Revistas
Revista:
MEDICINE (BALTIMORE)
ISSN 0025-7974
Vol. 100
N° 5
Año 2021
Págs.e24483
Intermediate care units (ImCUs) have been shown as appropriate units for the management of selected septic patients. Developing specific protocols for residents in training may be useful for their medical performance. The objective of this study was to analyze whether a simulation-based learning bundle is useful for residents while acquiring competencies in the management of sepsis during their internship in an ImCU.
A prospective study, set in a tertiary-care academic medical center was performed enrolling residents who performed their internship in an ImCU from 2014 to 2017. The pillars of the simulation-based learning bundle were sepsis scenario in the simulation center, instructional material, and sepsis lecture, and management of septic patients admitted in the ImCU. Each resident was evaluated in the beginning and at the end of their internship displaying a sepsis-case scenario in the simulation center. The authors developed a sepsis-checklist that residents must fulfill during their performance which included 5 areas: hemodynamics (0¿10), oxygenation (0¿5), antibiotic therapy (0¿9), organic injury (0¿5), and miscellaneous (0¿4).
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Revista:
BMC MEDICAL EDUCATION
ISSN 1472-6920
Vol. 21
N° 1
Año 2021
Págs.249
Background: Active learning strategies such as formative assessment through clinical cases may help to get a deeper learning. We have studied the effect of this kind of online formative assessment in pathophysiology teaching.
Methods: Seven brief clinical cases were used to give formative assessment in the first semester of a pathophysiology course. To evaluate its effect on learning, we analyzed the proportion of students that passed the end of semester exam with a score above 60 over 100. We also analyzed the effect of the intervention according to the students' previous academic performance.
Results: Ninety-six students participated in the study and sat the exam. Sixty-five of them passed it. Students that passed the exam had a higher previous academic performance and had done a higher number of exercises of formative assessment, both in univariate and multivariate analysis. The participants were divided in three groups, according to their previous academic performance. In the intermediate group, the number of cases done by the students who passed the exam was significantly higher than in those who did not pass it (median: 4 versus 0; P = 0.009).
Conclusion: Formative assessment through web-based clinical cases was followed by an improvement of the academic results in pathophysiology, mainly in students with intermediate performance.
Revista:
IEEE TRANSACTIONS ON VEHICULAR TECHNOLOGY
ISSN 0018-9545
Vol. 68
N° 12
Año 2019
Págs.11611 - 11620
Independently on the business case addressed, one of the main drawbacks of the railway use cases that need continuous Global Navigation Satellite Systems data is the lack of availability for the 100% of the time of the journey. Additionally, the integrity assessment of the position estimation given is also mandatory for safety critical applications. Thus, tunnels and multipath effects are one of the most challenging situations for the continuous positioning systems. In this context, an autonomous on-board Complementary Positioning System has been proposed to overcome the limitation of Global Navigation Satellite System based positioning systems. This paper proposes a positioning enhancement solution by means of fusing data from the satellite navigation system and inertial measurement units. That hybrid solution provides higher availability and accuracy to the positioning specially on known blocked scenarios, such as tunnels, or urban canyons, by means of a novel environment aware map aided software technique named Known Blocked Scenarios algorithm... This paper describes the Complementary Positioning System and the field test carried out in a challenging environment to validate the enhancement proposed by the authors, which demonstrate the benefits that this system has in known harsh environments for railways.
Revista:
AMERICAN JOURNAL OF CARDIOLOGY
ISSN 0002-9149
Vol. 121
N° 1
Año 2018
Págs.125 - 130
The 2014 American College of Cardiology/American Heart Association Perioperative Guidelines suggest using the Revised Cardiac Risk Index, myocardial infarction or cardiac arrest, or American College of Surgeons National Surgical Quality Improvement Program calculators for combined patient-surgical risk assessment. There are no published data comparing their performance. This study compared these risk calculators and a reconstructed Revised Cardiac Risk Index in predicting postoperative cardiac complications, both during hospitalization and 30 days after operation, in a patient cohort who underwent select surgical procedures in various risk categories. Cardiac complications occurred in 14 of 663 patients (2.1%), of which 11 occurred during hospitalization. Only 3 of 663 patients (0.45%) had a myocardial infarction or cardiac arrest. Because these calculators used different risk factors, different outcomes, and different durations of observation, a true direct comparison is not possible. We found that all 4 risk calculators performed well in the setting they were originally studied but were less accurate when applied in a different manner. In conclusion, all calculators were useful in defining low-risk patients in whom further cardiac testing was unnecessary, and the myocardial infarction or cardiac arrest may be the most reliable in selecting higher risk patients. (C) 2017 Elsevier Inc. All rights reserved.
Revista:
JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS
ISSN 0269-4727
Vol. 42
N° 5
Año 2017
Págs.638 - 641
What is known and objectiveChylous ascites is a rare condition. The most frequent causes are lymphomas, solid malignancies, abdominal trauma and cirrhosis. Isolated case reports describe the relationship between calcium channel blockers (CCB) and chyloperitoneum. Lercanidipine is a third-generation dihydropyridine with low rate of adverse events. We describe a case of lercanidipine-induced chylous ascites. Case summaryAn 80-year-old white female with hypertension treated with lercanidipine, developed chylous ascites and abdominal pain after the dosage of the CCB was doubled. The initial suspicion was a hidden neoplasm, but after a thorough research, no apparent cause was detected and the symptoms resolved after the drug was suspended. What is new and conclusionCalcium channel blockers should be considered as possible causes in cases of chyloperitoneum of unknown aetiology.
Revista:
ONCOTARGET
ISSN 1949-2553
Vol. 9
N° 5
Año 2017
Págs.6652 - 6656
Sorafenib is a multi-kinase inhibitor and a vascular endothelial growth factor (VEGF) inhibitor approved to treat patients with advanced hepatocellular carcinoma, renal cell carcinoma and differentiated thyroid carcinoma. Its most common side effects are asthenia/fatigue, skin toxicity, diarrhea and arterial hypertension. Reported respiratory adverse reactions include dyspnea, cough, pleural effusion and hoarseness. The aim of this report is to describe for the first time the occurrence of pneumatocele in two patients treated with Sorafenib. Patients had no respiratory symptoms and alternative diagnoses were ruled out. Primary tumors were different (liver metastases from a pancreatic neuroendocrine tumor and hepatocellular carcinoma) but both patients had been treated with yttrium 90 radioembolization 9 and 17 months before starting on Sorafenib, respectively. No complications occurred and Sorafenib withdrawal was followed by radiologic improvement.
Revista:
PLOS ONE
ISSN 1932-6203
Vol. 10
N° 6
Año 2015
Págs.e0130989
Background
Application of illness-severity scores in Intermediate Care Units (ImCU) shows conflicting results. The aim of the study is to design a severity-of-illness score for patients admitted to an ImCU.
Methods
We performed a retrospective observational study in a single academic medical centre in Pamplona, Spain. Demographics, past medical history, reasons for admission, physiological parameters at admission and during the first 24 hours of ImCU stay, laboratory variables and survival to hospital discharge were recorded. Logistic regression analysis was performed to identify variables for mortality prediction.
Results
A total of 743 patients were included. The final multivariable model (derivation cohort = 554 patients) contained only 9 variables obtained at admission to the ImCU: previous length of stay 7 days (6 points), health-care related infection (11), metastatic cancer (9), immunosuppressive therapy (6), Glasgow comma scale 12 (10), need of non-invasive ventilation (14), platelets 50000/mcL (9), urea 0.6 g/L (10) and bilirubin 4 mg/dL (9). The ImCU severity score (ImCUSS) is generated by summing the individual point values, and the formula for determining the expected in-hospital mortality risk is: eImCUSS points*0.099 ¿ 4,111 / (1 + eImCUSS points*0.099 ¿ 4,111). The model showed adequate calibration and discrimination. Performance of ImCUSS (validation cohort = 189 patients) was comparable to that of SAPS II and 3. Hosmer-Lemeshow goodness-of-fit C test was ¿2 8.078 (p=0.326) and the area under receiver operating curve 0.802.
Conclusions
ImCUSS, specially designed for intermediate care, is based on easy to obtain variables at admission to ImCU. Additionally, it shows a notable performance in terms of calibration and mortality discrimination.
Revista:
PLOS ONE
ISSN 1932-6203
Vol. 10
N° 10
Año 2015
Págs.e0139702.
These results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate car
Revista:
LIVER INTERNATIONAL
ISSN 1478-3223
Vol. 35
N° 5
Año 2015
Págs.1590 - 96
BACKGROUND & AIMS:
Radioembolization may rarely induce liver disease resulting in a syndrome that is similar to veno-occlusive disease complicating bone marrow transplantation where inflammation, endothelial cell activation and thrombosis are likely involved. We hypothesized that similar mechanisms could be implicated in radioembolization-induced liver disease (REILD). Moreover, lobar radioembolization may induce hypertrophy of the non-treated hemiliver most probably by inducing liver regeneration.
METHODS:
In patients with hepatocellular carcinoma, we prospectively studied serum levels of markers of liver regeneration, oxidative stress, pro-inflammatory pathways, endothelial activation and coagulation parameters over 2 months after radioembolization.
RESULTS:
Although REILD did not occur among 14 treated patients, a decrease in effective liver blood flow was observed. Radioembolization was followed by a persistent increase in pro-inflammatory (interleukin 6 and 8) and oxidative stress (malondyaldehide) markers, an induction of endothelial injury markers (vW factor and PAI-1) and an activation of the coagulation cascade (factor VIII, PAI-1, D-Dimer) as well as a significant increase in factors related to liver regeneration (FGF-19 and HGF).
CONCLUSION:
Radioembolization activates liver regeneration, produces oxidative stress, activates inflammatory cytokines and induces endothelial injury with partial activation of the coagulation cascade. These findings may have implicati
Revista:
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
ISSN 0066-4804
Vol. 58
N° 7
Año 2014
Págs.4227 - 4229
Mitochondrial toxicity has been recently suggested to be the underlying mechanism of long-term linezolid-associated toxicity in patients with 16S rRNA genetic polymorphisms. Here, we report for the first time two cases of lactic acidosis due to long-term linezolid exposure in liver transplant recipients who presented an A2706G mitochondrial DNA polymorphism.
Revista:
PEDIATRIC NEUROLOGY
ISSN 0887-8994
Vol. 51
N° 3
Año 2014
Págs.e9-e10
Currently there is no strong evidence to recommend any determined trough plasma levels, and thus we wait for additional observations and clinical trials to clarify the optimal dosage required to avoid unnecessary side effects. Meanwhile, we have found a safe and acceptable response with plasma levels within the lower range of efficacy described.
Revista:
HPB
ISSN 1365-182X
Vol. 16
N° 3
Año 2014
Págs.243-49
The present results warrant further studies to better elucidate the mechanism underlying this phenomenon of spared hemiliver hypertrophy and to investigate its role as an alternative to portal vein embolization in the management of patients with potentially resectable liver tumours.
Revista:
ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA
ISSN 0213-005X
Vol. 31
N° 6
Año 2013
Págs.412 - 413
Revista:
RARE TUMORS
ISSN 2036-3605
Vol. 4
N° 2
Año 2012
Págs.106-109
Hepatic epithelioid hemangioendothelioma (HEH) is a rare disease of unknown etiology for which a standard systemic treatment has not been established. The common expression of vascular endothelial growth factor (VEGF) and its receptor in HEH provide a rationale for the reported use of antiangiogenic drugs, including bevacizumab, lenalidomide and thalidomide. We report a case of a young male patient with HEH who was treated with sorafenib for almost 2 years. Sorafenib was used instead of other VEGF inhibitors due to its convenient oral route, its dual antiangiogenic and antiproliferative activity, and its favorable safety profile. Sorafenib therapy resulted in durable stabilization with progressive calcification of liver tumors and minor but stable response of lung lesions
Revista:
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
ISSN 0190-9622
Vol. 64
N° 6
Año 2011
Págs.e121-1