Neumonía adquirida en la comunidad en un hospital terciario español: ¿cómo se comporta en pacientes provenientes de residencia?

Con 4,63 casos por cada 1.000 personas/año y 1,64 hospitalizaciones por cada 1.000 personas/año la neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente en España. Varias guías de práctica clínica resumen el abordaje más adecuado para su manejo. Sin embargo, existe cierto debate sobre cómo se comportan los pacientes provenientes de residencia. En el presente artículo analizamos las características de un grupo de pacientes hospitalizados por NAC, comparando aquellos provenientes de residencia con los que no

Laboratorio de Ciencias Vivas con técnologías de código abierto

En este documento se presenta el Laboratorio de Ciencias Vivas con Técnologías de Código Abierto, creado en el marco del “Proyecto Piloto "Laboratorio de Ciencias Vivas con tecnologías `Házlo tú mismo mismo´, `Házlo con Otros´ y `Trae tu propio dispositivo`dispositivo`[ apoyado por Fondo Sectorial "Inclusión Digital Educación con Nuevos Horizontes CFE ANII (FSED_ 2 2018 1 150716 ) y desarrollado por un grupo de investigación interdisciplinario e interinstitucional integrado por Virginia E. Pellegrino1, Sandra Alonso1, Carolina Pereira1, Pablo M. Sedraschi2, Marcos I. Gimenez2, Fernando N. Acosta2, Marcos Umpiérrez2, Daniel A. Argente2, Jose Gomez-Marquez3, Anne Young3, Nikolas Albarran3, Javier Calvelo4, Martin Figares4, Maria I. Rehermann de Sagastizabal4 and Milka D. Radmilovich5 y María E. Castelló4 El Laboratorio Virtual de Ciencias Vivas consta de dos Laboratorios, uno de Fisiología y otro de Biología Celular. En el Laboratorio Virtual de Fisiología, los usuarios podrán hacer experimentos virtuales de registro de potenciales de acción en el sistema nervioso periférico de un invertebrado. Se puede visualizar registros en condiciones basales (sin estimulación) o en respuesta a distintos tipos estímulos (mecánico por una varilla o por aire a presión). En este caso se puede variar la intensidad del estímulo. De acuerdo a lo seleccionado, se pueden adquirir virtualmente registros que luego pueden ser visualizados y analizados. Por ejemplo, seleccionar una ventana teporal y contabilizar el número de potenciales estableciendo una ventana de amplitud de la señal. En el Laboratorio de Biología Celular, los usuarios podrán experimentar la Reacción de Hill. • Los laboratorios Virtuales Fisiología y Biología Celular son espacios en los que se puede aprender y experimentar sin peligro de daño personal, contaminación o pérdida de las muestras o rotura de equipos. Pueden ser descargados en sistema Ubuntu o Windows y los datos generados durante la experimentación pueden ser almacenados en las computadoras de los usuarios para posterior análisis.Agencia Nacional de Investigación e Innovació

Apixaban versus Enoxaparin for Thromboprophylaxis in Medically Ill Patients

BACKGROUND: The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin. METHODS: In this double-blind, double-dummy, placebo-controlled trial, we randomly assigned acutely ill patients who had congestive heart failure or respiratory failure or other medical disorders and at least one additional risk factor for venous thromboembolism and who were hospitalized with an expected stay of at least 3 days to receive apixaban, administered orally at a dose of 2.5 mg twice daily for 30 days, or enoxaparin, administered subcutaneously at a dose of 40 mg once daily for 6 to 14 days. The primary efficacy outcome was the 30-day composite of death related to venous thromboembolism, pulmonary embolism, symptomatic deep-vein thrombosis, or asymptomatic proximal-leg deep-vein thrombosis, as detected with the use of systematic bilateral compression ultrasonography on day 30. The primary safety outcome was bleeding. All efficacy and safety outcomes were independently adjudicated. RESULTS: A total of 6528 subjects underwent randomization, 4495 of whom could be evaluated for the primary efficacy outcome--2211 in the apixaban group and 2284 in the enoxaparin group. Among the patients who could be evaluated, 2.71% in the apixaban group (60 patients) and 3.06% in the enoxaparin group (70 patients) met the criteria for the primary efficacy outcome (relative risk with apixaban, 0.87; 95% confidence interval [CI], 0.62 to 1.23; P=0.44). By day 30, major bleeding had occurred in 0.47% of the patients in the apixaban group (15 of 3184 patients) and in 0.19% of the patients in the enoxaparin group (6 of 3217 patients) (relative risk, 2.58; 95% CI, 1.02 to 7.24; P=0.04). CONCLUSIONS: In medically ill patients, an extended course of thromboprophylaxis with apixaban was not superior to a shorter course with enoxaparin. Apixaban was associated with significantly more major bleeding events than was enoxaparin. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00457002.)

The Magpie Trial: A randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for women at 2 years

Objective: The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia. Design: Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998-2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre-eclampsia. Setting: Follow up after discharge from hospital at 125 centres in 19 countries across five continents. Population: A total of 7927 women were randomised at the follow-up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced. Methods: Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed. Main outcome measures: Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources. Results: Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). Conclusions: The reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.Articl