Nuevas recomendaciones de hipolipemiantes: perfil de uso de estatinas en un hospital terciario

Introducción: las enfermedades cardiovasculares suponen la principal causa de muerte en todo el mundo. La mayoría pueden prevenirse actuando sobre sus factores de riesgo, siendo el principal la hiperlipidemia. Para el tratamiento de las hiperlipidemias primero se debe actuar sobre los factores de riesgo, pero cuando esto no es suficiente se emplean fármacos hipolipemiantes, siendo de elección las estatinas. Objetivo: revisión de los hipolipemiantes, centrada en las estatinas y estudio descriptivo del uso de atorvastatina y simvastatina en un hospital terciario. Material y métodos: se revisaron las nuevas recomendaciones propuestas por el Servicio Madrileño de Salud (SERMAS) en su documento Criterios de utilización de fármacos hipolipemiantes para el tratamiento y control de la dislipemia como factor de riesgo cardiovascular. Para el estudio se realiza un corte transversal de un día de los pacientes ingresados en servicios de un hospital general, y que estaban siendo tratados con simvastatina o atorvastatina. Resultados y discusión: las estatinas se consideran los fármacos de elección para el tratamiento de la dislipemia. Son tratamiento de elección en prevención primaria de pacientes no diabéticos y diabéticos tipo 2 sin ningún otro FRCV mayor, en DM 1 y 2 con algún otro FRCV mayor o lesión en órgano diana, en hiperlipemias graves no genéticas, en ERC estadio G3b a G5, en claudicación intermitente de origen aterotrombótico y en prevención secundaria coronaria o cerebrovascular. Del estudio se concluye que el uso de atorvastatina, principalmente a dosis de 40 mg, es superior al de simvastatina. En todos los casos se cumple la pauta nocturna de administración. El servicio clínico de mayor utilización es Cardiología. En el 19% de los casos, las estatinas presentaron interacción con otros medicamentos prescritos, principalmente digoxina. Conclusión: se ha revisado en profundidad el documento de consenso del SERMAS con las indicaciones para las que las estatinas son fármacos de elección según el tipo de prevención (1ª o 2ª) y los factores de riesgo cardiovascular asociados. En el estudió predominó el uso de atorvastatina frente a simvastatina, utilizándose ambas preferentemente a dosis altas. Los pacientes se encontraban ingresados principalmente en Cardiología. Una quinta parte de las estatinas prescritas presentaban interacción potencial con otros medicamentos

Antibody response in patients admitted to the hospital with suspected SARS-CoV-2 infection: results from a multicenter study across Spain

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Diagnòstic; IgACoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Diagnóstico; IgACoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Diagnosis; IgAAim To evaluate the serological response against SARS-CoV-2 in a multicenter study representative of the Spanish COVID pandemic. Methods IgG and IgM + IgA responses were measured on 1466 samples from 1236 Spanish COVID-19 patients admitted to the hospital, two commercial ELISA kits (Vircell SL, Spain) based on the detection of antibodies against the viral spike protein and nucleoprotein, were used. Results Approximately half of the patients presented antibodies (56.8% were IgM + IgA positive and 43.0% were IgG positive) as soon as 2 days after the first positive PCR result. Serological test positivity increased with time from the PCR test, and 10 days after the first PCR result, 91.5% and 88.0% of the patients presented IgM + IgA and IgG antibodies, respectively. Conclusion The high values of sensitivity attained in the present study from a relatively early period of time after hospitalization support the use of the evaluated serological assays as supplementary diagnostic tests for the clinical management of COVID-19.The ELISA kits for the IgG and IgM + IgA assays were provided by Vircell SL. No additional funding was received

Transmitted drug resistance to antiretroviral drugs in Spain during the period 2019–2021

To evaluate the prevalence of transmitted drug resistance (TDR) to nucleoside and nonnucleoside reverse transcriptase inhibitors (NRTI, NNRTI), protease inhibitors (PI), and integrase strand transfer inhibitors (INSTI) in Spain during the period 2019-2021, as well as to evaluate transmitted clinically relevant resistance (TCRR) to antiretroviral drugs. Reverse transcriptase (RT), protease (Pro), and Integrase (IN) sequences from 1824 PLWH (people living with HIV) were studied. To evaluate TDR we investigated the prevalence of surveillance drug resistance mutations (SDRM). To evaluate TCRR (any resistance level >= 3), and for HIV subtyping we used the Stanford v.9.4.1 HIVDB Algorithm and an in-depth phylogenetic analysis. The prevalence of NRTI SDRMs was 3.8% (95% CI, 2.8%-4.6%), 6.1% (95% CI, 5.0%-7.3%) for NNRTI, 0.9% (95% CI, 0.5%-1.4%) for PI, and 0.2% (95% CI, 0.0%-0.9%) for INSTI. The prevalence of TCRR to NRTI was 2.1% (95% CI, 1.5%-2.9%), 11.8% for NNRTI, (95% CI, 10.3%-13.5%), 0.2% (95% CI, 0.1%-0.6%) for PI, and 2.5% (95% CI, 1.5%-4.1%) for INSTI. Most of the patients were infected by subtype B (79.8%), while the majority of non-Bs were CRF02_AG (n = 109, 6%). The prevalence of INSTI and PI resistance in Spain during the period 2019-2021 is low, while NRTI resistance is moderate, and NNRTI resistance is the highest. Our results support the use of integrase inhibitors as first-line treatment in Spain. Our findings highlight the importance of ongoing surveillance of TDR to antiretroviral drugs in PLWH particularly with regard to first-line antiretroviral therapy

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

In vitro neutralizing activity of BNT162b2 mRNA-induced antibodies against full B.1.351 SARS-CoV-2 variant.

SARS-CoV-2 variation represents a serious challenge to current COVID-19 vaccines. Recent reports suggest that B.1.351 and other variants may escape the neutralization activity of the antibodies generated by current vaccines. Ninety-nine healthcare workers undertaking BNT162b2 mRNA vaccination were sampled at baseline, on the day of the second dose, and 14 days after the latter. Neutralization activity against SARS-CoV-2 B.1, B.1.1.7 and B.1.351 was investigated using a Vero-E6 model. Eleven of the study participants had prior infection with SARS-CoV-2. Neutralization titers against the B.1 and the B.1.1.7 variants were not statistically different and were significantly higher than titers against the B.1.351 variant across pre-exposed and non-pre-exposed vaccinated individuals (p 1/80 after a single dose, while only 11% of non-exposed vaccinated individuals had titers >1/80. BNT162b2 mRNA-induced antibodies show a lower in vitro neutralizing activity against B.1.351 variant compared to neutralization against B.1.1.7 or B.1 variants. Interestingly, for individuals pre-exposed to SARS-CoV-2, one dose of BNT162b2 mRNA may be adequate to produce neutralizing antibodies against B.1.1.7 and B.1, while two doses of BNT162b2 mRNA provide optimal neutralizing antibody response against B.1.351 too

Transmitted drug resistance to integrase based first-line HIV antiretroviral regimens in the Mediterranean Europe

Objective: To study the prevalence of transmitted drug resistance (TDR) to INSTIs and NRTIs, and of clinically relevant resistance (CRR), in newly-diagnosed people with HIV (PWH) naïve to antiretroviral therapy (ART) in Europe. Methods: MeditRes HIV is a consortium that includes ART naïve PWH newly diagnosed in France, Greece, Italy, Portugal, and Spain during the years 2018-2021. Reverse transcriptase (RT) and Integrase (INSTI) sequences were provided by participating centers. To evaluate the prevalence of surveillance drug resistance mutations (SDRM) we used the CPR tools from Stanford HIV-website. To evaluate clinically relevant resistance (CRR), defined as any resistance level >= 3, we used the Stanford v.9.1HIVDB Algorithm. Results: We included 2705 PWH, 72% men, median age of 37 (IQR, 30-48); 43.7% infected by non-B subtypes. The prevalence of INSTI-SDRMs was 0.30% (T66I, T66A, E92Q, E138T, E138K, Y143R, S147G and R263K, all n = 1), and of NRTI-SDRMs was 5.77% (M184V n = 23, 0.85%; M184I n = 5, 0.18%; K65R/N n = 3, 0.11%; K70E n = 2, 0.07%; L74V/I n = 5, 0.18%; any TAMs n = 118, 4.36%). INSTI-CRR was 2.33% (0.15% dolutegravir/bictegravir; 2.29% raltegravir/elvitegravir), and 1.74% to first-line NRTIs (0.89% tenofovir/tenofovir alafenamide fumarate; 1.74% abacavir; 1.07% lamivudine/emtricitabine). Conclusions: We present the most recent data on TDR to integrase based first-line regimens in Europe. Given the low prevalence of CRR to second generation integrase inhibitors and to first-line NRTIs, in the years 2018-2021 it is unlikely that newly diagnosed PWH in MeditRes countries would present with baseline resistance to a first-line regimen based on second generation integrase inhibitors

Dicole, divertirnos con letras

El objetivo fundamental del proyecto es fomentar el interés por la lectura y la escritura, la comprensión y la expresión verbal y escrita, la representación artística, el conocimiento y la mejora del manejo de las reglas de ortografía y el desarrollo de la convivencia. Todos estos puntos se relacionan con el plan de atención a la diversidad que el centro desarrolla en el currículo anual. Otros objetivos son promover el acercamiento a la lectura desde una perspectiva vivencial y estimulante; fomentar la escritura creativa y la imaginación; incentivar el trabajo en equipo y la cooperación; aumentar y potenciar las cualidades creativas y de expresión; ampliar vocabulario; y fomentar actitudes de implicación, responsabilidad y compromiso con la tarea, tanto individual como en grupo. Se busca, además, fomentar la comunicación en la revisión y renovación de prácticas educativas y metodológicas del profesorado y promover actitudes que incrementen la capacidad de trabajar en equipo y el sentido grupal. Las actividades desarrolladas se relacionan con distintas áreas como la comprensión lectora. Otra área es el comentario oral y escrito de los contenidos de las lecturas a través de la elaboración de cómic, realización de cuestionarios o debates sobre las lecturas. Y otras actividades están relacionadas con el aprendizaje de recursos y mecanismos formales en textos literarios y no literarios, como ejercicios con diccionarios, visualización de películas o dictados. También se realizan lecturas en voz alta y búsqueda de información a través de nuevas tecnologías como Internet o mediante el uso de la Biblioteca. La metodología consiste inicialmente en seleccionar un bloque de 37 libros de los cuales finalmente sólo se quedan 18; en una segunda fase se selecciona un único texto, adaptado a cada una de las etapas, sobre el que se desarrollan todos los ejercicios propuestos para potenciar las competencias lecto-escritoras de los alumnos. Y éstos a través de diferentes actividades, principalmente el comic, la representación musical y teatral transmiten su propia versión de la obra al resto de compañeros. La evaluación es continua y, además de las revisiones semanales, se lleva a cabo una evaluación final y global en la que participan tanto el equipo de trabajo, como los profesores, representantes de los alumnos, el equipo directivo, el departamento de orientación y el AMPA. Este trabajo incorpora varios anexos que muestran las reuniones semanales de los profesores, la evaluación por parte del AMPA o actividades y ejercicios..Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Mejora de la Calidad de la EnseñanzaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES