Thyroid carcinoma in elderly people: Characterization using big data tools.

OBJECTIVE: To determine the clinical-histological data associated comorbidities and the use of health resources of elderly patients with thyroid cancer. METHODS: An observational, retrospective study was carried out using data from the electronic medical record (EMR) of the Hospital Universitario Puerta de Hierro Majadahonda (Madrid, Spain). The information was extracted using artificial intelligence techniques and analysed using the Savana Manager 3.0 software. We differentiated between younger people (0-59 years) and older people (60 or more years) and, within this latter group, between people of advanced age (60-74 years) and elderly people (75 or more years). RESULTS: Of a total of 509,517 patients, 1781 (0.35%) were diagnosed with thyroid cancer. Compared to younger patients, older patients presented a lower proportion of papillary carcinoma (64.2% vs. 75.3%) as well as a higher proportion of follicular carcinoma (9.3% vs. 5.0%) and other histological types (26.5% vs. 19.7%; p < 0.001). Young people with thyroid cancer exhibited prevalences of risk factors and most of the cardiovascular diseases studied significantly higher than those found in the general population. Elderly patients, compared with those of advanced age, showed greater comorbidity. However, a trend towards a lower consumption of healthcare resources was observed when elderly patients were compared with those of advanced age. CONCLUSION: The clinical characteristics, comorbidities and consumption of health resources of patients with thyroid cancer vary markedly with age. Elderly patients are characterized by a high burden of comorbidities that is not accompanied by a notable increase in their consumption of health resources.

Common weeds as alternate hosts of Mexican variant of Papaya meleira virus in papaya orchards in México.

Presence of alternate hosts of plants is a great threat to the agriculture industry. Plants from several species growing in the papaya orchards affected by papaya sticky disease were examined for Papaya meleira virus (PMeV) infection causing this disease. The viral dsRNA was already detected in some plants from the family Poaceae or in watermelon. To identify new hosts of PMeV, we have collected 38 plant species belonging to 15 families of common weed species found in papaya-growing areas in México and used reverse-transcription PCR (RT-PCR) or quantitative real-time RT-PCR (RT-qPCR) for virus detection. We have detected the viral RNA in 11 species belonging to the families Acanthaceae, Fabaceae and Poaceae. Under experimental conditions, PMeV-Mx in Panicum hirsutum and Ruellia nudiflora inoculated weed species, showed that PMeV-Mx is able to replicate in plant cells of these species and spread in a systemic way. These results highlight the importance of weed species as potential virus reservoirs for PMeV-Mx Keywords: Papaya meleira virus; papaya sticky disease; Carica papaya; RT-PCR; TaqMan.

The Insulin-Sensitizer Pioglitazone Remodels Adipose Tissue Phospholipids in Humans.

The insulin-sensitizer pioglitazone exerts its cardiometabolic benefits in type 2 diabetes (T2D) through a redistribution of body fat, from ectopic and visceral areas to subcutaneous adipose depots. Whereas excessive weight gain and lipid storage in obesity promotes insulin resistance and chronic inflammation, the expansion of subcutaneous adipose by pioglitazone is associated with a reversal of these immunometabolic deficits. The precise events driving this beneficial remodeling of adipose tissue with pioglitazone remain unclear, and whether insulin-sensitizers alter the lipidomic composition of human adipose has not previously been investigated. Using shotgun lipidomics, we explored the molecular lipid responses in subcutaneous adipose tissue following 6months of pioglitazone treatment (45mg/day) in obese humans with T2D. Despite an expected increase in body weight following pioglitazone treatment, no robust effects were observed on the composition of storage lipids (i.e., triglycerides) or the content of lipotoxic lipid species (e.g., ceramides and diacylglycerides) in adipose tissue. Instead, pioglitazone caused a selective remodeling of the glycerophospholipid pool, characterized by a decrease in lipids enriched for arachidonic acid, such as plasmanylethanolamines and phosphatidylinositols. This contributed to a greater overall saturation and shortened chain length of fatty acyl groups within cell membrane lipids, changes that are consistent with the purported induction of adipogenesis by pioglitazone. The mechanism through which pioglitazone lowered adipose tissue arachidonic acid, a major modulator of inflammatory pathways, did not involve alterations in phospholipase gene expression but was associated with a reduction in its precursor linoleic acid, an effect that was also observed in skeletal muscle samples from the same subjects. These findings offer important insights into the biological mechanisms through which pioglitazone protects the immunometabolic health of adipocytes in the face of increased lipid storage.

Medicalización de la vida y daño poblacional: revisión bibliográfica no sistematizada / Medicalization of life and population damage: non-systematic bibliographic review

La práctica de la medicina se encuentra atravesando una crisis, en la cual muchas de las prácticas médicas que se realizan son de poco valor y con frecuencia generan daño a las personas. Se presenta una revisión bibliográfica no sistematizada en la que se analizan en conjunto los diversos factores que contribuyen al desarrollo de excesos médicos y a los daños que estos generan. Consideramos que su conocimiento puede contribuir a mejorar la calidad de los cuidados que se ofrecen a nuestros pacientes. (AU)

The practice of medicine is going through a crisis, in which many of the medical practices that are carried out are of little value and often cause harm to people. An unsystematic bibliographic review is presented in which various factors that contribute to the development of medical excesses are analyzed. Their knowledge can contribute to improving the quality of medical care offered to our patients. (AU)

Empoasca papayae (Hemiptera: Cicadellidae)-Mediated Transmission of Papaya Meleira Virus-Mexican Variant in Mexico.

Papaya meleira virus (PMeV) causes sticky disease in Carica papaya in Brazil and Mexico. Despite its economic importance and the need for effective phytosanitary control, it remains unknown whether any insect is the vector of this virus. The aim of this work was to identify potential insect vectors of the PMeV-Mexican variant (PMeV-Mx) and determine whether these potential vectors are capable of transmitting the virus. Adult insects were collected in papaya fields in the south-southeast region of Mexico and were identified morphologically and molecularly. Their abundance and frequency were determined, and quantitative reverse transcription polymerase chain reaction was performed to establish if they carried PMeV-Mx. The Cicadellidae family (Hemiptera) was the most diverse and abundant, and Empoasca papayae was the most abundant species and had the highest virus titers. PMeV-Mx transmission assays were conducted under controlled conditions using E. papayae on C. papaya 'Maradol'. E. papayae was a carrier of PMeV-Mx at 6 h after exposure, and its viral titer increased with time, peaking at 2.125 pg/µl of PMeV-Mx RNA from 20 ng/µl of cDNA, 5 days after exposure (dae). From 14 days after plants were exposed to insects, PMeV-Mx was detected and quantified in 100% of the evaluated papaya plants, whose viral RNA titer increased from 0.06 (21 dae) to 26.6 pg/µl of PMeV-Mx RNA (60 dae) from 20 ng/µl of cDNA. Three months later, these plants developed sticky disease symptoms, demonstrating that E. papayae is capable of transmitting PMeV-Mx to C. papaya 'Maradol'.

Influence of two polarization potentials on a bioanode microbial community isolated from a hypersaline coastal lagoon of the Yucatan peninsula, in México.

In recent years, halotolerant biofilms have become a subject of interest for its application in Bioelectrochemical systems for wastewater treatment. To determine if the polarization potential affects the microbial community of a halotolerant bioanode, four bioanodes were poised at potentials of +0.34 V/SHE and - 0.16 V/SHE and the 16S rRNA gene was analyzed through a MiSeq (Ilumina) system. Oceanospirillum, Halomonas and Marinobacterium were the most predominant genus; no previous studies have reported the presence of Oceanospirillum in anodic biofilms. The fitness with the dataset for +0.34 V/SHE with a modified Butler Volmer Monod model, gives a value of K1 was 0.0002 (2.64 A m-2 and 38% coulombic efficiency), indicating the fastest electrochemical reaction. Whereas that -0.16 V/SHE case, the high value of K1 (12.2 with 1.82 A m-2 and 10% coulombic efficiency) indicated that the electron transfer was far from being reversible (Nernstian).

Genetic variation of Colletotrichum magnum isolated from Carica papaya as revealed by DNA fingerprinting.

Mexico is one of the five largest producers of papaya worldwide, but losses caused by pathogens, mainly fungus, at the pre- and post-harvest stages are often more than 50% of the crop. Papaya anthracnose, caused by three different species of the Colletotrichum genus in Mexico, occupies a preponderant place in this problem. Although two of these species, C. gloeosporiodes and C. truncatum, have been characterized morphologically and genotypically, this has not occurred with C. magnum, the third species involved, about which there is very little information. Because of this, it is vital to know its genetic characterization, much more so considering that the studies carried out on the other two species reveal a wide genetic diversity, differences in pathogenicity and in the response to fungicides of the different strains characterized. In this work, Colletotrichum spp. isolates were collected at different papaya orchards in the south-southeast of Mexico. C. magnum isolates identified by species-specific primers were characterized by morphological and molecular approaches. Differences in colony characteristics resulted in five morphological groups. AP-PCR, DAMD and ISSR markers were found to be very efficient for revealing the interspecific variability of this species. The high genetic variability found in the accessions of C. magnum was linked to the geographical area where they were collected. Isolates from Chiapas State were the most variable, showing point mutations in the ITS1-ITS2 region. These results will enable a better phytosanitary management of anthracnose in papaya in this region of Mexico.

New-Onset Diabetes Presenting as Monoballism Secondary to a Mixed Hyperglycemic Crisis.

Monoballism secondary to a mixed hyperglycemic crisis is a rare initial symptom of new-onset diabetes, which commonly affects the elderly and Asian women having inadequate glycemic control. In hyperglycemic states, the elevated serum glucose levels raise the viscosity of the blood reducing cerebral perfusion, decreasing gamma-aminobutyric acid levels, the latter being an inhibitory neurotransmitter of thalamocortical stimuli. In this case, we report a previously healthy 41-year-old male who attended the emergency department because of an abrupt onset movement disorder of the left arm, this being compatible with monoballism. He was diagnosed with a mixed hyperglycemic crisis.

Acciones motivacionales para promover actividad física en la comunidad que asiste a un Hospital Universitario / Taking action for promoting physical activity in the community attending a university hospital

Introducción: el sedentarismo ha llegado para quedarse. Cualquier tipo de acción para combatirlo será de gran utilidad; solo bastará con conocer su eficacia y con que la gente se adhiera. Métodos: se ha realizado un estudio cuasi experimental antes-después no controlado, con 3 intervenciones aditivas sobre la población que concurre al Hospital Italiano de Buenos Aires (Hospital Universitario). Se comparó la proporción de personas que usaban la escalera mecánica con aquellas que subían por la escalera convencional, antes y después de las siguientes intervenciones: con autoadhesivos que anunciaban las calorías perdidas al subir cada escalón, luego se agregaron carteles acerca del beneficio de hacer actividad física y, por último, se entregaron folletos sobre los beneficios de hacer actividad física. Resultados: se realizaron 39 967 observaciones. Cada intervención significó un aumento de personas que subían por la escalera convencional (P < 0,001). Con la intervención de los autoadhesivos se produjo un incremento del 2,39% frente al basal (11,07% - 8,68%, p=0,001) de personas que subieron por la escalera convencional. La intervención autoadhesivos + cartel aumentó 2,33% (13,4% -11,07%, p=0,001) y la intervención autoadhesivos + cartel + folletos produjo un aumento del 1,09% (14,49%-13,4%, p=0,03). Interpretación: en este estudio se midió cuál era el beneficio de las intervenciones para promover que más gente utilizara la escalera convencional; cada una de ellas proveyó una mayor cantidad de personas que, adoptando una actitud más activa, subieron por la escalera convencional. Medidas sencillas y económicas muestran un gran cambio en promover la actividad física. (AU)

Background: The sedentary lifestyle has become predominant in our society. Any measures taken to fight it are useful, it's just necessary to know their effectiveness and get people to stick with them. Methods: we performed a quasi-experimental pre-post study testing three persistent interventions on the population that attends a university hospital. Its main entrance allows the access to different areas through stairs, escalators or an elevator. We took baseline data on the number of people who took the escalator or the stairs. Then we performed progressive interventions designed to promote the use of the stairs. First, we used stickers placed on in each step that announced the amount of calories burned per step climbed. Then, we placed banners which informed the benefits of physical activity. Lastly, brochures were handed out with a list of benefits of doing physical activity. We quantified the number of people taking the stairs or the escalator with each intervention. Results: in eight weeks 39·967 observations were performed. Each intervention found an increase in the number of people that decided to take the stairs. At baseline, 880 people used the escalator and 9264 people took the stairs. With the first intervention, i.e. the use of stickers on the steps, there was an increase of 2·39% in the number of people that took the stairs compared to baseline data (from 8·68% to 11·07%, p=0.001). With the second intervention, i.e. stickers plus physical activity promotion banners, there was an additional increase of 2·33% (from 11·07% to 13·40%, p=0.001) in the proportion of people taking the stairs. Finally, the intervention of stickers in addition to the banners and brochures about benefits of physical activity, was associated with an increase of 1·09% (from 13·40% to 14·49%, p=0.03). Discussion: in this study we aimed to measure the benefits of multiple interventions to promote physical activity in a university hospital setting. Each intervention was associated with a larger number of people that decided to take the stairs instead of taking the escalator or the elevator. The interventions were simple, cheap and very effective to promote change independently from gender, age or health conditions. (AU)

Laccase Gene Expression and Vinasse Biodegradation by Trametes hirsuta Strain Bm-2.

Vinasse is the dark-colored wastewater that is generated by bioethanol distilleries from feedstock molasses. The vinasse that is generated from molasses contains high amounts of pollutants, including phenolic compounds and melanoindin. The goal of this work was to study the expression of laccase genes in the Trametes hirsuta strain Bm-2, isolated in Yucatan, Mexico, in the presence of phenolic compounds, as well as its effectiveness in removing colorants from vinasse. In the presence of all phenolic compounds tested (guaiacol, ferulic acid, and vanillic acid), increased levels of laccase-encoding mRNA were observed. Transcript levels in the presence of guaiacol were 40 times higher than those in the control. The lcc1 and lcc2 genes of T. hirsuta were differentially expressed; guaiacol and vanillin induced the expression of both genes, whereas ferulic acid only induced the expression of lcc2. The discoloration of vinasse was concomitant with the increase in laccase activity. The highest value of enzyme activity (2543.7 U/mL) was obtained in 10% (v/v) vinasse, which corresponded to a 69.2% increase in discoloration. This study demonstrates the potential of the Bm-2 strain of T. hirsuta for the biodegradation of vinasse.

FIELD GENERATED BY WAVES, SEQUENTIAL ACTIVATIONS AND APPARENT MOTION: EFFECTS AND TYPICAL PATTERNS / CAMPOS GENERADOS POR ONDAS, ACTIVACIONES SECUENCIALES Y MOVIMIENTO APARENTE: EFECTOS Y PATRONES TÍPICOS / CAMPOS ONDAS GERADAS, ATIVAÇÕES SEQÜENCIAIS E MOVIMENTO APARENTE: EFEITOS E PADRÕES TÍPICOS

Important components of the Extracellular Field (EF) can be caused by a sequential or moving depolarization generated by some cell-groups at specific sub-regions. These depolarizations can be sensed not only by man-made techniques -as electroencephalography (EEG) and electrocardiography (ECG) - but also by some physiological processes associated to ephaptic interactions. METHODS: Based on principles of electromagnetism we implement two computer simulations where this can be studied: 1. Bilateral waves, where subregions can have up to 3 mesoscopic states: activated, resting or sleeping (hyperpolarized) and 2. Stochastic propagation without deactivation. RESULTS: Biphasic, Gaussian and Mexican hat functions can be generated by these models. CONCLUSIONS: (i) Mesoscopic minimalistic models can explain in a simple way some electrophysiological signals. (ii) We suggest an analogy between mechanisms used in animal and robots to detect visual motion and engineering techniques to detect moving depolarizations in the nervous system. Similarly, such mechanisms might exist in cell-groups. (iii) Distorted waves can cause pathologies and their modulation by electric or magnetic stimulation can be potentially beneficial.

Componentes importantes de los campos extracelulares (CE) pueden ser causados por despolarización secuencial o en movimiento, generadas por algunos grupos celulares en subregiones específicas. Estas despolarizaciones pueden ser detectadas no solo con técnicas hechas por el hombre -como la electroencefalografía (EEG) o la electrocardiografía (ECG)- sino también por algunos procesos fisiológicos asociados con interacciones por efectos directos de campo eléctrico local. MÉTODOS: Basados en principios del electromagnetismo nosotros implementamos dos simulaciones de computador donde esto puede ser estudiado: 1. Ondas bilaterales, donde las subregiones pueden tener hasta 3 estados mesoscópicos: activación, reposo o dormido (hiperpolarización) y 2. Propagación estocástica sin desactivación. RESULTADOS: Funciones bifásicas, Gaussianas y tipo sombrero mexicano pueden ser generadas por estos modelos. CONCLUSIONES: (i) Modelos mesoscópicos minimalísticos pueden explicar de una manera simple algunas señales electrofisiológicas. (ii) Sugerimos una analogía entre mecanismos usados en animales y robots para detectar movimiento visual y técnicas de ingeniería para detectar despolarizaciones en movimiento en el sistema nervioso. Asimismo, tales mecanismos pueden existir en grupos celulares. (iii) Ondas distorsionadas pueden causar patologías y su modulación con estimulación eléctrica y magnética puede ser beneficiosa.

Os principais componentes do campos extracelulares ( CE ) pode ser causada por movimentos despolarizações seqüenciais ou alguma célula adj Gerado em grupos sub-regiões específicas . Está despolarizações pode ser detectado não apenas as técnicas feita pelo homem , tais como a eletroencefalografia (EEG) e eletrocardiograma (ECG) - Sino também para algumas adj associados processos fisiológicos com interações epapticas . MÉTODOS : Com base em : princípios do eletromagnetismo Implementamos duas simulações de computador onde este pode ser estudada : 1. ondas bilaterais , onde as sub-regiões podem ter até 3 ESTADOS mesoscópicos : ativação, descanso ou hiperpolarização e 2. estocástico propagação pecado desativação. RESULTADOS: funções bifásicos , Gaussian e tipo chapéu mexicano pode ser gerada por esses modelos. CONCLUSÕES : (i) minimalisticos modelos mesoscópicos pode explicar de uma forma simples Alguns sinais eletrofisiológicos . (Ii) sugerir uma analogia entre -mecanismos de animais e robôs usados para detectar movimento visual e técnicas afins despolarizações Pará detectar movimento no sistema nervoso . Além disso, histórias de mecanismos podem existir em grupos de células . (Iii) as doenças podem causar ondas distorcidas e modulação estímulo elétrico e magnético pode ser benéfico.

Dapagliflozin lowers plasma glucose concentration and improves ß-cell function.

BACKGROUND: ß-Cell dysfunction is a core defect in T2DM, and chronic, sustained hyperglycemia has been implicated in progressive ß-cell failure, ie, glucotoxicity. The aim of the present study was to examine the effect of lowering the plasma glucose concentration with dapagliflozin, a glucosuric agent, on ß-cell function in T2DM individuals. RESEARCH DESIGN AND METHODS: Twenty-four subjects with T2DM received dapagliflozin (n = 16) or placebo (n = 8) for 2 weeks, and a 75-g oral glucose tolerance test (OGTT) and insulin clamp were performed before and after treatment. Plasma glucose, insulin, and C-peptide concentrations were measured during the OGTT. RESULTS: Dapagliflozin significantly lowered both the fasting and 2-hour plasma glucose concentrations and the incremental area under the plasma glucose concentration curve (ΔG0-120) during OGTT by -33 ± 5 mg/dL, -73 ± 9 mg/dL, and -60 ± 12 mg/dL · min, respectively, compared to -13 ± 9, -33 ± 13, and -18 ± 9 reductions in placebo-treated subjects (both P < .01). The incremental area under the plasma C-peptide concentration curve tended to increase in dapagliflozin-treated subjects, whereas it did not change in placebo-treated subjects. Thus, ΔC-Pep0-120/ΔG0-120 increased significantly in dapagliflozin-treated subjects, whereas it did not change in placebo-treated subjects (0.019 ± 0.005 vs 0.002 ± 0.006; P < .01). Dapagliflozin significantly improved whole-body insulin sensitivity (insulin clamp). Thus, ß-cell function, measured as ΔC-Pep0-120/ ΔG0-120 ÷ insulin resistance, increased by 2-fold (P < .01) in dapagliflozin-treated vs placebo-treated subjects. CONCLUSION: Lowering the plasma glucose concentration with dapagliflozin markedly improves ß-cell function, providing strong support in man for the glucotoxic effect of hyperglycemia on ß-cell function.

Genetic diversity of Clavispora lusitaniae isolated from Agave fourcroydes Lem, as revealed by DNA fingerprinting.

This study characterized Clavispora lusitaniae strains isolated from different stages of the processing and early fermentation of a henequen (Agave fourcroydes) spirit produced in Yucatan, Mexico using a molecular technique. Sixteen strains identified based on morphological features, obtained from different substrates, were typed molecularly. Nine different versions of the divergent D1/D2 domain of the large-subunit ribosomal DNA sequence were identified among the C. lusitaniae strains. The greatest degree of polymorphism was found in the 90-bp structural motif of the D2 domain. The MSP-PCR technique was able to differentiate 100% of the isolates. This study provides significant insight into the genetic diversity of the mycobiota present during the henequen fermentation process, especially that of C. lusitaniae, for which only a few studies in plants have been published. The applied MSP-PCR markers were very efficient in revealing olymorphisms between isolates of this species.

Argentine valuation of the EQ-5D health states.

OBJECTIVE: To develop a set of health state values based on EuroQol EQ-5D instrument for the Argentine general population. METHODS: Consecutive subjects attending six primary care centers in Argentina were selected based on quota sampling and were interviewed using the EuroQol Group protocol for measurement and valuation of health studies. Initially, the respondents were randomly assigned a unique card set; however, to improve efficiency, the subjects were later randomly assigned to one of three fixed sets of EQ-5D states. Using the visual analog scale (VAS) and time-trade off (TTO) responses for these states, we estimated a valuation model using ordinary least squares regression clustered by respondent. Predicted values for EQ-5D health states are compared with published values for the United States. RESULTS: Six hundred eleven subjects were interviewed by 14 trained interviewers, rendering 6887 TTO and 6892 VAS responses. The model had an R(2) of 0.897 and 0.928 for TTO and VAS, respectively. The mean absolute difference between observed and predicted values was 0.039 for TTO and 0.020 for VAS, each showing a Lin's concordance coefficient more than 0.98. Argentine and US TTO-predicted values were highly correlated (Pearson's rho = 0.963), although the average absolute difference was clinically meaningful (0.06), rejecting the US values for nearly two-thirds of the states (62.8%). The Argentine population placed lower values on mild states and higher values on severe states. CONCLUSION: This study provides an Argentine value set that could be used locally or regionally, with meaningful and significant differences with that of the United States. Health policy in Latin America must incorporate local values for sovereignty and validity.

PCR-based detection and characterization of the fungal pathogens Colletotrichum gloeosporioides and Colletotrichum capsici causing anthracnose in papaya (Carica papaya l.) in the Yucatan peninsula.

Colletotrichum gloeosporioides is the common causal agent of anthracnose in papaya (Carica papaya L.) fruits, and infection by this fungal pathogen results in severe post-harvest losses. In the Yucatán peninsula (Mexico) a different Colletotrichum species was isolated from papaya fruits with atypical anthracnose lesions. The DNAs from a variety of Colletotrichum isolates producing typical and atypical lesions, respectively, were amplified by PCR with C.gloeosporioides-specific primers. All isolates from typical anthracnose lesions yielded a 450 bp PCR product, but DNAs from isolates with atypical lesions failed to produce an amplification product. For further characterization, the rDNA 5.8S-ITS region was amplified by PCR and processed for sequencing and RFLP analysis, respectively, to verify the identity of the papaya anthracnose pathogens. The results revealed unequivocally the existence of two Colletotrichum species causing anthracnose lesions on papaya fruits: C. gloeosporioides and C. capsici. PCR-RFLP using the restriction endonuclease MspI reliably reproduced restriction patterns specific for C. capsici or C. gloeosporioides. The generation of RFLP patterns by MspI (or AluI or RsaI) is a rapid, accurate, and unequivocal method for the detection and differentiation of these two Colletotrichum species.

Permanencia y devenir: de la filosofía griega al análisis de decisiones médicas / Permanence and moving: from greek philosophy to medica decision analysis

Haciendo un paralelo con los aportes de Markov a la moderna teoría del análisis de decisión, los autores de este artículodescriben las posturas antagónicas de Heráclito, que sostenía que el Universo estaba en un eterno fluir (devenir) y lade Parménides, que sostenía que el movimiento era una ilusión de los sentidos (permanencia) así como la síntesis deDemócrito en su teoría atómica, que combina elementos de ambas como la inmutabilidad de las partículas sub-atómicasy el movimiento de las mismas.

[Decision analysis: diagnostic approach in HIV infection associated chronic diarrhea]. / Análisis de decisión: diagnóstico de diarrea crónica asociada a la infección por HIV.

UNLABELLED: Chronic diarrhea is still a problem of difficult management in patients with AIDS, even in the HAART (Highly Active Antiretroviral Therapy) era. AIM: To establish the most appropriate diagnostic procedure for HIV infected patients, with CD4 count below 200 cells/ml and chronic diarrhea, starting on HAART. METHODS: Using a decision tree as the tool of a decision analysis, two alternatives were considered for the ethiologic diagnosis in AIDS associated chronic diarrhea. The compared alternatives were a minimal evaluation (stool culture and parasite stool examination), and complete evaluation (adding endoscopies with intestinal biopsies). The decision tree was constructed by TreeAge Data 32 software. Diagnostic and therapeutic data for both alternatives were obtained from medical publications. The outcome was the reported survival estimation for HIV infected patients with CD4 level bellow 200 cells/ml, starting HAART, with and without chronic diarrhea. RESULTS: In the basic analysis, as well as in the sensitivity analysis, a complete evaluation was the alternative that showed the highest expected value: 7.79 years of survival. The minimal evaluation showed a value of 7.05 years of survival. CONCLUSION: In HIV infected patients with chronic diarrhea and CD4 count below 200 cells/ml, starting on HAART, digestive endoscopies with biopsy samples are the best diagnostic approach.

Análisis de decisión: diagnóstico de diarrea crónica asociada a la infección por HIV. / [Decision analysis: diagnostic approach in HIV infection associated chronic diarrhea]

Chronic diarrhea is still a problem of difficult management in patients with AIDS, even in the HAART (Highly Active Antiretroviral Therapy) era. AIM: To establish the most appropriate diagnostic procedure for HIV infected patients, with CD4 count below 200 cells/ml and chronic diarrhea, starting on HAART. METHODS: Using a decision tree as the tool of a decision analysis, two alternatives were considered for the ethiologic diagnosis in AIDS associated chronic diarrhea. The compared alternatives were a minimal evaluation (stool culture and parasite stool examination), and complete evaluation (adding endoscopies with intestinal biopsies). The decision tree was constructed by TreeAge Data 32 software. Diagnostic and therapeutic data for both alternatives were obtained from medical publications. The outcome was the reported survival estimation for HIV infected patients with CD4 level bellow 200 cells/ml, starting HAART, with and without chronic diarrhea. RESULTS: In the basic analysis, as well as in the sensitivity analysis, a complete evaluation was the alternative that showed the highest expected value: 7.79 years of survival. The minimal evaluation showed a value of 7.05 years of survival. CONCLUSION: In HIV infected patients with chronic diarrhea and CD4 count below 200 cells/ml, starting on HAART, digestive endoscopies with biopsy samples are the best diagnostic approach.