Search

En este trabajo de final de grado, se realiza una programación que fomenta la interculturalidad frente al aumento de inmigrantes en nuestra sociedad. Esto va a ser tratado desde la transversalidad educativa, donde utilizaremos tanto el ámbito de las Ciencias Sociales, utilizando el mapa como herramienta de aprendizaje, como el ámbito musical para afrontar el desconocimiento multicultural entre los alumnos. Esto se llevará a cabo mediante una metodología activa y cooperativa, teniendo en cuenta los intereses del alumnado, mediante dinámicas como las rutinas de pensamiento, que permitirá unir los contenidos de las diferentes áreas, bloques y competencias clave del currículum para unirlo al aprendizaje significativo de los estudiantes., Grado en Educación Primaria

[Abstract] Background. The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results. We analyzed long‐term follow‐up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32–44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18–26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow‐up of 4.5 years, 91 deaths accounted for 4.21 higher‐than‐expected mortality in the age‐matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance—either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six‐month changes in the composite clinical score and in the 6‐minute walk test distance were related to survival. Conclusions. Persistent valvular heart disease–pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction proce

[Abstract] Aims: We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). Methods and results: The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22-0.67; P < 0.001]. The Kaplan-Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0-4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups. Conclusion: Treatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided.

Introducción. Un porcentaje elevado de pacientes intervenidos de cirugía cardíaca son tributarios de la realización de transfusiones durante el periodo perioperatorio. Son numerosos los trabajos que a partir de análisis uni y multivariantes han relacionado la práctica de transfusiones con variables relacionadas con las características de los pacientes y de las intervenciones realizadas. Objetivo. El objetivo del presente estudio es analizar diferentes variables relacionadas con la realización de transfusiones durante el periodo perioperatorio en pacientes tratados con una cirugía cardíaca mediante un método de partición recursiva. Material y métodos. Se evaluaron de forma ambispectiva un total de 2.122 procedimientos quirúrgicos de cirugía cardiaca realizados de forma consecutiva durante el periodo 2009-2013 en el Hospital de Sant Pau de Barcelona. Se consideró la relación entre una serie de variables clínicas y perioperatorias y la realización de transfusiones durante el periodo perioperatorio. Se analizó la relación entre las variables consideradas y la práctica transfusional mediante diferentes técnicas de partición recursiva, incluyendo los modelos CHAID (Chi-Square Automatic Interaction Detection) y CRT (Classification and Regression Trees). Resultados. El porcentaje de pacientes intervenidos de cirugía cardiaca y que recibieron algún tipo de transfusión durante el periodo perioperatorio fue del 69.9%. El análisis de partición recursiva clasificó a los pacientes en relación al uso de transfusiones en función de los valores de la hemoglobina preoperatoria, el aclaramiento de creatina y la morbilidad medida de acuerdo con el índice Euroscore. Para los pacientes del sexo masculino la variable más relacionada con la realización de transfusiones fue el nivel de hemoglobina preoperatoria, y para las pacientes del sexo femenino lo fue el aclaramiento de creatinina. Otras variables que se vieron asociadas a la realización de transfusiones durante el periodo perioperato, Introduction. A high percentage of patients treated with a cardiac surgery are candidates to hematic transfusion during the perioperative period. There are many studies evaluating the relationship between transfusions and variables associated with the characteristics of the patients or of the surgery with uni or multivariate analysis. Objective. The objective of our study is to analyze several variables related to the transfusion during the perioperative period in patients treated with a cardiac surgery with a recursive partitioning analysis approach. Material and methods. We evaluated ambispectively 2.122 cardiac surgery interventions carried out consecutively during the period 2009-2013 in the Hospital de Sant Pau of Barcelona. It was considered the relationship between several clinical and perioperative variables and transfusion with recursive partitioning analysis techniques, including the models CHAID (Chi-Square Automatic Interaction Detection) and CRT (Classification and Regression Trees). Results. The frequency of patients treated with a cardiac surgery that received some transfusion during the perioperative period was 69.9%.The recursive partitioning analysis classified the patients according to the preoperative hemoglobin values, the creatinine clearance and the general health status measured with the Euroscore index. For male patients the variable most related to practice of transfusions was the preoperative hemoglobin values, and for female patients it was the creatinine clearance. Other variable that appeared related to transfusion during the perioperatice period were the type of surgery and the priority of the surgery, the antiaggregation therapy, the extracorporeal circulation time, and the volume obtained from the thoracic drainages. There was a significant relationship between transfusion during the perioperative period and the hospital mortality and the duration of the hospital stays. The recursive partitioning analysis identified patients with a g