Inteligencia artificial y heridas: avances, limitaciones y perspectivas en la educación médica

En este artículo, se aborda el tema de la inteligencia artificial (IA) aplicada a la detección y gestión de heridas en el campo de la medicina. Se revisan cinco estudios científicos que exploran el uso de IA en diversas áreas de la medicina relacionadas con heridas. El objetivo principal es analizar los avances, limitaciones y perspectivas de la IA en la educación médica para el manejo de heridas, considerando la IA como una herramienta potencialmente valiosa en el abordaje especifico de diferentes tipos de heridas

1,10a-Dihydro-1-aza-10a-boraphenanthrene and 6a,7-Dihydro-7-aza-6a-boratetraphene: Two New Fluorescent BN-PAHs

Previously unknown 1,10a-dihydro-1-aza-10a-boraphenanthreneand 6a,7-dihydro-7-aza-6a-boratetraphene have been efficiently synthesized.Bromination of these BN-PAHs proceeds with complete regioselectivity, resultingin the formation of different substituted derivatives via cross-coupling reactions.These compounds exhibit rather highfluorescence quantum yields (up to?F=0.80)Ministerio de Ciencia e InnovaciónUniversity of AlcaláInstituto de Salud Carlos II

Análisis del entrenamiento pliométrico como trabajo de transferencia de la electroestimulación neuromuscular

P. 88-93Estudio sobre la influencia de la estimulación eléctrica neuromuscular (EENM) en el rendimiento físico en estudiantes de educación física. Se concluye que: 1) La EENM de alta frecuencia suplementada con un trabajo pliométrico mejora la fuerza máxima isométrica (FMI), hipertrofia, explosividad y velocidad, en el cuádriceps; 2) Dichas mejoras no son tan acusadas como las encontradas en la hipertrofia y FMI cuando sólo se aplica EENM; tampoco son tan acusadas como las encontradas en la explosividad y velocidad cuando sólo se lleva a cabo un entrenamiento pliométrico, ocupando un nivel intermedio entre ambas adaptaciones; 3) El entrenamiento pliométrico puede ser un buen trabajo de transferencia para evitar que los aumentos de FMI e hipertrofia asociados al entrenamiento con EENM disminuyan los valores de explosividad y velocidad. Futuros estudios debieran aislar y analizar, siguiendo un protocolo similar, los efectos de estas adaptaciones que pudieran deberse sólo al entrenamiento pliométricoS

Identification of ncRNAs as Potential Therapeutic Targets in Multiple Sclerosis Through Differential ncRNA – mRNA Network Analysis

Background: Several studies have revealed a potential role for both small nucleolar RNAs (snoRNAs) and microRNAs (miRNAs) in the physiopathology of relapsing-remitting multiple sclerosis (RRMS). This potential implication has been mainly described through differential expression studies. However, it has been suggested that, in order to extract additional information from large-scale expression experiments, differential expression studies must be complemented with differential network studies. Thus, the present work is aimed at the identification of potential therapeutic ncRNA targets for RRMS through differential network analysis of ncRNA - mRNA coexpression networks. ncRNA - mRNA coexpression networks have been constructed from both selected ncRNA (specifically miRNAs, snoRNAs and sdRNAs) and mRNA large-scale expression data obtained from 22 patients in relapse, the same 22 patients in remission and 22 healthy controls. Condition-specific (relapse, remission and healthy) networks have been built and compared to identify the parts of the system most affected by perturbation and aid the identification of potential therapeutic targets among the ncRNAs. Results: All the coexpression networks we built present a scale-free topology and many snoRNAs are shown to have a prominent role in their architecture. The differential network analysis (relapse vs. remission vs. controls' networks) has revealed that, although both network topology and the majority of the genes are maintained, few ncRNA - mRNA links appear in more than one network. We have selected as potential therapeutic targets the ncRNAs that appear in the disease-specific network and were found to be differentially expressed in a previous study. Conclusions: Our results suggest that the diseased state of RRMS has a strong impact on the ncRNA - mRNA network of peripheral blood leukocytes, as a massive rewiring of the network happens between conditions. Our findings also indicate that the role snoRNAs have in targeted gene silencing is a widespread phenomenon. Finally, among the potential therapeutic target ncRNAs, SNORA40 seems to be the most promising candidate.This work has been supported partially by Fondo de investigacion Sanitaria from Instituto Carlos III through the project FIS PS09/02105, by SAIOTEK (SAIO11-PC11BN003) and by the Spanish Net of Multiple Sclerosis. HI and MMC has been supported by departamento de educacion del Gobierno Vasco through a PhD grant

Anti-IL-6 Receptor Tocilizumab in Refractory Graves? Orbitopathy: National Multicenter Observational Study of 48 Patients

Graves’ orbitopathy (GO) is the most common extrathyroidal manifestation of Graves’ disease (GD). Our aim was to assess the e cacy and safety of Tocilizumab (TCZ) in GO refractory to conventional therapy. This was an open-label multicenter study of glucocorticoid-resistant GO treated with TCZ. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity Score (CAS) and intraocular pressure (IOP). These outcome variables were assessed at baseline, 1st, 3rd, 6th and 12th month after TCZ therapy onset. The severity of GO was assessed according to the European Group on Graves’ Orbitopathy (EUGOGO). We studied 48 (38 women and 10 men) patients (95 eyes); mean age standard deviation 51 11.8 years. Before TCZ and besides oral glucocorticoids, they had received IV methylprednisolone (n = 43), or selenium (n = 11). GO disease was moderate (n =29) or severe (n = 19) and dysthyroid optic neuropathy (DON) (n = 7). TCZ was used in monotherapy (n = 45) or combined (n = 3) at a dose of 8 mg/kg IV every four weeks (n = 43) or 162 mg/s.c. every week (n = 5). TCZ yielded a significant improvement in all of the main outcomes at the 1st month that was maintained at one year. Comparing the baseline with data at 1 year all of the variables improved; BCVA (0.78 0.25 vs. 0.9 0.16; p = 0.0001), CAS (4.64 1.5 vs. 1.05 1.27; p = 0.0001) and intraocular pressure (IOP) (19.05 4.1 vs. 16.73 3.4 mmHg; p = 0.007). After a mean follow-up of 16.1 2.1 months, low disease activity (CAS 3), was achieved in 88 eyes (92.6%) and TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or ine cacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment.This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain)

Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

PROBAC REIPI/GEIH-SEIMC/SAEI Group.The epidemiology of bloodstream infections (BSIs) is dynamic as it depends on microbiological, host and healthcare system factors. The aim of this study was to update the information regarding the epidemiology of BSIs in Spain considering the type of acquisition. An observational, prospective cohort study in 26 Spanish hospitals from October 2016 through March 2017 including all episodes of BSI in adults was performed. Bivariate analyses stratified by type of acquisition were performed. Multivariate analyses were performed by logistic regression. Overall, 6345 BSI episodes were included; 2510 (39.8%) were community-acquired (CA), 1661 (26.3%) were healthcare-associated (HCA) and 2056 (32.6%) hospital-acquired (HA). The 30-day mortality rates were 11.6%, 19.5% and 22.0%, respectively. The median age of patients was 71 years (interquartile range 60–81 years) and 3656 (58.3%; 95% confidence interval 57.1–59.6%) occurred in males. The proportions according to patient sex varied according to age strata. Escherichia coli (43.8%), Klebsiella spp. (8.9%), Staphylococcus aureus (8.9%) and coagulase-negative staphylococci (7.4%) were the most frequent pathogens. Multivariate analyses confirmed important differences between CA and HCA episodes, but also between HCA and HA episodes, in demographics, underlying conditions and aetiology. In conclusion, we have updated the epidemiological information regarding patients’ profiles, underlying conditions, frequency of acquisition types and aetiological agents of BSI in Spain. HCA is confirmed as a distinct type of acquisition.This work was financed by grants from Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades [PI16/01432] and the Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0001; RD16/0016/0008], co‐financed by the European Development Regional Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020

Tratado de justicia restaurativa. Un enfoque integrador

Esta obra nos presenta a la Justicia Restaurativa desde la configuración del derecho penal y los procesos de la misma en el orden penitenciario, en las comunidades escolares, en la igualdad de género. Realzando así mismo la habiliades del facilitador que habrá de llevarla a cabo, como parte integral de un nuevo paradigma en la formación de recursos humnos que atiendan la inminente necesidad de este tipo de ejercicio y en las redes primarias de apoyo, como elemento restaurativo para las mujeres víctimas de violencia doméstica, dónde ha crecido la respuesta de la sociedad para abatir este sector de la violenci

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription

Sostenibilidad y desarrollo humano integral

282 páginasEl Centro de Estudios para el Desarrollo Humano Integral (Cedhin) de la Universidad de La Sabana viene estudiando los desafíos del desarrollo global y la necesidad de un compromiso universal con el futuro del planeta. En este caso, ha reunido expertos en distintas áreas para proponer proyectos sociales, políticos, económicos y culturales, orientados a mejorar el modo de vida de muchas personas. En medio de la pandemia de la covid-19, vimos conveniente aportar ideas para la nueva sociedad que estamos llamados a construir entre todos después de la compleja situación que afrontamos. De ahí la convocatoria a esta reflexión interdisciplinaria, resultado de las investigaciones de los profesores invitados desde diversas áreas geográficas y epistemológicas. Esperamos que este libro, fruto de un trabajo mancomunado como aporte a la regeneración que exige la pandemia de la covid-19, estimule el compromiso generoso y solidario para promover un verdadero desarrollo humano integral.1. Desarrollo, desafíos, decisiones||2. El desarrollo humano integral en la doctrina social de la Iglesia||3. Contornos del bien común: derechos humanos, desarrollo y paz||4. La ecología de Francisco: de la “ecología integral” hacia el “pacto educativo global” ||5. Los negocios en la doctrina social de la Iglesia||6. Pilares de la perspectiva cristiana sobre la empresa y la acción directiva||7. La gerencia centrada en las capacidades humanas, condición necesaria para el desarrollo sostenible||8. La construcción de bienes públicos pospandemia: la renta básica universal||9. Las políticas de garantía pública de empleo: alternativa de dignificación del trabajo humano||10. Pensar las relaciones políticas, económicas y sociales desde el bien común, para lograr un desarrollo socioeconómico integral||11. La cooperación internacional como herramienta del desarrollo sostenible: una lectura desde las Agencias de Desarrollo Económico Local en Colombia||12. Programa de Desarrollo con Enfoque Territorial (PDET) de la subregión Chocó: aproximaciones desde las encíclicas sobre desarrollo humano integral||13. Epílogo. Experiencias internacionales para mejorar el desarrollo humano y la sostenibilida