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BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) misdiagnosis (i.e. the incorrect diagnosis of patients who truly have NMOSD) remains an issue in clinical practice. We determined the frequency and factors associated with NMOSD misdiagnosis in patients evaluated in a cohort from Latin America. METHODS: We retrospectively reviewed the medical records of patients with NMOSD, according to the 2015 diagnostic criteria, from referral clinics in six Latin American countries (Argentina, Chile, Paraguay, Colombia, Ecuador, and Venezuela). Diagnoses prior to NMOSD and ultimate diagnoses, demographic, clinical and paraclinical data, and treatment schemes were evaluated. RESULTS: A total of 469 patients presented with an established diagnosis of NMOSD (73.2% seropositive) and after evaluation, we determined that 56 (12%) patients had been initially misdiagnosed with a disease other than NMOSD. The most frequent alternative diagnoses were multiple sclerosis (MS; 66.1%), clinically isolated syndrome (17.9%), and cerebrovascular disease (3.6%). NMOSD misdiagnosis was determined by MS/NMOSD specialists in 33.9% of cases. An atypical MS syndrome was found in 86% of misdiagnosed patients, 50% had NMOSD red flags in brain and/or spinal magnetic resonance imaging (MRI), and 71.5% were prescribed disease-modifying drugs. CONCLUSIONS: NMOSD misdiagnosis is relatively frequent in Latin America (12%). Misapplication and misinterpretation of clinical and neuroradiological findings are relevant factors associated with misdiagnosis.
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Erros de Diagnóstico , Esclerose Múltipla , Neuromielite Óptica , Humanos , Aquaporina 4 , Encéfalo/patologia , América Latina/epidemiologia , Imageamento por Ressonância Magnética/métodos , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/epidemiologia , Neuromielite Óptica/diagnóstico por imagem , Neuromielite Óptica/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Optic neuritis (ON) causes several sequela. Aggressive treatment with plasma exchange (TPE) is an option. This study describes improvement and safety outcomes with TPE. METHODS: We recruited adults with ON in neuromyelitis optica spectrum disorders (NMOSD) patients treated with TPE. The primary outcome was an improvement in the visual acuity scale (VOS). We described the data and used multivariate logistic regression to identify factors associated with response. RESULTS: Eighty-three patients received 558 TPE sessions. Mean age was 40.9 years (±13.7 years); 73.5% were women, 50.1% were first attack, and 10.7% were bilateral. Median VOS: 5 (range [R], 2-7). Median time between onset and TPE was 8 days (R, 1-32). By Keegan's criteria, 82.4% experience improvement and 78.3% improve in at least 1 point in VOS. Age and pre-TPE VOS were related to improvement. Low fibrinogen occurs in 26% sessions. CONCLUSION: TPE is effective and safety for ON in NMOSD patients. There is a need for a clinical trial using a therapeutic equivalent.
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Neuromielite Óptica , Neurite Óptica , Adulto , Feminino , Humanos , Masculino , Aquaporina 4 , Modelos Logísticos , Neuromielite Óptica/terapia , Neurite Óptica/terapia , Troca Plasmática , Plasmaferese , Pessoa de Meia-IdadeRESUMO
Sampling blood for endocrine analysis from some species may not be practical or ethical. Quantification of hormones extracted from nontypical sample types, such as keratinized tissues, offers a less invasive alternative to the traditional collection and analysis of blood. Here, we aimed to validate assays by using parallelism and accuracy tests for quantification of testosterone, corticosterone, progesterone, and triiodothyronine (T3) in shed skins of tegu lizards. We assessed whether hormone content of sheds varied across one year similar to what was previously detected in plasma samples. In addition, we aimed to identify the phase relationship between hormone levels of shed skin and plasma levels obtained from the same animals. High frequency of shedding occurred during the active season for tegus (spring/summer), while shedding ceased during hibernation (winter). All hormones measured in shed skins exhibited seasonal changes in concentration. Levels of testosterone in shed skins of male tegus correlated positively with plasma testosterone levels, while corticosterone in both males and females exhibited an inverse relationship between sample types for the same month of collection. An inverse relationship was found when accounting for a lag time of 3 and 4 months between sheds and plasma testosterone. These results indicate that endocrine content of sheds may be confounded by factors (i.e., seasons, environmental temperature, thermoregulatory behavior, among others) that affect frequency of molting, skin blood perfusion, and therefore hormone transfer from the bloodstream and deposition in sheds of squamates.
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Lagartos , Animais , Corticosterona , Feminino , Lagartos/fisiologia , Masculino , Progesterona , Estações do Ano , Hormônios TireóideosRESUMO
The upregulation of endogenous antioxidants (i.e., preparation for oxidative stress, POS) is part of the biochemical responses underlying the adaptation of animals to adverse environments. Despite the phylogenetic diversity of animals in which POS has been described, most studies focus on animals under controlled laboratory conditions. To address this limitation, we have recently assessed the redox metabolism in the skeletal muscle of Proceratophrys cristiceps estivating under natural settings in the Caatinga. Here, we analyzed biochemical biomarkers in the muscle of another Caatinga species, Pleurodema diplolister, during the rainy (active) and dry (estivating frogs) seasons. We aimed to determine whether P. diplolister enhances its antioxidants during estivation under field conditions and to identify any effect of species on the biochemical responses of P. diplolister and P. cristiceps associated with estivation. To do so, we measured the activities of representative enzymes of intermediary metabolism and antioxidant systems, as well as glutathione and protein carbonyl levels, in the skeletal muscle of P. diplolister. Our findings revealed the suppression of oxidative metabolism and activation of antioxidant enzymes in estivating P. diplolister compared with active specimens. No changes in oxidative damage to proteins were observed and estivating P. diplolister had lower levels of disulfide glutathione (GSSG) and disulfide-to-total glutathione ratio (GSSG/tGSH) than those observed in active individuals. When data for P. diplolister and P. cristiceps were assembled and analyzed, significant effects of species were detected on the activities of metabolic enzymes (citrate synthase, isocitric dehydrogenase, malic enzyme, and creatine kinase) and antioxidant enzymes (catalase, glutathione peroxidase and glutathione transferase), as well as on GSSG/tGSH ratio. Such effects might underlie the physiological and behavioral differences between these two species that share the same microhabitat and survival strategy (i.e., to estivate) during the dry season. Despite some peculiarities, which reflect the physiological diversity of the mechanisms associated with estivation in the Brazilian Caatinga, both P. diplolister and P. cristiceps seem to balance the suppression of oxidative pathways, the maintenance of the capacity of oxygen-independent pathways, and the activation of endogenous antioxidants to preserve muscle function and be ready to resume activity whenever the unpredictable rainy period arrives.
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OBJECTIVE: Currently, there are several reasons to promote worldwide the concept of multiple sclerosis care units (MSCU) for a better management of affected patients. Ideally, the MSCU should have some human and technical resources that distinguish and improve the care of affected patients; however, local, and regional aspects should be considered when recommending how these units should operate. The objective of these consensus recommendations was to review how MSCU should work in Latin America to improve long-term outcomes in MS patients. METHODS: A panel of neurology experts from Latin America dedicated to the diagnosis and care of MS patients gathered virtually during 2019 and 2020 to carry out a consensus recommendation about objectives and functioning implementation of MSCU in Latin America. To achieve consensus, the methodology of "formal consensus-RAND/UCLA method" was used. RESULTS: Recommendations focused on the objectives, human and technical resources, and the general functioning that MSCU should have in Latin America. CONCLUSIONS: The recommendations of these consensus guidelines attempt to optimize the health care and management of MS patients by setting how MSCU should work in our region.
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Esclerose Múltipla , Neurologia , Consenso , Humanos , América Latina/epidemiologia , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/terapiaRESUMO
RESUMEN INTRODUCCIÓN: La esclerosis múltiple es una enfermedad neuroinflamatoria, crónica, degenerativa e incurable, asociada a pérdida neuronal, grados crecientes de discapacidad y deterioro cognoscitivo. Su manejo conlleva grandes costos para los sistemas de salud y la sociedad en general. OBJETIVO: Evaluar la eficacia y la seguridad del uso del rituximab en el manejo de la esclerosis múltiple. MATERIALES Y MÉTODOS: Revisión de la literatura y evaluación de la tecnología en salud tipo mini-HTA en red colaborativa con el Comité de Esclerosis Múltiple de la Asociación Colombiana de Neurología y el Instituto Global de Excelencia Clínica. RESULTADOS: Se identificaron 27 referencias de texto completo para el análisis de la seguridad y la eficacia del rituximab en el manejo de la esclerosis múltiple. Se utilizaron análisis de costos, indicadores epidemiológicos y estudios pivótales de rituximab. CONCLUSIÓN: La evidencia analizada confirma que la terapia con rituximab es efectiva y segura en el manejo de las formas de esclerosis múltiple remitente-recurrente (EMRR) y esclerosis múltiple primaria-progresiva (EMPP), con menor tasa de eventos adversos y tasas de interrupción o abandono del tratamiento más bajas que otras terapias modificadoras de la enfermedad (TME).
SUMMARY INTRODUCTION: Multiple sclerosis is a neuroinflammatory, chronic, degenerative, and incurable disease, associated with neuronal loss, increasing degrees of disability, and cognitive control. Its treatment causes great costs for health systems and society in general. OBJECTIVE: To evaluate the efficacy and safety of the use of rituximab in the management of multiple sclerosis. MATERIALS AND METHODS: Literature review and evaluation of mini-HTA type health technology in a collaborative network with the Multiple Sclerosis Committee of the Colombian Association of Neurology and the Global Institute of Clinical Excellence. RESULTS: 27 full-text references were identified for the safety and efficacy analysis of rituximab in the management of multiple sclerosis. Cost analysis, epidemiological indicators, and pivotal studies of rituximab were incorporated into the analysis. CONCLUSION: The evidence analyzed confirms that rituximab therapy is effective and safe in the management of the forms of Recurrent-Remittent Multiple Sclerosis (RRMS) and Primary-Progressive Multiple Sclerosis (PPMS), with a lower rate of adverse events and discontinuation or withdrawal rates of treatment lower than other disease-modifying therapies.
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Segurança , Avaliação da Tecnologia Biomédica , Terapêutica , Eficácia , Rituximab , Esclerose MúltiplaRESUMO
RESUMEN La relación entre las enfermedades inmunológicamente mediadas del sistema nervioso central (SNC) y las infecciones es muy estrecha. En primer lugar, es importante reconocer que las infecciones pueden desencadenar reacciones inmunopatológicas que pueden conducir posteriormente a la manifestación de enfermedades neurológicas. En segundo lugar, las infecciones se han reconocido como complicación de algunas de las terapias empleadas para tratar condiciones neurológicas que requieren cierto grado de inmunosupresión. Las estrategias de mitigación de riesgo (EMR) son muy importantes para prevenir complicaciones asociadas con los tratamientos farmacológicos, así como generar estrategias de prevención con respecto a inmunización y detección del perfil de riesgo, antes del inicio de terapias.
SUMMARY The relationship between immunologically mediated diseases of the central nervous system (CNS) and infections is very close. First, it is important to recognize that infections can trigger immunopathological reactions that can subsequently lead to the manifestation of neurological diseases. Second, infections have been recognized as a complication of some of the therapies used to treat neurological conditions that require some degree of immunosuppression. Risk mitigation strategies (RMS) are key in order to prevent complications associated with pharmacological treatments, as well as to generate prevention strategies with respect to immunization and detection of the risk profile, prior to starting therapies.
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Mobilidade UrbanaRESUMO
Resumen Introducción: Las secuencias ponderaras en T2 con tiempo de eco largo son tradicionalmente usadas para la evaluación de las lesiones de la médula espinal en esclerosis múltiple (EM). Existen otras secuencias, como la densidad de protones (primer eco T2), que pueden ser útiles en el plano axial pero que no se han estudiado lo suficiente. Objetivos Establecer la concordancia entre la densidad de protones (DP) y las secuencias axiales ponderadas en T2 en las lesiones de la médula espinal cervical en pacientes con EM. Métodos: Se trata de un estudio de concordancia entre secuencias DP y T2 axiales en magneto de 1,5 Tesla en sujetos colombianos. Las imágenes fueron revisadas por dos radiólogos, que determinaron el número de lesiones, así como la intensidad de señal - mediante la relación contraste- ruido (RCR). La comparación se realizó con el coeficiente de correlación y concordancia de Lin. Resultados: Se evaluaron 56 pacientes, 30,36% hombres y 69,64% mujeres. Se encontraron diferentes números de lesiones entre las secuencias axiales DP vs T2 (210 vs 144), coeficiente de concordancia entre el número de lesiones 0,72 (IC95%: 0,6-0,82, error estándar 0,05, desviación estándar 1,37) y en la conspicuidad -RCR- 0,62 (IC95%: 0,48-0,75, SE 0,05, DE 12,25). Conclusión: No encontramos concordancia en la evaluación del número o intensidad de la señal entre secuencias axiales DP y T2. Aunque las secuencias ponderadas en T2 son las más utilizadas, investigaciones recientes han demostrado falta de concordancia e incluso superioridad de las secuencias DP en otros planos, lo que sugiere que es necesario realizar estudios para evaluar la efectividad de las secuencias DP en el plano axial.
Abstract Introduction: Traditionally, T2 long echo time sequences are used for the evaluation of spinal cord lesions in multiple sclerosis. There are other sequences, like proton density (first echo of T2) that may be useful in the axial plane but have not been sufficiently studied. Objectives: To establish the agreement between axial PD and T2 sequences in cervical spinal cord lesions in patients with multiple sclerosis. Methods: This is a concordance study between axial PD and T2 sequences in a 1.5 Tesla magnet. The images were reviewed by two radiologists, who determined the number of lesions and signal intensity with the Contrast to Noise Ratio. The comparison was made with the Lin's concordance correlation coefficient. Results: 56 patients were evaluated, 30.36% men and 69.64% women; there were 210 lesions with PD vs 144 with T2, LCC for the number of lesions was 0.72 (95% CI: 0.6-0.82, SE 0.05) and for conspicuity was 0.62 (95% CI: 0.48-0.75, SE 0.05). Conclusion: This study did not find a satisfactory agreement in the evaluation of the number or signal intensity between PD and T2. Recent research has shown superiority of PD over T2 in other planes, suggesting that further studies are needed to evaluate the effectiveness of PD in the axial plane.
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Theoretical models predict that lizards adjust their body temperature through behavioral thermoregulation as a function of food availability. However, behavioral thermoregulation is also governed by interactions among physiological and ecological factors other than food availability, such as hydration state, and sometimes it can even conflict with the locomotor activity of animals. Here, we aimed to investigate the role of food intake and hydration state on behavioral thermoregulation and voluntary locomotor activity in the lizard Tropidurus catalanensis We hypothesized that food intake can influence behavioral thermoregulation via an interaction with hydration state. We also hypothesized that lizards should endeavor to spend as little time as possible to reach their preferred body temperature to defend other physiological and/or ecological functions. We collected lizards in the field and brought them to the laboratory to measure the preferred temperature selected in a thermal gradient and the total distance traveled by them in fed and unfed conditions and with variable hydration state. Our results showed that food consumption was the most important predictor of preferred temperature. In contrast, either the hydration state alone or its interaction with food consumption did not have important effects on the lizards' thermal preference. Also, we found that the total distance traveled by lizards was not affected by food intake and was barely affected by the hydration state. We provide an experimental approach and a robust analysis of the factors that influence behavioral thermoregulation and locomotor activity in a tropical lizard.
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Lagartos , Animais , Regulação da Temperatura Corporal , Ingestão de Alimentos , Locomoção , TemperaturaRESUMO
The origin of morphological diversity is a critical question in evolutionary biology. Interactions between the environment and developmental processes have determining roles in morphological diversity, creating patterns through space and over time. Also, the shape of organisms tends to vary with increasing size as a result of those developmental processes, known as allometry. Several studies have demonstrated that the body sizes of anurans are associated with hydric conditions in their environments and that localities with high water stress tend to select for larger individuals. However, how environmental conditions alter those patterns of covariance between size and shape is still elusive. We used 3D geometric morphometric analyses, associated with phylogenetic comparative methods, to determine if the morphological variations and allometric patterns found in Arboranae (Anura) is linked to water conservation mechanisms. We found effects of the hydric stress on the shape of Arboranae species, favouring globular shapes. Also, the allometric patterns varied in intensity according to the water stress gradient, being particularly relevant for smaller frogs, and more intense in environments with higher water deficits. Our study provides empirical evidence that more spherical body shapes, especially among smaller species, reflect an important adaptation of anurans to water conservation in water-constrained environments.
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Anuros/anatomia & histologia , Anuros/metabolismo , Tamanho Corporal/fisiologia , Água/metabolismo , Animais , Evolução Biológica , Filogenia , Crânio/anatomia & histologia , Crânio/metabolismoRESUMO
Preparation for oxidative stress (POS), i.e., the buildup of endogenous antioxidants during metabolic depression or low oxygen stress conditions, has been observed in at least 8 animal phyla under controlled conditions in laboratory. Despite the expected implications on the endurance to extreme environments and ecosystem occupation, the extent to which POS occurs in animals under natural conditions remains unexplored. Therefore, we took advantage of the natural history of the Brazilian Caatinga's frog Proceratophrys cristiceps to investigate the modulation of endogenous antioxidants and redox balance in their skeletal muscle and to verify if POS occurs under natural conditions. Expectedly, estivating frogs had low levels of the oxidative metabolism enzymes. Citrate synthase and isocitrate dehydrogenase activities were 36% and 25% lower than those in active frogs respectively. We found an overall upregulation of antioxidants in estivating P. cristiceps. Reduced glutathione concentration was 61% higher in estivating frogs than that in active animals. During estivation the activities of the hydroperoxide detoxification enzymes catalase, glutathione peroxidase, and glutathione H2O2-peroxidase were 48%, 57%, and 78% greater than those during the rainy season. Moreover, estivating frogs had a 47% lower ratio of disulfide to total glutathione levels than active frogs. Our findings confirm the occurrence of 'preparation for oxidative stress' in naturally estivating frogs and paves the way for further research on the redox biology of animals under natural settings. Such approach might reveal biochemical strategies under ecologically relevant scenarios.
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Anuros , Ecossistema , Animais , Antioxidantes , Brasil , Glutationa , Peróxido de Hidrogênio , Estresse OxidativoRESUMO
BACKGROUND: The Fitzpatrick skin phototype scale (FSPTS) is a widely used instrument to assess skin type. METHODS: A cross-sectional survey collected responses from 254 subjects from Quito regarding self-reported FSPTS, gender, age, education, and tobacco and alcohol consumption. Univariate and multivariate logistic regression analyses were performed to determine if ethnicity, hair color, and eye color significantly predict FSPTS. In addition, we studied the correlation between FSPTS and the SCINEXA scale with Pearson's correlation coefficient. RESULTS: Ethnicity, eye color, and hair color are significant independent predictors of FSPTS (p < 0.0001). CONCLUSIONS: Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by Fitzpatrick skin phototype. Our study does not fully represent the population of the country. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk.
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Transtornos de Fotossensibilidade/classificação , Transtornos de Fotossensibilidade/epidemiologia , Pigmentação da Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/diagnóstico , Transtornos de Fotossensibilidade/fisiopatologia , Grupos Raciais , Fatores de Risco , Autorrelato , Pigmentação da Pele/fisiologia , Queimadura Solar/diagnóstico , Queimadura Solar/epidemiologia , Queimadura Solar/etnologia , Queimadura Solar/fisiopatologia , Bronzeado/fisiologiaRESUMO
ABSTRACT Introduction: Neuromyelitis optica is an inflammatory disorder of the central nervous system that accounts for 5% of demyelinating diseases in pediatrics. Its clinical presentation is variable and associated to the involved area of the central nervous system. Case presentation: This is the case of a 15-year-old patient who consulted several times for nonspecific neurological symptoms. During his last visit to the Clínica Universitaria Colombia in Bogotá, he presented with bilateral optic neuritis, associated with frontal and parietal headache. Immunophenotyping studies were carried out, reporting positive IgG anti-aquaporin 4 antibodies (anti-AQP4 antibody), thus leading to a diagnosis of seropositive neuromyelitis optica spectrum disorder (NMOSD). Management with methylprednisolone pulses was initiated with subsequent outpatient management with rituximab that allowed stabilizing the disease. Discussion: This is an interesting case due to its insidious and uncertain onset in a pediatric patient. It was possible to evaluate clinical and diagnostic differences in relation to its presentation in adults. NMOSD mediated by anti-AQP4 is rare; brain and bone marrow MRI are essential for diagnosis. The treatment of choice for acute conditions consists of high doses of methylprednisolone. Conclusion: This disorder may result in irreversible neurological damage; for this reason, high suspicion is required for early diagnosis and timely treatment.
RESUMEN Introducción. La neuromielitis óptica es un trastorno inflamatorio del sistema nervioso central que representa el 5% de las enfermedades desmielinizantes en pediatría. Su presentación clínica es variable y está ligada al área del sistema nervioso central comprometida. Presentación de caso. Paciente masculino de 15 años quien consulta en varias oportunidades por síntomas neurológicos inespecíficos y que en su última visita a la Clínica Universitaria Colombia, en Bogotá, presenta un cuadro de neuritis óptica bilateral, asociado a cefalea frontal y parietal. Se realizan estudios de in-munotipificación que documentan positividad para anticuerpos IgG y anti acuaporina 4 (ACS anti-AQP4), permitiendo así el diagnóstico de desorden del espectro de neuromielitis óptica (NMOSD, por su sigla en inglés) seropositivo; se inicia manejo con pulsos de metilprednisolona a dosis de 1g intravenoso cada 24 horas, con posterior manejo ambulatorio con Rituximab, que permiten estabilización de la enfermedad. Discusión. Se presenta un caso interesante por su inicio insidioso e incierto en un paciente pediátrico. Este caso permite evaluar las diferencias clínicas y diagnósticas en relación a su presentación en adultos. El NMOSD mediado por ACS anti-AQP4 es poco común; para su diagnóstico es esencial la resonancia magnética cerebral y de médula ósea. El tratamiento de elección para cuadros agudos consiste en altas dosis de metilprednisolona. Conclusión. El NMOSD puede producir daño neurológico irreversible, por esto requiere un alto índice de sospecha para su diagnóstico temprano y tratamiento oportuno.
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Tradicionalmente Colombia se ha caracterizado por presentar grandes diferencias económicas, políticas y sociales entre sus territorios. Por tal motivo, el objeto de este documento es la comparación del desarrollo territorial en Colombia; por lo que se han analizado las desigualdades económicas y sociales entre los departamentos del país, así como la creciente polarización de sus niveles de ingreso per cápita; en este sentido se encontró que la realidad económica y social de la nación se caracteriza por presentar una gran disimilitud entre los diferentes territorios. Por eso, es necesario proponer un debate sobre el actual Sistema Tributario de Colombia, rediseñando políticas que permitan asegurar el equilibrio necesario entre la distribución de competencias impositivas y el fortalecimiento financiero de los entes territoriales (departamentos, municipios y distritos). Visto así, se presenta la realidad nacional frente a la distribución de las competencias tributarias y los recursos cedidos por el Gobierno central a los territorios; se presenta también cálculos del Índice de Gini y otros cálculos propios e indicadores tributarios para analizar el comportamiento de la tributación nacional desde los departamentos colombianos; además se toma como referencia el modelo de desigualdad, recientemente realizado por Thomas Piketty, para mostrar las desigualdades de ingreso en Colombia. Las fuentes de bases de datos, corresponden a la información de los sistemas estadísticos de la Dirección de Impuestos y Aduanas Nacionales (DIAN), Departamento Administrativo Nacional de Estadística (DANE) y el Departamento Nacional de Planeación (DNP). Finalmente, el objetivo de estos resultados es servir como base para el debate de una posible reforma fiscal y/ tributaria que contribuya a reducir la desigualdad y fomentar el desarrollo territorial en Colombia.
Traditionally Colombia has been characterized by wide economic, political and social between their territories. Therefore, the object of this document is the comparison of Territorial Development in Colombia, so I know have analyzed the economic and social inequalities between the departments, and the increasing polarization of levels of per capita income; in this sense, it found that the economic and social reality of the Nation was characterized by a great dissimilarity between different territories. Therefore, it is proposed necessary real debate on the tax system of Colombia, redesigning policies that ensure the Necessary balance between distribution of tax powers and financial Strengthening National sub-entities (departments, municipalities and districts). Seen this way, the National Reality is presented Faced with the distribution of tax powers and resources assigned by the central government Territories, calculations Gini and Other Own Calculations and tax indicators is also presented to analyze behavior taxation Colombian national from Departments, in addition, it is taken as a reference the example of inequality recently conducted by Thomas Piketty, for show income inequalities in Colombia. Sources Databases correspond to the Statistical Information Systems Directorate of National Taxes and Customs (DIAN), National Administrative Department of Statistics (DANE) and the National Planning Department (DNP). Finally the objective of these results is serve as the basis for the debate of a possible tax reform and tax to help reduce inequality and promote Territorial Development in Colombia.
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BACKGROUND: Few studies have been published related to the analysis of different skin aging parameters for whole-body skin using the SCINEXA scale for skin damage. The aim of this study was to evaluate the reproducibility of the SCINEXA scale (SCore for INtrinsic and EXtrinsic skin Aging) in South-Americans non-Caucasian population of a region of Ecuador. METHODS: Exploratory observational study. Thirty subjects of both genders, over 40 years old and living in a rural area with particular characteristics regarding sun exposure were included. The SCINEXA scale was applied at three different time points to assess its reproducibility. Repeated measures analysis of variance was used for comparison of mean SCINEXA scores. Intraclass correlation coefficient, 95% CI and "Cronbach's alpha" coefficient were performed to measure reproducibility. RESULTS: Among participants, 86.7% were female; mean age was over 67 years old, with mainly low educational level, and almost half had more than six hours of sun exposure per day. Test-retest reproducibility of this scale demonstrated almost perfect agreement. The SCINEXA score was greater than 2 points in half of the subjects, reflecting aging due to sun exposure. LIMITATIONS: Most participants were women from one town in a particular geographical area, and the sample size was small. Genetic determinants of skin phenotypes were not assessed. CONCLUSIONS: The SCINEXA score is reproducible in South American non-Caucasian subjects of a particular region of the country. Damage from sun exposure was evident in participants.
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Envelhecimento da Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular , Carcinoma de Células Escamosas , Equador , Exposição Ambiental , Eritema , Dermatoses Faciais , Feminino , Humanos , Hiperpigmentação , Ceratose Actínica , Lentigo , Masculino , Melanoma , Melanose , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Neoplasias Cutâneas , Queimadura Solar , Luz Solar , TelangiectasiaRESUMO
Feeding specialization is a recurrent issue in the evolution of snakes and is sometimes associated to morphological and/or behavioral adaptations that improve snake performance to exploit a particular food type. Despite its importance for animal fitness, the role of physiological traits has been much less studied than morphological and behavioral traits in the evolution of feeding specialization in snakes. In this context, the energetic cost of post-prandial period is an important physiological factor due to the remarkable effect on the snake energy budget. We collected data on post-prandial metabolic rate (SDA) in five species of pit vipers from the genus Bothrops with different degrees of mammal feeding specialization to test the hypothesis that feeding specialist species have lower energy costs during the digestion of their regular food item when compared to species with a more generalist diet. Our results support this hypothesis and suggest that ontogenetic changes in diet can be accompanied by changes in energy cost of the digestion process.
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Bothrops/fisiologia , Metabolismo Energético/fisiologia , Período Pós-Prandial/fisiologia , Envelhecimento , Animais , Bothrops/classificação , Especificidade da EspécieRESUMO
Declining body size has been suggested to be a universal response of organisms to rising temperatures, manifesting at all levels of organization and in a broad range of taxa. However, no study to date evaluated whether deforestation-driven warming could trigger a similar response. We studied changes in fish body size, from individuals to assemblages, in streams in Southeastern Amazonia. We first conducted sampling surveys to validate the assumption that deforestation promoted stream warming, and to test the hypothesis that warmer deforested streams had reduced fish body sizes relative to cooler forest streams. As predicted, deforested streams were up to 6 °C warmer and had fish 36% smaller than forest streams on average. This body size reduction could be largely explained by the responses of the four most common species, which were 43-55% smaller in deforested streams. We then conducted a laboratory experiment to test the hypothesis that stream warming as measured in the field was sufficient to cause a growth reduction in the dominant fish species in the region. Fish reared at forest stream temperatures gained mass, whereas those reared at deforested stream temperatures lost mass. Our results suggest that deforestation-driven stream warming is likely to be a relevant factor promoting observed body size reductions, although other changes in stream conditions, like reductions in organic matter inputs, can also be important. A broad scale reduction in fish body size due to warming may be occurring in streams throughout the Amazonian Arc of Deforestation, with potential implications for the conservation of Amazonian fish biodiversity and food supply for people around the Basin.
Assuntos
Tamanho Corporal/fisiologia , Conservação dos Recursos Naturais , Peixes/fisiologia , Animais , Brasil , Mudança Climática , Temperatura Alta , Floresta Úmida , RiosRESUMO
BACKGROUND: Multiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis. OBJECTIVE: The purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis. METHODS: A panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed. RESULTS: Tuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease. CONCLUSION: Latent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.
RESUMO
The current proposal about the variation of standard metabolic rates (SMR) in snakes predicts that SMR is influenced by the feeding frequency (frequent or infrequent feeders). However, feeding frequency in snakes is poorly studied and hard to quantify under natural conditions. Alternatively, foraging strategy was studied for a large number of species and is usually related to the feeding frequency. In this work, we performed a meta-analysis on the SMR of compiled data from 74 species of snakes obtained from the literature and five more different species of lanceheads (genus Bothrops), after categorization according to the foraging mode (ambush or active foraging) and regarding their phylogenetic history. We tested the hypothesis that foraging mode (FM) is a determinant factor on the interspecific variation of SMR despite the phylogenetic relationship among species. We demonstrated that FM predicted SMR, but there is also a partial phylogenetic structuration of SMR in snakes. We also detected that evolution rates of SMR in active foragers seem to be higher than ambush-hunting snakes. We suggested that foraging mode has a major effect over the evolution of SMR in snakes, which could represent an ecophysiological co-adaptation, since ambush hunters (with low feeding rates) present a lower maintenance energetic cost (SMR) when compared to active foragers. The higher SMR evolution rates for active foraging snakes could be related to a higher heterogeny in the degree of activity during hunting by active foragers when compared to ambush-hunting snakes.