Utilidad del dímero D en el diagnóstico de tromboembolismo pulmonar en la Fundación Santa Fé de Bogotá

INTRODUCCIÓN: El diagnóstico de Tromboembolismo Pulmonar (TEP) ha sido un reto clínico a pesar de los avances en modalidades diagnósticas y opciones terapéuticas, el TEP permanece como una entidad sub diagnosticada y letal. La medición en sangre del Dímero D, con punto de corte de 500 mcg/L, por lo tanto es una excelente prueba de tamizaje para los pacientes en el departamento de urgencias . Esta evaluación inicial debe ser complementada con la realización de angioTAC de tórax, decisión que debe ser tomada precozmente con el fin de evitar complicaciones que amenacen la vida METODOLOGIA: Se realizo un estudio de prueba diagnóstica retrospectivo donde se revisaron las historias clínicas de 109 pacientes adultos de la Fundación Santa Fe de Bogotá en quienes se realizo angioTAC de tórax con protocolo para TEP, con probabilidad diagnóstica de Tromboembolismo Pulmonar Baja o Intermedia por criterios de Wells y que además tengan Dímero D. Se calculo la sensibilidad y especificidad del Dímero D teniendo en cuenta la probabilidad clínica pre test calculada por criterios de Wells, y se calcularon likelihood ratio positivo y negativo para cada punto de corte de Dímero D. RESULTADOS: El estudio mostro una sensibilidad del 100% para valores de Dímero D menores de 1100 mcg/L, en pacientes con baja probabilidad, y sensibilidad de 100% para valores menores de 700 mcg/L en pacientes con probabilidad intermedia. DISCUSIÓN: Pacientes con baja probabilidad pre test por criterios de Wells con valores de Dímero D menores de 1100 mcg/L y de probabilidad intermedia con valores menores de 700 mcg/L no requieren estudios adicionales, lo cual disminuye de manera importante la toma de angioTAC y reduce costos de atención.

Citología de impresión para neoplasias de la superficie ocular

Se estimó la sensibilidad y especificidad de la citología de impresión como prueba diagnóstica en lesiones conjuntivales clínicamente sospechosas de neoplasia usando como patrón de oro la patología. Se estudiaron 60 pacientes, que ingresaron al azar a la Fundación Oftalmológica Nacional, con diagnóstico clínico de neoplasia de superficie ocular o lesión sospechosa de neoplasia, quienes fueron sometidos a citología de impresión y posterior resección quirúrgica completa, más estudio patológico de la lesión. Se realizó un análisis descriptivo, analizando la sensibilidad y la especificidad con el método clásico y análisis bayesiano.

Diferencia venoarterial de Pco2 como predictor de disfunción miocárdica en niños con sepsis severa y choque séptico.

Introducción: La sepsis es una de las principales causas de morbilidad y mortalidad en la población pediátrica a nivel mundial, siendo la disminución del gasto cardiaco uno de los principales factores asociados a mortalidad. Se ha planteado la diferencia venoarterial de pCO2 como predictor de la función miocárdica en pacientes con sepsis, sin embargo hasta el momento no hay estudios en la población pediátrica que lo evalúen. Objetivo: Determinar la capacidad predictora y las características operativas de la diferencia venoarterial de pCO2, como predictor de disfunción miocárdica en pacientes pediátricos con sepsis severa y choque séptico. Métodos: Para alcanzar los objetivos del estudio, se llevo a cabo un estudio prospectivo de pruebas diagnósticas. Se realizó ecocardiograma y diferencia venoarterial de pCO2 en cada paciente, posteriormente se calculó las características operativas de la diferencia venoarterial de pCO2 para determinar su utilidad. Resultados: Se incluyeron 71 pacientes. La mediana de la diferencia venoarterial de pCO2 no fue significativamente mayor en los pacientes que tuvieron disfunción cardiaca en el ecocardiograma en comparación con los que no tuvieron disfunción. Se encontró una relación estadísticamente significativa de valores de 1,5 a 2,1 mmHg, como predictor negativo de disfunción miocárdica con una sensibilidad de 100% y una especificidad de 88%. Conclusiones: La diferencia venoarterial de pCO2 requiere de estudios mas extensos para determinar la probabilidad como predictor de disfunción miocárdica en pacientes pediátricos con sepsis severa y choque séptico, incluso cuando otros biomarcadores se encuentran dentro de límites normales.

Propiedades psicométricas del test de competencias motoras Bruininks Oseretsky en versión corta para niños entre 4 y 7 años en Chía y Bogotá – Colombia.

Existen importantes pruebas de valoración que miden habilidades o competencias motoras en el niño; a pesar de ello Colombia carece de estudios que demuestren la validez y la confiabilidad de un test de medición que permita emitir un juicio valorativo relacionado con las competencias motoras infantiles, teniendo presente que la intervención debe basarse en la rigurosidad que exigen los procesos de valoración y evaluación del movimiento corporal. Objetivo. El presente estudio se centró en determinar las propiedades psicométricas del test de competencias motoras Bruininiks Oseretsky –BOT 2- segunda edición. Materiales y métodos. Se realizó una evaluación de pruebas diagnósticas con 24 niños aparentemente sanos de ambos géneros, entre 4 y 7 años, residentes en las ciudades de Chía y Bogotá. La evaluación fue realizada por 3 evaluadores expertos; el análisis para consistencia interna se realizó utilizando el Coeficiente Alfa de Cronbach, el análisis de reproducibilidad se estableció a través del Coeficiente de Correlación Intraclase –CCI- y para el análisis de la validez concurrente se utilizó el Coeficiente de Correlación de Pearson, considerando un alfa=0.05. Resultados. Para la totalidad de las pruebas, se encontraron altos índices de confiabilidad y validez. Conclusiones. El BOT 2 es un instrumento válido y confiable, que puede ser utilizado para la evaluación e identificación del nivel de desarrollo en que se encuentran las competencias motoras en el niño.

Caracterizacion de nódulos tiroideos: concordancia entre estudio citopatologico y ecografia en la detección de nódulos malignos

: Los métodos imagenológicos para evaluar los nódulos tiroideos han sido motivo de estudio en las últimas décadas, especialmente la ecografía sobresale sobre las otras modalidades diagnósticas por su accesibilidad, portabilidad, y seguridad. A pesar de ello, las características ecográficas de cada nódulo han sido objeto de controversia en cuanto a su potencial detección de malignidad o benignidad. Se presenta un estudio de concordancia entre el estudio citopatológico y la ecografía para la caracterización nódulos tiroideos de naturaleza maligna y benigna, y su análisis de pruebas diagnósticas. Metodología: Se realizó un estudio descriptivo de concordancia con estudio de pruebas diagnósticas anidado. Se escogieron todos los pacientes con nódulos tiroideos a quienes se les realizó ecografía y estudio citopatológico de la lesión y se estudiaron los hallazgos ecográficos para evaluar su potencial diagnóstico para malignidad. Se incluyeron un total de 100 pacientes con nódulos tiroideos potencialmente malignos. La concordancia entre la ecografía en modo B y el estudio citopatológico fue moderada (índice kappa 0.55). La característica con mayor potencial para detectar malignidad fue la presencia de Microcalcificaciones (sensibilidad 75%, especificidad 92%).

Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

The effect of talker age and gender on speech perception of pediatric hearing aid users

Even though pediatric hearing aid (HA) users listen most often to female talkers, clinically-used speech tests primarily consist of adult male talkers' speech. Potential effects of age and/or gender of the talker on speech perception of pediatric HA users were examined using two speech tests, hVd-vowel identification and CNC word recognition, and using speech materials spoken by four talker types (adult males, adult females, 10-12 year old girls, and 5-7 year old girls). For the nine pediatric HA users tested, word scores for the male talker's speech were higher than those for the female talkers, indicating that talker type can affect word recognition scores and that clinical tests may over-estimate everyday speech communication abilities of pediatric HA users.

Highly accurate detection of ovarian cancer using CA125 but limited improvement with serum matrix-assisted laser desorption/ionization time-of-flight mass spectrometry profiling

Objectives: Our objective was to test the performance of CA125 in classifying serum samples from a cohort of malignant and benign ovarian cancers and age-matched healthy controls and to assess whether combining information from matrix-assisted laser desorption/ionization (MALDI) time-of-flight profiling could improve diagnostic performance. Materials and Methods: Serum samples from women with ovarian neoplasms and healthy volunteers were subjected to CA125 assay and MALDI time-of-flight mass spectrometry (MS) profiling. Models were built from training data sets using discriminatory MALDI MS peaks in combination with CA125 values and tested their ability to classify blinded test samples. These were compared with models using CA125 threshold levels from 193 patients with ovarian cancer, 290 with benign neoplasm, and 2236 postmenopausal healthy controls. Results: Using a CA125 cutoff of 30 U/mL, an overall sensitivity of 94.8% (96.6% specificity) was obtained when comparing malignancies versus healthy postmenopausal controls, whereas a cutoff of 65 U/mL provided a sensitivity of 83.9% (99.6% specificity). High classification accuracies were obtained for early-stage cancers (93.5% sensitivity). Reasons for high accuracies include recruitment bias, restriction to postmenopausal women, and inclusion of only primary invasive epithelial ovarian cancer cases. The combination of MS profiling information with CA125 did not significantly improve the specificity/accuracy compared with classifications on the basis of CA125 alone. Conclusions: We report unexpectedly good performance of serum CA125 using threshold classification in discriminating healthy controls and women with benign masses from those with invasive ovarian cancer. This highlights the dependence of diagnostic tests on the characteristics of the study population and the crucial need for authors to provide sufficient relevant details to allow comparison. Our study also shows that MS profiling information adds little to diagnostic accuracy. This finding is in contrast with other reports and shows the limitations of serum MS profiling for biomarker discovery and as a diagnostic tool

Prediction of processed cheese instrumental texture and meltability by mid-infrared spectroscopy coupled with chemometric tools

The objective of this study was to determine the potential of mid-infrared spectroscopy coupled with multidimensional statistical analysis for the prediction of processed cheese instrumental texture and meltability attributes. Processed cheeses (n = 32) of varying composition were manufactured in a pilot plant. Following two and four weeks storage at 4 degrees C samples were analysed using texture profile analysis, two meltability tests (computer vision, Olson and Price) and mid-infrared spectroscopy (4000-640 cm(-1)). Partial least squares regression was used to develop predictive models for all measured attributes. Five attributes were successfully modelled with varying degrees of accuracy. The computer vision meltability model allowed for discrimination between high and low melt values (R-2 = 0.64). The hardness and springiness models gave approximate quantitative results (R-2 = 0.77) and the cohesiveness (R-2 = 0.81) and Olson and Price meltability (R-2 = 0.88) models gave good prediction results. (c) 2006 Elsevier Ltd. All rights reserved..

Cross-correlations and cross-bicorrelations in Sterling exchange rates

This paper proposes two new tests for linear and nonlinear lead/lag relationships between time series based on the concepts of cross-correlations and cross-bicorrelations, respectively. The tests are then applied to a set of Sterling-denominated exchange rates. Our analysis indicates that there existed periods during the post-Bretton Woods era where the temporal relationship between different exchange rates was strong, although these periods have become less frequent over the past 20 years. In particular, our results demonstrate the episodic nature of the nonlinearity, and have implications for the speed of flow of information between financial series. The method generalises recently proposed tests for nonlinearity to the multivariate context.

Comparison of terrain following and cut cell grids using a non-hydrostatic model

Terrain following coordinates are widely used in operational models but the cut cell method has been proposed as an alternative that can more accurately represent atmospheric dynamics over steep orography. Because the type of grid is usually chosen during model implementation, it becomes necessary to use different models to compare the accuracy of different grids. In contrast, here a C-grid finite volume model enables a like-for-like comparison of terrain following and cut cell grids. A series of standard two-dimensional tests using idealised terrain are performed: tracer advection in a prescribed horizontal velocity field, a test starting from resting initial conditions, and orographically induced gravity waves described by nonhydrostatic dynamics. In addition, three new tests are formulated: a more challenging resting atmosphere case, and two new advection tests having a velocity field that is everywhere tangential to the terrain following coordinate surfaces. These new tests present a challenge on cut cell grids. The results of the advection tests demonstrate that accuracy depends primarily upon alignment of the flow with the grid rather than grid orthogonality. A resting atmosphere is well-maintained on all grids. In the gravity waves test, results on all grids are in good agreement with existing results from the literature, although terrain following velocity fields lead to errors on cut cell grids. Due to semi-implicit timestepping and an upwind-biased, explicit advection scheme, there are no timestep restrictions associated with small cut cells. We do not find the significant advantages of cut cells or smoothed coordinates that other authors find.

Electromyographic Evaluation of Neuromuscular Coordination of Subject After Orthodontic Intervention

The aim of this work was to investigate the neuromuscular changes associated with the orthodontic post-treatment using surface electromyography. One hundred (100) young, healthy adults without signs and symptoms of temporomandibular dysfunction (TMD) were divided into two groups: 60 subjects who were undergoing orthodontic intervention (Ortho Group) and 40 subjects who had no orthodontic intervention (Control Group), aged 18-25 years. EMG activity of masseter and temporalis anterior muscle was recorded during two different tests: 1. maximum voluntary clench (MVC) with cotton rolls; and 2. MVC in intercuspal position. In all subjects, both tests were performed with symmetric muscular patterns (more than 85%) and with insignificant latero-deviating of the mandible (lower than 10%). There are no statistically significant differences between the subjects of both groups evaluated. Both groups showed medium index values calculated according to the normal standards established previously.

Identification of protein-coding and intronic noncoding RNAs down-regulated in clear cell renal carcinoma

The clear cell subtype of renal cell carcinoma (RCC) is the most lethal and prevalent cancer of the urinary system. To investigate the molecular changes associated with malignant transformation in clear cell RCC, the gene expression profiles of matched samples of tumor and adjacent non-neoplastic tissue were obtained from six patients. A custom-built cDNA microarray platform was used, comprising 2292 probes that map to exons of genes and 822 probes for noncoding RNAs mapping to intronic regions. Intronic transcription was detected in all normal and neoplastic renal tissues. A subset of 55 transcripts was significantly down-regulated in clear cell RCC relative to the matched nontumor tissue as determined by a combination of two statistical tests and leave-one-out patient cross-validation. Among the down-regulated transcripts, 49 mapped to untranslated or coding exons and 6 were intronic relative to known exons of protein-coding genes. Lower levels of expression of SIN3B, TRIP3, SYNJ2BP and NDE1 (P<0.02), and of intronic transcripts derived from SND1 and ACTN4 loci (P<0.05), were confirmed in clear cell RCC by Real-time RT-PCR. A subset of 25 transcripts was deregulated in additional six nonclear cell RCC samples, pointing to common transcriptional alterations in RCC irrespective of the histological subtype or differentiation state of the tumor. Our results indicate a novel set of tumor suppressor gene candidates, including noncoding intronic RNAs, which may play a significant role in malignant transformations of normal renal cells. (C) 2008 Wiley-Liss, Inc.

Ungdomars fysiska aktivitet och dess betydelse för prestationen i skolan

This study where designed to investigate if there are any positive relationship between the extent of physical activity during adolescent's leisure time and the academic performance, and also if there are any negative relationship between the academic performance and the time spent in front of the television or computers. Another part of the study tried to find out if physical activity has a direct and immediate influence on the performance in school. 91 pupils (51 girls and 40 boys) in the 8:th year of the Swedish primary school, from three different schools participated in the study. All 91 pupils first responded to a questionnaire concerning there activities in leisure time. They where then tested in a mathematical test and the results where compared with the extent of physical activity and TV/computer time they had stated in the questionnaire. 53 of the pupils also participated in the part of the study where direct and immediate influences of physical activity where tested. They where tested in two different but similar mathematical tests. Before the first test all pupils had a walk for about 3 km. The second test where accomplished whiteout preceding walk.Pupils who spend one hour or less/week on physical activity had significant lower mean score on the mathematical test then the pupils who spend more than one hour/week on physical activities, (Mann-Whitney U-test: Z= -2,486, p= 0,0129). Boys who spent 10,5 hours or less/week in front of the TV/computer had significant higher mean score than the boys who spent more than 10,5 hours/week in front of the TV/computer. No significant differences in the results of the two different tests, one white and one whiteout preceding walk, were observed.

Estudo da viabilidade técnica para a Bolívia de painéis de gesso reforçados com fibra de vidro para paredes internas não portantes

Na construção civil, nos países em desenvolvimento como a Bolívia, continua-se usando técnicas e materiais na execução de paredes, similar a décadas passadas. Os painéis de gesso reforçados com fibra de vidro são uma alternativa de simplificação e agilização na execução das paredes internas não portantes. A presente dissertação objetiva mostrar a viabilidade técnica e econômica dos painéis para paredes internas, na Bolívia; para tanto realizou-se uma avaliação dos recursos disponíveis (gesso), com relação às reservas, produção e custos. A técnica adotada na produção dos painéis é a de pré-mistura, que permite a moldagem dos painéis manual ou mecanicamente com equipamentos simples e de baixo custo. O estudo do compósito de gesso reforçado com fibra de vidro (GRG) foi realizado com gesso brasileiro e com gesso boliviano, verificando-se o seu comportamento mecânico com diferentes teores de fibra de vidro. Verificou-se aumento da resistência a tração na flexão e diminuição da resistência a compressão com o aumento do teor de fibra de vidro. A avaliação do comportamento mecânico dos painéis foi feita através dos ensaios de impacto (corpo mole e corpo duro). Nos ensaios de corpo mole, verificou-se aumento da resistência com o aumento do teor de fibra de vidro. Os teores de 0,75% e 1,5% se mostraram suficientes para que os painéis de GRG satisfaçam os requisitos de desempenho para divisórias internas respectivamente para o gesso brasileiro e boliviano. O comportamento dos painéis nos ensaios de impacto de corpo duro foi satisfatório, tanto para painéis com fibra como para painéis sem fibra de vidro. No estudo preliminar de custos, verificou-se uma redução em torno de 36% para os painéis de GRG em relação às paredes intemas tradicionalmente usadas na Bolívia.