Desenmascarar el “poder sobre la vida”

Sin resume

Aplicación de la topología molecular para la predicción de biodegradación anaerobia de clorofenoles

Se ha aplicado la topología molecular y el análisis de regresión multilineal en la búsqueda de un modelo de relación cuantitativa estructura-actividad (QSAR) capaz de predecir la capacidad de biodegradación anaerobia de un grupo de clorofenoles. Tomando el valor de la constante de velocidad de desaparición del derivado clorofenólico ,log k, como variable dependiente y los descriptores topológicos como variables independientes, se obtuvo una ecuación con tres variables y coeficientes de correlación y de predicción , R2=0.9291 y Q2=0.870. El modelo fue validado a través de una validación interna y un test de aleatoriedad. Los resultados obtenidos muestran una alta capacidad de predicción para la biodegradación de los compuestos analizados

La investigación cualitativa en enfermería en Colombia (1990-2010)

In this article, we present an analysis of the Qualitative Research (QR) in nursing in Colombia, which was based on a qualitative case study design that included key informants interviews complemented by document review. Data were collected in a parallel manner between June and October 2011. We conducted 19 semi-structured interviews with researchers of Colombian universities that have been central actors in the QR nursing in Colombia and we reviewed 159 documents published by Colombian nursing researchers between 1990 and 2010 mainly in Colombian and Latin American journals. The interpretative analysis that we present include the following themes: the beginnings of QR in nursing in Colombia; the topics, approaches and populations; and finally, the contributions, limitations, and challenges for the future. Through their practice on QR Colombian nurses have raised criticisms of the hegemonic positivist and biologists models of health research studies; they have conducted research studies with various individuals and population groups; they have used different approaches and methods such as ethnography, phenomenology, grounded theory, among the ones with higher frequency; they have had limitations related to the quality and rigor, lack of recognition, lack of time, and difficulties in funding and publications. Despite these limitations, Colombian nurses conducting QR have helped to give a complex look and humanization of nursing care and currently work in achieving greater impact of their research on policies and social action.Presentamos un análisis sobre la Investigación Cualitativa (IC) en enfermería en Colombia, realizado con base en el diseño de una investigación cualitativa tipo estudio de caso, que incluyó como herramientas centrales entrevistas a informantes claves y de manera complementaria, revisión documental. Los datos se recolectaron de manera paralela entre junio y octubre de 2011. Se realizaron 19 entrevistas semiestructuradas a investigadores de universidades colombianas que han sido actores centrales en la IC en enfermería en Colombia y se revisaron 159 documentos publicados en revistas colombianas y de América Latina durante el período 1990 a 2010. El análisis interpretativo incluye como temas: los inicios de la IC en enfermería; las temáticas, abordajes y poblaciones; las contribuciones; las limitaciones y los retos para el futuro de la IC en enfermería en Colombia. A través de la práctica de la IC, las enfermeras colombianas han planteado críticas a los modelos biologicistas y positivistas hegemónicos de la investigación en salud; han realizado estudios con diversas personas y grupos poblacionales, han utilizado diversos enfoques y métodos, siendo la etnografía, la fenomenología, la teoría fundamentada y la IC los de mayor frecuencia, y han tenido limitaciones relacionadas con la calidad y el rigor, la falta de reconocimiento, la escasez de tiempo y dificultades para la financiación y la publicación. A pesar de las limitaciones, han contribuido a dar una mirada compleja a la humanización del cuidado de enfermería y trabajan en lograr un mayor impacto de las investigaciones en las políticas y acciones sociales

Can artificial intelligence improve the management of pneumonia

The use of artificial intelligence (AI) to support clinical medical decisions is a rather promising concept. There are two important factors that have driven these advances: the availability of data from electronic health records (EHR) and progress made in computational performance. These two concepts are interrelated with respect to complex mathematical functions such as machine learning (ML) or neural networks (NN). Indeed, some published articles have already demonstrated the potential of these approaches in medicine. When considering the diagnosis and management of pneumonia, the use of AI and chest X-ray (CXR) images primarily have been indicative of early diagnosis, prompt antimicrobial therapy, and ultimately, better prognosis. Coupled with this is the growing research involving empirical therapy and mortality prediction, too. Maximizing the power of NN, the majority of studies have reported high accuracy rates in their predictions. As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes. In this review, we describe and discuss the most relevant studies of AI in pneumonia

Impact of Cefotaxime Non-susceptibility on the Clinical Outcomes of Bacteremic Pneumococcal Pneumonia

Background: We aimed to analyze the impact of cefotaxime non-susceptibility on the 30-day mortality rate in patients receiving a third-generation cephalosporin for pneumococcal bacteremic pneumonia. Methods: We conducted a retrospective observational study of prospectively collected data from the Hospital Clinic of Barcelona. All adult patients with monomicrobial bacteremic pneumonia due to Streptococcus pneumoniae and treated with a third-generation cephalosporin from January 1991 to December 2016 were included. Risk factors associated with 30-day mortality were evaluated by univariate and multivariate analyses. Results: During the study period, 721 eligible episodes were identified, and data on the susceptibility to cefotaxime was obtainable for 690 episodes. Sixty six (10%) cases were due to a cefotaxime non-susceptible strain with a 30-day mortality rate of 8%. Variables associated with 30-day mortality were age, chronic liver disease, septic shock, and the McCabe score. Infection by a cefotaxime non-susceptible S. pneumoniae did not increase the mortality rate. Conclusion: Despite the prevalence of cefotaxime, non-susceptible S. pneumoniae has increased in recent years. We found no evidence to suggest that patients hospitalized with bacteremic pneumonia due to these strains had worse clinical outcomes than patients with susceptible strains

Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies

[Background] There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection.[Methods] This is a multicenter post hoc study that included consecutive patients from 3 prospective candidemia cohorts (2007–2016). The impact of ED and factors associated with mortality were assessed.[Results] Of 1023 candidemia episodes, 235 met inclusion criteria. Of these, 54 (23%) were classified as the ED group and 181 (77%) were classified as the non-ED group. ED was more common in catheter-related candidemia (51.9% vs 31.5%; P = .006) and episodes caused by Candida parapsilosis, yet it was less frequent in patients in the intensive care unit (24.1% vs 39.2%; P = .043), infections caused by Nakaseomyces glabrata (0% vs 9.9%; P = .016), and candidemia from an unknown source (24.1% vs 47%; P = .003). In the ED and non-ED groups, 30-day mortality was 11.1% and 29.8% (P = .006), respectively. Chronic obstructive pulmonary disease (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.48–10.61), Pitt score > 2 (OR, 4.39; 95% CI, 1.94–9.20), unknown source of candidemia (OR, 2.59; 95% CI, 1.14–5.86), candidemia caused by Candida albicans (OR, 3.92; 95% CI, 1.48–10.61), and prior surgery (OR, 0.29; 95% CI, 0.08–0.97) were independent predictors of mortality. Similar results were found when a propensity score for receiving ED was incorporated into the model. ED had no significant impact on mortality (OR, 0.50; 95% CI, 0.16–1.53).[Conclusions] Early de-escalation is a safe strategy in patients with candidemia caused by fluconazole-susceptible strains with controlled source of bloodstream infection and hemodynamic stability. These results are important to apply antifungal stewardship strategies.This research forms part of an activity that has received funding from EIT Health. EIT Health is supported by the European Institute of Innovation and Technology (EIT), a body of the European Union that receives support from the European Union´s Horizon 2020 Research and Innovation Program. This study has been cofunded by the European Regional Development Fund. E. M.-G. (PI18/01061), P. P.-A. (“Rio Hortega” contract CM18/00132), M. F.-R. (“Miguel Servet” contract CP18/00073), and C. G.-V. (FIS PI18/01061) have received research grants from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III.Peer reviewe

Impact of Inflammatory Response Modifiers on the Incidence of Hospital-Acquired Infections in Patients with COVID-19.

The study aim was to assess the influence of inflammatory response modifiers, including anti-interleukin-6 (IL-6) biologics and corticosteroids, on the incidence of hospital-acquired infections in patients with coronavirus disease 2019 (COVID-19). METHODS: Case-control study performed at a university hospital from February 26 to May 26, 2020. Cases were defined as patients with COVID-19 who developed hospital-acquired infections. For each case, two controls were selected among patients without infections. Cases and controls were matched obeying three criteria in a hierarchical sequence: length of hospital stay up until the first infection; comorbidity; and need for Intensive care unit (ICU) admission. Conditional logistic regression analysis was used to estimate the association of exposures with being a case. RESULTS: A total of 71 cases and 142 controls were included. Independent predictors for acquiring a hospital infection were chronic liver disease [odds ratio (OR) 16.56, 95% CI 1.87-146.5, p = 0.012], morbid obesity (OR 6.11, 95% CI 1.06-35.4, p = 0.043), current or past smoking (OR 4.15, 95% CI 1.45-11.88, p = 0.008), exposure to hydroxychloroquine (OR 0.2, 95% CI 0.041-1, p = 0.053), and invasive mechanical ventilation (OR 61.5, 95% CI 11.08-341, p ≤ 0.0001). CONCLUSIONS: Inflammatory response modifiers had no influence on acquisition of nosocomial infections in admitted patients with COVID-19. Hospital-acquired infections primarily occurred in the critically ill and invasive mechanical ventilation was the main exposure conferring risk

Bacterial co-infection at hospital admission in patients with COVID-19

Objectives: We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19. Methods: Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020-February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included. Results: A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p94%

Incidence of co-infections and superinfections in hospitalised patients with COVID-19: a retrospective cohort study

Objectives: To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods: We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records. Results: Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes. Conclusions: Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies

Evaluación continua del curso 2º del Grado en Sonido e Imagen en Telecomunicación de la EPS

La evaluación en los grados según el EEES se realiza de forma continua en todas las asignaturas del curso. Desde la implantación de los grados, esta evaluación continua ha sido criticada por la carga de trabajo que supone tanto para el estudiante como el profesorado. En este sentido, hace unos años realizamos un proyecto colaborativo para la realización del calendario de evaluación continua por curso académico. Dicho calendario mostraba las evaluaciones y controles que se realizan en las asignaturas de cada curso y cada semestre, sin tener en cuenta las prácticas. Sin embargo, las actividades de evaluación han ido cambiando y en ocasiones no se detallan en la guía docente con el detalle adecuado, lo que no permite disponer de un calendario de evaluación real del curso. Por tanto, el objetivo de este proyecto ha sido coordinar todas las evaluaciones, controles, y actividades obligatorias o voluntarias de evaluación de todas las asignaturas del segundo curso de la titulación