Una complicación “indeseable” y “no esperada” a pesar de la mejoría metabólica, ¿llegamos tarde?

A 55-year-old male with type 2 diabetes mellitus 13 years of evolution and with poor metabolic control who is referred to Internal Medicine for treatment adjustment.Varón de 55 años con diabetes mellitus tipo 2 de 13 años de evolución y con mal control metabólico que es remitido a las consultas de Medicina Interna para ajuste de tratamiento

Insulinas basales… ¡A jugar!

In this clinical case, we show the importance of the continuous glucose monitoring to detect high variability and risk of hypoglycemia in apparently well-treated patients. We also show how the new basal insulins allow to avoid hypoglycemia and decrease the variability.En este caso clínico se muestra la utilidad de los sensores continuos de glucosa, con el fin de descubrir pacientes que por HbA1C están aparentemente bien tratados y la realidad es otra completamente diferente: mucha variabilidad, hipoglucemias inadvertidas. El uso de las nuevas insulinas lentas permite controlar mejor la variabilidad de muchos pacientes, al tiempo que disminuye el riesgo de hipoglucemias

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Literatura en familia : cuento lo que sé

La valoración general del proyecto por parte del asesor del CPR es muy buena.- No consta su publicación.Un grupo de diez profesores de secundaria de un instituto de Alcantarilla (Murcia) ha realizado este proyecto consistente en la creación de una herramienta didáctica para el aprendizaje de los contenidos curriculares del área de lengua y literatura bajo el enfoque metodológico del trabajo por proyectos, que desarrolla competencias y conocimientos conceptuales que integran el conocimiento del pasado histórico de dos configuraciones histórico-políticas integradas: el pasado histórico de España y el pasado histórico de la Comunidad Autónoma de la Región de Murcia. Los alumnos trabajan sobre su propia historia, creando personajes y haciendo intervenir otros basados en la investigación y documentación histórica sobre sus antepasados, miembros de las familias de los alumnos. La investigación sobre fuentes históricas ha permitido la construcción de las genealogías familiares de los alumnos, elaborando los contenidos digitales en soporte electrónico, lo que permite que sean usados en la implantación didáctica del proyecto, diseñando y elaborando guías didácticas de investigación y documentación histórica y de creación literaria..Consejería de Educación, Ciencia e Investigación. Dirección General de Formación Profesional e Innovación EducativaMurciaConsejería de Educación, Ciencia e Investigación. Servicio de Publicaciones y Estadística; Avda. La Fama, 15; 30006 Murcia; Tel. +34968278685; Fax +34968279835; [email protected]