProQuestpu

Electrocardiografía clínica

La enseñanza de la Medicina tropieza con dificultades derivadas del excesivo tecnicismo del lenguaje utilizado y también de la novedad o extrañeza de los principios físicoquímicos necesarios para explicar científicamente la realidad biológica. En la electrocardiografía, como técnica diagnóstica especializada, concurren ambas dificultades con una tercera que es la escasez de libros de textos sencillos, que sacrifiquen la belleza y la profundidad teórica en aras de una eficacia pedagógica. El objetivo de este libro del Prof. J. Millán y del Dr. A. Lorenzo es intentar llenar este vacío. Los estudiantes y los médicos jóvenes, creo que les agradecerán el esfuerzo realizado, que es el fruto de la experiencia de enseñar electrocardiografía a los estudiantes de Patología General, primero en Madrid y ahora aquí en Cádiz, durante diez años

Dyslipidemias: a pending challenge in cardiovascular prevention. Consensus document from CEIPC/SEA Committee

Documento presentado en el XXXI Congreso Nacional de la Sociedad Española de Medicina Interna (SEMI). Oviedo, 18 de noviembre de 2010.En España, donde la enfermedad cardiovascular (ECV) es la primera causa de muerte, aproximadamente el 20% de los adultos presentan hipercolesterolemia, de los cuales sólo el 12% estarían controlados. El abordaje de las dislipemias debe realizarse en un contexto más amplio, mediante acciones encaminadas a reducir el riesgo cardiovascular (RCV). La medición del RCV facilita la toma de decisiones, pero no puede sustituir al juicio clínico, dadas las limitaciones de los métodos de cálculo disponibles. Este documento, elaborado por el Comité Español Interdisciplinar de Prevención Cardiovascular, a iniciativa de la Sociedad Española de Arteriosclerosis, describe las principales iniciativas en prevención cardiovascular de administraciones sanitarias y sociedades científicas, y el papel que juegan en ellas los profesionales sanitarios. Además de apoyar las iniciativas en marcha, se propone la puesta en marcha de una estrategia nacional de prevención cardiovascular, centrada en la modificación de estilos de vida (prevención del tabaquismo y promoción de la alimentación saludable y la actividad física) mediante acciones en todos los ámbitos. A nivel poblacional, la regulación de la publicidad alimentaria, la eliminación de los ácidos grasos trans y la reducción de azúcares añadidos en la cadena alimentaria constituyen intervenciones viables y coste-efectivas para ayudar a controlar las dislipemias y reducir el RCV. En el ámbito sanitario, se propone reducir las barreras para la aplicación de las guías, mejorar la formación de los profesionales en modificación de estilos de vida e incorporar la valoración del RCV entre los indicadores de calidad de la asistencia. Las sociedades científicas son responsables de colaborar con la administración y contribuir a la generación del conocimiento, su transmisión y su aplicación. Finalmente, está en manos de los profesionales evaluar al paciente dislipémico en el contexto del RCV, promover estilos de vida saludables y hacer un uso eficiente del arsenal terapéutico disponible. In Spain, where cardiovascular disease (CVD) is the leading cause of death, hypercholesterolemia, one of the most prevalent risk factors in adults, is poorly controlled. Dyslipidemia should not be approached in isolation, but in the context of overall cardiovascular risk (CVR). Measurement of CVR facilitates decision making, but should not be the only tool nor should it take the place of clinical judgment, given the limitations of the available calculation methods. This document, prepared by the Interdisciplinary Spanish Committee on Cardiovascular Prevention, at the proposal of the Spanish Society of Arteriosclerosis, reviews the cardiovascular prevention activities of the regional health authorities, scientific societies and medical professionals. An initiation of a national strategy on cardiovascular prevention is proposed based on lifestyle modification (healthy diet, physical activity and smoking cessation) through actions in different settings. At the population level, regulation of food advertising, elimination of trans fats and reduction of added sugar are feasible and cost-effective interventions to help control dyslipidemias and reduce CVR. In the health setting, it is proposed to facilitate the application of guidelines, improve training for medical professionals, and include CVR assessment among the quality indicators. Scientific societies should collaborate with the health authorities and contribute to the generation and transmission of knowledge. Finally, it is in the hands of professionals to apply the concept of CVR, promote healthy lifestyles, and make efficient use of available pharmacological treatments

Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19

Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p < 0.0001). Hypertensive patients in the ACEI/ARB group had better results in IMV, ICU admission, and the composite outcome of prognosis (p < 0.0001 for all). No differences were found in the incidence of major adverse cardiovascular events. Patients previously treated with ACEI/ARB continuing treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63-0.76). ARB was associated with better survival than ACEI (HR 0.77, 95%CI 0.62-0.96). ACEI/ARB treatment during COVID-19 hospitalization was associated with protection on mortality. The benefits were greater in hypertensive, those who continue

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study

There is some evidence that male gender could have a negative impact on the prognosis and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of the present study was to compare the characteristics of coronavirus disease 2019 (COVID-19) between hospitalized men and women with confirmed SARS-CoV-2 infection. This multicenter, retrospective, observational study is based on the SEMI-COVID-19 Registry. We analyzed the differences between men and women for a wide variety of demographic, clinical, and treatment variables, and the sex distribution of the reported COVID-19 deaths, as well as intensive care unit (ICU) admission by age subgroups. This work analyzed 12,063 patients (56.8% men). The women in our study were older than the men, on average (67.9 vs. 65.7 years; p < 001). Bilateral condensation was more frequent among men than women (31.8% vs. 29.9%; p = 0.007). The men needed non-invasive and invasive mechanical ventilation more frequently (5.6% vs. 3.6%, p < 0.001, and 7.9% vs. 4.8%, p < 0.001, respectively). The most prevalent complication was acute respiratory distress syndrome, with severe cases in 19.9% of men (p < 0.001). In men, intensive care unit admission was more frequent (10% vs. 6.1%; p < 0.001) and the mortality rate was higher (23.1% vs. 18.9%; p < 0.001). Regarding mortality, the differences by gender were statistically significant in the age groups from 55 years to 89 years of age. A multivariate analysis showed that female sex was significantly and independently associated with a lower risk of mortality in our study. Male sex appears to be related to worse progress in COVID-19 patients and is an independent prognostic factor for mortality. In order to fully understand its prognostic impact, other factors associated with sex must be considered

The Use of Corticosteroids or Tocilizumab in COVID-19 Based on Inflammatory Markers

SEMI-COVID-19 Network.[Background] The inflammatory cascade is the main cause of death in COVID-19 patients. Corticosteroids (CS) and tocilizumab (TCZ) are available to treat this escalation but which patients to administer it remains undefined.[Objective] We aimed to evaluate the efficacy of immunosuppressive/anti-inflammatory therapy in COVID-19, based on the degree of inflammation. .[Design] A retrospective cohort study with data on patients collected and followed up from March 1st, 2020, to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Patients under treatment with CS vs. those under CS plus TCZ were compared. Effectiveness was explored in 3 risk categories (low, intermediate, high) based on lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and d-dimer values.[Patients] A total of 21,962 patients were included in the Registry by May 2021. Of these, 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ).[Main Measures] The primary outcome of the study was in-hospital mortality. Secondary outcomes were the composite variable of in-hospital mortality, requirement for high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission.[Key Results] A total of 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). No significant differences were observed in either the low/intermediate-risk category (1.5% vs. 7.4%, p=0.175) or the high-risk category (23.1% vs. 20%, p=0.223) after propensity score matching. A statistically significant lower mortality was observed in the very high–risk category (31.9% vs. 23.9%, p=0.049).[Conclusions] The prescription of CS alone or in combination with TCZ should be based on the degrees of inflammation and reserve the CS plus TCZ combination for patients at high and especially very high risk.Peer reviewe

Prognostic Value of D-dimer to Lymphocyte Ratio (DLR) in Hospitalized Coronavirus Disease 2019 (COVID-19) Patients: A Validation Study in a National Cohort

Background: This study aimed to validate the role of the D-dimer to lymphocyte ratio (DLR) for mortality prediction in a large national cohort of hospitalized coronavirus disease 2019 (COVID-19) patients. Methods: A retrospective, multicenter, observational study that included hospitalized patients due to SARS-CoV-2 infection in Spain was conducted from March 2020 to March 2022. All biomarkers and laboratory indices analyzed were measured once at admission. Results: A total of 10,575 COVID-19 patients were included in this study. The mean age of participants was 66.9 (+/- 16) years, and 58.6% (6202 patients) of them were male. The overall mortality rate was 16.3% (n = 1726 patients). Intensive care unit admission was needed in 10.5% (n = 1106 patients), non-invasive mechanical ventilation was required in 8.8% (n = 923 patients), and orotracheal intubation was required in 7.5% (789 patients). DLR presented a c-statistic of 0.69 (95% CI, 0.68-0.71) for in-hospital mortality with an optimal cut-off above 1. Multivariate analysis showed an independent association for in-hospital mortality for DLR > 1 (adjusted OR 2.09, 95% CI 1.09-4.04; p = 0.03); in the same way, survival analysis showed a higher mortality risk for DLR > 1 (HR 2.24; 95% CI 2.03-2.47; p < 0.01). Further, no other laboratory indices showed an independent association for mortality in multivariate analysis. Conclusions: This study confirmed the usefulness of DLR as a prognostic biomarker for mortality associated with SARS-CoV-2 infection, being an accessible, cost-effective, and easy-to-use biomarker in daily clinical practice