Otra forma de aprender: aulas de simulaci?n de Ferrol

Ponencia: "Outra forma de aprender: aulas de simulaci?n de Ferrol" presentada por Ram?n L?pez de los Reyes na Mesa Redonda 2 sobre "Proxectos innovadores na ?rea Sanitaria de Ferrol", na 1? Xornada de Innovaci?n en Sa?de da ?rea Sanitaria de Ferrol, celebrada en Ferrol o 22 de setembro de 2022.Ponencia: "Otra forma de aprender: aulas de simulaci?n de Ferrol" presentada por Ram?n L?pez de los Reyes en la Mesa Redonda 2 sobre "Proyectos innovadores en el ?rea Sanitaria de Ferrol", en la 1? Jornada de Innovaci?n en Salud del ?rea Sanitaria de Ferrol, celebrada en Ferrol el 22 de septiembre de 2022

Hospital general con unidad cardiovascular en la ciudad de Ibagu?

60 p. Recurso Electr?nicoEl hospital general con unidad cardiovascular localizado en la zona de expansi?n dispuesta por el plan de ordenamiento territorial (POT), es un proyecto que minimiza la crisis de salud por medio de infraestructura y cuerpo m?dico en la ciudad o departamento. Es producto al d?ficit de equipamientos de salud en Ibagu? y su prioridad o enfoque en las afecciones cardiovasculares, ya que es la principal causa de muerte en el Tolima. Est? compuesto por un juego de cinco vol?menes articulados, que concentran siete niveles; cada volumen adopta una funci?n espec?fica, lo mismo para cada nivel, donde se organizan las unidades puntuales del hospital; dando como resultado espacial, 15 consultorios m?dicos, una unidad de imagenologia general y otra cardiaca, la unidad de laboratorios y terapia, estos ubicados en el segundo nivel; en el tercer piso opera la unidad de quir?fanos y salas de recuperaci?n, el cuarto nivel la unidad de cuidados intensivos y del quinto al s?ptimo, la unidad de hospitalizaci?n. Continuo al volumen principal se ubica el volumen de servicios complementarios, dirigido a la pedagog?a m?dica, ?reas de comercio y zonas de estar. La propuesta ampliar?a la cobertura de salud de la ciudad y departamental, mejorando la calidad de vida para una falencia vigente; adem?s genera grandes oportunidades de orden f?sico, social, econ?mico y ambiental para un sector de futuro desarrollo de Ibagu?.The general hospital with a cardiovascular unit located in the expansion zone provided by the Territorial Order Plan (TOP) is a project that minimizes the health crisis through the infrastructure and the medical staff in the city or department. The project is a product of the deficit of health facilities in Ibagu?, Tolima and its priority are cardiovascular diseases, since it is the main cause of death in the region. It is composed of a set of five articulated volumes, which concentrate seven levels; each volume adopts a specific function, each level as well, where the specific units of the hospital are organized. As a result, in the second floor there are 15 medical clinics, a general imaging unit, a cardiac unit, laboratory and therapy unit. While in the third, there are the surgeon and recovery rooms. In the fourth there is the intensive care unit, and from the fifth to seventh, the hospitalization unit. The unit of complementary services is located next to the main unit; it is focused on medical pedagogy, areas of commerce, and living areas. The proposal will enhance the health coverage in the city and the department, improving the life quality. In addition, it generates great opportunities of physical, social, economic, and environmental order for a sector of future development in Ibagu?. Key words: health, hospital, unit, cardiology

CT Radiomics in Colorectal Cancer: Detection of KRAS Mutation Using Texture Analysis and Machine Learning

In this work, by using descriptive techniques, the characteristics of the texture of the CT (computed tomography) image of patients with colorectal cancer were extracted and, subsequently, classified in KRAS+ or KRAS-. This was accomplished by using different classifiers, such as Support Vector Machine (SVM), Grading Boosting Machine (GBM), Neural Networks (NNET), and Random Forest (RF). Texture analysis can provide a quantitative assessment of tumour heterogeneity by analysing both the distribution and relationship between the pixels in the image. The objective of this research is to demonstrate that CT-based Radiomics can predict the presence of mutation in the KRAS gene in colorectal cancer. This is a retrospective study, with 47 patients from the University Hospital, with a confirmatory pathological analysis of KRAS mutation. The highest accuracy and kappa achieved were 83% and 64.7%, respectively, with a sensitivity of 88.9% and a specificity of 75.0%, achieved by the NNET classifier using the texture feature vectors combining wavelet transform and Haralick coefficients. The fact of being able to identify the genetic expression of a tumour without having to perform either a biopsy or a genetic test is a great advantage, because it prevents invasive procedures that involve complications and may present biases in the sample. As well, it leads towards a more personalized and effective treatmentThis work has received financial support from the Xunta de Galicia (Centro singular de investigación de Galicia, accreditation 2020–2023) and the European Union (European Regional Development Fund—ERDF), Project MTM2016-76969-PS

Cost-Effectiveness Analysis of Apixaban Versus Edoxaban in Patients with Atrial Fibrillation for Stroke Prevention

OBJECTIVE: Our objective was to assess the cost effectiveness of apixaban versus edoxaban in the prevention of stroke and systemic embolism (SE) in patients with atrial fibrillation (AF) in Spain. METHODS: We customized a Markov model with ten health states to estimate the lifetime economic and clinical outcomes in 6-week cycles. The efficacy (clinical event rates per 100 patient-years) and safety data were derived from a pairwise indirect treatment comparison. The analysis was conducted from both the national health service (NHS) and societal perspectives, and included pharmaceutical costs (retail price plus value-added tax (VAT) and applicable national deductions) according to daily dosages (apixaban 10 mg (5 mg twice daily (bid)) and edoxaban 60 or 30 mg) and complications and disease-management costs, obtained from national databases. Utilities for quality-adjusted life-year (QALY) calculations reflected EuroQoL 5-Dimension scores in patients with AF. An annual discount rate of 3% was applied for costs (euro, year 2019 values) and outcomes. RESULTS: In a 1000-patient cohort, apixaban 5 mg bid versus edoxaban 60 mg could avoid five strokes, six major bleedings and 29 clinically relevant non-major bleedings (CRNMBs). Compared with edoxaban 30 mg, apixaban could avoid 21 strokes and two SEs. An increase in bleedings was observed with apixaban (seven haemorrhagic strokes, 48 major bleedings and 17 CRNMBs). Apixaban yielded 0.04 additional QALYs compared with edoxaban 60 mg or 30 mg. Incremental costs/QALY were euro9639.33 and euro354.22 for apixaban versus edoxaban 60 mg and edoxaban 30 mg, respectively, from the NHS perspective and euro7756.62 for apixaban versus edoxaban 60 mg from the societal perspective. Apixaban was dominant versus edoxaban 30 mg from the societal perspective. Sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: This study suggests that apixaban 5 mg bid is a cost-effective alternative to edoxaban for stroke prevention in the AF population in Spain

Cyclophilins in Ischemic Heart Disease: Differences Between Acute and Chronic Coronary Artery Disease Patients

Background: Cyclophilins (Cyps) are a family of peptidyl-prolyl cis/trans isomerases consistently involved in cardiovascular diseases through the inflammation pathway. This study aims to investigate the serum levels of Cyps (CypA, CypB, CypC and CypD) in patients with coronary artery disease (CAD) and the correlation with clinical characteristics and inflammation parameters. Methods: We developed an observational prospective study with a total of 125 subjects: 40 patients with acute CAD, 40 patients with chronic CAD and 45 control volunteers, in whom serum levels of Cyps (CypA, CypB, CypC and CypD), interleukins and metalloproteinases were measured. Results: CypA levels increased significantly in CAD patients compared with control subjects, but no differences were noted between acute CAD (7.80 +/- 1.30 ng/mL) and chronic CAD (5.52 +/- 0.76 ng/mL) patients (P = 0.13). No differences in CypB and CypD levels were showed between CAD patients and controls and between acute CAD and chronic CAD patients. In relation with CypC, the levels in CAD patients were significantly higher compared to controls (32.42 +/- 3.71 pg/mL vs. 9.38 +/- 1.51 pg/mL, P 17.5 pg/mL cut-off point, and it was significantly associated with older age, hypertension, dyslipidemia and more extensive CAD in acute and chronic CAD groups. Conclusions: CypA and CypC levels are increased in CAD patients. High CypC serum levels could be a novel biomarker in CAD patients correlating with a more severe disease

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis

Identifying the complexities of the effect of sex on stroke risk, etiology, and lesion progression may lead to advances in the treatment and care of ischemic stroke (IS) and non-traumatic intracerebral hemorrhage patients (ICH). We studied the sex-related discrepancies on the clinical course of patients with IS and ICH, and we also evaluated possible molecular mechanisms involved. The study's main variable was the patient's functional outcome at 3-months. Logistic regression models were used in order to study the influence of sex on different inflammatory, endothelial and atrial dysfunction markers. We recruited 5,021 patients; 4,060 IS (54.8% male, 45.2% female) and 961 ICH (57.1% male, 42.9% female). Women were on average 5.7 years older than men (6.4 years in IS, 5.1 years in ICH), and more likely to have previous poor functional status, to suffer atrial fibrillation and to be on anticoagulants. IS patients showed sex-related differences at 3-months regarding poorer outcome (55.6% women, 43.6% men, p < 0.0001), but this relationship was not found in ICH (56.8% vs. 61.9%, p = 0.127). In IS, women had higher levels of NT-proBNP and 3-months worse outcome in both cardioembolic and non-cardioembolic stroke patients. Stroke patients showed sex-related differences in pre-hospital data, clinical variables and molecular markers, but only IS patients presented independent sex-related differences in 3-months poor outcome and mortality. There was a relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, resulting in a possible indicator of increased dysfunction

Perturbative evolution of particle orbits around Kerr black holes: time domain calculation

Treating the Teukolsky perturbation equation numerically as a 2+1 PDE and smearing the singularities in the particle source term by the use of narrow Gaussian distributions, we have been able to reproduce earlier results for equatorial circular orbits that were computed using the frequency domain formalism. A time domain prescription for a more general evolution of nearly geodesic orbits under the effects of radiation reaction is presented. This approach can be useful when tackling the more realistic problem of a stellar-mass black hole moving on a generic orbit around a supermassive black hole under the influence of radiation reaction forces.Comment: 8 pages, 5 figures, problems with references and double-printing fixe

Intra- and extra-hospital improvement in ischemic stroke patients: influence of reperfusion therapy and molecular mechanisms

Neuroprotective treatments in ischemic stroke are focused to reduce the pernicious effect of excitotoxicity, oxidative stress and inflammation. However, those cellular and molecular mechanisms may also have beneficial effects, especially during the late stages of the ischemic stroke. The objective of this study was to investigate the relationship between the clinical improvement of ischemic stroke patients and the time-dependent excitotoxicity and inflammation. We included 4295 ischemic stroke patients in a retrospective study. The main outcomes were intra and extra-hospital improvement. High glutamate and IL-6 levels at 24 hours were associated with a worse intra-hospital improvement (OR:0.993, 95%CI: 0.990-0.996 and OR:0.990, 95%CI: 0.985-0.995). High glutamate and IL-6 levels at 24 hours were associated with better extra-hospital improvement (OR:1.13 95%CI, 1.07-1.12 and OR:1.14, 95%CI, 1.09-1.18). Effective reperfusion after recanalization showed the best clinical outcome. However, the long term recovery is less marked in patients with an effective reperfusion. The variations of glutamate and IL6 levels in the first 24 hours clearly showed a relationship between the molecular components of the ischemic cascade and the clinical outcome of patients. Our findings suggest that the rapid reperfusion after recanalization treatment blocks the molecular response to ischemia that is associated with restorative processes

Regulatory T cells participate in the recovery of ischemic stroke patients

BACKGROUND: Recent preclinical studies have shown that regulatory T cells (Treg) play a key role in the immune response after ischemic stroke (IS). However, the role of Treg in human acute IS has been poorly investigated. Our aim was to study the relationship between circulating Treg and outcome in human IS patients. METHODS: A total of 204 IS patients and 22 control subjects were recruited. The main study variable was good functional outcome at 3 months (modified Rankin scale </=2) considering infarct volume, Early Neurological Deterioration (END) and risk of infections as secondary variables. The percentage of circulating Treg was measured at admission, 48, 72 h and at day 7 after stroke onset. RESULTS: Circulating Treg levels were higher in IS patients compared to control subjects. Treg at 48 h were independently associated with good functional outcome (OR, 3.5; CI: 1.9-7.8) after adjusting by confounding factors. Patients with lower Treg at 48 h showed higher frequency of END and risk of infections. In addition, a negative correlation was found between circulating Treg at 48 h (r = - 0.414) and 72 h (r = - 0.418) and infarct volume. CONCLUSIONS: These findings suggest that Treg may participate in the recovery of IS patients. Therefore, Treg may be considered a potential therapeutic target in acute ischemic stroke