Feedback by automatic assessment systems used in mathematics homework in the engineering field

This research presents the results of the teaching innovation Dynamic Online Assessment System in Mathematics, which is implemented in higher education to promote self‐study by students outside the classroom. The WIRIS calculator was integrated into the Moodle platform to create questions with random elements, for example, students had access to different variants of the same question. The effect of the type of feedback (immediate or deferred) on the work of the students on the platform, measured by means of participation, time spent, and grades obtained, was evaluated. We used a quasi‐experimental methodology for a population of 5,507 students, distributed in 229 courses on four campuses that learn Mathematics I in engineering programs. Immediate feedback exhibits better work of students on the platform, but this work is not necessarily more efficient in comparison with the work performed by students using assessments online assessment with deferred feedback

Experience of Real-Life Use of Dalbavancin as an Off-Label Treatment of Complicated Infectious Diseases in a Tertiary Care Hospital

Dalbavancin is a lipoglycopeptide indicated for the treatment of acute bacterial skin and skin structure infections. The aim of this study is to describe the cases in which dalbavancin has been used as an off-label use for the treatment of infections by gram-positive microorganisms. Meth-ods: we carried out a case report series study of all patients treated with dalbavancin as off-label from January 2017 to March 2022. Results: Dalbavancin was administered to seventeen patients. The most frequent diagnosis was osteoarticular infection in 52.94%of patients. The principal isolated microorganism was Staphylococcus epidermidis (47.00%). The posology of dalbavancin was highly variable and the median number of days of treatment was 14 (1–56). At 3 months of treatment only 2 patient died for others reasons and no patient had reinfection. Conclusion: dalbavancin is an an-tibiotic with a novel dosage in infectious diseases of Gram-positive that proven to be high effective because no patient manifested symptoms of reinfection

Comparative Clinical Efficacy Study between Erenumab and Fremanezumab

A retrospective comparative study was conducted to compare the efficacy of monoclonal antibody drugs against the calcitonin gene-related peptide pathway in migraine and to establish whether they can be considered equivalent therapeutic alternatives for this pathology. A total of 21 patients with chronic migraine were treated with Fremanezumab 225 mg/30 days and 24 patients treated with Erenumab 70 mg/30 days for at least 6 months. Data were collected at baseline and at six months using the following scales: Headache Impact Test (HIT), Migraine Disability Assessment Scale (MIDAS), and a numerical scale of pain intensity (0 (no pain) and 10 (unbearable pain)). Days of migraine per month were recorded. Mean HIT at baseline and 6 months for Fremanezumab and Erenumab was 68.6 (62–76) and 54 (36–70) and 66 (42–78) and 53 (9–72), respectively. In both cases, it decreased by more than 6 points (efficacy criteria). Mean MIDAS at baseline and 6 months for Fremanezumab and Erenumab was 70 (25–127) and 25 (0–135) and 73.3 (19–150) and 23 (0–68), respectively. In both cases, it decreased by more than 30% (efficacy criteria). Mean pain intensity at baseline and 6 months for Fremanezumab and Erenumab was 8.8 (6–10) and 6(5–8) and 8.6 (7–10) and 6 (10–0), respectively. Mean number of migraine days in a month at baseline and 6 months for Fremanezumab and Erenumab were 16.6 (10–30) and 5.3 (0–11) days and 17 (3–30) and 5.8(–15) days, respectively. In both cases, the reduction was > 50%. It can be concluded that the initial values of the scales are very similar. The initial situation of the patient is not a trigger for the use of one drug or the other. Clinically, there is no difference between the two drugs

Líneas de investigación experimentales del grupo de dinámica no lineal y fibras ópticas del Instituto de Óptica "Daza de Valdes del CSIC"

Se presenta y describen las líneas de trabajo experimentales que se vienen cultivando en el Grupo de investigación en Dinámica no Lineal y Fibras ópticas, recientemente creado en el Instituto de Óptica del CSIC. We present the experimental lines developed in last years in the Nonlinear Dynamics and Fiber Optics Group (NDFO) of the Optics Institute "Daza de Valdés" (IO-CSIC)

DECTIN-1: A modifier protein in CTLA-4 haploinsufficiency.

Autosomal dominant loss-of-function (LoF) variants in cytotoxic T-lymphocyte associated protein 4 (CTLA4) cause immune dysregulation with autoimmunity, immunodeficiency and lymphoproliferation (IDAIL). Incomplete penetrance and variable expressivity are characteristic of IDAIL caused by CTLA-4 haploinsufficiency (CTLA-4h), pointing to a role for genetic modifiers. Here, we describe an IDAIL proband carrying a maternally inherited pathogenic CTLA4 variant and a paternally inherited rare LoF missense variant in CLEC7A, which encodes for the β-glucan pattern recognition receptor DECTIN-1. The CLEC7A variant led to a loss of DECTIN-1 dimerization and surface expression. Notably, DECTIN-1 stimulation promoted human and mouse regulatory T cell (Treg) differentiation from naïve αβ and γδ T cells, even in the absence of transforming growth factor-β. Consistent with DECTIN-1's Treg-boosting ability, partial DECTIN-1 deficiency exacerbated the Treg defect conferred by CTL4-4h. DECTIN-1/CLEC7A emerges as a modifier gene in CTLA-4h, increasing expressivity of CTLA4 variants and acting in functional epistasis with CTLA-4 to maintain immune homeostasis and tolerance.S

Resultados clínicos iniciales y variables pronósticas en la implementación de un Código Sepsis en un Hospital Universitario de alta complejidad

Objective: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. Methods: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. Results: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p 65 years (OR 5.33, p 3 mmol/L (OR 5,85, p 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). Conclusions: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programsObjetivo. Evaluar el impacto de un programa educativo y organizativo llamado Código Sepsis, en los primeros siete meses de su aplicación en un hospital de alta complejidad. Material y métodos. Se realizó un estudio observacional durante un período consecutivo de siete meses (Febrero 2015-Septiembre 2015). Se analizó la relación con la mortalidad de los factores de riesgo y los valores analíticos usando análisis uni y multivariante. Resultados. Se incluyeron un total de 237 pacientes. La mortalidad intrahospitalaria a los 30 días fue del 24 % y del 27% a los 60 días. La mortalidad de los pacientes ingresados en Unidades de Cuidados Críticos fue del 30%. Se encontraron diferencias significativas entre los pacientes que murieron y los que sobrevivieron en sus valores medios de creatinina (2,30 vs 1,46 mg/dL, p <0,05), ácido láctico (6,10 vs 2,62 mmol/L, p <0,05) y procalcitonina (23,27 vs 12,73 mg/dL, p <0,05). Se encontró una tendencia lineal estadísticamente significativa entre los valores de la escala SOFA y la mortalidad (p <0,05). En el análisis multivariante se identificaron otros factores de riesgo independientes asociados con la muerte: edad > 65 años (OR 5,33, p 3 mmol/L (OR 5,85, p <0,05), creatinina > 1,2 mgr/dL (OR 4,54, p <0,05) y el shock (OR 6,57, P <0,05). Conclusiones. La mortalidad en este estudio se encuentra dentro de los límites de los ensayos clínicos más recientes de sepsis. El estudio ha identificado varios marcadores que podrían ser útiles a nivel local para estimar el riesgo en pacientes sépticos. Estudios como éste son necesarios para hacer mejoras en los programas de Código Sepsi

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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio