Perspectivas de un grupo de adultos mayores frente al trato que han recibido de su familia y los servicios de salud

Enfermero (a)Pregrad

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

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

Los riesgos del puntivismo, presunción de inocencia e indignidad carcelaria en Colombia

Este libro es el resultado de las investigaciones realizadas, durante 2018, por la Red de Investigadores del Centro de Investigación en Política Criminal de la Universidad Externado de Colombia, y presentadas en el Congreso Internacional "Presunción de inocencia, libertad y abolicionismo", en el cual se discutieron los efectos y riesgos que tiene el punitivismo en el ejercicio de la presunción de inocencia. Esta publicación pretende generar reflexiones a partir del estudio de casos sobre distintas situaciones que se presentan en el interior de las cárceles colombianas y que atentan contra la dignidad de la población privada de la libertad, en especial la población más vulnerable: los adultos mayores, las mujeres y los indígenas, etcétera. En este sentido, es un llamado a los distintos actores –entre otros, las autoridades del sistema de política criminal, la academia, los miembros de la sociedad civil y los medios de comunicación– para que de manera introspectiva y crítica examinemos la presunción de inocencia no como un principio estático sino como un principio vivo que se manifiesta en las diferentes etapas de la política criminal y cuya mala aplicación está teniendo graves consecuencias en la dignidad de la población privada de la libertad

Política criminal y abolicionismo, hacia una cultura restaurativa

Este libro es el producto de las investigaciones realizadas durante el año 2017 que fueron presentadas en el Congreso internacional: “Perspectivas críticas de la política criminal y el abolicionismo”, donde se generaron reflexiones sobre la cultura del castigo y se plantearon las distintas alternativas abolicionistas. La publicación está dividida en dos partes, la primera parte del libro se denomina “De la cultura de castigo a una cultura restaurativa”, la cual contiene cinco capítulos que abordan desde una perspectiva crítica el punitivismo de la política criminal y el uso excesivo de la sanción privativa de la libertad. De igual forma explora la justicia transicional y la justicia restaurativa como posibles alternativas a la política criminal retributiva y una forma de promover la reconstrucción de los lazos sociales rotos. La segunda parte del libro titulada, “Los efectos de la política criminal punitivista en la población vulnerable”, contiene ocho capítulos que analizan la exclusión, el estigma y la marginalización que sufren mujeres, grupos indígenas, adultos mayores privados de la libertad y cuando cumplen su pena y recuperan la libertad, por lo cual surge la necesidad de generar transformaciones donde se transite hacia escenarios de reconciliación, la desnaturalización del punitivismo y el reconocimiento de la dignidad humana

Memorias semana de la Facultad de Educación. VII semana: historias, saberes y prácticas educativas innovadoras e incluyentes.

Las Memorias de la VII Semana de la Educación “Historias, saberes y prácticas educativas innovadoras e incluyentes”, publicadas por la Editorial de la Corporación Universitaria Minuto de Dios – UNIMINUTO, reúnen las ponencias y resúmenes sobre esta temática presentadas en un evento de realización anual, cuyo propósito es socializar experiencias investigativas y académicas de grupos, semilleros de investigación y trabajos de grado entre estudiantes y profesores de la Facultad de Educación, y con profesores y estudiantes de otras instituciones educativas que gentilmente compartieron experiencias en el campo de la educación, la pedagogía, el arte, la cultura y el deporte. El principal interés de este encuentro radica en recoger la construcción histórica educativa de la Corporación Universitaria Minuto de Dios – UNIMINUTO con respecto a sus orígenes y construcciones académicas; y las experiencias históricas de otras propuestas educativas a nivel de la educación infantil, básica, media y superior con tejido cultural y social, desde un enfoque diferencial y diverso en el cual todas las experiencias enriquecen la formación de maestros desde la innovación e inclusión en los diferentes contextos. En este encuentro participaron las universidades Antonio Nariño, de la Amazonia, del Rosario, La Gran Colombia y Pedagógica Nacional, así como la Corporación Escuela Pedagógica Experimental, el Centro Educativo de Nuestra Señora de la Paz, el Instituto Colombo Sueco y varios docentes de la Secretaría de Educación Distrital de Bogotá D. C

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

International audienceBackground: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/ hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH 2 O, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmH 2 O, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

Background: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p &lt; 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH2O, p &lt; 0.001), plateau (20 [15-23] vs 22 [19-26] cmH2O, p &lt; 0.001) and peak (21 [17-27] vs 26 [20-32] cmH2O, p &lt; 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p &lt; 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073