Evaluación in vitro del tratamiento para la queratitis por Acanthamoeba: revisión metodológica

La queratitis por Acanthamoeba, pese a tener un pronóstico incierto todavía no cuenta con un tratamiento eficaz. Dado que las pruebas in vivo de nuevos tratamientos suponen la utilización de modelos animales, su evaluación in vitro es imprescindible. Existen hasta la fecha numerosos estudios probando múltiples compuestos; destacando los que evalúan la eficacia de la clorhexidina, PHMB y propamidina isetionato, por ser la primera línea empleada de manera empírica en la práctica clínica. Antifúngicos como ketoconazol o anfotericina B; antiobióticos pertenecientes a los amigoglucósidos o quinolonas y antiprotozoarios como la miltefosina o la pentamidina también han sido analizados in vitro. Además se han evaluado extractos procedentes de plantas basados en la sabiduría popular y en el hecho de que han mostrado eficacia de manera aislada en otras infecciones bacterianas, víricas o parasitarias y algunos compuestos de estructuras mucho más complejas. Sin embargo, pese a existir tantos estudios en esta línea con tantas posibilidades terapéuticas, la comparación de los mismos se ve dificultada por la falta de estandarización. Dentro de cada grupo; el número y procedencia de las amebas empleadas es diferente para cada estudio; las unidades de concentración utilizadas para un mismo compuesto difieren y también lo hace el método de interpretación de los resultados obtenidos. Este trabajo lleva a cabo la revisión de estos estudios, para comparar tanto la metodología como los resultados obtenidos por los diferentes autores y facilitar el avance en las evaluaciones de estos mismos compuestos o de otros nuevos para conseguir un tratamiento, al menos prometedor, para la queratitis por Acanthamoeba.<br /

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

La expresión oral y escrita, objetivo fundamental de calidad de la enseñanza

Convocatoria de Proyectos de innovación de Extremadura 2017/2018Se describe un proyecto llevado a cabo en el IES Miguel Durán (Azuaga, Badajoz) desarrollado dentro del Sistema de Gestión de Calidad del centro, que tenía como objetivo principal que los alumnos adquirieran las competencias necesarias para una correcta expresión oral y escrita (mejora de la competencia informacional y las competencias comunicativa e idiomática). Para conseguir el objetivo se organizaron distintas actividades promovidas por el Grupo de Trabajo de la Biblioteca del centro: fomento de la lectura, feria del libro, Día de la poesía, diversas actividades de lectura en la biblioteca, club de lectura con libros digitales, etc., así como la realización de otras actividades y la elaboración de materiales por parte de los distintos departamentos del instituto como: exposiciones de los alumnos ante el aula, lectura en distintos soportes, realización de trabajos de investigación, actividades de enriquecimiento del vocabulario, etc.ExtremaduraES

The database of the PREDICTS (Projecting Responses of Ecological Diversity In Changing Terrestrial Systems) project

The PREDICTS project—Projecting Responses of Ecological Diversity In Changing Terrestrial Systems (www.predicts.org.uk)—has collated from published studies a large, reasonably representative database of comparable samples of biodiversity from multiple sites that differ in the nature or intensity of human impacts relating to land use. We have used this evidence base to develop global and regional statistical models of how local biodiversity responds to these measures. We describe and make freely available this 2016 release of the database, containing more than 3.2 million records sampled at over 26,000 locations and representing over 47,000 species. We outline how the database can help in answering a range of questions in ecology and conservation biology. To our knowledge, this is the largest and most geographically and taxonomically representative database of spatial comparisons of biodiversity that has been collated to date; it will be useful to researchers and international efforts wishing to model and understand the global status of biodiversity