Análisis de la morbimortalidad en una cohorte de 1,115 pacientes con infección VIH, (1989-1997)

OBJETIVOS A,- Evaluar en una cohorte de pacientes VIH, los cambios en la incidencia de las enfermedades oportunistas surgidas en cualquier momento de su evolución (incluidas recidivas), y en las tasas de mortalidad, entre 1989-1997. B,- Valorar el efecto de la adherencia al tratamiento antirretroviral y de la porfilaxis frente a la neumonía por Pheumocystis carinni (antinpc) sobre la morbilidad y mortalidad. C,- Examinar la supervivencia de los pacientes con sida, sus variaciones en el tiempo, y el efecto de la adherencia a los tratamientos. POBLACIÓN DEL ESTUDIOS Se incluyeron en el estudio a 1.115 pacientes VIH> 16 años que ingresaron en la Unidad VIH del Hospital 12 de Octubre de Madrid entre el 1/01/89 y el 31/12/94 y A,- En algún momento del tiempo de observación (hasta mayo del 97) su nivel medio de linfocitos CD4 fue 100/mm3. El cumplimiento del tratamiento antirretroviral se asocia a un incremento de la supervivencia, pero fue significación únicamente en los pacientes VIH asintomáticos al inicio del seguimiento. 6,- Las tasas de mortalidad alcanzaron su punto máximo en 1994, disminuyendo desde entonces, con un descenso más marcado en el último periodo de seguimiento. Respecto a los no tratados, la reducción del riesgo de muerte fue del 53% para la monoterpia, del 68% para la biterpia y del 86% para la triple terapia (incluyendo uninhibidor de la porteasa). Los pacientes que siguieron correctamente la profilaxis anti-NPC presentaron una disminución en las tasas de mortalidad del 49

Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

<div><p>Objective</p><p>To evaluate the incidence of diabetic retinopathy in patients with Type 2 Diabetes Mellitus, to identify the risk factors associated with the incidence of retinopathy and to develop a risk table to predict four-year retinopathy risk stratification for clinical use, from a four-year cohort study.</p><p>Design</p><p>The MADIABETES Study is a prospective cohort study of 3,443 outpatients with Type 2 Diabetes Mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain).</p><p>Results</p><p>The cumulative incidence of retinopathy at four-year follow-up was 8.07% (95% CI = 7.04–9.22) and the incidence density was 2.03 (95% CI = 1.75–2.33) cases per 1000 patient-months or 2.43 (95% CI = 2.10–2.80) cases per 100 patient-years. The highest adjusted hazard ratios of associated risk factors for incidence of diabetic retinopathy were LDL-C >190 mg/dl (HR = 7.91; 95% CI = 3.39–18.47), duration of diabetes longer than 22 years (HR = 2.00; 95% CI = 1.18–3.39), HbA1c>8% (HR = 1.90; 95% CI = 1.30–2.77), and aspirin use (HR = 1.65; 95% CI = 1.22–2.24). Microalbuminuria (HR = 1.17; 95% CI = 0.75–1.82) and being female (HR = 1.12; 95% CI = 0.84–1.49) showed a non-significant increase of diabetic retinopathy. The greatest risk is observed in females who had diabetes for more than 22 years, with microalbuminuria, HbA1c>8%, hypertension, LDL-Cholesterol >190 mg/dl and aspirin use.</p><p>Conclusions</p><p>After a four-year follow-up, the cumulative incidence of retinopathy was relatively low in comparison with other studies. Higher baseline HbA1c, aspirin use, higher LDL-Cholesterol levels, and longer duration of diabetes were the only statistically significant risk factors found for diabetic retinopathy incidence. This is the first study to demonstrate an association between aspirin use and diabetic retinopathy risk in a well-defined cohort of patients with Type 2 Diabetes Mellitus at low risk of cardiovascular events. However, further studies with patients at high cardiovascular and metabolic risk are needed to clarify this issue.</p></div

Risk table: probability of developing Diabetic Retinopathy in four-year (n = 2,405).

<p>Bold type indicated the minimum and maximum values.</p

Baseline characteristics of follow-up patients (n = 2,405).

<p>SD: Standard Deviation; IQR: Interquartile range; DM: Diabetes mellitus; BMI: Body mass index; SBP: Systolic Blood Pressure; DBP: Dyastolic Blood Pressure; FPG: Fasting plasma glucose; HbA1c: Glycated haemoglobin; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; MAU: Microalbuminuia.</p

Associated Risk Factors for Incident Diabetic Retinopathy (n = 194) after four-year follow-up of 2,405 patients (Multivariable Cox Regression).

<p>HbA1c: Glycated hemoglobin a1c; aHR: adjusted hazard ratios; CI: Confidence interval.</p

Baseline characteristics of MADIABETES Diabetic Retinopathy Cohort (N = 2,748), and mortality rate during follow-up.

<p>SD: Standard Deviation; IQR: Interquartile range; DM: Diabetes mellitus; BMI: Body mass index; SBP: Systolic Blood Pressure; DBP: Dyastolic Blood Pressure; FPG: Fasting plasma glucose; HbA1c: Glycated haemoglobin; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; MAU: Microalbuminuia.</p

Flow diagram of the MADIABETES cohort.

<p>Flow diagram of the MADIABETES cohort.</p

Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort

Purpose To analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences. Methods 3443 T2DM outpatients were studied. At baseline and annually, patients were subjected to anamnesis, a physical examination, and biochemical tests. Data about demographic and clinical characteristics was also recorded, as was the treatment each patient had been prescribed. Mortality records were obtained from the Spanish National Institute of Statistics. Survival curves for BMI categories (Gehan-Wilcoxon test) and a multivariate Cox proportional hazard analysis were performed to identify adjusted Hazard Ratios (HRs) of mortality. Results Mortality rate was 26.38 cases per 1000 patient-years (95% CI, 23.92–29.01), with higher rates in men (28.43 per 1000 patient-years; 95% CI, 24.87–32.36) than in women (24.31 per 1000 patient-years; 95% CI, 21.02–27.98) (p = 0.079). Mortality rates according to BMI categories were: 56.7 (95% CI, 40.8–76.6), 28.4 (95% CI, 22.9–34.9), 24.8 (95% CI, 21.5–28.5), 21 (95% CI, 16.3–26.6) and 23.7 (95% CI, 14.3–37) per 1000 person-years for participants with a BMI of 39.4 kg/m2, respectively. The BMI values associated with the highest all-cause mortality were < 23 kg/m2, but only in males [HR: 2.78 (95% CI, 1.72–4.49; p < 0.001)], since in females this association was not significant [HR: 1.14 (95% CI, 0.64–2.04; p = 0.666)] (reference category for BMI: 23.0–26.8 kg/m2). Higher BMIs were not associated with higher mortality rates. Conclusions In an outpatient T2DM Mediterranean population sample, low BMI predicted all-cause mortality only in males.Instituto de Salud Carlos IIIUnión EuropeaDepto. de MedicinaFac. de MedicinaTRUEpu

Perfeccionamiento y evaluación de las experiencias de enseñanza y aprendizaje bimodal en las Ciencias Penales desarrolladas durante el curso 2020-2021

Memoria de las actividades desarrolladas en el marco del Proyecto de Innovación Docente UCM curso 2021-2022 (continuación 2019-2020)

Enseñanza y aprendizaje bimodal de las Ciencias Penales. Materiales de estudio y evaluación para un correcto equilibrio docente

El presente proyecto de innovación tiene como objetivo desarrollar materiales de enseñanza, aprendizaje y evaluación Derecho Penal Penitenciario y Criminología para equilibrar la enseñanza y aprendizaje en un escenario de enseñanza bimodal