ABSTRACT
La Artritis Reumatoide (AR) tiene adversas consecuencias en la salud su diagnóstico temprano y manejo óptimo requiere recomendaciones basadas en evidencia de alta calidad adaptadas a cada sistema de salud. Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y manejo inicial de la AR. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 10 preguntas clínicas a ser respondidas por la presente GPC. Se realizaron búsquedas sistemáticas de la evidencia publicada en PubMed y CENTRAL entre diciembre 2017 a julio 2019 (revisiones sistemáticas y cuando fue considerado pertinente estudios primarios). Se seleccionó la evidencia de mayor calidad para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE) y en reuniones de trabajo periódicas, el GEG usó dicha metodología para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y los flujogramas. Finalmente, la GPC fue aprobada con Resolución N° 132 IETSI ESSALUD 2019. Resultados: La presente GPC abordó 10 preguntas clínicas, divididas en dos temas: diagnóstico y manejo. En base a dichas preguntas se formularon 16 recomendaciones (5 fuertes y 11 condicionales), 45 puntos de buena práctica clínica, y 3 flujogramas. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y manejo inicial de la AR en EsSalud.
Rheumatoid arthritis (RA) has adverse health consequences its early diagnosis and optimal management requires high quality evidence-based recommendations tailored to each health system. Objective: To provide evidence-based clinical recommendations for the diagnosis and initial management of RA. Material and Methods: A guideline development group (GDG) was formed that included medical specialists and methodologists. The GEG formulated 10 clinical questions to be answered by this CPG. Systematic searches of the evidence published in PubMed and CENTRAL were performed between December 2017 and July 2019 (systematic reviews and -when considered relevant- primary studies). The highest quality evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, and in periodic working meetings, the GEG used this methodology to review the evidence and formulate the recommendations, good clinical practice points, and flowcharts. Finally, the CPG was approved by Resolution No. 132 - IETSI - ESSALUD - 2019. Results: This CPG addressed 10 clinical questions, divided into two topics: diagnosis and management. Based on these questions, 16 recommendations (5 strong and 11 conditional), 45 points of good clinical practice, and 3 flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the diagnosis and initial management of RA in EsSalud.
Subject(s)
Humans , Arthritis, Rheumatoid/therapy , Peru , Arthritis, Rheumatoid/diagnosis , Adrenal Cortex Hormones/therapeutic use , Drug Therapy, CombinationABSTRACT
OBJETIVO:Investigar el patrón de distribución espacial de la tasa de homicidios y su relación con las características sociodemográficas en las delegaciones de Benito Juárez, Coyoacán y Cuauhtémoc de la Ciudad de México en el año 2010. MÉTODOS: Estudio inferencial de corte transversal que usa métodos de análisis espacial para estudiar la asociación espacial de la tasa de homicidios y las características demográficas. La asociación espacial fue determinada a través del cociente de localización, análisis de regresión múltiple y el uso de la regresión geográficamente ponderada. RESULTADOS: Los homicidios muestran un patrón de localización heterogéneo con altas tasas en zonas con uso del suelo no residencial, con baja densidad de población y baja marginación. CONCLUSIONES: El uso de herramientas de análisis espacial son instrumentos poderosos para el diseño de políticas de seguridad pública preventiva y recreativa que busquen reducir la mortalidad por causas externas como homicidios.
OBJECTIVE:Investigate the spatial distribution pattern of the homicide rate and its relation to sociodemographic features in the Benito Juárez, Coyoacán, and Cuauhtémoc districts of Mexico City in 2010. METHODS: Inferential cross-sectional study that uses spatial analysis methods to study the spatial association of the homicide rate and demographic features. Spatial association was determined through the location quotient, multiple regression analysis, and the use of geographically weighted regression. RESULTS: Homicides show a heterogeneous location pattern with high rates in areas with non-residential land use, low population density, and low marginalization. CONCLUSIONS: Spatial analysis tools are powerful instruments for the design of prevention- and recreation-focused public safety policies that aim to reduce mortality from external causes such as homicides.
Subject(s)
Humans , Animals , Male , Female , Cattle , Rats , Hypoxia/metabolism , Cation Transport Proteins/metabolism , Hypertension, Pulmonary/metabolism , Muscle, Smooth, Vascular/metabolism , Animals, Congenic , Hypoxia/genetics , Arterioles/metabolism , Cation Transport Proteins/deficiency , Cation Transport Proteins/genetics , Cell Hypoxia , Cell Proliferation , Cells, Cultured , Chromosomes, Mammalian/genetics , Chronic Disease , Gene Knockdown Techniques , Homeostasis , Hypertension, Pulmonary/genetics , Intracellular Space/metabolism , Muscle, Smooth, Vascular/cytology , Rats, Inbred WKY , Zinc/metabolismABSTRACT
Determinar la resistencia a la tracci¢n de los cementos de resina autoadhesivo Relyx u100 y de resina autocurado Multilink en la retenci¢n de postes de fibra de vidrio. Material y mtodos. Se realiz¢ un estudio comparativo, transversal, in vitro, prospectivo, experimental. Se utiliz¢ 40 premolares unirradiculares, se separaron en dos grupos conformados por 20 piezas dentales y fueron seccionados a nivel del techo cameral, se obtuvo as¡ la uniformidad de la muestra con una medida de 18 mm cada una. Se realiz¢ el tratamiento de conductos con la tcnica corona apical respectiva y se esper¢ 7 d¡as posteriores al tratamiento. Se desobtur¢ con fresas Gates, Pesso y luego con la fresa del kit de los postes, se estandariz¢ el mismo tama¤o para todos los dientes. Se procedi¢ a la cementaci¢n de los postes seg£n las especificaciones establecidas por los fabricantes Relyx u100 y Multilink. Las piezas dentales fueron colocadas en una probeta (cubo de acr¡lico r pido) por un extremo y, por el otro extremo, los postes en otro cubo. Las probetas para las pruebas de fractura se colocaron dentro de la m quina universal de ensayos hasta el momento en que perdieron su adhesi¢n, una vez obtenidos los resultados fueron archivados en la ficha de recolecci¢n de datos para, posteriormente, realizar las comparaciones respectivas. Resultados. Los postes de fibra de vidrio cementados con resina autocurado presentaron una resistencia a la tracci¢n 30,6 kg, y el cemento de resina autoadhesivo present¢ una resistencia a la tracci¢n de 24,2 kg. Conclusiones. El cemento de resina autocurado present¢ una mayor resistencia a la tracci¢n, comparada con el cemento de resina autoadhesivo, sin embargo, no hubo diferencia estad¡stica.
To determine the resistance to the traction of the cements of autoadhesive resin Relyx u100 and Multilink self-curing resin in retaining glass fiber posts. Material and methods. A comparative, cross, in vitro, prospective, experimental study was made. 40 monoradicular premolars were used, they were separated into two groups comprised of 20 teeth and they were sectioned on cameral roof level obtaining thereby the uniformity of the sample with a measurement of 18 mm each. The root canal with crown apical technique was performed and seven days after treatment were waited. They were desobtureted with Gates, Pesso drill and then with the drill of the posts kit, the same size was standardized for all teeth. It was proceeded to the cementation of posts according to specifications set by manufacturers of Multilink and Relyx u100. The teeth were placed in a test tube (acrylic cube fast) at one end and at the other end in another hub studs. The specimens for fracture tests were placed within the universal testing machine Amsler mark up the time they lost their accession after the results obtained were kept in the data collection sheet to then be able to perform the respective comparisons. Results. The glass fiber poles cemented with cement of self-curing resin presented a tensile strength Kg. 30,6 and the cement of autoadhesive resin presented a tensile strength of 24,2 Kg. Conclusions. The cement of self-curing resin had a higher tensile strength compared with the cement of autoadhesive resin, however we evidenced that there is no statistical difference.
Subject(s)
Humans , Dental Cements , Resin Cements , Tensile Strength , Pit and Fissure SealantsABSTRACT
Mice from the syngeneic strains BALB/c, C57Bl/6 and (BALB/cxC57Bl/6) F1 hybrids (CB6F1) were infected in the fottpad with six different stains of Leishmania mexicana mexicana isolated from Mexican patients. Three Leishmania strains were isolated from patients with localized cutaneous leishmaniasis (LCL, the benign form of the disease and three from patients with diffuse cutaneous leishmaniasis (DCL, the malignant form of the disease). In BALB/c mice, four Leishmania strains showed a sustained fast growth from 4 to 5 weeks postinfection until the end of the experiment (15 weeks), and the other two grew slowly up to 10 or 12 weeks after infection and then started to grow faster. In C57Bl/6 mice four Leismania strains showed a limited to moderate growth up to 6 to 11 weeks postinfection and then started to decrease. One strain showed a moderate growth during the entire experiment and one strain grew as fast as in BLB/c mice up to 11 weeks postinfection and then started to decrease. The CB6F1 hybrid behaved like the C57Bl/6 parent strain with five Leishmania strains but was much more resistant to one Leishmania strain than the C57Bl/6 mice. Sex of the mouse did not influence the outcome of infection. One important purpose of this work was to see if the Leishmania strains that cause DCL are intrinsically more virulent than those that cause the benign form (LCL). Although important variations in virulence among the Leishmania strains were observed, especially in BALB/c mice, they were not correlated with the type of disease caused in humans