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Resumen Introducción: El desfibrilador automático implantable (DAI) transvenoso es el tratamiento de elección para la prevención de muerte súbita (MS) cardiaca por arritmias ventriculares malignas. Su uso se puede ver limitado cuando existe infección del sistema de estimulación o en población pediátrica donde representa un reto por diversas razones, incluyendo: las mínimas dimensiones del sistema venoso de los niños, la longitud de los electrodos, el tamaño del generador, así como por la complejidad anatómica en casos de cardiopatía congénita asociada. Objetivo: El presente artículo tiene por objetivo presentar la primera serie de casos de pacientes mexicanos a los cuales se les implantó un DAI subcutáneo (DAI-SC) como terapia para la prevención de MS. Métodos: Se presentan los cuatro primeros casos que fueron implantados en el Instituto Nacional de Cardiología Ignacio Chávez con un DAI-SC (Emblem, Boston Scientific, EE.UU.), tres de ellos eran pacientes pediátricos, incluyendo el primer implante de este tipo de dispositivo en un paciente pediátrico en América Latina. Las técnicas de tres y dos incisiones fueron empleadas bajo anestesia general. Resultados: Se realizó el implante exitoso con técnica de tres incisiones en los dos primeros casos y con técnica de dos incisiones en los dos últimos casos. Se corroboró el adecuado funcionamiento del dispositivo en sala, con la verificación de terapia apropiada (65 J) de la fibrilación ventricular inducida mediante estimulación a 50 Hz. No hubo complicaciones inmediatas. Un paciente presentó descargas apropiadas a los dos meses del implante. En el seguimiento, un niño desarrolló erosión de la piel a nivel de la curva del electrodo en el esternón, sin datos de infección. En quirófano se resecó la piel dañada, se retiró el barril y la seda de fijación, se realizó lavado quirúrgico y se volvió a cerrar la piel, logrando así evitar el retiro del sistema. Conclusiones: El DAI-SC es una terapia alternativa al DAI endovenoso y puede ser considerado de primera elección en aquellos casos que no requieran de estimulación ventricular, incluyendo pacientes pediátricos. Pueden ocurrir complicaciones cutáneas, pero no representan una amenaza como las complicaciones venosas de los DAI convencionales.
Abstract Introduction: The transvenous implantable cardioverter defibrillator (ICD) is the treatment of choice for the prevention of sudden cardiac death (SCD). Its use could be restricted when device-related infections occurs or in the pediatric population. In the later, an ICD represents a challenge, due to the minimal dimensions of the venous system in children, the length of the electrodes, the size of the generator, as well as the anatomical complexity in cases with associated congenital heart disease. Objective: This article presents the first Mexican patients with a subcutaneous ICD (SC-ICD) implant as a therapy for the prevention of SCD. Methods: The first four cases were implanted at the Ignacio Chávez National Institute of Cardiology with a SC-ICD (Emblem, Boston Scientific, USA), three of them were pediatric patients, including the first implant of this type of device in a pediatric patient in Latin America. The 3-incision and 2-incision techniques were used under general anesthesia. Results: A successful implantation was obtained with the 3-incision technique in the first 2 cases and the last 2 with the 2-incision technique. Proper functioning of the device was corroborated in the operating room with proof of appropriate therapy (65 J) for ventricular fibrillation induced with 50 Hz stimulation. No immediate complications were observed. One patient had appropriate shocks two months after the implant. During follow-up, one child developed skin erosion at the level of the curve of the electrode on the sternum, with no signs of infection. In the operating room, the damaged skin was resected, the barrel and the fixation silk were removed, surgical lavage was performed, and the skin was closed again, thus avoiding removal of the system. Conclusions: The SC-ICD is an alternative therapy to the transvenous ICD. It can be considered first choice in subjects who do not require ventricular pacing, including pediatric patients. Skin complications can occur but do not pose a threat as venous complications of conventional ICDs.
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INTRODUCTION: The transvenous implantable cardioverter defibrillator (ICD) is the treatment of choice for the prevention of sudden cardiac death (SCD). Its use could be restricted when device-related infections occurs or in the pediatric population. In the later, an ICD represents a challenge, due to the minimal dimensions of the venous system in children, the length of the electrodes, the size of the generator, as well as the anatomical complexity in cases with associated congenital heart disease. OBJECTIVE: This article presents the first Mexican patients with a subcutaneous ICD (SC-ICD) implant as a therapy for the prevention of SCD. METHODS: The first four cases were implanted at the Ignacio Chávez National Institute of Cardiology with a SC-ICD (Emblem, Boston Scientific, USA), three of them were pediatric patients, including the first implant of this type of device in a pediatric patient in Latin America. The 3-incision and 2-incision techniques were used under general anesthesia. RESULTS: A successful implantation was obtained with the 3-incision technique in the first 2 cases and the last 2 with the 2-incision technique. Proper functioning of the device was corroborated in the operating room with proof of appropriate therapy (65 J) for ventricular fibrillation induced with 50 Hz stimulation. No immediate complications were observed. One patient had appropriate shocks two months after the implant. During follow-up, one child developed skin erosion at the level of the curve of the electrode on the sternum, with no signs of infection. In the operating room, the damaged skin was resected, the barrel and the fixation silk were removed, surgical lavage was performed, and the skin was closed again, thus avoiding removal of the system. CONCLUSIONS: The SC-ICD is an alternative therapy to the transvenous ICD. It can be considered first choice in subjects who do not require ventricular pacing, including pediatric patients. Skin complications can occur but do not pose a threat as venous complications of conventional ICDs.
INTRODUCCIÓN: El desfibrilador automático implantable (DAI) transvenoso es el tratamiento de elección para la prevención de muerte súbita (MS) cardiaca por arritmias ventriculares malignas. Su uso se puede ver limitado cuando existe infección del sistema de estimulación o en población pediátrica donde representa un reto por diversas razones, incluyendo: las mínimas dimensiones del sistema venoso de los niños, la longitud de los electrodos, el tamaño del generador, así como por la complejidad anatómica en casos de cardiopatía congénita asociada. OBJETIVO: El presente artículo tiene por objetivo presentar la primera serie de casos de pacientes mexicanos a los cuales se les implantó un DAI subcutáneo (DAI-SC) como terapia para la prevención de MS. MÉTODOS: Se presentan los cuatro primeros casos que fueron implantados en el Instituto Nacional de Cardiología Ignacio Chávez con un DAI-SC (Emblem, Boston Scientific, EE.UU.), tres de ellos eran pacientes pediátricos, incluyendo el primer implante de este tipo de dispositivo en un paciente pediátrico en América Latina. Las técnicas de tres y dos incisiones fueron empleadas bajo anestesia general. RESULTADOS: Se realizó el implante exitoso con técnica de tres incisiones en los dos primeros casos y con técnica de dos incisiones en los dos últimos casos. Se corroboró el adecuado funcionamiento del dispositivo en sala, con la verificación de terapia apropiada (65 J) de la fibrilación ventricular inducida mediante estimulación a 50 Hz. No hubo complicaciones inmediatas. Un paciente presentó descargas apropiadas a los dos meses del implante. En el seguimiento, un niño desarrolló erosión de la piel a nivel de la curva del electrodo en el esternón, sin datos de infección. En quirófano se resecó la piel dañada, se retiró el barril y la seda de fijación, se realizó lavado quirúrgico y se volvió a cerrar la piel, logrando así evitar el retiro del sistema. CONCLUSIONES: El DAI-SC es una terapia alternativa al DAI endovenoso y puede ser considerado de primera elección en aquellos casos que no requieran de estimulación ventricular, incluyendo pacientes pediátricos. Pueden ocurrir complicaciones cutáneas, pero no representan una amenaza como las complicaciones venosas de los DAI convencionales.
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Cardiologia , Desfibriladores Implantáveis , Humanos , Criança , México , Resultado do Tratamento , Cardioversão Elétrica , Morte Súbita Cardíaca/prevenção & controle , Morte Súbita Cardíaca/etiologiaRESUMO
Falling events are a global health concern with short- and long-term physical and psychological implications, especially for the elderly population. This work aims to monitor human activity in an indoor environment and recognize falling events without requiring users to carry a device or sensor on their bodies. A sensing platform based on the transmission of a continuous wave (CW) radio-frequency (RF) probe signal was developed using general-purpose equipment. The CW probe signal is similar to the pilot subcarriers transmitted by commercial off-the-shelf WiFi devices. As a result, our methodology can easily be integrated into a joint radio sensing and communication scheme. The sensing process is carried out by analyzing the changes in phase, amplitude, and frequency that the probe signal suffers when it is reflected or scattered by static and moving bodies. These features are commonly extracted from the channel state information (CSI) of WiFi signals. However, CSI relies on complex data acquisition and channel estimation processes. Doppler radars have also been used to monitor human activity. While effective, a radar-based fall detection system requires dedicated hardware. In this paper, we follow an alternative method to characterize falling events on the basis of the Doppler signatures imprinted on the CW probe signal by a falling person. A multi-class deep learning framework for classification was conceived to differentiate falling events from other activities that can be performed in indoor environments. Two neural network models were implemented. The first is based on a long-short-term memory network (LSTM) and the second on a convolutional neural network (CNN). A series of experiments comprising 11 subjects were conducted to collect empirical data and test the system's performance. Falls were detected with an accuracy of 92.1% for the LSTM case, while for the CNN, an accuracy rate of 92.1% was obtained. The results demonstrate the viability of human fall detection based on a radio sensing system such as the one described in this paper.
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Aprendizado Profundo , Humanos , Idoso , Redes Neurais de Computação , Radar , Atividades HumanasRESUMO
In this work, an AlGaN-based Deep-Ultraviolet Light-Emitting Diode structure has been designed and simulated for the zincblende and wurtzite approaches, where the polarization effect is included. DFT analysis was performed to determine the band gap direct-to-indirect cross-point limit, AlN carrier mobility, and activation energies for p-type dopants. The multiple quantum wells analysis describes the emission in the deep-ultraviolet range without exceeding the direct-to-indirect bandgap cross-point limit of around 77% of Al content. Moreover, the quantum-confined Stark effect on wavefunctions overlapping has been studied, where Al-graded quantum wells reduce it. Both zincblende and wurtzite have improved electrical and optical characteristics by including a thin AlGaN with low Al content. Mg and Be acceptor activation energies have been calculated at 260 meV and 380 meV for Be and Mg acceptor energy, respectively. The device series resistance has been decreased by using Be instead of Mg as the p-type dopant from 3 kΩ to 0.7 kΩ.
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A solar cell structure with a graded bandgap absorber layer based on InGaN has been proposed to overcome early predicted efficiency. Technological issues such as carrier concentration in the p- and n-type are based on the data available in the literature. The influence of carrier concentration-dependent mobility on the absorber layer has been studied, obtaining considerable improvements in efficiency and photocurrent density. Efficiency over the tandem solar cell theoretical limit has been reached. A current density of 52.95 mA/cm2, with an efficiency of over 85%, is determined for a PiN structure with an InGaN step-graded bandgap absorption layer and 65.44% of power conversion efficiency for the same structure considering piezoelectric polarization of fully-strained layers and interfaces with electron and hole surface recombination velocities of 10-3 cm/s.
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The growing elderly population living independently demands remote systems for health monitoring. Falls are considered recurring fatal events and therefore have become a global health problem. Fall detection systems based on WiFi radio frequency signals still have limitations due to the difficulty of differentiating the features of a fall from other similar activities. Additionally, the antenna orientation has not been taking into account as an influencing factor of classification performance. Therefore, we present in this paper an analysis of the classification performance in relation to the antenna orientation and the effects related to polarization and radiation pattern. Furthermore, the implementation of a device-free fall detection platform to collect empirical data on falls is shown. The platform measures the Doppler spectrum of a probe signal to extract the Doppler signatures generated by human movement and whose features can be used to identify falling events. The system explores two antenna polarization: horizontal and vertical. The accuracy reached by horizontal polarization is 92% with a false negative rate of 8%. Vertical polarization achieved 50% accuracy and false negatives rate.
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Acidentes por Quedas , Monitorização Ambulatorial , Idoso , Algoritmos , Humanos , Movimento , Ondas de RádioRESUMO
This paper reports on the progress of a wearable assistive technology (AT) device designed to enhance the independent, safe, and efficient mobility of blind and visually impaired pedestrians in outdoor environments. Such device exploits the smartphone's positioning and computing capabilities to locate and guide users along urban settings. The necessary navigation instructions to reach a destination are encoded as vibrating patterns which are conveyed to the user via a foot-placed tactile interface. To determine the performance of the proposed AT device, two user experiments were conducted. The first one requested a group of 20 voluntary normally sighted subjects to recognize the feedback provided by the tactile-foot interface. The results showed recognition rates over 93%. The second experiment involved two blind voluntary subjects which were assisted to find target destinations along public urban pathways. Results show that the subjects successfully accomplished the task and suggest that blind and visually impaired pedestrians might find the AT device and its concept approach useful, friendly, fast to master, and easy to use.
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Pedestres , Tecnologia Assistiva , Pessoas com Deficiência Visual , Dispositivos Eletrônicos Vestíveis , Humanos , SmartphoneRESUMO
Objectives. We investigated the association between physical fitness and cognitive status. Further, we examined whether physical fitness mediates the association between cognitive functioning and aging. Design. Cross-sectional study. Setting. Urban and rural Colombian older adults. Methods. 4416 participants from the SABE study were included in the current analysis. Physical fitness was assessed with the handgrip test and the usual gait speed test. Cognitive status was evaluated through the Folstein Mini-Mental State Examination. A parallel mediation path was used to test the possible mediator role of physical fitness between aging and cognitive functioning. Results. Older adults with lower handgrip strength (HGS) were more likely to have mild-cognitive status than older adults with healthy HGS (OR = 1.53, 95% CI = 1.15; 2.02). In addition, older adults with a slower gait speed were more likely to have mild cognitive impairment (OR = 2.05, 95% CI = 1.54; 2.78). Age had an inverse relationship with cognitive function (ß = -0.110, 95% CI = -0.130; -0.100) and it was also inversely associated with HGS (ß = -0.003, 95% CI = -0.005; -0.002) and gait speed (ß = -0.010, 95% CI = -0.011; -0.009). The indirect effects, which indicate that the effect of age on cognitive function is transmitted through mediators, showed that both gait speed (ß = -0.028, 95% CI = -0.036; -0.020) and HGS (ß = -0.014, 95% CI = -0.024; -0.005) were independent mediators of the detrimental effect of aging on cognitive function. Conclusions. Physical fitness mediates the effects of aging on cognitive functioning. Our findings suggest that physical activity can be a key factor to prevent cognitive deterioration during aging process.
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Envelhecimento/fisiologia , Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Aptidão Física , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Disfunção Cognitiva/etiologia , Colômbia/epidemiologia , Estudos Transversais , Feminino , Marcha/fisiologia , Força da Mão/fisiologia , Humanos , Masculino , Análise de Mediação , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricosRESUMO
The proportion of the world's older adults and of its dementia cases is increasing in low and middle-income countries. This is particularly true in Colombia. There, the number of individuals with dementia may increase five-fold by 2050. Yet research is lacking on dementia in such settings. This work estimates the prevalence of dementia in a community-dwelling population in Colombia. It also assesses how gender-based differences in cardiovascular conditions and socioeconomic disparities affect dementia. This work analyzes data on 2000 respondents at least 60 years of age in the Health, Well-Being, And Aging (SABE) study in Bogota. Respondents with dementia are those who have cognitive impairment and at least two limitations in instrumental activities of daily living. The SABE study finds 8.4% of respondents have dementia. Age, cardiovascular risks, and socioeconomic disparities contributed to higher odds of dementia. The contributors to dementia can differ for men and women. For example, socioeconomic disparities were a larger contributor to dementia for women than men. The findings support the cognitive reserve hypothesis on dementia. This holds that pre-existing cognitive processes and compensatory mechanisms influence dementia. Women in Latin America are more likely to suffer from socioeconomic disparities that limit their cognitive reserve. This research points to several policy implications that can help offset these disparities and reduce the prevalence of dementia.
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Envelhecimento/psicologia , Demência/epidemiologia , Fatores Sexuais , Classe Social , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva , Colômbia/epidemiologia , Demência/psicologia , Feminino , Humanos , Renda , Vida Independente , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
OBJECTIVES: The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recently defined the new concept of probable sarcopenia to help improve screening and prevent future sarcopenia. We investigated the prevalence of probable sarcopenia, defined as weak grip strength, in community-dwelling older Colombian adults, and examined the long-term associated conditions. DESIGN: Cross-sectional study. SETTING: Urban and rural Colombian older adults from the "Estudio Nacional de Salud, Bienestar y Envejecimiento (SABE) study". PARTICIPANTS: 5237 Colombian older adults aged ≥60 years. MEASUREMENTS: Probable sarcopenia was assessed following the cut-off points for weak grip strength recommended by EWGSOP2 guidelines. Odds ratios (ORs) of the relationship between long-term conditions and probable sarcopenia were determined using logistic regression. RESULTS: The prevalence of probable sarcopenia defined as weak grip strength was 46.5% [95% confidence interval (CI), 45.1-47.8]. Physical inactivity "proxy" (OR 1.35, 95% CI 1.14-1.59); diabetes (OR 1.32, 95% CI 1.11-1.56); and arthritis, osteoarthritis, and rheumatism (OR 1.44, 95% CI 1.25-1.67) were independently associated with probable sarcopenia. CONCLUSIONS AND IMPLICATIONS: We found that almost half of all the Colombian older adults in our sample had probable sarcopenia. Individuals with physical inactivity, diabetes, arthritis, or osteoarthritis and rheumatism had a higher prevalence of probable sarcopenia. Probable sarcopenia is clinically highly relevant, and several of the factors associated with this condition are potentially preventable, treatable, and reversible.
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Geriatria , Sarcopenia , Idoso , Colômbia/epidemiologia , Estudos Transversais , Força da Mão , Humanos , América Latina , Prevalência , Sarcopenia/diagnóstico , Sarcopenia/epidemiologiaRESUMO
Background: Understanding the metabolic syndrome (MetS) prevalence at the national level is important to develop effective programs and strategies to prevent and control MetS. This study aimed to analyze the prevalence of MetS according to gender and aging stage, and its association with potential factors in older individuals ≥60 years of age in Colombia. Methods: The data for this study came from a secondary cross-sectional, nationally representative SABE study Survey on Health, Well-Being, and Aging in Colombia, 2015. A total of 1637 participants (60.7% women, 70.5 ± 7.9 years) from 86 Colombian municipalities participated. A structured questionnaire was used to collect data on socio-demography, lifestyle, and self-report medical conditions. Measurements included anthropometric (weight, waist circumference, body mass index), sarcopenia "proxy" status (calf circumference) handgrip strength levels, high-density lipoprotein cholesterol, triglycerides, fasting glucose, and blood pressure. Univariate and multiple regression models were established as part of the main analysis. Results: Using the harmonized Joint Scientific Statement criteria, MetS was present in 54.9% of the study population, with a higher prevalence among females than males (59.8% vs. 47.3%). Individuals who were cigarette smokers (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.0-2.4; P = 0.034), female gender (OR = 1.3; 95% CI = 1.0-1.8; P = 0.020), and sarcopenia "proxy" (OR = 1.6; 95% CI = 1.0-2.5; P = 0.026) were more likely to have a higher prevalence estimate of MetS, after controlling for relevant covariates. Conclusions: Overall prevalence of MetS among older adults in Colombia is high. Smoking, female gender, and sarcopenia "proxy" status are associated with MetS. These results suggested that MetS is still a serious public burden in Colombia, and screening for promotion of healthy lifestyle and nutrition counseling should be offered routinely in old age.
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Envelhecimento , Interpretação Estatística de Dados , Inquéritos Epidemiológicos , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Fatores Sexuais , Idoso , Idoso de 80 Anos ou mais , Antropometria , Pressão Sanguínea , Colômbia/epidemiologia , Feminino , Força da Mão , Humanos , Estilo de Vida , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Fumar , Classe Social , Inquéritos e QuestionáriosRESUMO
Although most cases of Brugada syndrome have been described in adults, pediatric patients with the disease have been reported since the original article from Josep and Pedro Brugada. Herein is presented the case series of Brugada syndrome in pediatric population of the National Institute of Cardiology Ignacio Chavez. One boy and two adolescent males had palpitations as clinical presentation of the disease. Atrial arrhythmias were documented in two, in the third case there was a high clinical suspicion and quinidine abolished symptoms. The aim of this report is to highlight the importance of performing a detailed clinical history as well as the usefulness of high precordial leads for the diagnosis of this entity.
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Síndrome de Brugada , Adolescente , Arritmias Cardíacas , Síndrome de Brugada/diagnóstico , Criança , Morte Súbita Cardíaca , Eletrocardiografia , Humanos , Masculino , Quinidina/uso terapêuticoRESUMO
Background: The short physical performance battery (SPPB) is a physical performance test of lower extremity function designed for non-disabled older adults. We aimed to establish reference values for community-dwelling Colombian adults aged 60 years or older in terms of (1) the total score; (2) the three subtest scores (walking speed, standing balance performance, and five times sit-to-stand test); and (3) the time to complete the five times sit-to-stand test, s and the walking speed test. Additionally, we sought to explore how much of the variance in the SPPB subtest scores could be explained by anthropometric variables (age, body mass, height, body mass index, and calf circumference). Methods: Participants were men and women aged 60 years or older who participated in the Health and Well-being and Aging Survey in Colombia, 2015. A sample of 4,211 participants (57.3% women) completed the SPPB test, and their anthropometric variables were evaluated. Age-specific percentiles were calculated using the LMS method (3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles). Results: The mean SPPB total score for the entire sample was 8.73 (2.0) points. On average, the total SPPB score was 0.85 points greater in men than in women (p < 0.001). Significant sex differences were observed in all three age groups tested (60-69, 70-79, and 80+ years). In the full sample, our findings suggested that age, body mass, height, body mass index, and calf circumference are significant contributors to walking speed (p < 0.001) after controlling for confounding factors, including ethnicity, socioeconomic status, and urbanicity. Conclusions: Percentile values are of interest to identify target populations for primary prevention and to estimate the proportion of high or low values for SPPB measures in community-dwelling Colombians aged at least 60 years.
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INTRODUCTION: Gait speed worsens with the presence of obesity, and is a powerful marker of functional dependence. Accordingly, gait speed could be a factor that improves or worsens the relationship between obesity and dependence in activities of daily living (ADL). However, to date this potential role has not been examined and the minimum gait speed threshold in the relationship between obesity and ADL is not known. The aim of this study was to determine whether speed moderates the association between obesity and dependence in ADL, and also define the gait speed threshold of this relationship. METHODS: A total of 20,507 community-dwelling older adults from a cross-sectional analysis of national survey data - the Colombian Health, Well-being and Aging study (SABE, 2015) - were surveyed. The research data were collected using structured questionnaires, including basic information, ADL measured using the Barthel Index, body mass index, and gait speed (3â¯m). The Johnson-Neyman technique was applied to determine the gait speed threshold adjusted for age, sex and comorbidities. RESULTS: Regression analysis showed a significant detrimental effect of obesity on dependence in ADL, which was moderated by gait speed (ßâ¯=â¯0.081; 95%CI: 0.045 to 0.117; pâ¯<â¯0.001). Adjusted for major covariates, the Johnson-Neyman technique defined two gait speed thresholds: < 0.77â¯m/s, indicating an aggravated adverse effect; and >1.06â¯m/s, indicating a positive effect. CONCLUSIONS: The adverse effect of obesity on dependence in ADL is moderated by gait speed. Considering these thresholds, the distribution of older adults in each of the proposed areas of significance were: below 0.77 (m/s)â¯=â¯14,324 (70.0%), above 1.06 (m/s)â¯=â¯1553 older adults (7.5%) and between areasâ¯=â¯4630 older adults (22.5%).
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Atividades Cotidianas , Pessoas com Deficiência , Obesidade/fisiopatologia , Velocidade de Caminhada/fisiologia , Idoso , Índice de Massa Corporal , Colômbia , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Força Muscular/fisiologia , Obesidade/complicações , Apoio SocialRESUMO
The present study evaluated the ability of five obesity-related parameters, including a body shape index (ABSI), conicity index (CI), body roundness index (BRI), body mass index (BMI), and waist-to-height ratio (WtHR) for predicting increased cardiometabolic risk in a population of elderly Colombians. A cross-sectional study was conducted on 1502 participants (60.3% women, mean age 70 ± 7.6 years) and subjects' weight, height, waist circumference, serum lipid indices, blood pressure, and fasting plasma glucose were measured. A cardiometabolic risk index (CMRI) was calculated using the participants' systolic and diastolic blood pressure, triglycerides, high-density lipoprotein and fasting glucose levels, and waist circumference. Following the International Diabetes Federation definition, metabolic syndrome was defined as having three or more metabolic abnormalities. All surrogate anthropometric indices correlated significantly with CMRI (p < 0.01). Receiver operating characteristic curve analysis of how well the anthropometric indices identified high cardiometabolic risk showed that WtHR and BRI were the most accurate indices. The best WtHR and BRI cut-off points in men were 0.56 (area under curve, AUC 0.77) and 4.71 (AUC 0.77), respectively. For women, the WtHR and BRI cut-off points were 0.63 (AUC 0.77) and 6.20 (AUC 0.77), respectively. In conclusion, BRI and WtHR have a moderate discriminating power for detecting high cardiometabolic risk in older Colombian adults, supporting the idea that both anthropometric indices are useful screening tools for use in the elderly.
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Antropometria , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Fatores Etários , Idoso , Índice de Massa Corporal , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Fatores Sexuais , Razão Cintura-EstaturaRESUMO
Este documento fue preparado por un grupo multidisciplinario de expertos seleccionados por la Asociación Colombiana de Infectología (ACIN) para poner al día las recomendaciones previas dadas por nuestro grupo en cuanto a la inmunización del adolescente, de la población adulta y de aquellos mayores de 60 años de edad. Para este último grupo, hemos decidido, como lo han hecho en otros países, el inmunizar a esta edad (y no después), debido a la carga de enfermedad incrementada por afecciones respiratorias y otros factores propios para América Latina y las condiciones socioeconómicas de nuestro país. Esta edición reescribe ciertos párrafos y actualiza en parte las recomendaciones hechas anteriormente y publicadas en Infectio en mayo de 2012. Las guías están orientadas al uso por aquellos que cuidan de estos pacientes y hacemos énfasis en el anciano, el inmunocomprometido y en aquellos que sufren de varias comorbilidades. Aunque en un momento dado el documento pudiera parecer incompleto, la intención deseada fue la de abarcar los recientes cambios en la administración de nuevas vacunas y otros regímenes en dosificación. Se incluye por primera vez el uso de las vacunas de 4 valencias contra la influenza. El uso de la vacuna contra el herpes zóster se discute, y se toma un cuidado especial en cuanto a la redacción del "cuándo y por qué" de la vacunación contra Streptococcus pneumoniae. En la administración de esta vacuna, el tiempo de aplicación y la secuencia asociada con la aplicación de la administración de la vacuna polisacárida de 23 valencias puede variar de acuerdo con la edad del paciente,las comorbilidades y en aquellos previamente vacunados con dicha vacuna. Finalmente, exponemos las nuevas recomendaciones de vacunación contra fiebre amarilla y dengue y le damos la bienvenida a la vacuna nonavalente contra el virus humano del papiloma.
This document was prepared by a multi-disciplinary panel of experts who have been selected by the Asociación Colombiana de Infectologia (ACIN) to revise and update previous recommendations (by our group) for the immunization of adolescents and adult population and those older than 60 years of age. For the latter group, we have chosen to move forward, like many others, and immunize them at that age because of the particular burden of disease due to respiratory conditions, and other factors strictly related to Latin America and Colombian socio-economic conditions. This edition replaces in part, updates or ads to previous recommendations published in Infectio, May 2012. The guidelines are intended to assist those caring for these patients, and emphasizes on the elderly, the immunocompromissed and on those who suffer from several co-morbidities.The contents of the guidelines could seem in complete at some point; nevertheless, they were purposefully thought as such to embrace on major changes in new vaccines or new dosin gregimens. It is included for the first time the use of cuadri-valent vaccines against influenza. The use of herpes zoster vaccine is discussed and special care is placed in the phrasing for the reader so he (she) understands the "when and why" of vaccine administration against Streptococcus pneumoniae. With pneumococcal vaccines, timing of administration may vary according to age, co-morbidities and in those previously vaccinated with the 23-polyvalent polysaccharide vaccine. There are new recommendations for the vaccination against yellow fever and dengue and we welcome the new nona-valent vaccine against the human papillomavirus.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Vírus , Vacinação em Massa , Guia Informativo , Vacinas Pneumocócicas , Infectologia , Papiloma , Polissacarídeos , Associação , Classe Social , Streptococcus pneumoniae , Efeitos Psicossociais da Doença , Vacinas Combinadas , Colômbia , Alphapapillomavirus , Vacina contra Herpes ZosterRESUMO
We introduce a two-loop power control that allows an efficient use of the overall power resources for commercial wireless networks based on cross-layer optimization. This approach maximizes the network's utility in the outer-loop as a function of the averaged signal to interference-plus-noise ratio (SINR) by considering adaptively the changes in the network characteristics. For this purpose, the concavity property of the utility function was verified with respect to the SINR, and an iterative search was proposed with guaranteed convergence. In addition, the outer-loop is in charge of selecting the detector that minimizes the overall power consumption (transmission and detection). Next the inner-loop implements a feedback power control in order to achieve the optimal SINR in the transmissions despite channel variations and roundtrip delays. In our proposal, the utility maximization process and detector selection and feedback power control are decoupled problems, and as a result, these strategies are implemented at two different time scales in the two-loop framework. Simulation results show that substantial utility gains may be achieved by improving the power management in the wireless network.
Assuntos
Redes de Comunicação de Computadores , Tecnologia sem Fio , Modelos Teóricos , Razão Sinal-RuídoRESUMO
Objetivos Determinar la prevalencia del parasitismo intestinal e identificar los factores de riesgo asociados a estos, en el corregimiento de Loma Arena, Departamento de Bolívar, Colombia Metodología Mediante encuesta aplicada a cada grupo familiar, fueron evaluadas las condiciones socio-sanitarias y educativas de la población. Para el estudio coproparasitológico se recolectó por cada persona, dos muestras de heces obtenidas por evacuación espontánea y en dos días diferentes. El análisis de las heces se realizó mediante un examen directo en solución salina fisiológica y coloración temporal con lugol y por el método de concentración formol-éter Resultados Se encontró que el 92 por ciento de las personas estaban parasitadas, 92 por ciento de ellas con al menos un patógeno. El poliparasitismo fue muy importante (89,2 por ciento) encontrándose hasta un máximo de 7 especies por hospedador. La coinfección de protozoarios y helmintos fue frecuente (64 por ciento). Solo se encontró una frecuencia de teniosis de 0,9 por ciento. Se observó una asociación significativa entre sintomatología y presencia de parásitos (p<0,05) no así, entre síntomas y parásitos potencialmente patógenos a excepción de Trichuris trichura y dolor abdominal. El análisis estadístico no mostró asociación entre las parasitosis y los niveles educativos o hábitos higiénicos sanitarios. Conclusión La distribución uniforme de la mayoría de las parasitosis intestinales en los cinco grupos de edad evaluados, da cuenta de la exposición a las fuentes de infección en todas las etapas de la vida de los pobladores de Loma Arena.
Objectives Determining the prevalence of intestinal parasitism and identifying the associated risk factors in the village of Loma Arena, Bolivar department, Colombia. Methodology The community's sanitary and educational conditions were evaluated by using a questionnaire which was applied to each family group. Two stool samples obtained by spontaneous evacuation, on two different days, were gathered from each participating person for the coproparasitological study. The coprological test involved direct examination in saline physiological solution and temporary staining with Lugol's solution and the formol-ether concentration method. Results It was found that 92 percent of the population was parasitised, 92 percent of them with at least one pathogenic parasite. Polyparasitism was very important (89,2 percent); a maximum of 7 species per host was found. Helminth and protozoa coinfection was frequent (64 percent). There was only 0,9 percent teniosis prevalence. There was a significant association between symptomatology and parasite presence (p< 0.05), though such relationship was not seen with potentially pathogenic parasites (with the exception of Trichuris trichura and abdominal pain). The statistical analysis did not reveal any relationship between parasitism and educational level or sanitary habits. Conclusion The uniform distribution of most intestinal parasites amongst the five age-groups evaluated showed that people in Loma Arena were evenly exposed to sources of infection in all age-groups.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Enteropatias Parasitárias/epidemiologia , Ascaríase/epidemiologia , Colômbia/epidemiologia , Interpretação Estatística de Dados , Entamebíase/epidemiologia , Helmintíase/epidemiologia , Prevalência , Infecções por Protozoários/epidemiologia , Fatores Socioeconômicos , Tricuríase/epidemiologiaRESUMO
OBJECTIVES: Determining the prevalence of intestinal parasitism and identifying the associated risk factors in the village of Loma Arena, Bolivar department, Colombia. METHODOLOGY: The community's sanitary and educational conditions were evaluated by using a questionnaire which was applied to each family group. Two stool samples obtained by spontaneous evacuation, on two different days, were gathered from each participating person for the coproparasitological study. The coprological test involved direct examination in saline physiological solution and temporary staining with Lugol's solution and the formol-ether concentration method. RESULTS: It was found that 92 % of the population was parasitised, 92 % of them with at least one pathogenic parasite. Polyparasitism was very important (89,2 %); a maximum of 7 species per host was found. Helminth and protozoa coinfection was frequent (64 %). There was only 0,9 % teniosis prevalence. There was a significant association between symptomatology and parasite presence (p< 0.05), though such relationship was not seen with potentially pathogenic parasites (with the exception of Trichuris trichura and abdominal pain). The statistical analysis did not reveal any relationship between parasitism and educational level or sanitary habits. CONCLUSION: The uniform distribution of most intestinal parasites amongst the five age-groups evaluated showed that people in Loma Arena were evenly exposed to sources of infection in all age-groups.