Open versus percutaneous tracheostomy in patients with COVID-19: retrospective cohort analysis.

BACKGROUND: During the COVID-19 pandemic, a great number of patients required Mechanical Ventilation (MV). Tracheostomy is the preferred procedure when difficult weaning is presented. Surgical techniques available for performing tracheostomy are open and percutaneous, with contradictory reports on the right choice. This paper aims to describe the clinical results after performing a tracheostomy in patients with COVID-19, regarding both surgical techniques. METHODS: An observational, analytical study of a retrospective cohort was designed. All patients admitted to the Hospital Universitario Mayor Méderi, between March 2020 and April 2021 who presented COVID-19 requiring MV and who underwent tracheostomy were reviewed. Open versus percutaneous tracheostomy groups were compared and the primary outcome evaluated was in-hospital mortality. RESULTS: A total of 113 patients were included in the final analysis. The median age was 66.0 (IQR: 57.2 - 72.0) years old and 77 (68.14%) were male. Open tracheostomy was performed in 64.6% (n = 73) of the patients and percutaneous tracheostomy in 35.4% (n = 40) with an in-hospital mortality of 65.7% (n = 48) and 25% (n = 10), respectively (p < 0.001). In a multivariate analysis, open tracheostomy technique [OR 9.45 (95% CI 3.20-27.92)], older age [OR 1.05 (95% CI 1.01-1.09)] and APACHE II score [OR 1.10 (95% CI 1.02-1.19)] were identified as independent risk factors for in-hospital mortality. Late tracheostomy (after 14 days) [OR 0.31 (95% CI 0.09-1.02)] and tracheostomy day PaO2/FiO2 [OR 1.10 (95% CI 1.02-1.19)] were not associated to in-hospital mortality. CONCLUSIONS: Percutaneous tracheostomy was independently associated with lower in-hospital mortality and should be considered the first option to perform this type of surgery in patients with COVID-19 in extended MV or difficulty weaning.

Agreement between two scales used for assessing risk classification for thromboembolic events and the requirement of postpartum pharmacological prophylaxis / Concordancia entre dos escalas para evaluar la clasificación del riesgo de eventos tromboembólicos y el requerimiento de profilaxis farmacológica en el posparto.

Objectives: To determine agreement in assessing the need for postpartum pharmacological prophylaxis between the scale of the Royal College of Obstetricians and Gynaecologists and the Colombian guideline scale in a Level IV institution in Bogota, Colombia. Material and methods: Diagnostic agreement study assembled on a cross-sectional study. The included population consisted of pregnant women with 24 or more weeks of pregnancy admitted between March 1 and April 30 of 2021 to a high complexity private institution in Bogotá, Colombia, for labor induction, in active labor, for elective cesarean section, or who required urgent cesarean section. Convenience sampling was used. Measured variables included demographics, risk factors, risk classification and pharmacological prophylaxis according to the two scales. The prevalence of risk factors for each scale was estimated and agreement regarding prophylaxis indication between the two scales was measured using the weighted kappa value. Results: Overall, 320 patients were included. According to the scale of the Royal College Obstetricians and Gynaecologists, 54.7 % patients were classified as low risk, 42.5 % as intermediate risk and 2.8 % as high risk. The Colombian scale classified 80 % of patients as low risk, 17.2 % as intermediate risk, 2.2 % as high risk, and 0.6 % as very high risk. The weighted kappa value for agreement regarding the indication was 0.47 (95 % CI: 0.38-0.56). Conclusions: Agreement between the two scales to determine the need for postpartum pharmacological prophylaxis is moderate. Risk classification criteria for the Colombian scale should be validated in a second cohort. Moreover, the predictive ability of the Colombian guideline tool should be assessed at different cut-off points in terms of the consequences of false positive and false negative results.

Objetivos: establecer la concordancia para evaluar el requerimiento de profilaxis farmacológica en el puerperio entre la escala del Royal College Obstetricians and Gynaecologists y la escala de la guía colombiana en una institución de cuarto nivel en Bogotá, Colombia. Materiales y métodos: estudio de concordancia diagnóstica ensamblado sobre un estudio transversal. Se incluyeron mujeres embarazadas con 24 o más semanas de gestación que ingresaron para inducción de trabajo de parto, en trabajo de parto activo, para cesárea electiva, o que requirieron cesárea de urgencia, hospitalizadas entre el 1 de marzo y 30 de abril de 2021 en una institución privada de alta complejidad en Bogotá, Colombia. Se realizó un muestreo por conveniencia. Se midieron variables demográficas, factores de riesgo, clasificación del riesgo y profilaxis farmacológica según las dos escalas. Se calculó la prevalencia de los factores de riesgo por cada escala y la concordancia en la indicación de la profilaxis entre las dos escalas por medio del valor de kappa ponderado. Resultados: se incluyeron 320 pacientes. La escala del Royal College Obstetricians and Gynaecologists clasificó al 54,7 % de las pacientes en riesgo bajo, riesgo intermedio al 42,5 % y riesgo alto al 2,8 %. La escala colombiana clasificó al 80 % de las pacientes en riesgo bajo, 17,2 % riesgo intermedio, 2,2 % riesgo alto y 0,6 % con riesgo muy alto. El valor kappa ponderado para la concordancia para indicación fue de 0,47 (IC 95 %: 0,38-0,56). Conclusiones: la concordancia de las dos escalas para definir requerimiento de profilaxis farmacológica en el posparto tiene un acuerdo moderado. Se considera es necesario validar los criterios de clasificación del riesgo de la escala colombiana en una segunda cohorte, además evaluar la capacidad predictiva de la herramienta de la guía colombiana en diferentes puntos de corte en términos de las consecuencias de falsos positivos y negativos.

Concordancia entre dos escalas para evaluar la clasificación del riesgo de eventos tromboembólicos y el requerimiento de profilaxis farmacológica en el posparto / Agreement between two scales used for assessing risk classification for thromboembolic events and the requirement of postpartum pharmacological prophylaxis

RESUMEN Objetivos: Establecer la concordancia para evaluar el requerimiento de profilaxis farmacológica en el puerperio entre la escala del Rojal College Obstetricians and Gynaecologists y la escala de la guía colombiana en una institución de cuarto nivel en Bogotá, Colombia. Materiales y métodos: Estudio de concordancia diagnóstica ensamblado sobre un estudio transversal. Se incluyeron mujeres embarazadas con 24 o más semanas de gestación que ingresaron para inducción de trabajo de parto, en trabajo de parto activo, para cesárea electiva, o que requirieron cesárea de urgencia, hospitalizadas entre el 1 de marzo y 30 de abril de 2021 en una institución privada de alta complejidad en Bogotá, Colombia. Se realizó un muestreo por conveniencia. Se midieron variables demográficas, factores de riesgo, clasificación del riesgo y profilaxis farmacológica según las dos escalas. Se calculó la prevalencia de los factores de riesgo por cada escala y la concordancia en la indicación de la profilaxis entre las dos escalas por medio del valor de kappa ponderado. Resultados: Se incluyeron 320 pacientes. La escala del Royal College Obstetricians and Gynaecologists clasificó al 54,7 % de las pacientes en riesgo bajo, riesgo intermedio al 42,5 % y riesgo alto al 2,8 %. La escala colombiana clasificó al 80 % de las pacientes en riesgo bajo, 17,2 % riesgo intermedio, 2,2 % riesgo alto y 0,6 % con riesgo muy alto. El valor kappa ponderado para la concordancia para indicación fue de 0,47 (IC 95 %: 0,38-0,56). Conclusiones: La concordancia de las dos escalas para definir requerimiento de profilaxis farmacológica en el posparto tiene un acuerdo moderado. Se considera es necesario validar los criterios de clasificación del riesgo de la escala colombiana en una segunda cohorte, además evaluar la capacidad predictiva de la herramienta de la guía colombiana en diferentes puntos de corte en términos de las consecuencias de falsos positivos y negativos.

ABSTRACT Objectives: To determine agreement in assessing the need for postpartum pharmacological prophylaxis between the scale of the Royal College of Obstetricians and Gynaecologists and the Colombian guideline scale in a Level IV institution in Bogota, Colombia. Material and methods: Diagnostic agreement study assembled on a cross-sectional study. The included population consisted of pregnant women with 24 or more weeks of pregnancy admitted between March 1 and April 30 of 2021 to a high complexity private institution in Bogotá, Colombia, for labor induction, in active labor, for elective cesarean section, or who required urgent cesarean section. Convenience sampling was used. Measured variables included demographics, risk factors, risk classification and pharmacological prophylaxis according to the two scales. The prevalence of risk factors for each scale was estimated and agreement regarding prophylaxis indication between the two scales was measured using the weighted kappa value. Results: Overall, 320 patients were included. According to the scale of the Royal College Obstetricians and Gynaecologists, 54.7 % patients were classified as low risk, 42.5 % as intermediate risk and 2.8 % as high risk. The Colombian scale classified 80 % of patients as low risk, 17.2 % as intermediate risk, 2.2 % as high risk, and 0.6 % as very high risk. The weighted kappa value for agreement regarding the indication was 0.47 (95 % CI: 0.38-0.56). Conclusions: Agreement between the two scales to determine the need for postpartum pharmacological prophylaxis is moderate. Risk classification criteria for the Colombian scale should be validated in a second cohort. Moreover, the predictive ability of the Colombian guideline tool should be assessed at different cut-off points in terms of the consequences of false positive and false negative results.

Los colombianos se comprometen a cuidar el corazón / Colombians are committed to taking care of the heart

Resumen Como una respuesta a la realidad epidemiológica del crecimiento de la mortalidad a causa de las enfermedades cardiocerebrovasculares en el país, la Fundación Colombiana del Corazón (FCC) decidió, como estrategia, incentivar en la comunidad el cuidado como estilo de vida, y para ello propuso movilizar a los colombianos para que realizaran promesas para el cuidado de su corazón. El objetivo de este artículo es mostrar cómo se realizó la implementación de esta estrategia y revisar los resultados de las promesas hechas por los colombianos para cuidar su corazón en septiembre de 2018, denominado el “Mes del corazón”. Más de 30.000 compromisos se lograron en todo el país con la estrategia de comunicación denominada “Mes del corazón, haz tu promesa” mediante un instrumento que indagó por los compromisos de las personas para el cuidado de su corazón. La FCC identificó cincuenta posibles promesas obtenidas de los comportamientos planteados por la propuesta institucional de generación propia, conocida como “Corazones responsables”. Se procesaron 2.412 promesas (encuestas) obtenidas en el marco de los eventos académicos y de empresas programados por la FCC y la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, y de cuya tabulación pudieron identificarse los compromisos comúnmente propuestos por la comunidad. Entre los más destacados, los colombianos se comprometieron a: 1. caminar y hacer más ejercicio, 2. tener pensamientos positivos, 3. dormir más (este más frecuente en mujeres), 4. aumentar el consumo de agua durante el día, 5. incrementar el consumo de frutas y verduras y 6. desayunar todos los días en forma saludable.

Abstract As a response to the epidemiological reality of the growth of mortality from cardio-cerebrovascular diseases in our country, the Colombian Heart Foundation (FCC) decided as a strategy to encourage “care as a lifestyle” in the community and to this end proposed to mobilize Colombians to make promises for the care of your heart. The objective of this article is to present how the implementation of this strategy was carried out and to review the results of the promises made by Colombians to care for their hearts in September 2018, called Heart Month. More than 30 thousand commitments were achieved throughout the country with the communication strategy called “Month of the heart, make your promise” through an instrument that investigated the commitments of people to care for their hearts. The FCC identified 50 possible promises, obtained from the behaviors raised by the institutional proposal of its own generation, known as “Responsible hearts”. 2412 promises (surveys) obtained within the framework of the academic and business events programmed by the FCC and the Colombian Society of Cardiology and Cardiovascular Surgery were processed and whose tabulation we were able to identify the commitments most frequently proposed by the community. Among the most prominent, Colombians committed to: 1. walking and exercising more, 2. having positive thoughts, 3. sleeping more (this is more frequent in women), 4. increasing water consumption during the day, 5. to increase the consumption of fruits and vegetables and 6. to eat breakfast every day in a healthy way.

Pericarp growth dynamics associate with final grain weight in wheat under contrasting plant densities and increased night temperature.

BACKGROUND AND AIMS: The pericarp weight comprises <17 % of wheat grain weight at harvest. The pericarp supports the hydration and nutrition of both the embryo and endosperm during early grain filling. However, studies of the pericarp and its association with final grain weight have been scarce. This research studied the growth dynamics of wheat pericarp from anthesis onwards and its relationship to final grain weight under contrasting plant densities and night warming. METHODS: Two spring wheat cultivars contrasting in kernel weight (Bacanora and Kambara) were sown in field conditions during seasons 2012-13 and 2014-15. Both genotypes were grown under contrasting plant density (control, 370 plants m-2; and low plant density, 44 plants m-2) and night temperatures, i.e. at ambient and increased (>6 °C) temperature for short periods before and after anthesis. From anthesis onward, grains were harvested every 3 or 4 d. Grain samples were measured and the pericarp was removed with a scalpel. Whole grain and pericarp fresh and dry weight were weighed with a precision balance. At harvest, 20 grains from ten spikes were weighed and grain dimensions were measured. KEY RESULTS: Fresh weight, dry matter and water content of pericarp dynamics showed a maximum between 110 and 235 °Cd. Maximum dry matter of the pericarp ranged between 4.3 and 5.7 mg, while water content achieved values of up to 12.5 mg. Maximum values and their timings were affected by the genotype, environmental condition and grain position. Final grain weight was closely associated with maximum dry matter and water content of the pericarp. CONCLUSIONS: Maximum pericarp weight is a determinant of grain weight and size in wheat, which is earlier than other traits considered as key determinants of grain weight during grain filling. Better growing conditions increased maximum pericarp weight, while higher temperature negatively affected this trait.

Early but not late conformational changes of tau in association with ubiquitination of neurofibrillary pathology in Alzheimer's disease brains.

In Alzheimer's disease, tau protein undergoes post-translational modifications including hyperphosphorylation and truncation, which promotes two major conformational changes associated with progressive N-terminal folding. Along with the development of the disease, tau ubiquitination was previously shown to emerge in the early and intermediate stages of the disease, which is closely associated with early tau truncation at aspartic acid 421, but not with a subsequently truncated tau molecule at glutamic acid 391. In the same group of cases, using multiple immunolabeling and confocal microscopy, a possible relationship between the ubiquitin-targeting of tau and the progression of conformational changes adopted by the N-terminus of this molecule was further studied. A comparable number of neurofibrillary tangles was found displaying ubiquitin, an early conformation recognized by the Alz-50 antibody, and a phosphorylation. However, a more reduced number of neurofibrillary tangles were immunoreactive to Tau-66 antibody, a late tau conformational change marker. When double-labeling profiles of neurofibrillary tangles were assessed, ubiquitination was clearly demonstrated in tau molecules undergoing early N-terminal folding, but was barely observed in late conformational changes of the N-terminus adopted by tau. The same pattern of colocalization was visualized in neuritic pathology. Overall, these results indicate that a more intact conformation of the N-terminus of tau may facilitate tau ubiquitination, but this modification may not occur in a late truncated and more compressed folding of the N-terminus of the tau molecule.

Fragmentation of the Golgi Apparatus in Neuroblastoma Cells Is Associated with Tau-Induced Ring-Shaped Microtubule Bundles.

Abnormal fibrillary aggregation of tau protein is a pathological condition observed in Alzheimer's disease and other tauopathies; however, the presence and pathological significance of early non-fibrillary aggregates of tau remain under investigation. In cell and animal models expressing normal or modified tau, toxic effects altering the structure and function of several membranous organelles have also been reported in the absence of fibrillary structures; however, how these abnormalities are produced is an issue yet to be addressed. In order to obtain more insights into the mechanisms by which tau may disturb intracellular membranous elements, we transiently overexpressed human full-length tau and several truncated tau variants in cultured neuroblastoma cells. After 48 h of transfection, either full-length or truncated tau forms produced significant fragmentation of the Golgi apparatus (GA) with no changes in cell viability. Noteworthy is that in the majority of cells exhibiting dispersion of the GA, a ring-shaped array of cortical or perinuclear microtubule (Mt) bundles was also generated under the expression of either variant of tau. In contrast, Taxol treatment of non-transfected cells increased the amount of Mt bundles but not sufficiently to produce fragmentation of the GA. Tau-induced ring-shaped Mt bundles appeared to be well-organized and stable structures because they were resistant to Nocodazole post-treatment and displayed a high level of tubulin acetylation. These results further indicate that a mechanical force generated by tau-induced Mt-bundling may be responsible for Golgi fragmentation and that the repeated domain region of tau may be the main promoter of this effect.

HPV16-E6 Oncoprotein Activates TGF-ß and Wnt/ß-Catenin Pathways in the Epithelium-Mesenchymal Transition of Cataracts in a Transgenic Mouse Model.

OBJECTIVE: This work aimed to determine if cataractous changes associated with EMT occurring in the K14E6 mice lenses are associated with TGF-ß and Wnt/ß-catenin signaling activation. MATERIALS AND METHODS: Cataracts of K14E6 mice were analysed histologically; and components of TGF-ß and Wnt/ß-catenin signaling were evaluated by Western blot, RT-qPCR, in situ RT-PCR, IHC, or IF technics. Metalloproteinases involved in EMT were also assayed using zymography. The endogenous stabilisation of Smad7 protein was also assessed using an HDAC inhibitor. RESULTS: The K14E6 mice, which displayed binocular cataracts in 100% of the animals, exhibited loss of tissue organisation, cortical liquefaction, and an increase in the number of hyperproliferative-nucleated cells with mesenchymal-like characteristics in the lenses. Changes in lenses' cell morphology were due to actin filaments reorganisation, activation of TGF-ß and Wnt/ß-catenin pathways, and the accumulation of MTA1 protein. Finally, the stabilisation of Smad7 protein diminishes cell proliferation, as well as MTA1 protein levels. CONCLUSION: The HPV16-E6 oncoprotein induces EMT in transgenic mice cataracts. The molecular mechanism may involve TGF-ß and Wnt/ß-catenin pathways, suggesting that the K14E6 transgenic mouse could be a useful model for the study or treatment of EMT-induced cataracts.

Opciones en Colombia para la regulación del uso de sistemas electrónicos con o sin dispensación de nicotina: un resumen de evidencias para política (policy brief) / Opciones en Colombia para la regulación del uso de sistemas electrónicos con o sin dispensación de nicotina: un resumen de evidencias para política (policy brief)

Objetivo: El propósito de este resumen de evidencias para política (policy brief) fue sintetizar en un formato amigable, la evidencia de investigación de mejor calidad disponible respecto al uso de sistemas electrónicos con o sin dispensación de nicotina y similares, y sobre los efectos de cuatro opciones de abordaje de regulación seleccionadas por el Ministerio de Salud y Protección Social. Estas intervenciones podrían mejorar lo que actualmente se está haciendo en materia de regulación de sistemas electrónicos con o sin dispensación de nicotina y similares en Colombia, especialmente para la protección de grupos vulnerables como son los niños y adolescentes quienes actualmente pueden acceder a estos dispositivos sin ninguna restricción, exponiéndose a temprana edad a sustancias como la nicotina y el propilenglicol, las cuales están asociadas con cáncer y otras enfermedades. El presente documento da cuenta de cuatro opciones de abordaje en términos de sus beneficios, daños y consideraciones acerca de la implementación, monitoreo, evaluación y equidad: • Opción 1: regulación de los SEAN, los SSSN y similares como productos sucedáneos del tabaco, en el marco de la legislación vigente; • Opción 2: regulación de los SEAN y similares como medicamentos para la cesación tabáquica; • Opción 3: regulación específica para los SEAN, los SSSN y similares como productos de consumo humano; • Opción 4: prohibición total para la fabricación, exportación, importación, comercialización, uso, consumo, publicidad, promoción y patrocinio de los SEAN, los SSSN y similares.

Prevalencia de infección tuberculosa latente en trabajadores de salud de establecimientos del primer nivel de atención. Lima, Perú / Prevalence of latent tuberculosis infection in health workers from primary health care centers in Lima, Peru

RESUMEN Con el propósito de disponer de información sobre los riesgos para infección por tuberculosis, la Dirección General de Epidemiología del Ministerio de Salud, desarrolló una vigilancia centinela en establecimientos de salud de la Provincia constitucional del Callao, dicha vigilancia incluyó el diagnóstico de infección tuberculosa latente (ITL) mediante la aplicación del método IGRA. El objetivo del presente estudio fue estimar la prevalencia de ITL en trabajadores de salud de un área con alta carga de enfermedad de tuberculosis. La prevalencia de ITL en trabajadores de salud fue 56%. En trabajadores con más de 10 años de servicio la prevalencia se incrementó a 63% y en trabajadores con más de 35 años de servicio se encontraron prevalencias entre 58 y 60%. Existe una alta prevalencia de ITL en trabajadores de salud de establecimientos del primer nivel de atención, identificándose al mayor tiempo de servicio, como uno de los principales factores de riesgo.

ABSTRACT To evaluate the risk of tuberculosis (TB) infection, the General Directorate of Epidemiology of the Ministry of Health developed a sentinel surveillance system in health centers located in the Constitutional Province of Callao. This surveillance system included the diagnosis of latent tuberculosis infection (LTI) using interferon gamma release assays. The objective of the present study was to estimate the prevalence of LTI in health workers in a region with a high burden of TB. The prevalence of LTI in health workers was 56%. The prevalence of LTI was 63% in workers with more than 10 years of service and 58-60% in workers with more than 35 years of service. The prevalence of LTI in health workers from primary health care centers was high, and longer service time was one of the main risk factors.

The PDZ-Binding Motif of HPV16-E6 Oncoprotein Modulates the Keratinization and Stemness Transcriptional Profile In Vivo.

OBJECTIVE: The aim of this work was to compare the early gene expression profiles in the skin of HPV16-E6 transgenic mice regulated by the E6 PDZ-binding motif. MATERIALS AND METHODS: The global transcriptional profiles in dorsal skin biopsies from K14E6 and K14E6Δ146-151 transgenic mice were compared using microarrays. Relevant genes obtained from the most differentially expressed processes were further examined by RT-qPCR, in situ RT-PCR, Western blot, or immunofluorescence. RESULTS: The transcriptomic landscape of K14E6 versus K14E6Δ146-151 shows that the most affected expression profiles were those related to keratinocyte differentiation, stem cell maintenance, and keratinization. Additionally, downregulation of epidermal stemness markers such as K15 and CD34, as well as the upregulation of cytokeratin 6b, appeared to be dependent on the E6 PDZ-binding motif. Finally, wound healing, a physiological process linked to stemness, is impaired in the K14E6 mice compared to K14E6Δ146-151. CONCLUSION: The E6 PDZ-binding motif appears to affect stemness and keratinization during early stages of skin carcinogenesis. As E6 plays a significant role in HPV-induced skin carcinogenesis, the K14E6 versus K14E6Δ146-151 transcriptional profile provides a source of valuable data to uncover novel E6 functions in the skin.

Maternal-Fetal Outcomes in 34 Pregnant Women with Type 1 Diabetes in Sensor-Augmented Insulin Pump Therapy.

BACKGROUND: Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity and mortality. Optimizing glycemic control improves these outcomes. OBJECTIVE: To describe the experience of using sensor-augmented insulin pump therapy (SAPT) and SAPT + low-glucose suspension (LGS) on pregnant women with T1D, including neonatal and maternal outcomes. METHODS: A prospective observational study was conducted in women with T1D who started SAPT and SAPT + LGS before or during pregnancy at the San Ignacio University Hospital Diabetes Center in Bogotá, Colombia. The main indication was severe hypoglycemia (SH) and poor glycemic control. Glycated hemoglobin (A1c), hypoglycemia, and maternal and fetal outcomes were assessed. RESULTS: Thirty-four pregnant women with T1D on SAPT and SAPT + LGS were included. Sixteen patients started therapy during pregnancy at a mean gestational age of 17.6 ± 8.3 weeks. Mean preconceptional A1c was 8.24% ± 2.02%. Absolute reduction of A1c level from prepregnancy to third trimester was -1.63% (P < 0.0001), with a significant clinical and statistical reduction in both groups, women who initiated SAPT before or during pregnancy. 52.9% of patients in second trimester and 66.6% in third trimester achieved A1c <6.5%, respectively. 91.1% underwent cesarean section. The main reasons were iterative cesarean (30%), fetal distress (20%), and preeclampsia (16%). The median gestational age at delivery was 37 weeks and 15 pregnancies resulted in preterm delivery. There was neither maternal-fetal mortality nor severe hypoglycemic episodes. Two patients had diabetic ketoacidosis. CONCLUSIONS: In pregnant patients with T1D and high risk of hypoglycemia, SAPT and SAPT + LGS should be considered as a therapeutic alternative for A1c reduction with a low risk of SH. However, additional studies are required to evaluate the efficacy and safety of this therapy during pregnancy.

Manejo de mediastinitis posterior a cirugía cardíaca: reporte de caso / Management of mediastinitis after cardiac surgery: a case report

RESUMEN La mediastinitis es una complicación rara pero devastadora en cirugía cardíaca, la cual incrementa los costos en salud. Los pacientes con mediastinitis posterior a cirugía cardíaca tienen alto índice de morbilidad y mortalidad. La obesidad es el único factor de riesgo perioperatorio que es modificable. El objetivo de éste reporte de caso es describir el manejo de la mediastinitis posterior a cirugía cardíaca que incluye un sistema de cierre asistido por presión de vacío con posterior fijación de la pared torácica a través de barras de titanio. MÉD. UIS. 2017;30(1):107-111.

ABSTRACT Mediastinitis is a rare and devastating complication of cardiac surgery, it increases the cost of care. Patients with mediastinitis after cardiac surgery have higher morbidity and mortality. Obesity is the only modifiable perioperative risk factor for mediastinitis. The aim of this case report is to describe the management of mediastinitis after cardiac surgery that includes vacuum assisted pressure with a subsequent fixation of the thorax wall with titanium bars. MÉD.UIS. 2017;30(1):107-111.

Embolectomía pulmonar quirúrgica en el manejo del tromboembolismo pulmonar agudo: reporte de caso / Surgical pulmonary embolectomy for the management of acute pulmonary embolism: a case report

RESUMEN Introducción: El tromboembolismo pulmonar es una patología que compromete la vida y requiere tratamiento inmediato. De esta manera, para obtener los mejores resultados debe existir un alto grado de sospecha clínica que permita realizar el diagnóstico de manera temprana. Su manejo es farmacológico con anticoagulación, pero en ciertas ocasiones requiere de tratamiento quirúrgico. El objetivo de este reporte de caso es describir las indicaciones actuales para embolectomía pulmonar quirúrgica en un paciente con tromboembolismo pulmonar. Presentación del caso: Se presenta un caso de una paciente con tromboembolismo pulmonar, inestabilidad hemodinámica y foramen oval permeable, en el cual se encontraba atrapado un trombo en silla de montar con extensión a las dos aurículas, quien fue tratada con embolectomía pulmonar quirúrgica. Posterior a la embolectomía pulmonar quirúrgica la paciente presentó un episodio de tromboembolismo pulmonar recurrente que fue manejado nuevamente con embolectomía quirúrgica previo a la implantación de un filtro de vena cava por vía percutánea. Su evolución fue satisfactoria permitiendo suspender el soporte ventilatorio y hemodinámico de manera temprana. Conclusiones: La embolectomía pulmonar quirúrgica se mantiene vigente como manejo del tromboembolismo pulmonar en pacientes con inestabilidad hemodinámica que tienen contraindicación para trombolisis o en quiénes esta terapia ha fallado, así como en pacientes que tienen un trombo intracardíaco o en un foramen oval permeable. MÉD.UIS. 2017;30(1):93-7.

ABSTRACT Introduction: The pulmonary embolism is a pathology that endangers life and it requires an immediate treatment. In order to get the best results there should be a high degree of clinical suspicion that allows us to make an early diagnosis. It requires a pharmacological treatment with anticoagulation but in certain cases there is necessary a surgical treatment. The objective of this case report is to describe the current indications for the surgical pulmonary embolectomy in a patient with pulmonary embolism. Case Presentation: This is the presentation of a case in a patient with pulmonary embolism, haemodynamic instability and a horse saddle thrombus located in a patent foramen ovale which was expanded on the both heart atriums. This patient was treated with surgical pulmonary embolectomy. Following the surgical pulmonary embolectomy the patient had a recurrent pulmonary embolism episode that was treated with the insertion of a percutaneous vena cava filter and a newly surgical pulmonary embolectomy. The patient had a satisfactory postoperative evolution with an early discontinuation of the ventilatory and haemodynamic support. Conclusion: The surgical pulmonary embolectomy is still an applicable treatment for the pulmonary embolism in patients with haemodynamic instability, absolute contraindication to systemic thrombolytic therapy or failure to this therapy, patent foramen ovale and an intracardiac floating thrombus. mÉD.uIs. 2017;30(1):93-7.

[Prevalence of latent tuberculosis infection in health workers from primary health care centers in Lima, Peru]. / Prevalencia de infección tuberculosa latente en trabajadores de salud de establecimientos del primer nivel de atención. Lima, Perú.

To evaluate the risk of tuberculosis (TB) infection, the General Directorate of Epidemiology of the Ministry of Health developed a sentinel surveillance system in health centers located in the Constitutional Province of Callao. This surveillance system included the diagnosis of latent tuberculosis infection (LTI) using interferon gamma release assays. The objective of the present study was to estimate the prevalence of LTI in health workers in a region with a high burden of TB. The prevalence of LTI in health workers was 56%. The prevalence of LTI was 63% in workers with more than 10 years of service and 58-60% in workers with more than 35 years of service. The prevalence of LTI in health workers from primary health care centers was high, and longer service time was one of the main risk factors.

Con el propósito de disponer de información sobre los riesgos para infección por tuberculosis, la Dirección General de Epidemiología del Ministerio de Salud, desarrolló una vigilancia centinela en establecimientos de salud de la Provincia constitucional del Callao, dicha vigilancia incluyó el diagnóstico de infección tuberculosa latente (ITL) mediante la aplicación del método IGRA. El objetivo del presente estudio fue estimar la prevalencia de ITL en trabajadores de salud de un área con alta carga de enfermedad de tuberculosis. La prevalencia de ITL en trabajadores de salud fue 56%. En trabajadores con más de 10 años de servicio la prevalencia se incrementó a 63% y en trabajadores con más de 35 años de servicio se encontraron prevalencias entre 58 y 60%. Existe una alta prevalencia de ITL en trabajadores de salud de establecimientos del primer nivel de atención, identificándose al mayor tiempo de servicio, como uno de los principales factores de riesgo.

Expression of Tau Produces Aberrant Plasma Membrane Blebbing in Glial Cells Through RhoA-ROCK-Dependent F-Actin Remodeling.

Abnormal aggregation of Tau in glial cells has been reported in Alzheimer's disease (AD) and other tauopathies; however, the pathological significance of these aggregates remains unsolved to date. In this study, we evaluated whether full-length Tau (Tau441) and its aspartic acid421-truncated Tau variant (Tau421) produce alterations in the normal organization of the cytoskeleton and plasma membrane (PM) when transiently expressed in cultured C6-glial cells. Forty-eight hours post-transfection, abnormal microtubule bundling was observed in the majority of the cells, which expressed either Tau441 or Tau421. Moreover, both variants of Tau produced extensive PM blebbing associated with cortical redistribution of filamentous actin (F-Actin). These effects were reverted when Tau-expressing cells were incubated with drugs that depolymerize F-Actin. In addition, when glial cells showing Tau-induced PM blebbing were incubated with inhibitors of the Rho-associated protein kinase (ROCK) signaling pathway, both formation of abnormal PM blebs and F-Actin remodeling were avoided. All of these effects were initiated upstream by abnormal Tau-induced microtubule bundling, which may release the microtubule-bound guanine nucleotide exchange factor-H1 (GEF-H1) into the cytoplasm in order to activate its major effector RhoA-GTPase. These results may represent a new mechanism of Tau toxicity in which Tau-induced microtubule bundling produces activation of the Rho-GTPase-ROCK pathway that in turn mediates the remodeling of cortical Actin and PM blebbing. In AD and other tauopathies, these Tau-induced abnormalities may occur and contribute to the impairment of glial activity.

Profilaxis tromboembólica en pacientes posparto. Estudio de corte transversal en tres instituciones en Colombia / Thromboembolic prophylaxis in post-partum patients. Cross-sectional study in three institutions in Colombia

Describir el nivel de riesgo de enfermedad tromboembólica en pacientes posparto y hacer una aproximación al uso actual de la tromboprofilaxis.Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron pacientes que fueron hospitalizadas para atención de parto entre agosto de 2012 y abril de 2013 en tres instituciones generales de alta complejidad en Bogotá y Medellín. Se aplicó la Guía de manejo del Royal College Obstetrics & Gynecology (RCOG) para establecer el riesgo de enfermedad tromboembólica. Las pacientes fueron evaluadas en el posparto y clasificadas en alto, intermedio y bajo riesgo. Se midió la frecuencia real de aplicación de tromboproilaxis. Los resultados se presentan como proporciones.Resultados: se evaluaron un total de 3516 pacientes, el 1,9 % de las pacientes fueron clasificadas como de alto riesgo, 42 % de riesgo medio y 56,1 % de riesgo bajo. La tromboprofilaxis solo se aplicó a un 7,4 % de las pacientes con alto riesgo y riesgo intermedio.Conclusión: según los criterios de la Guía del RCOG, un 43,9 % de las pacientes tendrían indicación de tromboprofilaxis; sin embargo, solo un 7,4 % de ellas la recibió. Se requieren estudios complementarios para evaluar los riesgos y beneficios del uso de la tromboprofilaxis según la guía del Reino Unido...

To describe the risk of thromboembolic disease in post-partum patients and examine the current use of thromboprophylaxis.Materials and methods: Descriptive cross-sectional study that included patients admitted for delivery care between August 2012 and April 2013 in three high-complexity general healthcare institutions in Bogotá and Medellín. The Royal College of Obstetrics & Gynaecology (RCOG) Management Guideline was applied for determining the risk of thromboembolic disease. Patients were assessed during the post-partum period and classified as high, intermediate and low risk. The actual frequency of the use of prophylaxis was measured. Results are presented as proportions.Results: Overall, 3516 patients were assessed and 1.9 % were classified as high risk, 42 % as intermediate risk and 56.1 % as low risk. Thromboprophylaxis was only used in 7.4 % of patients with high or intermediate risk.Conclusion: According to the criteria of the RCOG guidelines, 43.9 % of the patients had an indication for thromboprophylaxis and yet only 7.4 % of them received it. Further studies are required to assess the risk and evaluate the benefits and risks of giving thromboprophylaxis in accordance with the United Kingdom guidelines...

Autonomía médica y ley estatutaria de salud / Medical autonomy and statutory health law

La sociedad colombiana en los últimos 23 años ha hecho tránsito desde la prestación de un servicio de salud, financiado por el Estado y complementado con aseguramiento para la población trabajadora y sus beneficiarios, hacia un modelo de aseguramiento universal con subsidio a la demanda, y con un plan de beneficios único con exclusiones explícitas, reconociendo de manera plena la autonomía con autorregulación de los profesionales de la salud, y dentro del marco de la validación constitucional de la salud como un "derecho fundamental autónomo e irrenunciable en lo individual y en lo colectivo". Este viaje social no ha estado libre de logros y fracasos. Los principales logros han sido el crecimiento en la equidad en la prestación de los servicios, y la mayor conciencia del ciudadano del derecho que le asiste. El principal fracaso ha consistido en la mercantilización del sistema que conlleva mecanismos de transacción tramposos, y que condujeron a la pérdida de la autonomía profesional y por ende a múltiples afectaciones a la prestación de los servicios de salud a los enfermos y a los sanos, generando eso sí, grandes rentabilidades para aseguradores, prestadores y funcionarios, con el corolario de un inmenso desperdicio de enormes, pero aún insuficientes recursos del sistema.

Entamoeba histolytica and E. dispar Calreticulin: inhibition of classical complement pathway and differences in the level of expression in amoebic liver abscess.

The role of calreticulin (CRT) in host-parasite interactions has recently become an important area of research. Information about the functions of calreticulin and its relevance to the physiology of Entamoeba parasites is limited. The present work demonstrates that CRT of both pathogenic E. histolytica and nonpathogenic E. dispar species specifically interacted with human C1q inhibiting the activation of the classical complement pathway. Using recombinant EhCRT protein, we demonstrate that CRT interaction site and human C1q is located at the N-terminal region of EhCRT. The immunofluorescence and confocal microscopy experiments show that CRT and human C1q colocalize in the cytoplasmic vesicles and near to the surface membrane of previously permeabilized trophozoites or are incubated with normal human serum which is known to destroy trophozoites. In the presence of peripheral mononuclear blood cells, the distribution of EhCRT and C1q is clearly over the surface membrane of trophozoites. Nevertheless, the level of expression of CRT in situ in lesions of amoebic liver abscess (ALA) in the hamster model is different in both Entamoeba species; this molecule is expressed in higher levels in E. histolytica than in E. dispar. This result suggests that EhCRT may modulate some functions during the early moments of the host-parasite relationship.

Gene expression profile regulated by the HPV16 E7 oncoprotein and estradiol in cervical tissue.

The HPV16 E7 oncoprotein and 17ß-estradiol are important factors for the induction of premalignant lesions and cervical cancer. The study of these factors is crucial for a better understanding of cervical tumorigenesis. Here, we assessed the global gene expression profiles induced by the HPV16 E7 oncoprotein and/or 17ß-estradiol in cervical tissue of FvB and K14E7 transgenic mice. We found that the most dramatic changes in gene expression occurred in K14E7 and FvB groups treated with 17ß-estradiol. A large number of differentially expressed genes involved in the immune response were observed in 17ß-estradiol treated groups. The E7 oncoprotein mainly affected the expression of genes involved in cellular metabolism. Our microarray data also identified differentially expressed genes that have not previously been reported in cervical cancer. The identification of genes regulated by E7 and 17ß-estradiol, provides the basis for further studies on their role in cervical carcinogenesis.