Caso clínico de cáncer de mama localmente avanzado

Se presenta un caso clínico de cáncer de mama en el que existe invasión de la cadena mamaria interna sin previa afectación axilar. Se trata de una mujer de 49 años que mediante autoexploración se detecta un nódulo en la mama derecha. La enfermedad se diagnostica en un estadio localmente avanzado lo que posibilita un tratamiento conservador con intención curativa. Se discute el caso, incluyendo diagnóstico, posibilidades terapéuticas y resultados.OtroGrado en Medicin

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

I Congresso Ibero-Americano de Bibliotecas Escolares

Actas de la primera edición del I Congreso Iberoamericano de Bibliotecas Escolares, CIBES 2015, organizado por la Universidad Carlos III de Madrid (España), la Universidad Estatal Paulista (Brasil) y el Ayuntamiento de Getafe (España). Celebrado: 21 - 23 de octubre de 2015 en la Universidad Estatal Paulista (Marília) y 26 - 28 de octubre de 2015 en la Universidad Carlos III de Madrid (Getafe)Universidad Carlos III de Madrid (España)Universidad Estatal Paulista (Brasil)Ayuntamiento de Getafe (España)Dimensiones y visiones de la biblioteca escolar en una Educación por competencias: la necesidad de una política estratégica / Miguel Ángel Marzal. -- Getafe ciudad educadora, lectora y escritora: Bibliotecas escolares / Lourdes Muñoz Santiuste. -- Presente y futuro: biblioteca escolar-CREA y proyectos interdisciplinares / Rosa Piquín. -- Cultura en información: un reto esencial de la biblioteca escolar / Mónica Baró. -- Bibliotecas escolares de Galicia: un mundo de oportunidades a favor de la Educación / Cristina Novoa. -- 10 años de la Red de Bibliotecas Escolares de Extremadura (REBEX) / Casildo Macías Pereira. -- Biblioteca Escolar y uso ético de la información para una Cultura de Paz / Ana Barrero Tíscar. -- Dinamización de la Biblioteca Escolar Plumita durante el curso escolar 2014/15 / María Antonia Cano Cañada. -- Experiencia de la creación de una biblioteca escolar / Susana Santos Martín. -- Grupo cooperativo Bibliotecas escolares en Red-Albacete / José Manuel Garrido Argandoña y Eva Leal Scasso. -- La BCREA "Juan Leiva". El fomento de la lectura desde la web social / Andrés Pulido Villar. -- Proceso de implantación de una herramienta de autoevaluación en la red de bibliotecas escolares de Extremadura (REBEX) / Casildo Macías Pereira. -- La biblioteca escolar: abriendo fronteras / Lorena Verónica Cabrera Orellana. -- O programa RBE e a avaliaçao das bibliotecas escolares: melhoria, desenvolvimiento e innovaçao / Elsa Conde. -- Profesional de Biblioteconomía y Documentación: esencial en la plantilla de la escuela / Pilar del Campo Puerta. -- Una mirada activa al proceso educativo desde la biblioteca escolar / María Jesús Fontela Fernández . -- Con otra mirada "La ilustración como vehículo de comunicación y aprendizaje en las bibliotecas escolares" / Pablo Jurado Sánchez-Galán. -- Fingertips. Recriar a biblioteca escolar na sala de aula / Rui Alfonso Mateus. -- Hablemos de libros. Cómo transformar una clase de literatura en una comunidad de interpretación de textos / Francisco César Díaz Rey. -- Inclusión social de familias inmigrantes a través de un programa de aprendizaje de la lengua castellana / Ana Carmen Tolino Fernández-Henarejos. -- O desenvolvimento de atividades de mediação de leitura em biblioteca escolar: o caso da biblioteca da Escola Sesc de Ensino Médio / Vagner Amaro. -- La biblioteca escolar. Proceso de enseñanza-aprendizaje de padres a hijos / Ana Carmen Tolino Fernández- Henarejos. -- Leo con y para los demás / Ismael Fernández Fernández, Ana María Moreno Vicente y Ana Beatriz Vicente Pérez. -- Nanas y arrullo. Poesía a la deriva / Bernardo Fuentes Navarrete y Carlos García-Romeral Pérez. -- Gestión y evaluación de servicios bibliotecarios para personas con dislexia: una biblioteca escolar inclusiva desde una perspectiva internacional / Carmen Jorge García-Reyes. -- Sueños lectores compartidos hechos realidad: la biblioteca escolar del C.E.I.P-S.E.S-A.A “LA PAZ” de Albacete / Ana Rosa Cabañero Tobarra, Juan Manuel Herráez, Eva Leal Scasso, María Marín Sánchez, Ana Belén Medrano Martínez y María José Nortes Ruipérez. -- El programa biblioteca escuela en Civican. La literatura como elemento motivador para la alfabetización informacional / Villar Arellano Yanguas. -- La competencia digital en el diseño curricular: desde la biblioteca al aula / Felicidad Campal García. -- O deselvomimento da pesquisa escolar por meio da competência em informaçao / Luciane de Fátima Cavalcante Beckman y Marta Leandro da Mata. -- Proyecto escolar de investigación documental "Te pillé leyendo" / José Manuel Garrido Argandoña. -- Aprender com a Biblioteca Escolar: formar para as literacias / Paula Correia y Isabel Mendinhos. -- Sucedió en el siglo XX / María Antonia Becerra Montalbán, Ángel Bernabé Muñoz y Sofía Vaz Romero. -- El Club de lectura en la nube / Belén Benito Blázquez y Ana Ordás García. -- Promover a leitura e a escrita na era digital: prácticas nas bibliotecas escolares / María Raquel Ramos. -- A biblioteca escolar e o desafío da interculturalidade: o projeto Ser + cidadao / María da Conceição Tomé. -- Cuando la competencia digital encontró a la alfabetización informacional o Mucho ruido y pocas nueces / Felicidad Campal García. -- Hora de ler, un programa para el fomento de la lectura en contexto educativo / Cristina Novoa. -- Hábitos de lectura para las competencias en información y alfabetización en información en bibliotecas escolares de Puerto Rico / Karen Denise Centeno Casillas. -- Repositorios digitales en las bibliotecas escolares andaluzas: situación, modelos y herramientas para su creación / Dolores Olmos Olmos y Andrés Pulido Villar. -- Trabajando las competencias clave con las aventuras de Mozarito en Extremadura / María Teresa Carballosa González y María Esther Nieto Vidal. -- Análisis de modelos de evaluación de la web de la biblioteca escolar / Raúl Cremades García. -- Emociónate con las historias: El bosque de las emociones e historias con mucho teatro / Esther Luis Pérez y Ana María Peromingo Fernández. -- Biblioteca escolar de innovación y continuación / E. María Guerrero Palacios y Silvia Mora Ramírez. -- Uso de estándares y licencias para la creación y difusión de contenidos en las bibliotecas escolares / José Luis Barreiro Cebey. -- La biblioteca escolar digital móvil / Javier Fernández Delgado. -- Uso de aplicaciones móviles para el desarrollo de la competencia lingüística. Proyecto Hansel App Gretel / Dolores Olmos Olmos. -- A memória e a mediação segundo Vigotski / Leda Maria Araújo, Patricia Celia Santana, Sueli Bortolin y Leticia Gorri Molina. -- Bibliotecas escolares como tema de estudo dos alunos de graduação em blioteconomia do Instituto de Ensino Superior da FUNLEC: estado da arte / Tiago Pereira Nocera y Rodrigo Pereira. -- Ações de mediação da leitura e da informação em bibliotecas escolares: um olhar sobre as bibliotecas dos Colégios de Aplicação / Tatyanne Christina Gonçalves Ferreira Valdez y Alberto Calil Júnior. -- Mediação pedagógica numa biblioteca de escola pública em Londrina / Rovilson José da Silva, Teba Silva Yllana y Sueli Bortolin. -- Utilização de categorias por cores em sistema de biblioteca voltado ao público infanto-juvenil / Liliana Giusti Serra. -- Atividades de ensino dos atos de leitura com crianças em risco social / Adriana Naomi Fukushima da Silva y Dagoberto Buim Arena. -- Biblioteca escolar: espaço de significados entre alunos, professores e bibliotecários / Rodrigo Barbosa Paulo, Marisa Xavier, Helen Castro Casarin y Creuza Barbaroto. -- A Biblioteca Escolar no Contexto da Legislação e do Processo Educativo / Eliane Lourdes da Silva Moro, Francisca Rosaline Leite Mota y Raimundo Martins de Lima. -- O jornal impresso como fonte de informação: a importância da formação de leitores críticos / Mariana Pícaro Cerigatto. -- Bibliotecas escolares no estado do Rio Grande do Sul: a trajetória de realização dos fóruns gaúchos pela melhoria das bibliotecas escolares / Eliane Lourdes da Silva Moro y Lizandra Brasil Estabel. -- O acesso à informação dos usuários surdos na biblioteca escolar / André Luís Onório Coneglian y Mayara Melo Santana. -- Aprendizagem coletiva de bibliotecários e a competência de pesquisa dos docentes: o caso do Instituto Federal do Espírito Santo / Maristela Almeida Mercandeli Rodrigues y Beatriz Quiroz Villardi. -- Biblioteca escolar: atores, parâmetros e competências / Mavi Galante Mancera Dall´Acqua Carvalho y Claudio Marcondes de Castro Filho. -- Estratégias de aprendizagem de escrita no Ensino Fundamental II / Érika Christina Kohle. -- Bebês e livros: leitura nas bebetecas. Kenia Adriana de Aquino Modesto Silva, Juliane Francischeti Martins Motoyama y Renata Junqueira de Souza. -- Práticas alternativas para organização de acervos nos espaços de leitura em ambientes escolares / Luciana Souza Gracioso, Ariovaldo Alves, Débora Nascimento, Suelen Redondo, Tainara Torika Kiri de Castro, Elizabete Angelon y Eduardo Barbosa. -- Reflexões sobre a modelagem e criação de uma Rede Virtual de Leitores para Bibliotecas Escolares / Carla Floriana Martins y Raoni Guerra Rajão. -- Biblioteca escolar: espaço de formação leitora? / Silvana Ferreira de Souza Balsan y Renata Junqueira de Souza. -- “Se a Biblioteca Escolar é minha mãe, o Google é meu pai”: representações da relação entre Biblioteca Escolar e Google no imaginário de alunos do ensino técnico / Adriana Bogliolo Sirihal-Duarte, Maria L. Amorim Antunes y Raquel Miranda Vilela Paiva. -- Desafios e propostas para a universalização das bibliotecas escolares no Brasil e na Espanha / Rodrigo Pereira, Daniela Spudeit y Fernanda de Sales. -- Bibliotecário educador: possibilidades de atuação no contexto da biblioteca escolar / André Carlos da Silva, Valéria Martin Valls y Mariana de Paula Silva. -- Uma ONG para Bibliotecas Escolares : estratégia para ampliar a igualdade e capacidade de acesso e uso da informação e educação escolar de qualidade / Suelen Camilo Ferreira y Luciana de Souza Gracioso. -- O aluno com deficência: o papel do bibliotecário na disponibilidade de recursos acessíveis na biblioteca escolar / Adriano de Sales Coelho, Rosilene de Melo Oliveira y Marcos Pastana Santos. -- Biblioteca digital virtual e o uso do tablete: uma possibilidade de construção de novas práticas de leitura na escola / Barbara Cibelli da Silva Monteagudo y Dagoberto Buim Arena. -- A importância da biblioteca na educação de crianças de 0 a 3 anos / Yngrid Karolline Mendonça Costa y Cyntia Graziella Guizelim Simões Girotto. -- Comportamento Informacional de adolescentes: a relação com bibliotecas e escolas / Nelson Sebastian Silva-Jerez y Helen de Castro S. Casarin

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe