Multimorbilidad y resultados clínicos de una población pediátrica con sospecha de COVID-19 atendida en un hospital mexicano

Introducción: datos de varios países del mundo sugieren que los niños con COVID-19 podrían presentar síntomas diferentes y menos graves que los adultos. Sin embargo, los patrones epidemiológicos y clínicos en este grupo poblacional son poco claros. Métodos: el presente es un estudio observacional, con una caracterización inicial transversal-analítica, y con un componente longitudinal o de seguimiento a un grupo de menores con sospecha y/o diagnóstico confirmado de COVID-19, que presentaron desenlaces como mejoría, traslado a un nivel superior de atención o defunción por sintomatología respiratoria. Los niños recibieron atención médica en el Hospital General Regional con Medicina Familiar N.o 1 (HGR C/MF N.o 1), y se les realizó prueba de reacción en cadena de la polimerasa en tiempo real (RT-PCR). Resultados: se estudiaron 98 niños como casos sospechosos para COVID-19, a quienes se les realizó RT-PCR. Del total, 24 resultaron positivos y 74 fueron negativos. La mediana de edad de los participantes fue 64,4 meses (0 a 203 meses), 55 menores eran de sexo masculino, 59 niños tuvieron manejo ambulatorio, y de estos 14 presentaron resultado positivo. Entre los que requirieron manejo hospitalario (39), 10 niños dieron positivo para SARS-CoV-2, y, de estos, 84,7% alcanzaron mejoría y fueron dados de alta; 4 fueron trasladados a hospitales de nivel superior de atención. De los 98 niños en estudio, 11 fallecieron, 7 con resultado negativo y 4 con resultado positivo para SARS-CoV-2.Introduction: Data from several countries around the world suggest that children with COVID-19 may present different and less severe symptoms than adults. However, the epidemiological and clinical patterns in this population group have been unclear. Methods: This is an observational study, with an initial cross-analytical characterization, and with a longitudinal or follow-up component in a group of minors with suspected and or confirmed case of COVID-19, which have outcomes such as improvement, transfer to a higher level of care or death due to respiratory symptoms. The children received medical attention at the Regional General Hospital with Family Medicine No 1 (HGR C / MF No 1), and underwent a Real Time Polymerase Chain Reaction test (RT-PCR). Results: 98 children were studied as suspected cases for COVID-19, who underwent RT-PCR. Of the total 24 were positive and 74 were negatives. The median age was 64.4 months (0 to 203 months), 55 minors were male, 59 children had outpatient management, and of these 14 had a positive result. Among those who required hospital management (39), 10 children were positive for SARS-CoV-2, y 84.7% achieved improvement and were discharged. Four were transferred to a higher level of care hospital. Of the 98 children in the study 11 died, seven had a negative result and four a positive result for SARS-CoV-2. Conclusions: The main symptoms of the pediatric population in this study were; fever, cough and general discomfort. Four of those who died had a positive result for SARS-CoV-2; however, they had other comorbidities.Introducción: datos de varios países del mundo sugieren que los niños con COVID-19 podrían presentar síntomas diferentes y menos graves que los adultos. Sin embargo, los patrones epidemiológicos y clínicos en este grupo poblacional son poco claros. Métodos: el presente es un estudio observacional, con una caracterización inicial transversal-analítica, y con un componente longitudinal o de seguimiento a un grupo de menores con sospecha y/o diagnóstico confirmado de COVID-19, que presentaron desenlaces como mejoría, traslado a un nivel superior de atención o defunción por sintomatología respiratoria. Los niños recibieron atención médica en el Hospital General Regional con Medicina Familiar N.o 1 (HGR C/MF N.o 1), y se les realizó prueba de reacción en cadena de la polimerasa en tiempo real (RT-PCR). Resultados: se estudiaron 98 niños como casos sospechosos para COVID-19, a quienes se les realizó RT-PCR. Del total, 24 resultaron positivos y 74 fueron negativos. La mediana de edad de los participantes fue 64,4 meses (0 a 203 meses), 55 menores eran de sexo masculino, 59 niños tuvieron manejo ambulatorio, y de estos 14 presentaron resultado positivo. Entre los que requirieron manejo hospitalario (39), 10 niños dieron positivo para SARS-CoV-2, y, de estos, 84,7% alcanzaron mejoría y fueron dados de alta; 4 fueron trasladados a hospitales de nivel superior de atención. De los 98 niños en estudio, 11 fallecieron, 7 con resultado negativo y 4 con resultado positivo para SARS-CoV-2

Adelante / Endavant

Séptimo desafío por la erradicación de la violencia contra las mujeres del Institut Universitari d’Estudis Feministes i de Gènere "Purificación Escribano" de la Universitat Jaume

Multilocus Phylogeography of the <i>Tuber mesentericum</i> Complex Unearths Three Highly Divergent Cryptic Species

Tuber mesentericum is an edible European black truffle, apparently easy to recognize, but showing a high degree of genetic variability. In this study, we performed an integrative taxonomic assessment of the T. mesentericum complex, combining a multilocus phylogeographic approach with morphological analyses, and including authentic specimens of Vittadini, and Berkeley and Broome. We performed maximum likelihood phylogenetic analyses, based on single and concatenated gene datasets (ITS rDNA, β-tubulin, elongation factor 1-α), and including all available sequences from previous studies. Phylogenetic analyses consistently recovered three reciprocally monophyletic and well-supported clades: clade I, with a wide range across Europe; clade II, specimens collected mainly in the Iberian, Italian, and Balkan peninsulas; and clade III, specimens collected almost exclusively in central Italy. Genetic distance between clades ranged from 10.4% to 13.1% at the ITS region. We also designed new primer pairs specific for each phylogenetic lineage. Morphology of spores, asci, and peridium were investigated on specimens representing the three lineages. Macro- and micromorphological analyses of ascomata revealed only a few, but not diagnostic, differences between the three phylogenetic lineages, thus, confirming that they are morphologically cryptic. By studying authentic specimens of Vittadini, and Berkeley and Broome, it was possible to identify the three clades as T. mesentericum, Tuber bituminatum, and Tuber suave sp. nov., and to designate an epitype for T. mesentericum s.s. and a lectotype for T. bituminatum. Future investigations on volatile organic compound (VOC) composition are needed to define the aroma repertoires in this species complex

Virtual environments of teaching learning for training in experimental techniques. Innovation in multidisciplinary groups

In this research, through the development of a teaching innovation project, the aim is to highlight the importance of educational and pedagogical changes that require both the adaptation of teaching to new situations and the possibility of taking advantage of the available resources to be applied in different degrees (master and degree) simultaneously.For this, the innovation experience carried out by a group of professors from the University of Granada who teach subjects in the CiTPA Master, MARA Master and Degree in Conservation and Restoration of Cultural Assets is presented. It addresses the development of unpublished teaching material (videos, manuals for the application of analytical techniques and the use of specialized software, all in a bilingual version), for its integration into different subjects in which it is necessary to make different research techniques known, use of specific software and precise operational activities that are used for the characterization of materials.Competency-based learning through innovation offers students a real and applied experience that has an immediate practical and professional implication, taking advantage of the skills of the new generations. The results, expected in future evaluations, must be analyzed both individually and for the group of subjects, being recognized in advance the good result and the facilities that teamwork, the recognition of skills and the facilities entail in the field of the teacher, the selection of common competences between different subjects and training levels

Trabajar el arte en Educación Infantil

Se presenta memoria final de proyecto educativo que pretende demostrar que desde muy pequeños los niños y niñas de Educación Infantil pueden observar obras de arte de autores consagrados y expresar los sentimientos que esta interacción despierta en ellos y ellas. Se realiza en el CEIP Eduardo Ocón Rivas de Benamocarra, Málaga. Los objetivos son: acercar la pintura a la comunidad escolar; observar e interpretar lo observado; razonar la contemplación de el arte; aprender a escuchar los sentimientos que despierta una obra; despertar en el alumnado un interés personal por el lenguaje plástico; disfrutar y criticar con criterio; conocer a célebres pintores e investigar su vida y su obra; ampliar la biblioteca de aula; trabajar el lenguaje escrito partiendo del lenguaje plástico y viceversa. Los resultados demuestran que los niños y niñas de infantil poseen la capacidad suficiente para tratar el arte con mayúsculas, y de 'tu a tu'; queda comprobada la multitud de posibilidades que nos ofrece la pintura para ilustrar cualquier aspecto de los contenidos de educación infantil.Junta de Andalucía. Consejería de EducaciónAndalucíaES

Memoria del proyecto para la adaptación de la troncalidad del título de Diplomado en Biblioteconomía y Documentación y diseño de un postgrado en gestión de la transferencia del conocimiento en las organizaciones

Se analizan las asignaturas troncales de la Diplomatura en Biblioteconomía y Documentación para la adaptación al sistema de créditos ECTS, y se diseña un postgrado en Gestión y Transferencia del Conocimiento en las Organizaciones. Para la elaboración del proyecto se establecen dos grupos permanentes de trabajo, uno encargado de la adaptación de las asignaturas troncales y el otro del diseño del postgrado. Se realiza un estudio de la correlación entre las materias troncales de Biblioteconomía y Documentación y las propuestas por el Libro Blanco de la Educación de la ANECA del título de grado en Información y Documentación y se adaptan los contenidos, la teoría, la práctica, el estudio personal y la evaluación a la nueva titulación. Se realiza una propuesta de contenidos en relación a las competencias que el alumno ha de adquirir. En cuanto al diseño del título de postgrado en Gestión y Transferencia del Conocimiento en las Organizaciones, se trata de ofrecer en el ámbito de la administración pública y de las empresas, profesionales que aúnen los conocimientos jurídicos, económicos y de gestión con competencias y habilidades imprescindibles en el contexto de la sociedad de la información. Se realiza un estudio de los perfiles profesionales y competencias genéricas y específicas de la figura del gestor del conocimiento.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; +34983411939;ES

Nivolumab plus Ipilimumab in Advanced Non-Small-Cell Lung Cancer.

BACKGROUND: In an early-phase study involving patients with advanced non-small-cell lung cancer (NSCLC), the response rate was better with nivolumab plus ipilimumab than with nivolumab monotherapy, particularly among patients with tumors that expressed programmed death ligand 1 (PD-L1). Data are needed to assess the long-term benefit of nivolumab plus ipilimumab in patients with NSCLC. METHODS: In this open-label, phase 3 trial, we randomly assigned patients with stage IV or recurrent NSCLC and a PD-L1 expression level of 1\% or more in a 1:1:1 ratio to receive nivolumab plus ipilimumab, nivolumab alone, or chemotherapy. The patients who had a PD-L1 expression level of less than 1\% were randomly assigned in a 1:1:1 ratio to receive nivolumab plus ipilimumab, nivolumab plus chemotherapy, or chemotherapy alone. All the patients had received no previous chemotherapy. The primary end point reported here was overall survival with nivolumab plus ipilimumab as compared with chemotherapy in patients with a PD-L1 expression level of 1\% or more. RESULTS: Among the patients with a PD-L1 expression level of 1\% or more, the median duration of overall survival was 17.1 months (95\% confidence interval [CI], 15.0 to 20.1) with nivolumab plus ipilimumab and 14.9 months (95\% CI, 12.7 to 16.7) with chemotherapy (P = 0.007), with 2-year overall survival rates of 40.0\% and 32.8\%, respectively. The median duration of response was 23.2 months with nivolumab plus ipilimumab and 6.2 months with chemotherapy. The overall survival benefit was also observed in patients with a PD-L1 expression level of less than 1\%, with a median duration of 17.2 months (95\% CI, 12.8 to 22.0) with nivolumab plus ipilimumab and 12.2 months (95\% CI, 9.2 to 14.3) with chemotherapy. Among all the patients in the trial, the median duration of overall survival was 17.1 months (95\% CI, 15.2 to 19.9) with nivolumab plus ipilimumab and 13.9 months (95\% CI, 12.2 to 15.1) with chemotherapy. The percentage of patients with grade 3 or 4 treatment-related adverse events in the overall population was 32.8\% with nivolumab plus ipilimumab and 36.0\% with chemotherapy. CONCLUSIONS: First-line treatment with nivolumab plus ipilimumab resulted in a longer duration of overall survival than did chemotherapy in patients with NSCLC, independent of the PD-L1 expression level. No new safety concerns emerged with longer follow-up. (Funded by Bristol-Myers Squibb and Ono Pharmaceutical; CheckMate 227 ClinicalTrials.gov number, NCT02477826.)

Nivolumab (N) + Low-Dose Ipilimumab (I) vs Platinum-Doublet Chemotherapy (Chemo) as First-Line (1L) Treatment (tx) for Advanced Non-Small Cell Lung Cancer (NSCLC): Checkmate 227 Part 1 Final Analysis

BackgroundPart 1 of CheckMate 227 (NCT02477826), a phase III study in 1L NSCLC, has dual primary endpoints. The primary endpoint of progression-free survival (PFS) with NIVO + IPI vs chemo in patients (pts) with tumor mutational burden ≥ 10 mut/Mb was met, as reported previously. Here we present the primary endpoint of overall survival (OS) for NIVO + IPI vs chemo in pts with tumor PD-L1 expression ≥ 1%.MethodsPts were chemo-naive, with stage IV or recurrent NSCLC without EGFR or known ALK alterations, ECOG PS 0–1. Pts with PD-L1 ≥1% (n = 1189) were randomized 1:1:1 to NIVO 3 mg/kg Q2W + IPI 1 mg/kg Q6W, NIVO 240 mg Q2W, or histology-based chemo; pts with PD-L1 ResultsBaseline characteristics were balanced across tx arms. Minimum follow-up for the primary endpoint was 29.3 mo. For pts with PD-L1 ≥ 1%, OS was significantly longer with NIVO + IPI vs chemo (HR 0.79, 97.72% CI: 0.65–0.96; P = 0.007); PFS, objective response rates, and duration of response favored NIVO + IPI vs chemo. OS benefit was also observed in pts with PD-L1 ConclusionsCheckMate 227 met its primary endpoint of significantly improved OS with NIVO + IPI vs chemo in 1L advanced NSCLC with PD-L1 ≥ 1%. OS was also improved with NIVO + IPI in PD-L1 < 1% and in all randomized pts. Safety profile was consistent with previous reports in NSCLC. NIVO + IPI represents a new chemo-free tx option for pts in 1L advanced NSCLC

Nivolumab plus Ipilimumab in Advanced Non-Small-Cell Lung Cancer.

In an early-phase study involving patients with advanced non-small-cell lung cancer (NSCLC), the response rate was better with nivolumab plus ipilimumab than with nivolumab monotherapy, particularly among patients with tumors that expressed programmed death ligand 1 (PD-L1). Data are needed to assess the long-term benefit of nivolumab plus ipilimumab in patients with NSCLC. In this open-label, phase 3 trial, we randomly assigned patients with stage IV or recurrent NSCLC and a PD-L1 expression level of 1% or more in a 1:1:1 ratio to receive nivolumab plus ipilimumab, nivolumab alone, or chemotherapy. The patients who had a PD-L1 expression level of less than 1% were randomly assigned in a 1:1:1 ratio to receive nivolumab plus ipilimumab, nivolumab plus chemotherapy, or chemotherapy alone. All the patients had received no previous chemotherapy. The primary end point reported here was overall survival with nivolumab plus ipilimumab as compared with chemotherapy in patients with a PD-L1 expression level of 1% or more. Among the patients with a PD-L1 expression level of 1% or more, the median duration of overall survival was 17.1 months (95% confidence interval [CI], 15.0 to 20.1) with nivolumab plus ipilimumab and 14.9 months (95% CI, 12.7 to 16.7) with chemotherapy (P = 0.007), with 2-year overall survival rates of 40.0% and 32.8%, respectively. The median duration of response was 23.2 months with nivolumab plus ipilimumab and 6.2 months with chemotherapy. The overall survival benefit was also observed in patients with a PD-L1 expression level of less than 1%, with a median duration of 17.2 months (95% CI, 12.8 to 22.0) with nivolumab plus ipilimumab and 12.2 months (95% CI, 9.2 to 14.3) with chemotherapy. Among all the patients in the trial, the median duration of overall survival was 17.1 months (95% CI, 15.2 to 19.9) with nivolumab plus ipilimumab and 13.9 months (95% CI, 12.2 to 15.1) with chemotherapy. The percentage of patients with grade 3 or 4 treatment-related adverse events in the overall population was 32.8% with nivolumab plus ipilimumab and 36.0% with chemotherapy. First-line treatment with nivolumab plus ipilimumab resulted in a longer duration of overall survival than did chemotherapy in patients with NSCLC, independent of the PD-L1 expression level. No new safety concerns emerged with longer follow-up. (Funded by Bristol-Myers Squibb and Ono Pharmaceutical; CheckMate 227 ClinicalTrials.gov number, NCT02477826.)

First-Line Nivolumab Plus Ipilimumab in Advanced NSCLC : 4-Year Outcomes From the Randomized, Open-Label, Phase 3 CheckMate 227 Part 1 Trial

Introduction: In CheckMate 227, nivolumab plus ipilimumab prolonged overall survival (OS) versus chemotherapy in patients with tumor programmed death-ligand 1 (PD-L1) greater than or equal to 1% (primary end point) or less than 1% (prespecified descriptive analysis). We report results with minimum 4 years' follow-up. Methods: Adults with previously untreated stage IV or recurrent NSCLC were randomized (1:1:1) to nivolumab plus ipilimumab, nivolumab, or chemotherapy (PD-L1 ≥1%); or to nivolumab plus ipilimumab, nivolumab plus chemotherapy, or chemotherapy (PD-L1 <1%). Efficacy included OS and other measures. Safety included timing and management of immune-mediated adverse events (AEs). A post hoc analysis evaluated efficacy in patients who discontinued nivolumab plus ipilimumab due to treatment-related AEs (TRAEs). Results: After 54.8 months' median follow-up, OS remained longer with nivolumab plus ipilimumab versus chemotherapy in patients with PD-L1 greater than or equal to 1% (hazard ratio = 0.76; 95% confidence interval: 0.65–0.90) and PD-L1 less than 1% (0.64; 0.51–0.81); 4-year OS rate with nivolumab plus ipilimumab versus chemotherapy was 29% versus 18% (PD-L1 ≥1%); and 24% versus 10% (PD-L1 <1%). Benefits were observed in both squamous and nonsquamous histologies. In a descriptive analysis, efficacy was improved with nivolumab plus ipilimumab relative to nivolumab (PD-L1 ≥1%) and nivolumab plus chemotherapy (PD-L1 <1%). Safety was consistent with previous reports. The most common immune-mediated AE with nivolumab plus ipilimumab, nivolumab, and nivolumab plus chemotherapy was rash; most immune-mediated AEs (except endocrine events) occurred within 6 months from start of treatment and resolved within 3 months after, mainly with systemic corticosteroids. Patients who discontinued nivolumab plus ipilimumab due to TRAEs had long-term OS benefits, as seen in the all randomized population. Conclusions: At more than 4 years' minimum follow-up, with all patients off immunotherapy treatment for at least 2 years, first-line nivolumab plus ipilimumab continued to demonstrate durable long-term efficacy in patients with advanced NSCLC. No new safety signals were identified. Immune-mediated AEs occurred early and resolved quickly with guideline-based management. Discontinuation of nivolumab plus ipilimumab due to TRAEs did not have a negative impact on the long-term benefits seen in all randomized patients.</p