Approach to the experience of the burned patient in the recovery process. Investigation project.

Trabajo fin de grado en EnfermeríaIntroducción: Se estima que las quemaduras provocan alrededor de 180.000 muertes al año en todo el mundo. A pesar de que las tasas de mortalidad han descendido en los últimos años sobre todo en los países de renta alta, siguen constituyendo un problema de salud pública a nivel mundial. Son una de las principales causas de pérdida de años de vida, morbilidad, hospitalización prolongada, desfiguración, discapacidad, así como estigmatización y rechazo. Objetivo: Este estudio tiene como principal objetivo conocer el impacto de las lesiones por quemadura y su recuperación en la calidad de vida del paciente gran quemado. Metodología: Estudio cualitativo apoyado en el paradigma fenomenológico, el cual nos permitirá conocer la realidad vivida por estos pacientes. La población de estudio serán aquellos pacientes que hayan estado ingresados en la Unidad de Quemados de los Hospitales Universitarios La Paz y Getafe, pertenecientes a la Comunidad Autónoma de Madrid (CAM) por ser ambos centros de referencia a nivel nacional. Para llevar a cabo el estudio se realizarán entrevistas abiertas y semiestructuradas que serán grabadas mediante un sistema de audio y transcritos verbatim. Para el análisis y la organización de los datos utilizaremos el software ATLAS TI y se llevará a cabo en tres etapas: lectura en profundidad, codificación e integración de la información.Background: It is estimated that burns cause around 180,000 deaths a year worldwide. Although mortality rates have decreased in recent years, especially in high-income countries, they still are a public health problem worldwide. They are one of the leading cause of lost years of life, morbidity, long-time hospitalization, disfigurement, disability, as well as stigmatization and rejection. Objetive: The main aim of this study is to know the impact of burn injuries and their recovery on the quality of life of the burned patient. Methods: Qualitative study supported by the phenomenological paradigm, which will allow us to know the reality lived by these patients. The study population will be those patients who have been admitted to the Burns Unit of the University Hospitals of La Paz and Getafe, belonging to the Community of Madrid because they are both reference centers at a national level. To carry out the study, open and semi-structured interviews will be conducted and recorded using an audio system and transcribed textually. For the analysis and organization of the data we will use the ATLAS TI software and it will be carried out in three stages: in-depth reading, coding and integration of the information

Tailoring Surfaces to improve Biomaterials performance: piCVD & iCVD approaches

S’han dipositat capes primes d’hidrogel per tal de modificar les propietats superficials i millorar el comportament dels biomaterials. Dues de les tècniques de deposició química en fase vapor més comunes s’han estudiat per poder dur a terme aquestes modificacions. La deposició química foto-iniciada en fase vapor (piCVD) és un mètode simple, ràpid i no agressiu que permet depositari films d’hidrogel. És un mètode que s’inicia a la superfície de la mostra i que permet recobrir de manera homogènia superfícies tridimensionals com és el cas de les micro-partícules. El piCVD ofereix un ventall molt ampli d’hidrogels amb capacitat d’absorbir aigua, incorporant co-monòmers amb diferents propietats. Els hidrogels poden ser dissenyats perquè la reactivitat es localitzi a nivell superficial, millorant d’aquesta manera la funcionalització química dels hidrogels. Tanmateix, un nou mètode s’ha utilitzat per micro-estructurar les superfícies durant la deposició via piCVD per obtenir hidrogels amb comportaments especials. Els hidrogels termo-sensibles s’han obtingut via deposició química iniciada en fase vapor (iCVD). S’ha desenvolupat una llibreria d’hidrogels termo-sensibles, els quals exhibeixen una temperatura de transició molt marcada. La microbalança de quars amb dissipació (QCM-D) s’ha fet servir per analitzar la transició d’aquests films. La combinació de les propietats que ofereixen els films termo-sensibles dona la possibilitat de dissenyar una plataforma per prevenir la formació de biofilms.Se han depositado capas delgadas de hidrogel para lamodificación superficial y mejora del comportamiento de los biomateriales. Dos de las técnicasmás comunes de deposición química en fase vapor se han estudiado para llevar a cabo estas modificaciones. La deposición química foto-iniciada en fase vapor (piCVD) es un método simple, rápido y no agresivo que permite depositar films de hidrogel. Es un método que se inicia en la superficie de la muestra y que permite recubrir de manera homogénea superficies tridimensionales como es el caso de las micro-partículas. El piCVD ofrece un abanico muy amplio de hidrogeles con capacidad de absorber agua, incorporando co-monomeros con diferentes propiedades. Los hidrogeles se pueden diseñar para que la reactividad se localice a nivel superficial, mejorando de esta manera la funcionalización química de los hidrogeles. Así mismo, un nuevo método se ha utilizado para micro-estructurar las superficies durante la deposición vía piCVD para obtener hidrogeles con comportamientos especiales. Los hidrogeles termo-sensibles se han obtenido vía deposición química iniciada en fase vapor (iCVD). Se ha desarrollado una librería de hidrogeles termo-sensibles, los cuales exhiben una temperatura de transición muy marcada. La microbalanza de cuarzo con disipación (QCM-D) se ha utilizado para analizar la transición de este film. La combinación de las propiedades que ofrecen los films termo-sensibles da la posibilidad de diseñar una plataforma para prevenir la formación de biofilms.Thin hydrogel films have been deposited to modify surface properties and improve biomaterials performance. Two of the most common chemical vapor deposition techniques have been studied to carry out these modifications. Photo-initiated chemical vapor deposition piCVD has been developed as a simple, not aggressive and easy method for the deposition of thin hydrogel films. This method follows a versatile surface-driven reaction process that allows homogeneous coating of both 2D and 3D geometries, such as microspheres. piCVD offers the possibility to fabricate a wide range of swellable thin films, incorporating co-monomers with different properties, such as amine-reactivity, suitable for further modification. The hydrogels can be designed by nano-confining the reactivity to the near surface region, improving the chemical functionality of hydrogels. In addition, a new method to create micro-patterned surfaces can be applied during piCVD deposition to design surfaces having special behavior. Thermo-responsive thin hydrogel films have also been obtained via initiated chemical vapor deposition (iCVD). A library of thermo-sensitive films exhibiting controlled lower critical solution temperatures (LCST) has been generated. Quartz crystal microbalance with dissipation analysis has been used to analyze the phase-transition of these films. The intrinsic properties of thermo-sensitive hydrogels, such as tunable surface hydrophilicity or release of film-entrapped molecules, open the possibility to design systems for controlling biofilm formation

Leigh Syndrome Associated with TRMU Gene Mutations

tRNA 5-methylaminomethyl-2-thiouridylate methyltransferase (TRMU) deficiency causes an early onset potentially reversible acute liver failure, so far reported in less than 30 patients. We describe two new unrelated patients with an acute liver failure and a neuroimaging compatible with Leigh syndrome (LS) due to TRMU deficiency, a combination not previously reported. Our report enlarges the phenotypical spectrum of TRMU diseaseThe Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), is an initiative of the Instituto de Salud Carlos III (Ministerio de Ciencia e Innovacion, Spain). This study was supported by the Agencia de Gestio d'Ajuts Universitaris i de Recerca (AGAUR) (2014: SGR 393) and the CERCA Programme/Generalitat de Catalunya. The present study was supported by the Department de Salut, Generalitat de Catalunya (URDCAT project, SLT002/16/00174

Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry

(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects

Autoantibody screening in Guillain-Barré syndrome

Background: Guillain-Barré syndrome (GBS) is an acute inflammatory neuropathy with a heterogeneous presentation. Although some evidences support the role of autoantibodies in its pathogenesis, the target antigens remain unknown in a substantial proportion of GBS patients. The objective of this study is to screen for autoantibodies targeting peripheral nerve components in Guillain-Barré syndrome. Methods: Autoantibody screening was performed in serum samples from all GBS patients included in the International GBS Outcome study by 11 different Spanish centres. The screening included testing for anti-ganglioside antibodies, anti-nodo/paranodal antibodies, immunocytochemistry on neuroblastoma-derived human motor neurons and murine dorsal root ganglia (DRG) neurons, and immunohistochemistry on monkey peripheral nerve sections. We analysed the staining patterns of patients and controls. The prognostic value of anti-ganglioside antibodies was also analysed. Results: None of the GBS patients (n = 100) reacted against the nodo/paranodal proteins tested, and 61 (61%) were positive for, at least, one anti-ganglioside antibody. GBS sera reacted strongly against DRG neurons more frequently than controls both with IgG (6% vs 0%; p = 0.03) and IgM (11% vs 2.2%; p = 0.02) immunodetection. No differences were observed in the proportion of patients reacting against neuroblastoma-derived human motor neurons. Reactivity against monkey nerve tissue was frequently detected both in patients and controls, but specific patterns were only detected in GBS patients: IgG from 13 (13%) patients reacted strongly against Schwann cells. Finally, we confirmed that IgG anti-GM1 antibodies are associated with poorer outcomes independently of other known prognostic factors. Conclusion: Our study confirms that (1) GBS patients display a heterogeneous repertoire of autoantibodies targeting nerve cells and structures; (2) gangliosides are the most frequent antigens in GBS patients and have a prognostic value; (3) further antigen-discovery experiments may elucidate other potential antigens in GBS

Apoyo psicosocial a afectada(o)s por terremoto del 5 de setiembre de 2012

Ponencia--Universidad de Costa Rica, Vicerrectoría de Acción Social, Extensión Docente. 2013. Para mayor información puede escribir a [email protected] Brigada de Intervención Psicosocial de la Universidad de Costa Rica, acompañada por la Red Sismológica Nacional (RSN: ICE-UCR), el Preventec y estudiantes de la Maestría en Gestión de Riesgos y Atención de Emergencias, visitó varias comunidades del cantón de Santa Cruz de Guanacaste y del distrito de Cóbano de la provincia de Puntarenas. Las intervenciones incluyeron charlas técnicas sobre terremotos y tsunamis, planes de emergencia y atención a personas afectadas por el terremoto del 5 de setiembre. Se encontraron grandes temores en la población entre los que destacan el miedo a: un sismo futuro, a un tsunami, a las réplicas, a un desprendimiento de la península de Nicoya, a intoxicación masiva por gases y al surgimiento de un volcán submarino.Universidad de Costa RicaUCR::Vicerrectoría de Docencia::Ciencias Sociales::Facultad de Ciencias Sociales::Escuela de Psicologí

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics