Relationship between tricuspid annular plane systolic excursion, fluid responsiveness and volume status in hospitalised dogs with circulatory abnormalities.

AIMS: To evaluate the echocardiographic variable tricuspid annular plane systolic excursion normalised to body weight (TAPSEnorm) as a predictor of fluid responsiveness in hospitalised dogs with haemodynamic and tissue perfusion alterations and to investigate the association of left ventricular internal diameter in diastole normalised to body weight (LVIDdN) and aortic velocity time integral (VTIAo) with TAPSEnorm. METHODS: A single-centre, prospective study was carried out in a cohort of spontaneously breathing dogs, hospitalised for any reason, with severe haemodynamic and tissue perfusion alterations. The echocardiographic variables TAPSEnorm, LVIDdN, and VTIAO were measured. A bolus of 30 mL/kg of lactated Ringer's solution was administered and then VTIAo was subsequently remeasured. Patients were classified as fluid responsive if VTIAo increased by ≥15% after fluid expansion, or non-responsive if VTIAo increased by <15% after fluid expansion. The area under the receiver operating characteristic (AUROC) curve was generated to evaluate the ability of TAPSE to predict fluid responsiveness. Simple regression models were used to assess the linear relationship between TAPSEnorm and LVIDdN or VTIAO. RESULTS: TAPSEnorm was lower in fluid responsive dogs (mean 0.57 (95% CI = 0.50-0.64) cm/kg) compared to non-responsive dogs (mean 0.76 (95% CI = 0.62-0.90) cm/kg). The AUROC for TAPSEnorm was 0.827 (95% CI = 0.65-1.00). The optimal cut-off point was 0.76 with sensitivity of 80 (95% CI = 28.4-99.5)% and specificity of 86.7 (95% CI = 69.3-99.2)%, positive predictive value of 50 (95% CI = 15.7-84.3)% and negative predictive value of 96.3 (95% CI = 81-99.9)%. A monotonic linear relationship was observed between TAPSEnorm and LVIDdN (p<0.001) and between TAPSEnorm and VTIAo (p=0.001). CONCLUSIONS AND CLINICAL RELEVANCE: TAPSEnorm could be useful in determining those dogs that are likely to respond to a fluid bolus from those that are likely to be non-responsive. Additionally, a positive linear association between the LVIDdN and the TAPSEnorm suggests that TAPSEnorm decreases at lower preload values. The present study results suggest that TAPSEnorm could be a valuable tool for evaluating blood volume status and fluid responsiveness in hospitalised dogs.Abbreviations: AUROC: Area under the receiver operating characteristic; CO: Cardiac output; ICC: Intraclass correlation coefficient; LVIDd: Left ventricular internal diameter in diastole; LVIDdN: Left ventricular internal diameter in diastole normalised to body weight; TAPSE: Tricuspid annular plane systolic excursion; TAPSEnorm: Tricuspid annular plane systolic excursion normalised to body weight; VTIAo: Aortic velocity time integral.

Clinicopathological factors associated with the presence of hypercapnia at admission in hospitalised cats with decompensated chronic kidney disease.

AIMS: To evaluate associations between clinicopathological variables and hypercapnia measured in cats with decompensated chronic kidney disease (CKD) on admission to a veterinary hospital. METHODS: This is a retrospective, cross-sectional study of cats (n = 39) that presented to a tertiary veterinary hospital in Argentina between June 2015 and December 2017 with blood creatinine concentrations >140 µmol/L, and abdominal ultrasound results consistent with CKD. Data recorded included venous partial pressure of CO2 (PvCO2), blood pH, haematocrit and concentrations of glucose, potassium, sodium, corrected sodium (Na+c), and ionised calcium in blood. A logistic regression model was used to assess associations between the presence of hypercapnia (PvCO2 ≥ 44.7 mmHg) and the other clinicopathologic variables. The duration of hospitalisation was compared in cats with and without hypercapnia using the Wilcoxon Rank Sum test. RESULTS: The final study population comprised 39 cats. Eleven cats (28.2%) had hypercapnia. In the logistic regression model, two independent variables were associated with the presence of hypercapnia at admission in cats with CKD: the concentration of creatinine in blood (OR = 1.06 (95% CI = 1.016-1.108); p = 0.007) and Na+c (OR = 1.33 (95% CI = 1.08-1.63); p = 0.005). There were no statistically significant differences in the length of hospital stay between the two groups. CONCLUSIONS AND CLINICAL RELEVANCE: There appears to be an association between elevated concentrations of creatinine and Na+c in blood, and hypercapnia in cats with CKD, suggesting careful assessment of blood gas and electrolyte parameters during hospitalisation is required. Further prospective studies are needed to evaluate the mechanisms behind this association and the association of hypercapnia with disease outcome including mortality.

Change Management in Healthcare Organizations: Soft Skills Training Strategies Through Blended Learning Environments.

Teaching soft skills for change management in healthcare organizations is becoming increasingly necessary, even more, when implementing health information systems (HIS). There is little evidence that these skills can be learned through online teaching environments. This paper describes the experience of having taught soft skills to health informatics master's degree students, through blended learning environments.

Insuficiencia ovárica prematura / Premature ovarian insufficiency

RESUMEN La insuficiencia ovárica prematura es la pérdida de la función ovárica antes de los 40 años de edad. Se caracteriza por hipogonadismo hipergonadotrófico y amenorrea u oligomenorrea. Su etiología es multifactorial, pudiendo deberse a causas iatrogénicas, genéticas, metabólicas, autoinmunes y ambientales; siendo de origen idiopático en el 90 % de los casos. Su incidencia es de 1 cada 100 mujeres menores de 40 años y 1 cada 1000 mujeres menores de 30 años. En la actualidad no existe un único marcador que se pueda utilizar para calcular la reserva ovárica; sin embargo, en los últimos años la hormona antimülleriana ha demostrado presentar algunas ventajas respecto a los biomarcadores clásicamente utilizados. Además, diversos estudios indican que existe una correlación positiva entre los niveles de esta hormona y el recuento de folículos antrales, que es, por el momento, el método más confiable para evaluar reserva ovárica debido a las actuales dificultades técnicas para la determinación de hormona antimülleriana.

ABSTRACT Premature ovarian insufficiency, the loss of ovarian function before the age of 40 years, is characterized by hipergonadotrofic hipogonadism and amenorrhea or oligomenorrhea. The etiology is multifactorial, and can be due to genetic, metabolic, autoimmune, environmental or iatrogenic causes, being idiopathic 90% of cases. Currently there is not a single marker that can be used for estimate ovarian reserve in this patients; however, in recent years antimüllerian hormone has proved to have some advantages over other classical biomarkers. Moreover, several studies indicate a positive correlation between antimüllerian hormone concentration and antral follicle count, considered nowadays the most reliable method for ovarian reserve estimation.

The Polyploid State Restricts Hepatocyte Proliferation and Liver Regeneration in Mice.

The liver contains a mixture of hepatocytes with diploid or polyploid (tetraploid, octaploid, etc.) nuclear content. Polyploid hepatocytes are commonly found in adult mammals, representing ~90% of the entire hepatic pool in rodents. The cellular and molecular mechanisms that regulate polyploidization have been well characterized; however, it is unclear whether diploid and polyploid hepatocytes function similarly in multiple contexts. Answering this question has been challenging because proliferating hepatocytes can increase or decrease ploidy, and animal models with healthy diploid-only livers have not been available. Mice lacking E2f7 and E2f8 in the liver (liver-specific E2f7/E2f8 knockout; LKO) were recently reported to have a polyploidization defect, but were otherwise healthy. Herein, livers from LKO mice were rigorously characterized, demonstrating a 20-fold increase in diploid hepatocytes and maintenance of the diploid state even after extensive proliferation. Livers from LKO mice maintained normal function, but became highly tumorigenic when challenged with tumor-promoting stimuli, suggesting that tumors in LKO mice were driven, at least in part, by diploid hepatocytes capable of rapid proliferation. Indeed, hepatocytes from LKO mice proliferate faster and out-compete control hepatocytes, especially in competitive repopulation studies. In addition, diploid or polyploid hepatocytes from wild-type (WT) mice were examined to eliminate potentially confounding effects associated with E2f7/E2f8 deficiency. WT diploid cells also showed a proliferative advantage, entering and progressing through the cell cycle faster than polyploid cells, both in vitro and during liver regeneration (LR). Diploid and polyploid hepatocytes responded similarly to hepatic mitogens, indicating that proliferation kinetics are unrelated to differential response to growth stimuli. Conclusion: Diploid hepatocytes proliferate faster than polyploids, suggesting that the polyploid state functions as a growth suppressor to restrict proliferation by the majority of hepatocytes.

[Helicobacter pylori: How do we treat it in 2018?] / Helicobacter pylori: ¿cómo se trata en el 2018?

This work is a review on the basic aspects of the treatment of Helicobacter pylori, highlighting the causes of treatment failure and strategies exist to optimize the treatment according to the best evidence posted. Stands out the antimicrobial resistance as the main cause of treatment failure, as well as the different compartments where the microorganism is hosted. Shows major schemes currently available and how to choose therapies first, second, third line and rescue therapies.

Helicobacter pylori: ¿cómo se trata en el 2018? / Helicobacter pylori: How do we treat it in 2018?

En el presente trabajo, se hace una revisión sobre los aspectos básicos del tratamiento de Helicobacter pylori, destacando las causas de la falla del tratamiento y se dan estrategias para optimizar el tratamiento de acuerdo a la mejor evidencia publicada. Se destaca la resistencia a los antimicrobianos como la principal causa de fracaso terapéutico, así como también los diferentes compartimentos donde se aloja el microrganismo. Se muestran los principales esquemas actualmente disponibles y la forma de elegir las terapias de primera, segunda, tercera línea y terapias de rescate.

This work is a review on the basic aspects of the treatment of Helicobacter pylori, highlighting the causes of treatment failure and strategies exist to optimize the treatment according to the best evidence posted. Stands out the antimicrobial resistance as the main cause of treatment failure, as well as the different compartments where the microorganism is hosted. Shows major schemes currently available and how to choose therapies first, second, third line and rescue therapies.

Cultural Problems Associated with the Implementation of eHealth.

A major hurdle in eHealth implementation is that it is difficult to put into practice. In this study, the primary aim was to identify the main barrier associated with implementing eHealth. This study surveyed IMIA members from May to November 2015. From the results, it is clear that medical professionals were recording most of their data by hand. This paper culture is a paradigm that is difficult to break. Cultural factors are the primary barrier in eHealth implementation.

Guía de práctica clínica para el diagnóstico y tratamiento de la infección por Helicobacter pylori en adultos / Clinical Practice Guideline for the Diagnosis and Management of Adult Patients with Helicobacter pylori Infection

Objetivo: brindar una guía de práctica clínica basada en la evidencia más reciente para el diagnóstico y tratamiento de la infección por Helicobacter pylori teniendo en cuenta la efectividad y seguridad de las intervenciones dirigidas a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atención en Colombia. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; una de ellas cumplió los criterios de adaptación, por lo que se decidió adaptar 4 preguntas clínicas y construir 10 de novo. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base en la metodología GRADE. Las recomendaciones de la guía fueron socializadas en una reunión de expertos con entes gubernamentales y pacientes. Resultados: se desarrolló una guía de práctica clínica basada en la evidencia para el diagnóstico y tratamiento de la infección de Helicobacter pylori en Colombia. Conclusiones: la erradicación de H. pylori, curará las ulceras pépticas asociadas al mismo, la gastritis crónica sin atrofia o metaplasia intestinal y contribuirá a disminuir el riesgo de cáncer gástrico, que es la primera causa de muerte por cáncer en Colombia.

Objective: To provide a clinical practice guideline with the latest evidence for diagnosis and treatment of Helicobacter pylori infection for patients, caregivers, administrative and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated quality and applicability. One guideline met the criteria for adaptation, so the group decided to adapt 4 clinical questions and to develop 10 de novo clinical questions. Systematic literature searches were conducted by the Cochrane Group. The tables of evidence and recommendations were made based on the GRADE methodology. The recommendations of the guide were socialized in a meeting of experts with government agencies and patients. Results: An evidence-based Clinical Practice Guidelines for the diagnosis and treatment of Helicobacter pylori infection was developed for the Colombian context. Conclusions: The opportune detection and appropriate management of Helicobacter pylori would contribute to the burden of the disease in Colombia and its associated diseases.

Utilidad de los marcadores de remodelado óseo teniendo en cuenta el valor de referencia para el cambio / Clinical Utility of Bone Remodeling Markers Taking Into Account the Reference Value Change

La Modelación y el Remodelado de hueso son llevados a cabo a través del proceso de Recambio Óseo en sitios específicos llamados Unidades de Remodelación Ósea (URO). Este proceso puede evaluarse a través de marcadores bioquímicos de Formación y de Resorción que reflejan cambios globales del metabolismo esquelético. Estos marcadores de remodelado óseo son utilizados para investigación de enfermedades óseo-metabólicas, porque proveen información dinámica del metabolismo del hueso y pueden ser cuantificados en suero o en orina. La variación de estos marcadores se deben principalmente a variables preanalíticas, analíticas y biológicas y debe interpretarse teniendo en cuenta el Valor de Referencia para el Cambio significativo (VRC), que resulta de un cálculo en el que intervienen la variabilidad biológica (VB) del analito y el error aleatorio del método utilizado en el laboratorio.

The Modeling and Remodeling processes are conducted through the process of replacement bone at specific sites called Units Bone Remodeling (URO).These can be evaluated by biochemical markers of formation and resorption that reflect changes in skeletal metabolism. These markers of bone turnover are used for research óseo-metabolic diseases because they provide dynamic information of bone metabolism and can be quantified in serum or urine. The variation of these markers is mainly due to preanalytical, analytical and biological variables and should be interpreted taking into account the Reference Value Change (VRC), which results from a calculation in which the biological variability (VB) of the analyte and the random error of the method used in the laboratory are involved.

Challenges and Hurdles of eHealth Implementation in Developing Countries.

UNLABELLED: Health informatics has the potential to improve the security and quality of patient care, but its impact has varied between developed and developing countries. Related to this, the objective of this study is to identify the challenges and hurdles to improve eHealth in developing countries. We surveyed experts to discover their opinions about five general questions: economic support by Government for eHealth, Government education or training projects in the field, issues related to cultural or educational problems for the implementation of eHealth, policies in terminology or messaging standards and eHealth status policies for long periods. The respondents answered affirmatively in these proportions: 1. Economic support policies 58%, 2. Training policies 25%, 3. Cultural and educational problems 95%, 4. Standards policies, 38%, 5. Policies for long periods, 50% CONCLUSION: Our survey has shown that the important problems that need to be addressed in order to implement e-Health in developing countries are firstly, cultural and educational, secondly, economic resources and thirdly policies for long periods.

Reference values of parathyroid hormone and vitamin D Hormone by chemiluminescent automated assay / Valores de referencia de hormona paratiroidea y vitamina D por método quimioluminiscente automatizado en perros

Objective. Provide reference data for parathyroid hormone 1-84 (PTH 1-84) and 25OH Vitamin D (25OH D) using a new technique. Materials and methods. The hormones were evaluated, in serum, using a third generation automated chemiluminescent method for PTH in a group of 60 adult dogs, clinically healthy, grouped according to age in years in GA: 1 to 5, GB: 6 to 10 and GC:>10. Results. Data expressed as average ± DS were for PTH (pg/ml): 9.3±2.3; 12±6.3; 12.2±3.7; and for 25OH D (ng/ml): 84.2±27.8; 68.2±16.0; 63.6±23.1, respectively. The PTH value was significantly greater (p<0.05) in groups B and C in comparison with A, but no significant differences were observed between GB and GC. The 25OH D concentration was significantly less in GB (p<0.05) and in GC (p<0.01) in comparison with GA, showing no differences between GB and GC. A negative correlation between 25OH D and PTH was found (r= -0.28; p=0.015). Conclusions. Data contributed by this study provide reference values for PTH 1-84 and 25OH D, evaluated using a third generation automated chemiluminescent method for PTH in local dogs. The results will facilitate monitoring diseases that alter the metabolism of calcium and phosphorus in dogs.

Objetivo. Aportar datos de referencia, para hormona paratiroidea 1-84 (PTH 1-84) y 25OH Vitamina D (25OH D) con una nueva técnica. Materiales y métodos. Las hormonas fueron valoradas, en suero, por un método quimioluminiscente automatizado, y de tercera generación para la PTH, en una población de 60 perros adultos clínicamente sanos, agrupados según edad en años en GA: 1 a 5, GB: 6 a 10 y GC:>10. Resultados. Los datos expresados como media ± DS fueron para la PTH (pg/ml): 9.3±2.3; 12±6.3; 12.2±3.7; y para la 25OH D (ng/ml): 84.2±27.8; 68.2±16.0; 63.6±23.1, respectivamente. El valor de PTH fue significativamente mayor (p<0.05) en los grupos B y C con respecto al A, pero no se observó diferencia significativa entre GB y GC. La concentración de 25OH D fue significativamente menor en el GB (p<0.05) y en el GC (p<0.01) con respecto al GA, sin haber diferencias entre los GB y GC. Se encontró una correlación negativa entre 25OH D y PTH (r= -0.28; p=0.015). Conclusiones. Los datos aportados en este trabajo permiten disponer de valores de referencia de PTH 1-84 y de 25OH D, valorados por un método quimioluminiscente automatizado y de tercera generación para la PTH, en una población local de perros. Los resultados facilitarán el seguimiento de enfermedades que alteran el metabolismo del calcio y fósforo en perros.

Enfoque del paciente con dispepsia y dispepsia funcional: actualización / Update on Approaches to Patients with Dyspepsia and Functional Dyspepsia

La dispepsia (DP) describe el dolor o malestar en el abdomen superior. Puede ser dispepsia no investigada o dispepsia funcional (DF), cuando después de realizar pruebas diagnósticas, como la endoscopia digestiva alta (EDA) y ocasionalmente ecografía abdominal superior, no se encuentran alteraciones orgánicas que la expliquen. No obstante, hallazgos recientes controvierten la clasificación de la DF en DP tipo dolor y DP posprandial, pese a su amplia difusión. Se discute el enfoque del paciente con DP y la fisiopatología y el tratamiento farmacológico de la DF.

Dyspepsia (DP) is pain or discomfort in the upper abdomen. It may be uninvestigated dyspepsia or functional dyspepsia (FD) which is diagnosed after diagnostic tests such as upper endoscopy and occasionally upper abdominal ultrasound find no organic changes that explain the condition. Despite the wide dissemination of the classifications of dyspepsia, functional dyspepsia and postprandial dyspepsia, recent findings controvert these classifications. This article discusses the approach to patients with dyspepsia and the pathophysiology and drug treatment of functional dyspepsia.

Efecto del alimento sobre variables productivas de dos especies de Cladóceros bajo condiciones de laboratorio / Effect of food intake on productive variables of two species of cladocera, under laboratory conditions

Objetivo. Evaluar los efectos de diferentes tipos de alimentos sobre la productividad de Diaphanosoma sp., y Alona sp bajo condiciones de laboratorio. Materiales y métodos. Juveniles de Diaphanosoma sp., y Alona sp., fueron sembrados en acuarios de 20 L a una densidad de 6 org L-1 y mantenidos con aireación constante y fotoperíodo 12:12 (luz : oscuridad). Se alimentaron con Saccharomyces cereviseae y Chlorella vulgaris a concentración de 4 x 10(5) Cel/ml cada uno, en tres combinaciones: 1. C. vulgaris, 2. S. cereviseae, 3. C. vulgaris + S. cereviseae en proporciones iguales; de cada tratamiento se realizaron 3 réplicas. Con el propósito de determinar la densidad poblacional, cada 3 días y durante un período de 27 días, y se midió la concentración de individuos por ml. Resultados. Se obtuvieron mejores resultados en el tratamientos de microalgas + levadura, con valores de TCE=0.1323±0.07 y 0.1598±0.04 días-1; R=0.010 ±0.004 y 0.019±0.01 org ml-1 día-1, TD=5.2±0.5 y 4.3±0.38 días para Diaphanosoma sp., y Alona sp., respectivamente, pero sin presentar diferencias significativas (p>0.05). Conclusiones. La dieta mixta de levadura y microalgas produjo mayor eficiencia productiva en las dos especies estudiadas, constituyendo una alternativa de fuente de alimento vivo para la acuicultura.

Objective. Assess the effects of different types of food intake on the productivity of Diaphanosoma sp. and Alona sp. under laboratory conditions. Materials and methods. Young Diaphanosoma sp. and Alona sp. were planted in 20 L aquariums at a density of 6 org L-1 and maintained with constant aeration and a photoperiod 12:12 (light: dark). The organisms were fed with Saccharomyces cereviseae and Chlorella vulgaris at a concentration of 4 x 10(5) cells/ml in three combinations: 1. C. vulgaris, 2. S. cereviseae 3. C. vulgaris + S. cereviseae); 3 replicas were carried out for each treatment. To determine the population density, every 3 days over a 27 day period, the concentration of individuals per ml was measured using a Bogorov camera. Results. The best results were obtained in treatments with microalgae and yeast, with values of TCE=0.1323±0.07 and 0.1598±0.04 days-1, R=0.010±0.004 and 0.019±0.01 org ml-1 days-1, TD=5.2±0.5 and 4.3±0.38 days for Diaphanosoma sp., and Alona sp., respectively, but without significant differences (p>0.05). Conclusions. The mixed diet of yeast and microalgae produced greater productive efficiency in the studied species, constituting an alternative source of live feed for aquaculture.

Education in Biomedical and Health Informatics in the Web 3.0 Era: Standards for data, curricula, and activities. Contribution of the IMIA Working Group on Health and Medical Informatics Education.

UNLABELLED: Web 3.0 is transforming the World Wide Web by allowing knowledge and reasoning to be gleaned from its content. OBJECTIVE: Describe a new scenario in education and training known as "Education 3.0" that can help in the promotion of learning in health informatics in a collaborative way. METHODS: Review of the current standards available for curricula and learning activities in in Biomedical and Health Informatics (BMHI) for a Web 3.0 scenario. RESULTS: A new scenario known as "Education 3.0" can provide open educational resources created and reused throughout different institutions and improved by means of an international collaborative knowledge powered by the use of E-learning. Currently there are standards that could be used in identifying and deliver content in education in BMHI in the semantic web era such as Resource Description Format (RDF), Web Ontology Language (OWL) and Sharable Content Object Reference Model (SCORM). In addition, there are other standards to support healthcare education and training. There are few experiences in the use of standards in e-learning in BMHI published in the literature. CONCLUSION: Web 3.0 can propose new approaches to building the BMHI workforce so there is a need to build tools as knowledge infrastructure to leverage it. The usefulness of standards in the content and competencies of training programs in BMHI needs more experience and research so as to promote the interoperability and sharing of resources in this growing discipline.

A medical informatics distance-learning course for Latin America. Translation, implementation and evaluation.

BACKGROUND: There is a growing need and interest worldwide for healthcare and information technology professionals trained in medical informatics. Distance learning technologies are increasingly used to deliver such education, but have mainly been limited to the English language. OBJECTIVE: Describe the implementation and student satisfaction of a medical informatics course delivered in Spanish for a Latin American audience. METHODS: The course was based on the 10 x 10 program of the American Medical Informatics Association and Oregon Health & Science University that was translated and adapted to the Latin American setting. The initial course consisted of ten one-week units, currently the course has 15 modules that are delivered in 16 weeks with topics that address the needs of medical informatics in the region. We also administered an anonymous questionnaire of student satisfaction. RESULTS: A total of 499 individuals have enrolled in the course, and 70% have completed it. Most of the students have been healthcare professionals (86%), with the largest proportion from Argentina. Student satisfaction with all aspects of the course was high. After the initial experience and feedback from the students, the course has been adapted to better meet regional needs. CONCLUSION: The initial experience obtained in training healthcare professionals in medical informatics in Latin America in their own language demonstrated that it could be used across the region, and this could represent a model for disseminating knowledge of medical informatics across other languages and cultures.

Spreading knowledge in medical informatics: the contribution of the hospital Italiano de Buenos Aires.

UNLABELLED: Medical Informatics (MI) is an emerging discipline with a high need of trained and skillful professionals. OBJECTIVE: To describe the educational experience of the Department of Health Informatics of the Hospital Italiano de Buenos Aires. METHODS: A descriptive study of the development of the Medical Informatics Residency Program (MIRP) and the e-learning courses related to medical informatics. RESULTS: A four-year MIRP with 15 rotations was started in 2000, and was awarded national educational accreditation. Eight residents have been fully trained and their main academic contributions are shown in this study. The e-learning courses related to medical informatics (Healthcare Management, Epidemiology & Biostatistics, Information Retrieval, Computer Literacy started, 10x10 Spanish version and HL7 introductory course) started in 2006 and were followed by more than 2266 students from all over the world, with an increase trend in foreign students. CONCLUSIONS: These educational activities have produced skilled human resources for the development and maintenance of the health informatics projects at our Hospital. In parallel, the number of students trained by e-learning continues to increase, demonstrating the worldwide need of knowledge in this field.

Ecoepidemiología de los escorpiones de importancia médica en Colombia / Eco-epidemiology of scorpions of medical importance in Colombia

El escorpionismo se ha convertido en un problema de salud pública en algunos países tropi-cales y subtropicales de América latina, como México (200.000- 250.000 casos/año) y Brasil (8.000-21.000 casos/año). En Colombia no hay registros que permitan definir con certeza la magnitud del escorpionismo. La familia Buthidae es la de mayor importancia médica en todo el mundo, representada en el país por cuatro géneros, de los cuales Centruroides (una especie) y Tityus (29 especies) son los de mayor importancia. En estudios recientes realizados en Antioquia y Tolima, se demostró que T. pachyurus, T. asthenes, T. fuehrmanni y C. gracilis son las especies que por sus accidentes podrían poner en grave riesgo la vida humana en el país. Los escorpiones de Colombia exhiben alto endemismo en lugares donde han vivido en condiciones de _ equilibrio por millones de años. Con la presión ejercida por el avance de la civilización humana y los continuos cambios antrópicos de los hábitats y microhábitats, algunas especies de escorpiones que viven simpátricamente con especies en equilibrio aprovechan las condiciones de disclímax que, al combinarse con un alto grado de toxicidad de sus venenos, alta plasticidad ecológica, gran capacidad reproductora y distribución amplia y errática, las convierte en especies llamadas oportunistas, potencialmente peligrosas para el hombre. En este artículo se efectúa la revisión de algunos aspectos biológicos, epidemiológicos y ecológicos de los escorpiones de Colombia y su incidencia en las poblaciones humanas.

Scorpionism has become a public health problem in some tropical and subtropical countries from Latin America such as Mexico (200,000-250,000 cases/year) and Brazil (8,000-21,000 cases/year). There is no epidemiologic surveillance in Colombia to accurately define the real extent of scorpion stings. Buthidae is the family of major importance world-wide, which is represented in Colombia by four genera, being Centruroides (1 spp) and Tityus (29 spp) the most protruding. In recent clinical and epidemiological studies performed in two regions of the country (Antioquia and Tolima), it was demonstrated that T. pachyurus, T. asthenes, T. fuehrmanni and C. gracilis are the species that may induce moderate/severe envenoming and severe risk of death. Colombian scorpions exhibit high endemism in places in which they have lived undisturbed, in equilibrium for millions of years. When a high ecological disturbance caused by civilization by means of continuous anthropic changes occurs in the environment, some scorpion species which live sympatrically with other species in equlibrium take advantage of this disclimax. When all those new conditions get mixed with a high toxicity venoms, high ecological plasticity, high reproductive capacity, and extended and erratic distribution, these species which can be called opportunistic species become potentially dangerous for the human being. In this article some biological, epidemiological and ecological aspects of Colombian scorpions, and their incidence in human populations are discussed.

Impact on lipoprotein profile after long-term testosterone replacement in hypogonadal men.

Testosterone serum levels may influence the lipoprotein metabolism and possibly atherogenic risk. Our aim was to investigate the effects of long-term testosterone supplementation in hypogonadal men on multiple lipoprotein markers. 18 Hypogonadal men were studied before and after 3, 6, and 18 (n = 7) months of treatment with testosterone enanthate. During treatment, serum testosterone and estradiol increased, reaching normal levels (p < 0.0001 and 0.003, respectively). This was associated with a decrease in HDL cholesterol (from 1.40 +/- 0.10 mmol/l to 1.22 +/- 0.08 mmol/l, p < 0.001) after six months at the expense of HDL2 cholesterol (p < 0.01), as well as apoprotein A1 (from 139 +/- 3.4 mg/dl to 126 +/- 3.0 mg/dl, p < 0.005). Hepatic lipase activity increased (p < 0.05) and correlated positively with testosterone (r = 0.56, p < 0.02) and negatively with HDL cholesterol (r = - 0.58, p < 0.02). Total and LDL cholesterol, triglycerides, and apoprotein B did not increase. Among the seven patients who completed 18 months of treatment, triglycerides, total cholesterol, LDL and HDL cholesterol, as well as total cholesterol/HDL cholesterol ratio values did not differ from baseline while apoprotein A1 (p < 0.03) and HDL cholesterol (p < 0.015) remained decreased and hepatic lipase unchanged. Restoration of testosterone levels in hypogonadal men in this study did not reveal unfavorable changes based on total cholesterol/HDL cholesterol and LDL cholesterol/apoprotein B ratios, which are both atherogenic risk markers. Whether the changes in light of lipoprotein metabolism will adversely influence cardiovascular risk over time remains to be determined.