Mural Endocarditis: The GAMES Registry Series and Review of the Literature

Introduction: Mural infective endocarditis (MIE) is a rare type of endovascular infection. We present a comprehensive series of patients with mural endocarditis. Methods: Patients with infectious endocarditis (IE) from 35 Spanish hospitals were prospectively included in the GAMES registry between 2008 and 2017. MIEs were compared to non-MIEs. We also performed a literature search for cases of MIE published between 1979 and 2019 and compared them to the GAMEs series. Results: Twenty-seven MIEs out of 3676 IEs were included. When compared to valvular IE (VIE) or device-associated IE (DIE), patients with MIE were younger (median age 59 years, p \0.01). Transplantation (18.5% versus 1.6% VIE and 2% DIE, p \ 0.01), hemodialysis (18.5% versus 4.3% VIE and 4.4% DIE, p = 0.006), catheter source (59.3% versus 9.7% VIE and 8.8% DIE, p \ 0.01) and Candida etiology (22.2% versus 2% DIE and 1.2% VIE, p \ 0.01) were more common in MIE, whereas the Charlson Index was lower (4 versus 5 in non MIE, p = 0.006). Mortality was similar.MIE from the literature shared many characteristics with MIE from GAMES, although patients were younger (45 years vs. 56 years, p \ 0.001), the Charlson Index was lower (1.3 vs. 4.3, p = 0.0001), catheter source was less common (13.9% vs. 59.3%) and there were more IVDUs (25% vs. 3.7%). S. aureus was the most frequent microorganism (50%, p = 0.035). Systemic complications were more common but mortality was similar. Conclusion: MIE is a rare entity. It is often a complication of catheter use, particularly in immunocompromised and hemodialysis patients. Fungal etiology is common. Mortality is similar to other IEs

Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry

(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects

Plan de Acción Tutorial Integrado, en Educación

En el proyecto que se presenta se parte no solamente de una amplia trayectoria de los Grados de la Facultad de Ciencias de la Educación de la UGR en orientación universitaria, sino, además, de una necesidad patente plasmada en los Objetivos Estratégicos que se incluyen dentro del Sistema para la Garantía de la Calidad de la Facultad; siendo el segundo objetivo “Orientación y tutoría académica”, y una de sus acciones (Plan Director 19-21): Crear curriculum complementario para los estudiantes (desarrollo de competencias transversales a través de un PAT). Otras acciones relacionadas y en las que continuamos trabajando en el Plan Director 22 24 son Establecer acciones de tutorización coordinadas y complementarias al PAT, formar a los tutores de grupo-curso, establecer un plan general de orientación profesional y empleabilidad, potenciar la orientación académica y profesional de los estudiantes NEAE, entre otras. Con el diseño del Plan de Acción Tutorial Integrado, en Educación, se pretende desarrollar en el estudiantado de los Grados en Pedagogía, Ed. Social, Ed. Infantil y Ed. Primaria, competencias transversales que complementen su formación académica y le ayuden en su desarrollo académico, personal y profesional. En él participará profesorado, alumnado y PAS de la Facultad, no solamente para fomentar su sentimiento de pertenencia y favorecer un clima de comunidad universitaria, sino además, para enriquecerse unos a otros, aprendiendo juntos, solventando dudas, guiando, orientando y haciendo que el paso por la Universidad de todo el alumnado que participe del mismo, sea lo más enriquecedor y productivo posible, logrando un elevado rendimiento académico, un adecuado desarrollo personal y un posterior futuro profesional colmado de éxitos. Para ello se ha llevado a cabo un análisis de necesidades mediante el Cuestionario para detección de necesidades formativas transversales del alumnado en la Facultad de Ciencias de la Educación (Escala de competencias transversales del cuestionario CECTGRA de Martínez y González, 2018), a partir del cual se diseñan diferentes talleres orientados a cada curso según sus intereses, motivaciones y necesidades, haciendo una posterior evaluación de los resultados y un análisis de los mismos. Se ha logrado además del diseño del PAT, dotar de unidad a todas las actividades que desde la Facultad se realizaban en torno a la orientación del estudiantado. Se ha realizado un esfuerzo porque los resultados obtenidos se vean reflejados en las diferentes materias, no solamente a nivel transversal sino de forma directa. Por ejemplo, al trabajarse la normativa APA se ha introducido este punto en las rúbricas de evaluación de diferentes asignaturas para, de este modo, relacionar su aprendizaje con la evaluación y rendimiento académico. Al centrarse el primer curso fundamentalmente en el análisis de necesidades, la asistencia ha sido mucho mayor en el segundo curso (21-22), haciendo especial hincapié en la difusión de las actividades, siguiendo el Plan de Comunicación del Centro, a través de la web de la Facultad y de la figura de los tutores de grupo curso. Un objetivo a largo plazo, es incluir las competencias aprendidas en los talleres dirigidos al estudiantado de 4º en la calificación del Trabajo Fin de Grado. Este punto no ha dado tiempo a consolidarlo en dos cursos académicos, pero seguiremos trabajando en ello ya que consideramos que es fundamental además de poder dar de esta forma respuesta a una de las alegaciones realizadas por la DEVA en el informe de la renovación de la acreditación de los Grados.This project is based not only on a wide trajectory of the Degrees of the Faculty of Education Sciences of the UGR in university orientation, but, in addition, from a patent need embodied in the Strategic Objectives that are included within the System for the Guarantee of the Quality of the Faculty; the second objective being "Academic guidance and tutoring", and one of its actions (Master Plan 19-21): Create complementary curriculum for students (development of transversal competences through a PAT). Other related actions and in which we continue to work in the Master Plan 22 24 are To establish coordinated and complementary tutoring actions to the PAT, to train the group-course tutors, to establish a general plan of professional orientation and employability, to enhance the academic and professional orientation of the NEAE students, among others. With the design of the Integrated Tutorial Action Plan, in Education, it is intended to develop in the students of the Degrees in Pedagogy, Social Ed., Infant Ed. and Primary Ed., transversal competences that complement their academic training and help them in their academic, personal and professional development. It will involve teachers, students and PAS of the Faculty, not only to promote the feeling of belonging of the same and favor a climate of university community, but, in addition, to enrich each other, learning together, solving doubts, guiding, guiding and making the passage through the University of all the students who participate in it, as enriching and productive as possible, achieving a high academic performance, a competent personal development and a subsequent professional future full of successes. To this end, a needs analysis has been carried out (through the Questionnaire for the detection of transversal training needs of students in the Faculty of Education Sciences (Scale of transversal competences of the CECTGRA questionnaire of Martínez y González, 2018), reflected in different workshops oriented to each course according to their interests, motivations and needs, making a subsequent evaluation of the results and analysis of them. It has been achieved in addition to the design of the PAT, to provide unity to all the activities that from the Faculty were carried out around the orientation of the students. We have worked so that the results obtained are reflected in the different subjects, not only at a transversal level but directly. For example, when working on the APA regulations, it has been introduced in the evaluation rubrics of different subjects in order to relate their learning with evaluation and academic performance. By focusing the first course mainly on the analysis of needs, the attendance has been much higher in the second year (21 22), with special emphasis on the dissemination of the activities, following the Communication Plan of the Center, through the website of the Faculty and the figure of the tutors of the course group. A long-term objective is to include the skills learned in the workshops of the 4th grade students in the TFG qualification. This point has not given time to consolidate it in two academic years but we will continue working on it since we consider that it is fundamental in addition to being able to respond in this way to one of the allegations made by the DEVA in the report of the renewal of the accreditation of the Degrees.Unidad de Calidad, Innovación Docente y Prospectiva. Universidad de Granada

Discourse Analysis and Terminology in Languages for Specific Purposes

Aquest importantíssim recull conté estudis i reflexions sobre temes rellevants en la recerca sobre LSP: anglès mèdic, el llenguatge de la publicitat i periodístic, telecomunicacions i terminologia informàtica, llenguatge comercial i jurídic... Malgrat que gran part dels treballs aplegats es refereixen a l'anglès, també hi ha que tracten l'alemany, francès i altres llengües. Conté textos en anglès, francés, portuguès i castellà

Diverse Large HIV-1 Non-subtype B Clusters Are Spreading Among Men Who Have Sex With Men in Spain

In Western Europe, the HIV-1 epidemic among men who have sex with men (MSM) is dominated by subtype B. However, recently, other genetic forms have been reported to circulate in this population, as evidenced by their grouping in clusters predominantly comprising European individuals. Here we describe four large HIV-1 non-subtype B clusters spreading among MSM in Spain. Samples were collected in 9 regions. A pol fragment was amplified from plasma RNA or blood-extracted DNA. Phylogenetic analyses were performed via maximum likelihood, including database sequences of the same genetic forms as the identified clusters. Times and locations of the most recent common ancestors (MRCA) of clusters were estimated with a Bayesian method. Five large non-subtype B clusters associated with MSM were identified. The largest one, of F1 subtype, was reported previously. The other four were of CRF02_AG (CRF02_1; n = 115) and subtypes A1 (A1_1; n = 66), F1 (F1_3; n = 36), and C (C_7; n = 17). Most individuals belonging to them had been diagnosed of HIV-1 infection in the last 10 years. Each cluster comprised viruses from 3 to 8 Spanish regions and also comprised or was related to viruses from other countries: CRF02_1 comprised a Japanese subcluster and viruses from 8 other countries from Western Europe, Asia, and South America; A1_1 comprised viruses from Portugal, United Kingom, and United States, and was related to the A1 strain circulating in Greece, Albania and Cyprus; F1_3 was related to viruses from Romania; and C_7 comprised viruses from Portugal and was related to a virus from Mozambique. A subcluster within CRF02_1 was associated with heterosexual transmission. Near full-length genomes of each cluster were of uniform genetic form. Times of MRCAs of CRF02_1, A1_1, F1_3, and C_7 were estimated around 1986, 1989, 2013, and 1983, respectively. MRCA locations for CRF02_1 and A1_1 were uncertain (however initial expansions in Spain in Madrid and Vigo, respectively, were estimated) and were most probable in Bilbao, Spain, for F1_3 and Portugal for C_7. These results show that the HIV-1 epidemic among MSM in Spain is becoming increasingly diverse through the expansion of diverse non-subtype B clusters, comprising or related to viruses circulating in other countries

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 5

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 5, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research