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Introducción. El deslizamiento en céntrica (DC) y su incidencia en la sintomatología mioarticular ha sido un tema ampliamente estudiado, sin embargo, aún no está clara la relación entre ambos fenómenos. Objetivo. Evaluar la relación entre el DC y la prevalencia de ruido y/o sintomatología mioarticular de las articulaciones temporomandibulares en una muestra de pacientes. Material y Método. Se analizó una muestra de 183 modelos de estudio con dentición permanente completa excluyendo terceros molares. Se midió el DC en sentido sagital, vertical y transversal. Se recopilaron los datos del examen funcional de cada paciente para registrar las variables ruido y sintomatología mioarticular. Resultados. La magnitud del DC en los sentidos sagital, vertical y transversal está relacionada significativamente (p<0,05) con la presencia de ruido articular. El DC como variable dicotómica está relacionado significativamente, en sentido vertical, con la presencia de sintomatología mioarticular de las articulaciones temporomandibulares. El DC como magnitud y como variable dicotómica, en los sentidos sagital y transversal, están relacionados significativamente con la presencia de ruido y sintomatología mioarticular. Conclusión. Los pacientes que presentan DC con valores superiores a los normales presentan algún tipo de ruido y/o sintomatología mioarticular.
Introduction. Centric slide (CS) and its incidence in myoarticular symptoms have been widely studied: However, the relationship between both phenomena is still unclear. Objective. To evaluate the relationship between CS and the prevalence of noise and/or myoarticular symptoms of the temporomandibular joints in a sample of patients. Material and method. A sample of 183 study models with complete permanent dentition, excluding third molars, was analyzed. CS was measured in the sagittal, vertical, and transverse directions. Data from the functional examination of each patient were collected to record the "noise" and "myoarticular symptoms" variables. Results. The magnitude of CS in the sagittal, vertical, and transverse directions is significantly (p<0.05) related to the presence of joint noise. CS as a dichotomous variable is significantly related, vertically, to the presence of myoarticular symptoms of the temporomandibular joints. As a magnitude and as a dichotomous variable in the sagittal and transverse directions, CS is significantly related to the presence of noise and myoarticular symptoms. Conclusion. Patients with CS values higher than normal present some type of noise and/or myoarticular symptoms.
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INTRODUCTION: The diagnosis of acute respiratory distress syndrome (ARDS) includes the ratio of pressure arterial oxygen and inspired oxygen fraction (P/F) ≤ 300, which is often adjusted in locations more than 1,000 meters above sea level (masl) due to hypobaric hypoxemia. The main objective of this study was to develop a prediction model for in-hospital mortality among patients with ARDS due to coronavirus disease 2019 (COVID-19) (C-ARDS) at 2,600 masl with easily available variables at patient admission and to compare its discrimination capacity with a second model using the P/F adjusted for this high altitude. METHODS: This study was an analysis of data from patients with C-ARDS treated between March 2020 and July 2021 in a university hospital located in the city of Bogotá, Colombia, at 2,600 masl. Demographic and laboratory data were extracted from electronic records. For the prediction model, univariate analyses were performed to screen variables with p <0.25. Then, these variables were automatically selected with a backward stepwise approach with a significance level of 0.1. The interaction terms and fractional polynomials were also examined in the final model. Multiple imputation procedures and bootstraps were used to obtain the coefficients with the best external validation. In addition, total adjustment of the model and logistic regression diagnostics were performed. The same methodology was used to develop a second model with the P/F adjusted for altitude. Finally, the areas under the curve (AUCs) of the receiver operating characteristic (ROC) curves of the two models were compared. RESULTS: A total of 2,210 subjects were included in the final analysis. The final model included 11 variables without interaction terms or nonlinear functions. The coefficients are presented excluding influential observations. The final equation for the model fit was g(x) = age(0.04819)+weight(0.00653)+height(-0.01856)+haemoglobin(-0.0916)+platelet count(-0.003614)+ creatinine(0.0958)+lactate dehydrogenase(0.001589)+sodium(-0.02298)+potassium(0.1574)+systolic pressure(-0.00308)+if moderate ARDS(0.628)+if severe ARDS(1.379), and the probability of in-hospital death was p (x) = e g (x)/(1+ e g (x)). The AUC of the ROC curve was 0.7601 (95% confidence interval (CI) 0.74-0, 78). The second model with the adjusted P/F presented an AUC of 0.754 (95% CI 0.73-0.77). No statistically significant difference was found between the AUC curves (p value = 0.6795). CONCLUSION: This study presents a prediction model for patients with C-ARDS at 2,600 masl with easily available admission variables for early stratification of in-hospital mortality risk. Adjusting the P/F for 2,600 masl did not improve the predictive capacity of the model. We do not recommend adjusting the P/F for altitude.
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COVID-19 , Síndrome do Desconforto Respiratório , Humanos , Recém-Nascido , Mortalidade Hospitalar , Altitude , COVID-19/complicações , Curva ROC , Oxigênio , Prognóstico , Estudos RetrospectivosRESUMO
SUMMARY: Malocclusion is usually treated based on clinical decisions complemented with a cephalometric analysis, allowing the comparison of an individual with standard reference norms. Cephalometric standards have mostly been obtained from Caucasian population, but may not be appropriate for other ethnic groups, becoming a clinically relevant problem in multicultural and multiracial societies. The present study aimed to establish cephalometric norms for Chilean-Latino population, using a representative sample of class I individuals in permanent dentition. A sample of 72 cephalometric x-rays of class I growing individuals (47 women and 25 men) between 10 and 20 years of age with class I occlusion and harmonic profile was obtained from the records of the Universidad de los Andes taken between 2012 and 2019, including 1164 individuals. The radiographs were classified according to their cervical vertebral maturation status, and cephalometrically analyzed, obtaining vertical and sagittal parameters in soft and hard tissues, which were compared with Caucasian cephalometric norms. The statistical analysis was performed using descriptive and inferential statistics (T-test, ANOVA and Bonferroni tests). Cephalometric norms were obtained for hard and soft tissues. Upon comparison with Caucasian norms, the subjects included in the sample present a tendency towards a convex profile, significant incisal proclination, dental protrusion, labial biprotrusion and an acute nasolabial angle. There are cephalometric differences between the Caucasian cephalometric norms and those observed Chilean Latino population, displaying differences at a hard and soft tissue level that should be taken into account for clinical decision making in Orthodontics.
La maloclusión generalmente se trata con base en decisiones clínicas complementadas con un análisis cefalométrico, lo que permite la comparación de un individuo con normas de referencia estándar. Los estándares cefalométricos se han obtenido en su mayoría de población caucásica, pero pueden no ser apropiados para otros grupos étnicos, convirtiéndose en un problema clínicamente relevante en sociedades multiculturales y multirraciales. El presente estudio tuvo como objetivo establecer normas cefalométricas para población chileno-latina, utilizando una muestra representativa de individuos clase I en dentición permanente. Se obtuvo una muestra de 72 radiografías cefalométricas de individuos en crecimiento clase I (47 mujeres y 25 hombres) entre 10 y 20 años de edad con oclusión clase I y perfil armónico de los registros de la Universidad de los Andes tomados entre 2012 y 2019, incluidas 1164 personas. Las radiografías se clasificaron según su estado de maduración vertebral cervical, y se analizaron cefalométricamente, obteniendo parámetros verticales y sagitales en tejidos blandos y duros, que se compararon con normas cefalométricas caucásicas. El análisis estadístico se realizó mediante estadística descriptiva e inferencial (T-test, ANOVA y pruebas de Bonferroni). Se obtuvieron normas cefalométricas para tejidos duros y blandos. En comparación con las normas caucásicas, los sujetos incluidos en la muestra presentan una tendencia hacia un perfil convexo, proinclinación incisal significativa, protrusión dental, biprotrusión labial y un ángulo nasolabial agudo. Existen diferencias entre las normas cefalométricas caucásicas y las observadas en población latina chilena, mostrando diferencias a nivel de tejidos duros y blandos que se deben considerar para la toma de decisiones clínicas en Ortodoncia.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Cefalometria/normas , Dentição Permanente , Oclusão Dentária , Radiografia , Chile , Estudos RetrospectivosRESUMO
Introducción. La colonización por microorganismos patógenos de los dispositivos médicos usados en las unidades de cuidados intensivos es un factor de riesgo para el aumento de infecciones asociadas con la atención en salud y, por lo tanto, al de la morbilidad y la mortalidad de los pacientes intubados. En Colombia, no se ha descrito la colonización por hongos de los tubos endotraqueales, con lo cual se podrían considerar nuevas opciones terapéuticas para el beneficio de los pacientes. Objetivo. Describir los hongos que colonizan los tubos endotraqueales de los pacientes en unidades de cuidados intensivos, junto con su perfil de sensibilidad a los antifúngicos. Materiales y métodos. Se realizó un estudio observacional, descriptivo, en dos centros hospitalarios durante 12 meses. Se recolectaron tubos endotraqueales de pacientes de las unidades de cuidados intensivos. Estos fueron procesados para cultivar e identificar hongos, y para establecer su perfil de sensibilidad a los antifúngicos. Resultados. Se analizaron 121 tubos endotraqueales obtenidos de 113 pacientes. De estos, el 41,32 % se encontró colonizado por los hongos Candida albicans (64,61 %), C. no-albicans (30,77 %), Cryptococcus spp. (3,08 %) o mohos (1,54 %). Todos los hongos evaluados presentaron una gran sensibilidad a los antifúngicos, con un promedio del 91 %. Conclusión. Se encontró colonización fúngica en los tubos endotraqueales de pacientes con asistencia respiratoria mecánica. El perfil de sensibilidad en estos pacientes fue favorable. Se requiere un estudio clínico para correlacionar los microorganismos colonizadores y su capacidad de generar infección.
Introduction. Medical device colonization by pathogenic microorganisms is a risk factor for increasing infections associated with health care and, consequently, the morbidity and mortality of intubated patients. In Colombia, fungal colonization of endotracheal tubes has not been described, and this information could lead to new therapeutic options for the benefit of patients. Objective. To describe the colonizing fungi of the endotracheal tubes from patients in the intensive care unit, along with its antifungal sensitivity profile. Materials and methods. We conducted a descriptive, observational study in two health centers for 12 months. Endotracheal tubes were collected from patients in intensive care units. Samples were processed for culture, fungi identification, and antifungal sensitivity profile assessment. Results. A total of 121 endotracheal tubes, obtained from 113 patients, were analyzed: 41.32 % of the tubes were colonized by Candida albicans (64.62%), C. non-albicans (30.77%), Cryptococcus spp. (3.08%) or molds (1.54%). All fungi evaluated showed a high sensitivity to antifungals, with a mean of 91%. Conclusion. Fungal colonization was found in the endotracheal tubes of patients under invasive mechanical ventilation. The antifungal sensitivity profile in these patients was favorable. A clinical study is required to find possible correlations between the colonizing microorganisms and infectivity.
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Microbiota , Intubação Intratraqueal , Pneumonia Associada à Ventilação Mecânica , Micobioma , Unidades de Terapia IntensivaRESUMO
Contexto las personas con diálisis se consideran una población de alto riesgo de infección por SARS-CoV-2, complicaciones y muerte. En Colombia, cerca del 44 % de la población en diálisis es menor de 60 años, adicionalmente, por los mismos retos que ha impuesto la pandemia a los programas de trasplantes, se ha incrementado notoriamente la población joven que debe seguir en diálisis al no tener opción a corto plazo de un trasplante renal, por lo tanto, las limitaciones en el acceso temprano a la vacunación contra SARS-CoV-2 agudizarían los problemas de esta población, provocando pérdidas considerables en años de vida que la vacuna podría salvar. Objetivo el objetivo del presente documento es sintetizar los principales motivos por los que se recomienda la priorización de la vacunación de los pacientes en diálisis crónica y lista de espera para trasplante renal. Metodología se realizó una búsqueda rápida de información sobre la vacunación en pacientes con ERC en diálisis o en espera de trasplante renal. La información resultante fue analizada críticamente por expertos en nefrología para la formulación de recomendaciones. Los resultados de la búsqueda se presentan a manera de síntesis narrativa. Resultados a partir de la información revisada y discutida por los expertos en nefrología se proponen 4 recomendaciones para la vacunación contra el virus SARS-Cov-2. Conclusiones la Asociación Colombiana de Nefrología e Hipertensión Arterial, la Asociación Colombiana de Nefrología Pediátrica y la Asociación Colombiana de Trasplante de Órganos, comprometidos con la salud de los pacientes con enfermedad renal en diálisis y listas de espera de trasplantes en Colombia, se unen a la solicitud mundial de generar recomendaciones para la vacunación contra SARS-CoV-2.
Background People on dialysis are considered a high-risk population for SARS-CoV-2 infection, complications, and death. In Colombia, about 44% of the population on dialysis is under 60 years of age. In addition, due to the same challenges that the pandemic has imposed on transplant programs, the young population that must continue on dialysis has increased markedly, as they have no option in the short term of a kidney transplant, therefore, the limitations in early access to vaccination against SARS-CoV-2 would exacerbate the problems of this population, causing considerable losses in years of life that the vaccine could save. Purpose The objective of this document is to summarize the main reasons why the prioritization of vaccination of patients on chronic dialysis and on the kidney transplant waiting list is recommended. Methodology A rapid search for information on vaccination in patients with CKD on dialysis or awaiting kidney transplantation was performed. The resulting information was critically analyzed by experts in nephrology for the formulation of recommendations. The search results are presented as a narrative synthesis. Results Based on the information reviewed and discussed by nephrology experts, 4 recommendations are proposed for vaccination against the SARS-Cov-2 virus. Conclusions The Colombian Association of Nephrology and Arterial Hypertension (ASOCOLNEF), the Colombian Association of Pediatric Nephrology (ACONEPE) and the Colombian Association of Organ Transplantation (ACTO), committed to the health of patients with kidney disease on dialysis and transplant waiting lists in Colombia, join to generate recommendations for prioritization and vaccination against SARS-CoV-2.
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RESUMEN Este artículo analiza 17 municipios pertenecientes al estado de Oaxaca (México) durante el período 2000-2018, con el objetivo de conocer la relación entre el desarrollo humano y la participación electoral a nivel local. Utiliza una metodología cuantitativa a través del diseño de una base de datos con información documental de instituciones gubernamentales y no gubernamentales. La hipótesis que se plantea es que el desarrollo humano tiene un impacto positivo y significativo en la participación electoral de los municipios de estudio. Para su comprobación se aplican métodos de estadística descriptiva y regresión, y se obtuvo una asociación positiva entre las variables analizadas. Información valiosa para las instituciones del Estado encargadas de consolidar la democracia y credibilidad del sistema político mexicano; así como para actores políticos cuyo objetivo es ocupar puestos públicos de elección popular, para el diseño de estrategias que tengan por objetivo el incentivar la participación ciudadana, como elemento clave para afianzar sus proyectos.
ABSTRACT The article analyzes 17 municipalities belonging to the state of Oaxaca, Mexico, during the 2000-2018period, with the aim of knowing the relationship between human development and electoral participation at the local level. It uses a quantitative methodology, through the design of a database with documentary information from governmental and non-governmental institutions. The hypothesis that arises is that human development has a positive and significant impact on the electoral participation of the municipalities. For its verification, descriptive statistics and regression methods are applied, obtaining a positive association between the analyzed variables. This is valuable information for the State institutions in charge of consolidating the democracy and credibility of the Mexican political system, as well as for political actors whose objective is to occupy public positions of popular election, to design strategies that aim to encourage citizen participation, as a key element to strengthen their projects.
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Humanos , Participação da Comunidade , Sistemas Políticos , Política , Estado , Democracia , Cidadania , Desenvolvimento HumanoRESUMO
Abstract Introduction: Access to essential medicines, including opioids, is a component of the right to health. Objective: To identify barriers to opioid availability and accessibility for pain and palliative care. Methods: Online survey with Colombian prescribers. Availability barriers were analyzed for each facility (distribution and/or dispensing). Accessibility barriers were analyzed by type. Descriptive analyses were conducted using relative frequencies. Significance within categories and regions was measured using Fisher's exact test. Results: Out of 1,208 prescribers invited, 806 (66.7%) completed the survey. Availability: 76.43% reported barriers. The most cited barrier was "Pharmacies authorized by health insurance companies", where opioids are frequently unavailable. Accessibility: 74.6% reported barriers. Most frequently cited was "Difficulty securing payment authorization for medication from health insurance companies". Significant differences were observed in terms of regions and "Cost" (p=0.02). Lack of coordination among procuring and distributing agencies affects availability. Limited awareness and bureaucratic procedures affect accessibility. Conclusions: There are barriers to opioid availability and access in Colombia, related to the existing structure for guaranteeing equitable supply. From the perspective of healthcare providers, problems related to pharmacy availability, prescription and cost of medicines hinder pain treatment.
Resumen Introducción: El acceso a medicamentos esenciales, incluidos los opioides, es un componente del derecho a la salud. Objetivo: Identificar las barreras de disponibilidad y acceso a los opioides para dolor y cuidados paliativos. Métodos: Encuesta virtual a prescriptores colombianos. Las barreras de disponibilidad se analizaron para cada centro (distribución y/o dispensación) y las barreras de acceso se analizaron por tipo. Los análisis descriptivos se realizaron utilizando frecuencias relativas. La significancia dentro de categorías y regiones se midió utilizando la prueba exacta de Fischer. Resultados: De los 1208 prescriptores invitados, 806 (66.7%) respondieron la encuesta. Disponibilidad: el 76,43% reportó barreras. La barrera más citada fue la relacionada con las "farmacias autorizadas por las aseguradoras de salud", donde los opioides con frecuencia no están disponibles. Acceso: el 74,6% reportó barreras. Se citó con mayor frecuencia la "Dificultad para obtener la autorización de pago de medicamentos por parte de las aseguradoras". Se observaron diferencias significativas entre regiones y "costos" (p=0,02). La falta de coordinación entre las entidades de adquisición y distribución afecta la disponibilidad. La limitada conciencia y los procedimientos burocráticos afectan la accesibilidad. Conclusiones: Existen barreras de disponibilidad y acceso a los opioides en Colombia, las cuales están relacionadas con la estructura disponible para garantizar un suministro equitativo. Desde el punto de vista de los prescriptores, los problemas relacionados con la disponibilidad de las farmacias, la prescripción y el costo de los medicamentos, obstaculizan el tratamiento adecuado del dolor.
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Pâncreas DivisumRESUMO
The aim of this study was to generate and analyze the atlas of the loggerhead turtle blood transcriptome by RNA-seq, as well as identify and characterize thioredoxin (Tnxs) and peroxiredoxin (Prdxs) antioxidant enzymes of the greatest interest in the control of peroxide levels and other biological functions. The transcriptome of loggerhead turtle was sequenced using the Illumina Hiseq 2000 platform and de novo assembly was performed using the Trinity pipeline. The assembly comprised 515,597 contigs with an N50 of 2,631 bp. Contigs were analyzed with CD-Hit obtaining 374,545 unigenes, of which 165,676 had ORFs encoding putative proteins longer than 100 amino acids. A total of 52,147 (31.5%) of these transcripts had significant homology matches in at least one of the five databases used. From the enrichment of GO terms, 180 proteins with antioxidant activity were identified, among these 28 Prdxs and 50 putative Tnxs. The putative proteins of loggerhead turtles encoded by the genes Prdx1, Prdx3, Prdx5, Prdx6, Txn and Txnip were predicted and characterized in silico. When comparing Prdxs and Txns of loggerhead turtle with homologous human proteins, they showed 18 (9%), 52 (18%) 94 (43%), 36 (16%), 35 (33%) and 74 (19%) amino acid mutations respectively. However, they showed high conservation in active sites and structural motifs (98%), with few specific modifications. Of these, Prdx1, Prdx3, Prdx5, Prdx6, Txn and Txnip presented 0, 25, 18, three, six and two deleterious changes. This study provides a high quality blood transcriptome and functional annotation of loggerhead sea turtles.
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To understand changes in enzyme activity and gene expression as biomarkers of exposure to methylmercury, we exposed loggerhead turtle erythrocytes (RBCs) to concentrations of 0, 1, and 5 mg L-1 of MeHg and de novo transcriptome were assembled using RNA-seq. The analysis of differentially expressed genes (DEGs) indicated that 79 unique genes were dysregulated (39 upregulated and 44 downregulated genes). The results showed that MeHg altered gene expression patterns as a response to the cellular stress produced, reflected in cell cycle regulation, lysosomal activity, autophagy, calcium regulation, mitochondrial regulation, apoptosis, and regulation of transcription and translation. The analysis of DEGs showed a low response of the antioxidant machinery to MeHg, evidenced by the fact that genes of early response to oxidative stress were not dysregulated. The RBCs maintained a constitutive expression of proteins that represented a good part of the defense against reactive oxygen species (ROS) induced by MeHg.
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Resumen Introducción: identificar los factores asociados con pérdida de la función del injerto puede ser un paso importante hacia la prolongación de la sobrevida del injerto renal. Objetivo: determinar la asociación entre los cambios histológicos presentes en las biopsias por protocolo, en el primer año postrasplante en receptores de bajo riesgo inmunológico, recibiendo inducción con basiliximab y pérdida en la función del injerto 12 meses postrasplante. Métodos: se incluyeron pacientes receptores de riñones de donante cadavérico (95 %) o donante vivo (5 %) trasplantados entre agosto de 2007 y julio de 2012. El desenlace primario fue pérdida en la tasa de filtración glomerular calculada (Cockroft & Gault) mayor a 5ml/min 12 meses postrasplante, en comparación con la función renal previa a la biopsia por protocolo. Resultados: la cohorte de estudio estuvo conformada por 114 pacientes, de los cuales 25 presentaron el desenlace principal. Los hallazgos asociados con pérdida de función fueron glomerulitis (p=0,024), inflamación intersticial (p=0,001), tubulitis (p=0,001), capilaritis (p=0,001), glomerulitis + capilaritis (p=0,001), nefropatía por polioma virus (p=0,04) y la presencia de rechazo subclínico (p=0,015). Por análisis de regresión logística la presencia de inflamación intersticial (OR = 2,11; IC 95 %: 1,13-3,95) y capilaritis (0R=7,12; IC 95 %:1,57-32,27) fueron las variables asociadas con pérdida de función del injerto renal 12 meses postrasplante renal. Conclusión: la inflamación intersticial y capilaritis son variables histológicas asociadas con pérdida de función del injerto renal, 12 meses postrasplante, independiente de otras variables.
Abstract Introduction: Identifying factors that are associated of allograft function loss might be an important step toward prolonging kidney allograft survival. Purpose: In this study we found to determine the association between histologic changes on 1-year surveillance biopsies and changes in graft function. Methods: Recipients of kidneys from deceased donors (95%) or living donors (5%) trasplanted between 2007 and 2012. The primary end point was reduction in calculated glomerular filtration rate (Cockroft anf Gault) higher 5ml/min 12 months post transplant vs calculated glomerular filtration rate previous surveillance biopsie. Results: This analysis included 114 adults, recipients of kidneys with low immunological risk receiving basiliximab induction from deceased donors (95%) or living donors (5%), transplanted between august 2007 and july 2012. The primary end point was reduction in calculated glomerular filtration rate (Cockroft & Gault) higher 5ml/min 12 months post trasplant. 25 of 114 patientes showing reduction; The histologic changes associated with renal function reduction were glomerulitis (p=0,024), interstitial inflamation (p=0,001), tubulitis (p=0,001), capilaritis (p=0,001), glomerulitis + capilaritis (p=0,001), polyoma virus nephropathy (p=0,04) and subclinical rejection (p=0,015). By regression analyses, interstitial inflamation (OR = 2,11; IC 95%: 1,13-3,95) and capilaritis (0R=7,12; IC 95%: 1,57-32,27) were associated with renal function reduction 12 month post-transplant. Conclusion: inflammation and capilaritis in protocol biopsies in first year post-transplant predict loss of graft function and independently of other variables.
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Humanos , Masculino , Feminino , Transplante de Rim , Basiliximab , Nefropatias , Biópsia , ColômbiaRESUMO
RESUMEN Al considerar el conflicto como la tensión que los elementos, las organizaciones, las regiones o las ciudades mantienen o generan con otros elementos similares que se excluyen de forma mutua, el presente artículo analiza la influencia de los conflictos sociales en el turismo y el desarrollo sustentable de las pequeñas, las medianas y las grandes ciudades de Oaxaca, durante el periodo 2000-2015. Propone como hipótesis que los conflictos sociales afectan desfavorablemente la actividad turística y el desarrollo sustentable de estas ciudades. El análisis estadístico realizado muestra que, en las 17 ciudades analizadas, los conflictos sociales van al alza, lo que genera efectos desfavorables en la actividad turística y el desarrollo. Se recomiendan políticas públicas sociales de negociación basadas en la planeación para reducir los efectos indeseables de los conflictos, y hacer más efectivo el impacto territorial del desarrollo en las ciudades analizadas.
ABSTRACT Considering the conflict as the tension that elements, organizations, regions or cities maintain, or generate with other similar elements that are mutually exclusive, this article analyzes the influence of social conflicts on tourism and the sustainable development of small, medium and large cities of Oaxaca, during 2000-2015. It proposes as a hypothesis that social conflicts adversely affect tourism activity and the sustainable development of these Oaxaca cities. The statistic analysis shows that in the 17 cities analyzed, social conflicts are on the rise, generating unfavorable effects on tourism and development. Public social negotiation policies based on planning are recommended to reduce the undesirable effects of conflicts, and to make the territorial impact of development more effective in the cities analyzed.
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Humanos , Turismo , PolíticasRESUMO
Introducción. La hiponatremia es la alteración electrolítica más frecuente en pacientes con falla cardíaca crónica, que afecta hasta el 28% de pacientes en el ingreso hospilatario. Se ha demostrado que es un predictor independiente de mortalidad, estancia prolongada y rehospitalización. El objetivo es describir la frecuencia de hiponatremia en pacientes con falla cardíaca descompensada y su relación con la estancia hospitalaria y mortalidad. Metodología. Cohorte prospectiva en pacientes hospitalizados por el servicio de Medicina Interna en un hospital de cuarto nivel de Bogotá, Colombia, con diagnóstico de falla cardíaca descompensada entre abril de 2011 y marzo de 2012. Se midió el sodio al ingreso, a las 72 horas y al día séptimo de hospitalización. Se evaluó la relación de la hiponatremia al ingreso con la estancia hospitalaria y la mortalidad intrahospitalaria a 30 días. Resultados. Se incluyeron 162 pacientes, con promedio de edad de 72 años, 52.5% hombres. Cuarenta y uno (25.3%) presentaron hiponatremia al ingreso. Entre los pacientes que presentaron sodio normal al ingreso, 6 presentaron hiponatremia a las 72 horas y 2 a los 7 días. La mortalidad intrahospitalaria en la población total fue 9.2%, en el grupo de hiponatremia 12.2%, y 8.2% en los que no la tuvieron (p= 0.45). El promedio de estancia hospitalaria fue superior en los pacientes con hiponatremia, 6.6 vs. 8.4 días (p= 0.12). Discusión. La incidencia de hiponatremia al ingreso en este grupo de pacientes fue semejante a la reportada en la literatura. Conclusiones. Existe una tendencia hacia una mayor mortalidad y estancia hospitalaria en pacientes con hiponatremia, aun cuando no fue estadísticamente significativa. Cómo citar. Diaztagle-Fernández JJ, Chaves-Saltiago WG, Sprockel-Díaz JJ, Acevedo-Velasco AD, Rodríguez-Benítez FH, Benavides-Solarte MF, et al. Asociación entre hiponatremia, mortalidad y estancia hospitalaria en pacientes con falla cardíaca descompensada. MedUNAB. 2019;22(3), 294-303. doi: 10.29375/01237047.3497
Introduction. Hyponatremia is the most common electrolyte disorder in patients with chronic heart failure affecting up to 28% of patients at admission. It has been shown to be an independent predictor of mortality, extended length of hospital stay and rehospitalization. The objective is to evaluate the presence of hyponatremia in patients with decompensated heart failure and describe its relationship with length of hospital stay and mortality. Methodology. A prospective cohort study in patients hospitalized at internal medicine service at a high level of complexity hospital in Bogotá, Colombia diagnosed with decompensated heart failure between April 2011 and March 2012. Sodium was measured on admission, 72 hours and at the seventh day of hospitalization. We evaluated the association between hyponatremia at hospital admission, mortality at 30 days and length of hospital stay. Results. 162 patients were included with an average age of 72 years, 52.5% male. Forty-one (25.3%) had hyponatremia at admission. Among the patients with normal sodium at admission, 6 had hyponatremia at 72 hours and 2 at the seventh day. Inhospital mortality in the total population was 9.2%, in the hyponatremia group 12.2%, and 8.2% in those who did not have it (p = 0.45). The average length of hospital stay was higher in patients with hyponatremia, 6.6 vs 8.4 days (p = 0.12). Discussion. The incidence of hyponatremia at admission in this group of patients was similar to that reported in the literature. Conclusions. The results showed a trend towards higher mortality and hospital stay in patients with hyponatremia, even though it was not statistically significant. Cómo citar. Diaztagle-Fernández JJ, Chaves-Saltiago WG, Sprockel-Díaz JJ, Acevedo-Velasco AD, Rodríguez-Benítez FH, Benavides-Solarte MF, et al. Asociación entre hiponatremia, mortalidad y estancia hospitalaria en pacientes con falla cardíaca descompensada. MedUNAB. 2019;22(3), 294-303. doi: 10.29375/01237047.3497
Introdução. A hiponatremia é o desequilíbrio hidroeletrolítico mais frequente em pacientes com insuficiência cardíaca crônica, que afeta até 28% dos pacientes internados. Demonstrou ser um preditor independente de mortalidade, permanencia prolongada e re-internação. O objetivo é descrever a frequência de hiponatremia em pacientes com insuficiência cardíaca descompensada e sua relação com internação hospitalar e mortalidade. Metodologia. Coorte prospectiva em pacientes internados pelo serviço de Medicina Interna em um hospital de quarto nível em Bogotá, Colômbia, com diagnóstico de insuficiência cardíaca descompensada, entre abril de 2011 e março de 2012. Foi medido o sódio na admissão, às 72 horas e no sétimo dia de internação. Foi avaliada a relação de hiponatremia na admissão com internação e a mortalidade hospitalar aos 30 dias. Resultados. Foram incluídos 162 pacientes, com idade média de 72 anos, 52,5% homens. Quarenta e um (25,3%) apresentaram hiponatremia na admissão. Entre os pacientes que apresentaram sódio normal na admissão, seis apresentaram hiponatremia às 72 horas, e dois aos sete dias. A mortalidade hospitalar na população total foi de 9,2%, no grupo de hiponatremia 12,2% e 8,2% naqueles que não apresentaram (p = 0,45). O tempo médio de internação foi maior nos pacientes com hiponatremia, 6,6 vs. 8,4 dias (p = 0,12). Discussão. A incidência de hiponatremia na admissão nesse grupo de pacientes foi semelhante à relatada na literatura. Conclusões. Existe uma tendência de maior mortalidade e permanência hospitalar em pacientes com hiponatremia, mesmo que não tenha sido estatisticamente significante. Cómo citar. Diaztagle-Fernández JJ, Chaves-Saltiago WG, Sprockel-Díaz JJ, Acevedo-Velasco AD, Rodríguez-Benítez FH, Benavides-Solarte MF, et al. Asociación entre hiponatremia, mortalidad y estancia hospitalaria en pacientes con falla cardíaca descompensada. MedUNAB. 2019;22(3), 294-303. doi: 10.29375/01237047.3497
Assuntos
Insuficiência Cardíaca , Prognóstico , Mortalidade , Hospitalização , HiponatremiaRESUMO
Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC) is a very rare disease that is inherited in an autosomal dominant manner. Affected patients may develop from cutaneous and uterine leiomyomas to type 2 papillary renal cell carcinoma (Schmidt and Linehan, Int J Nephrol Renovasc Dis 7:253-260, 2014). HLRCC is caused by germline mutations in the FH gene, which produces the fumarate hydratase protein that participates in the tricarboxylic acid cycle during the conversion of fumarate to malate. In FH-deficient cells, high concentrations of fumarate lead to a series of intricate events, which seem to be responsible for the malignant transformation (Yang et al., J Clin Invest 123(9):3652-3658, 2013) (Bardella et al., J Pathol 225(1):4-11, 2011). Among these events, one that is gaining attention is the pathological activation of the nuclear factor erythroid 2-related factor 2 (NRF2) pathway, which has been found in several types of cancer and is implicated in the expression of genes associated with antioxidant responses (Linehan and Rouault, Clin Cancer Res 19(13):3345-3352, 2013). In this article, we present the results of a gene expression analysis performed on peripheral blood cells from patients with HLRCC syndrome, where upregulation of numerous NRF2 targets and the differential expression of two key genes, Jun dimerization protein 2 (JDP2) and Phosphoglycerate mutase family member 5 (PGAM5), which are involved in the control of this pathway, was observed.
Assuntos
Regulação Neoplásica da Expressão Gênica , Leiomiomatose/genética , Fator 2 Relacionado a NF-E2/genética , Síndromes Neoplásicas Hereditárias/genética , Neoplasias Cutâneas/genética , Neoplasias Uterinas/genética , Adulto , Estudos de Casos e Controles , Humanos , Leucócitos Mononucleares/fisiologia , Masculino , Proteínas Mitocondriais/genética , Fator 2 Relacionado a NF-E2/metabolismo , Fosfoproteínas Fosfatases/genética , Proteínas Repressoras/genéticaRESUMO
PURPOSE: Collapsin response mediator protein-2 (CRMP2) is a CNS protein involved in neuronal development, axonal and neuronal growth, cell migration, and protein trafficking. Recent studies have linked perturbations in CRMP2 function to neurodegenerative disorders such as Alzheimer's disease, neuropathic pain, and Batten disease, and to psychiatric disorders such as schizophrenia. Like most proteins, CRMP2 functions though interactions with a molecular network of proteins and other molecules. EXPERIMENTAL DESIGN: Here, we have attempted to identify additional proteins of the CRMP2 interactome to provide further leads about its roles in neurological functions. We used a combined co-immunoprecipitation and shotgun proteomic approach in order to identify CRMP2 protein partners. RESULTS: We identified 78 CRMP2 protein partners not previously reported in public protein interaction databases. These were involved in seven biological processes, which included cell signaling, growth, metabolism, trafficking, and immune function, according to Gene Ontology classifications. Furthermore, 32 different molecular functions were found to be associated with these proteins, such as RNA binding, ribosomal functions, transporter activity, receptor activity, serine/threonine phosphatase activity, cell adhesion, cytoskeletal protein binding and catalytic activity. In silico pathway interactome construction revealed a highly connected network with the most overrepresented functions corresponding to semaphorin interactions, along with axon guidance and WNT5A signaling. CONCLUSIONS AND CLINICAL RELEVANCE: Taken together, these findings suggest that the CRMP2 pathway is critical for regulating neuronal and synaptic architecture. Further studies along these lines might uncover novel biomarkers and drug targets for use in drug discovery.
Assuntos
Encéfalo/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Animais , Humanos , Ligação Proteica , Esquizofrenia/metabolismoRESUMO
We conducted a telephone survey of all patients referred to a realtime telemedicine consultation at the Centre for Telehealth in Bogotá. Over a six-month period, 281 teleconsultations were conducted, and we were able to retrieve telephone numbers for 156 patients. Of these, 121 patients (78%) agreed to answer the questionnaire. Eighty percent of the respondents were satisfied or very satisfied with the teleconsultation and 63% would use telemedicine again. Sixty-five percent thought that telemedicine improved their medical care. More than 50% believed that telemedicine had a positive effect in terms of medical care improvement, time- and cost-savings. Twenty-seven percent felt that teleconsultation was not as good as a traditional face-to-face consultation. Lack of familiarity with ICT did not appear to act as a major barrier to telemedicine, and cognitive factors may be more important in acceptability to patients and their satisfaction. The results of the present study may also be relevant to the poorest countries of the world, where two-thirds of the population live in rural areas.
Assuntos
Satisfação do Paciente , Qualidade da Assistência à Saúde/normas , Consulta Remota/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colômbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Consulta Remota/economia , Saúde da População Rural , Telefone , Fatores de Tempo , Adulto JovemRESUMO
INTRODUCTION: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically. CONCLUSIONS: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.
Assuntos
Neoplasias Ovarianas , Assistência ao Convalescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Resistencia a Medicamentos Antineoplásicos , Diagnóstico Precoce , Feminino , Genes Neoplásicos , Humanos , Laparoscopia , Excisão de Linfonodo , Terapia Neoadjuvante , Estadiamento de Neoplasias/normas , Síndromes Neoplásicas Hereditárias/genética , Omento/cirurgia , Compostos Organoplatínicos/administração & dosagem , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Ovariectomia/métodos , Cuidados Paliativos , Qualidade de Vida , Radioterapia Adjuvante , Terapia de Salvação , Taxoides/administração & dosagemRESUMO
INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.