Utilidad del electrocardiograma de 12 derivaciones para localizar la arteria responsable del infarto de miocardio inferior con elevación del ST

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de Lectura: 13-09-202

High-Resolution Optical Thickness Measurement Based on Electro-Optic Dual-Optical Frequency Comb Sources

We propose an optical thickness measurement device based on electro-optic dual-optical frequency combs (dual-OFCs). Optical frequency combs (OFCs) are light sources that provide an optical signal consisting of many equidistant monochromatic tones. In this paper, we present an agile dual-OFC architecture with adjustable frequency separation of the comb modes and total frequency span, allowing high-resolution measurements of the thickness of transparent thick samples. This architecture is based on a single continuous-wave laser diode and external electro-optic devices to implement the dual-comb sensor, allowing easy control of the optical spectrum of the interrogation source (dual-OFC). As it is characteristic of dual-OFC systems, the optical transmittance function of the sample (etalon) is directly translated to the radiofrequency domain, where detection, demodulation, and processing of signals are performed. The shift in the complexity of implementation from the optical to the electronic domain yields many advantages, as acquisition and signal processing are made independently on the optical characteristics of the sample (thickness).This work was supported by the Spanish Ministry of Economy and Competitiveness under the RTC-2015-4205-4 Salicar and TEC-2014-52147-R Mossi grants

Ischaemic conditioning and targeting reperfusion injury: a 30 year voyage of discovery

To commemorate the auspicious occasion of the 30th anniversary of IPC, leading pioneers in the field of cardioprotection gathered in Barcelona in May 2016 to review and discuss the history of IPC, its evolution to IPost and RIC, myocardial reperfusion injury as a therapeutic target, and future targets and strategies for cardioprotection. This article provides an overview of the major topics discussed at this special meeting and underscores the huge importance and impact, the discovery of IPC has made in the field of cardiovascular research

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Aprendiendo a aprender. Reflexiones de los profesores sobre el ABP

El ABP es un método didáctico para promover la participación activa del estudiante y abordar la complejidad del “aprender a aprender” (Branda, 2009), pero no está exento de dificultades. Este trabajo es el resultado de una investigación cualitativa realizada para mejorar la implementación del ABP en la Facultad de Ciencias de la Salud de la Universidad Europea de Madrid (UEM), durante los cursos 2012-13 y 2013-14. El método utilizado ha sido la investigación-acción. Las técnicas de recogida de información han sido: grupos de discusión con profesores y estudiantes y, diario de campo de los profesores. El propósito es presentar las reflexiones de los profesores de manera que nuestra experiencia pueda ser útil para otros colegas en la implementación de esta metodología docente. Conclusiones: El ABP requiere un planteamiento educativo diferente, no es solo cuestión de cambiar de metodología. El papel del docente y los estudiantes cambian la forma de aprendizaje, ambos tiene que aprender a aprender y esto es algo complejo que requiere reflexión de los docentes y la institución.SIN FINANCIACIÓNNo data 2015UE

Circadian variations of infarct size in acute myocardial infarction

Estudio retrospectivo unicéntrico que evaluó a 811 pacientes con un infarto agudo de miocardio. El estudio comparó el momento en el que presentaron el evento con el tamaño del infarto. Se pudo comprobar que los infartos fueron mas grandes en pacientes que lo padecieron durante la transición noche-día (entre las 6.00 y 12.00 am), resultados que ayudaron a interpretar el efecto cardioprotector de otras estrategias terapéuticas en pacientes con infarto de miocardio en ensayos clínicos posteriores.Background: The circadian clock influences a number of cardiovascular (patho)physiological processes including the incidence of acute myocardial infarction. A circadian variation in infarct size has recently been shown in rodents, but there is no clinical evidence of this finding. Objective: To determine the impact of time-of-day onset of ST segment elevation myocardial infarction (STEMI) on infarct size. Methods: A retrospective single-centre analysis of 811 patients with STEMI admitted between 2003 and 2009 was performed. Infarct size was estimated by peak enzyme release. The relationship between peak enzyme concentrations and time-of-day were characterised using multivariate regression splines. Time of STEMI onset was divided into four 6-hour periods in phase with circadian rhythms. Results: Model comparisons based on likelihood ratio tests showed a circadian variation in infarct size across time-of-day as evaluated by peak creatine kinase (CK) and troponin-I (TnI) concentrations (p=0.015 and p=0.012, respectively). CK and TnI curves described similar patterns across time, with a global maximum in the 6:00-noon period and a local minimum in the noon-18:00 period. Infarct size was largest in patients with STEMI onset in the dark-to-light transition period (6:00-noon), with an increase in peak CK and TnI concentrations of 18.3% (p=0.031) and 24.6% (p=0.033), respectively, compared with onset of STEMI in the 18:00-midnight period. Patients with anterior wall STEMI also had significantly larger infarcts than those with STEMI in other locations. Conclusions: Significant circadian oscillations in infarct size were found in patients according to time-of-day of STEMI onset. The infarct size was found to be significantly larger with STEMI onset in the dark-to-light transition period (6:00-noon). If confirmed, these results may have a significant impact on the interpretation of clinical trials of cardioprotective strategies in STEMIDepto. de MedicinaFac. de MedicinaTRUEpu

Mejorar la práctica del aprendizaje basado en problemas a través de la investigación-acción

SIN FINANCIACIÓNNo data 201

Manuale di Chirurgia Generale

Dal continuo lavoro del corpo docenti dell’Accademia Italiana Medici Specializzandi (AIMS) nasce questa sesta edizione del Manuale di Chirurgia Generale - Sesta Edizione 2020. Si tratta di un testo specificamente pensato per la preparazione del laureato in Medicina e Chirurgia affinché possa affrontare efficacemente il nuovo Concorso delle Scuole di Specializzazione Mediche: è una risorsa schematica, sintetica e aggiornata in base alle più recenti linee guida che consente uno studio rapido della disciplina. La trattazione semplice ma, al tempo stesso, rigorosa, stimola la capacità di ragionamento clinico del giovane medico che ne affronta lo studio e rende quest’opera un strumento valido, unico nel suo genere e complementare alla preparazione del corso di preparazione AIMS. L’intera Opera è corredata da una grande varietà di immagini e schemi, pensati per facilitare la comprensione e la memorizzazione degli argomenti trattati