Diferencias microbiológicas en pacientes con exacerbación severa de EPOC con o sin consolidación neumónica

La EPOC es una causa importante de morbilidad y mortalidad en el mundo y su prevalencia en Bogotá alcanza hasta 8,5%. Las exacerbaciones están asociadas a deterioro funcional y de la calidad de vida por lo que se consideran un factor cardinal de la enfermedad. En la literatura se ha descrito que las infecciones por bacterias y/o virus son las responsables del 78% de las exacerbaciones. Estos datos han sido descritos en poblaciones diferentes y no hay datos en la literatura que muestren cual es la epidemiología local de las exacerbaciones de EPOC y menos aún de aquellas que se asocian a consolidaciones neumónicas. Objetivo: Comparar la microbiología de las exacerbaciones severas de la EPOC que requieren ingreso a UCI con y sin infiltrados alveolares. Materiales y métodos: Estudio de corte transversal en el que se estudiaron pacientes con EPOC que ingresaron a la UCI Médica de la FCI-IC por exacerbación severa, asociada o no a infiltrados alveolares. Se tomaron muestras de microbiología, serológicas y radiografía de tórax para evaluar la etiología de la exacerbación, si se asocia a coinfección viral y a consolidación neumónica o no. Resultados: No se encontró una diferencia estadísticamente significativa en la microbiología de los diferentes grupos evaluados. Se encontró un resistencia global del 24% y llama la atención que hay una alta prevalencia de Serratia Marcescens AMPc entre los 2 grupos, germen que no está descrito como patógeno común en la literatura. Se encontraron diferencias en cuanto a factores de riesgo para presentar neumonía asociada como lo son un mayor índice de paquetes/año (55.1.6 vs. 36.3 paq/año, sig.=0.021). Así mismo se demostró que los pacientes con neumonía asociada presentan mayor necesidad de IOT (48.9 vs. 23.9, sig.=0.013). No hay diferencia significativa en desenlaces como mortalidad (20.5 vs. 13.0, sig.=0.346). Conclusiones: A pesar de no haber diferencia microbiológica entre los 2 grupos se encontraron variables como factores de riesgo y variables clínicas que pueden ayudar a proponer planes de manejo en los dos escenarios. El hecho de encontrar un paciente con neumonía asociada al cuadro de exacerbación no debe afectar en la toma de decisiones en relación al tratamiento antibiótico.

Alteraciones respiratorias durante el sueño en niños con Síndrome Down a la altura de Bogotá

Objetivo: determinar la frecuencia de las diferentes alteraciones respiratorias durante el sueño (ARS) e hipertensión pulmonar (HTP) y establecer la saturación de oxígeno (SpO2) en vigilia, sueño y durante los eventos en niños con Síndrome Down (SD) a la altura de Bogotá (2640m) de acuerdo a grupos de edad e IMC. Métodos: estudio descriptivo de corte transversal, se incluyeron todos los niños con SD con sospecha de ARS remitidos a polisonograma (PSG) de octubre de 2011 a enero de 2013 a la Fundación Neumológica Colombina (FNC). Se dividieron en 3 grupos: apnea obstructiva, apnea obstructiva y central, sin apneas. Resultados: 74 niños, el 36,5% mujeres, edad media 4 años. 47,3% presento apnea obstructiva, más frecuente en >2 años, 35,1% apnea obstructiva y central, más frecuente en < 2 años y 17,6 % sin apnea. SpO2 promedio en apnea obstructiva 84,63%, apnea obstructiva y central: 81,8% y sin apnea: 86,85% (p 0,058). 23% presento obesidad, 16% con apnea obstructiva. 53 pacientes tenían ecocardiograma: 28% HTP, 53,3% tuvo apnea obstructiva y 26,7 apnea obstructiva y central, no diferencias significativas. SpO2 promedio en HTP 88,3% vigilia, 86,2% sueño REM, 85,7 % sueño no REM, no diferencia significativa comparada con pacientes sin HTP. Conclusiones: Las ARS son frecuentes en los niños con SD, La desaturación está presente en los niños con SD independiente del tipo de apnea. A todos los niños SD se les debe practicar un PSG en el primer año de vida.

Presión arterial en preescolares de la localidad de Usaquén en Bogotá

Introducción: La hipertensión arterial es un problema de salud pública tanto en países industrializados como en vía de desarrollo. Su prevalencia en la infancia viene en aumento por lo que es relevante determinarla en niños preescolares a nivel local. Objetivo: Determinar la prevalencia de hipertensión arterial en niños de tres a cinco años de una cohorte de 14 hogares infantiles del ICBF de la localidad de Usaquén en Bogotá. Materiales y métodos: Se realizó un estudio de corte transversal analítico, utilizando la base de datos de un ensayo aleatorizado y controlado del año 200913, y se evaluaron las cifras de tensión arterial de acuerdo a sexo, edad, talla y su correlación con el IMC con un nivel de confianza del 95% y precisión del 1%. Se calcularon las medias, desviaciones estándar, percentiles y prevalencia. Resultados: Se obtuvo una muestra de 1035 casos, encontrándose una prevalencia de 4,5% de HTA sistólica, 10,4% de diastólica, ambas en estadio I; teniendo en cuenta tanto sistólica como diastólica, fue de 11,6% en estadio I. Se determinaron los valores de presión arterial sistólica y diastólica en cuartiles de acuerdo a edad, sexo y talla. El coeficiente de correlación entre el IMC y los niveles de presión arterial sistólica y diastólica fueron de 0.0992 y 0.0362 respectivamente. Conclusión: La prevalencia de HTA general fue de 11,6%, predominando la diastólica en estadio I en niños preescolares. No se encontró correlación entre el IMC y las cifras de tensión arterial sistólica y diastólica.

Búsqueda de caso y diagnóstico temprano en sujetos con sospecha de la EPOC

La enfermedad pulmonar obstructiva crónica es una patología comúnmente sub-diagnosticada. A la fecha no existe ninguna revisión sistemática publicada que evalué la búsqueda de caso (sujetos mayores de 40 años con factores de riesgo sin síntomas) y el diagnóstico temprano (factor de riesgo y síntomas) de la enfermedad. Métodos: Se condujo una revisión sistemática en tres bases de datos (Pubmed, CINAHL, EMBASE) para identificar estudios observacionales que reportaran la prevalencia de la EPOC en diferentes poblaciones expuestas a factores de riesgo (búsqueda de caso) o con factores de riesgo y síntomas (diagnóstico temprano), posteriormente con dichos estudios se calculó una prevalencia ponderada para cada grupo y esta se comparó con la prevalencia reportada en la población general en estudios locales. Así mismo se identificaron estudios para determinar la precisión de estrategias de búsqueda de caso (cuestionarios y el pico flujo espiratorio portátil PiKo 6®) usando la espirometría como patrón de oro para el diagnóstico de la EPOC. Dos autores seleccionaron de forma independiente los estudios que cumplían con los criterios de inclusión y exclusión y se evaluó la calidad metodológica por medio de la estrategia GRADE. El número necesario a tamizar (1/ prevalencia) para diagnosticar un caso de EPOC con espirometría fue calculado para los dos grupos de interés y comparado con el valor conocido de la prevalencia nacional. A los cuestionarios y estudios de Piko 6® se les evaluó las características operativas (VPP, VPN) y se calcularon las probabilidades pos test negativas y positivas teniendo en cuenta la prevalencia ponderada. Resultados Para la estrategia de búsqueda de caso, once estudios cumplieron los criterios de inclusión y la prevalencia ponderada en este grupo fue de 22% con un número necesario a tamizar (NNS) con espirometría de 5, comparado con un NNS de 11 obtenido de la prevalencia de la EPOC en Colombia 8.9% ( IC 95% 8.2-9.7). Posterior a la evaluación critica de varios cuestionarios y estudios de piko 6®, seleccionamos el cuestionario desarrollado por Mullernová y cols y el estudio de Frith y cols respectivamente. El cuestionario validado mostro una probabilidad postest positiva del 56% y postest negativa del 3% con un NNS de 2; para piko 6® los valores correspondientes fueron de 44%, 7% y 2 respectivamente. Para el diagnóstico temprano la prevalencia ponderada fue del 33.9% con un NNS de 3. Conclusiones El número necesario a tamizar para la estrategia de búsqueda de caso con cuestionarios y piko 6® es substancialmente menor que el número necesario a tamizar en la población general. El uso de cuestionarios o de piko 6® disminuye a 2 el NNS en el grupo de búsqueda de caso y a 3 para el grupo de diagnóstico temprano.

Alteración del centro de gravedad y riesgo de caída en pacientes con trastornos neurológicos. Bogotá. 2014

Introducción: el objetivo de la rehabilitación en los pacientes neurológicos es reducir su discapacidad, potencializar su funcionalidad y promover su independencia para así permitirle desempeñar un rol activo en la comunidad. Por esta razón, es de gran importancia prevenir la aparición de eventos adversos en esta población mediante la detección temprana de factores de riesgo que conllevan a pacientes con enfermedad cerebro vascular a presentar caídas y a su vez le permita a los profesionales de la salud generar estrategias para minimizar su incidencia, complicaciones y/o secuelas. Objetivo: determinar los factores relacionados con la alteración del centro de gravedad y riesgos de caída en paciente con trastornos neurológicos Metodología: se realizó un estudio cuantitativo descriptivo exploratorio retrospectivo donde se tuvieron en cuenta pacientes diagnóstico de enfermedades neurológicas que presentaron o no antecedentes de caídas junto con otros criterios de inclusión y exclusión, tomados de las bases de datos de la institución Mobility Group. Resultados: Se evaluaron en total 19 sujetos (52,6 % hombres) con edad media de 48,37 años. Se clasificaron en dos grupos (alto y bajo riesgo de caída ) de pacientes según la aplicación de la escala de riesgo de caída de J.H. Downton a los cuales se aplicó estadística descriptiva para describir su comportamiento en referencia a factores como diagnóstico clínico, presencia de dolor, fuerza y tono de miembros inferiores en los principales grupos musculares , clasificación de espasticidad y finalmente con la alteración de la trayectoria del centro de gravedad según la valoración realizada con el dispositivo THERA-TRAINER BALANCE.

The influence of the atmospheric boundary layer on nocturnal layers of noctuids and other moths migrating over southern Britain

Insects migrating at high altitude over southern Britain have been continuously monitored by automatically-operating, vertical-looking radars over a period of several years. During some occasions in the summer months, the migrants were observed to form well-defined layer concentrations, typically at heights of 200-400 m, in the stable night-time atmosphere. Under these conditions, insects are likely to have control over their vertical movements and are selecting flight heights which are favourable for long-range migration. We therefore investigated the factors influencing the formation of these insect layers by comparing radar measurements of the vertical distribution of insect density with meteorological profiles generated by the UK Met. Office’s Unified Model (UM). Radar-derived measurements of mass and displacement speed, along with data from Rothamsted Insect Survey light traps provided information on the identity of the migrants. We present here three case studies where noctuid and pyralid moths contributed substantially to the observed layers. The major meteorological factors influencing the layer concentrations appeared to be: (a) the altitude of the warmest air, (b) heights corresponding to temperature preferences or thresholds for sustained migration and (c), on nights when air temperatures are relatively high, wind-speed maxima associated with the nocturnal jet. Back-trajectories indicated that layer duration may have been determined by the distance to the coast. Overall, the unique combination of meteorological data from the UM and insect data from entomological radar described here show considerable promise for systematic studies of high-altitude insect layering.

Spatial and temporal scale issues in determining biomass burning regimes in Bolivia and Peru

ATSR-2 active fire data from 1996 to 2000, TRMM VIRS fire counts from 1998 to 2000 and burn scars derived from SPOT VEGETATION ( the Global Burnt Area 2000 product) were mapped for Peru and Bolivia to analyse the spatial distribution of burning and its intra- and inter-annual variability. The fire season in the region mainly occurs between May and October; though some variation was found between the six broad habitat types analysed: desert, grassland, savanna, dry forest, moist forest and yungas (the forested valleys on the eastern slope of the Andes). Increased levels of burning were generally recorded in ATSR-2 and TRMM VIRS fire data in response to the 1997/1998 El Nino, but in some areas the El Nino effect was masked by the more marked influences of socio-economic change on land use and land cover. There were differences between the three global datasets: ATSR-2 under-recorded fires in ecosystems with low net primary productivities. This was because fires are set during the day in this region and, when fuel loads are low, burn out before the ATSR-2 overpass in the region which is between 02.45 h and 03.30 h. TRMM VIRS was able to detect these fires because its overpasses cover the entire diurnal range on a monthly basis. The GBA2000 product has significant errors of commission (particularly areas of shadow in the well-dissected eastern Andes) and omission (in the agricultural zone around Santa Cruz, Bolivia and in north-west Peru). Particular attention was paid to biomass burning in high-altitude grasslands, where fire is an important pastoral management technique. Fires and burn scars from Landsat Thematic Mapper (TM) and Enhanced Thematic Mapper (ETM) data for a range of years between 1987 and 2000 were mapped for areas around Parque Nacional Rio Abiseo (Peru) and Parque Nacional Carrasco (Bolivia). Burn scars mapped in the grasslands of these two areas indicate far more burning had taken place than either the fires or the burn scars derived from global datasets. Mean scar sizes are smaller and have a smaller range in size between years the in the study area in Peru (6.6-7.1 ha) than Bolivia (16.9-162.5 ha). Trends in biomass burning in the two highland areas can be explained in terms of the changing socio-economic environments and impacts of conservation. The mismatch between the spatial scale of biomass burning in the high-altitude grasslands and the sensors used to derive global fire products means that an entire component of the fire regime in the region studied is omitted, despite its importance in the farming systems on the Andes.

Climate change, glacier retreat, and water availability in the Caucasus region

The paper discusses the observed and projected warming in the Caucasus region and its implications for glacier melt, water availability and potential hazards. A strong positive trend in summer air temperatures of 0.05 degrees C year(-1) is observed in the high-altitude areas (above 2000 m) providing for a strong glacier melt. A widespread glacier retreat has also been reported between 1985 and 2000, with an average rate of 8 m year(-1). A warming of 5-7 degrees C is projected for the Sum mer months in the 2071-2100 period under the A2 emission group of scenarios, Suggesting that enhanced glacier melt and a changing water balance can be expected.

An Assessment of the Recent Past and Future Climate Change, Glacier Retreat, and Runoff in the Caucasus Region Using Dynamical and Statistical Downscaling and HBV-ETH Hydrological Model

The paper discusses the observed and projected warming in the Caucasus region and its implications for glacier melt and runoff. A strong positive trend in summer air temperatures of 0.05 degrees C a(-1) is observed in the high-altitude areas providing for a strong glacier melt and continuous decline in glacier mass balance. A warming of 4-7 degrees C and 3-5 degrees C is projected for the summer months in 2071-2100 under the A2 and B2 emission scenarios respectively, suggesting that enhanced glacier melt can be expected. The expected changes in winter precipitation will not compensate for the summer melt and glacier retreat is likely to continue. However, a projected small increase in both winter and summer precipitation combined with the enhanced glacier melt will result in increased summer runoff in the currently glaciated region of the Caucasus (independent of whether the region is glaciated at the end of the twenty-first century) by more than 50% compared with the baseline period.

Mid-infrared filters for astronomical and remote sensing instrumentation

As improvements to the optical design of spectrometer and radiometer instruments evolve with advances in detector sensitivity, use of focal plane detector arrays and innovations in adaptive optics for large high altitude telescopes, interest in mid-infrared astronomy and remote sensing applications have been areas of progressive research in recent years. This research has promoted a number of developments in infrared coating performance, particularly by placing increased demands on the spectral imaging requirements of filters to precisely isolate radiation between discrete wavebands and improve photometric accuracy. The spectral design and construction of multilayer filters to accommodate these developments has subsequently been an area of challenging thin-film research, to achieve high spectral positioning accuracy, environmental durability and aging stability at cryogenic temperatures, whilst maximizing the far-infrared performance. In this paper we examine the design and fabrication of interference filters in instruments that utilize the mid-infrared N-band (6-15 µm) and Q-band (16-28 µm) atmospheric windows, together with a rationale for the selection of materials, deposition process, spectral measurements and assessment of environmental durability performance.

Turbulent flow at 190 m height above London during 2006-2008: A climatology and the applicability of similarity theory

Flow and turbulence above urban terrain is more complex than above rural terrain, due to the different momentum and heat transfer characteristics that are affected by the presence of buildings (e.g. pressure variations around buildings). The applicability of similarity theory (as developed over rural terrain) is tested using observations of flow from a sonic anemometer located at 190.3 m height in London, U.K. using about 6500 h of data. Turbulence statistics—dimensionless wind speed and temperature, standard deviations and correlation coefficients for momentum and heat transfer—were analysed in three ways. First, turbulence statistics were plotted as a function only of a local stability parameter z/Λ (where Λ is the local Obukhov length and z is the height above ground); the σ_i/u_* values (i = u, v, w) for neutral conditions are 2.3, 1.85 and 1.35 respectively, similar to canonical values. Second, analysis of urban mixed-layer formulations during daytime convective conditions over London was undertaken, showing that atmospheric turbulence at high altitude over large cities might not behave dissimilarly from that over rural terrain. Third, correlation coefficients for heat and momentum were analyzed with respect to local stability. The results give confidence in using the framework of local similarity for turbulence measured over London, and perhaps other cities. However, the following caveats for our data are worth noting: (i) the terrain is reasonably flat, (ii) building heights vary little over a large area, and (iii) the sensor height is above the mean roughness sublayer depth.

Cusp observations during a sequence of fast IMF B-Z reversals

In recent years, a large number of papers have reported the response of the cusp to solar wind variations under conditions of northward or southward Interplanetary Magnetic Field (IMF) Z-component (BZ). These studies have shown the importance of both temporal and spatial factors in determining the extent and morphology of the cusp and the changes in its location, connected to variations in the reconnection geometry. Here we present a comparative study of the cusp, focusing on an interval characterised by a series of rapid reversals in the BZ-dominated IMF, based on observations from space-borne and ground-based instrumentation. During this interval, from 08:00 to 12:00 UT on 12 February 2003, the IMF BZ component underwent four reversals, remaining for around 30 min in each orientation. The Cluster spacecraft were, at the time, on an outbound trajectory through the Northern Hemisphere magnetosphere, whilst the mainland VHF and Svalbard (ESR) radars of the EISCAT facility were operating in support of the Cluster mission. Both Cluster and the EISCAT were, on occasion during the interval, observing the cusp region. The series of IMF reversal resulted in a sequence of poleward and equatorward motions of the cusp; consequently Cluster crossed the high altitude cusp twice before finally exiting the dayside magnetopause, both times under conditions of northward IMF BZ. The first magnetospheric cusp encounter, by all four Cluster spacecraft, showed reverse ion dispersion typical of lobe reconnection; subsequently, Cluster spacecraft 1 and 3 (only) crossed the cusp for a second time. We suggest that, during this second cusp crossing, these two spacecraft were likely to have been on newly closed field lines, which were first reconnected (opened) at low latitudes and later reconnected again (re-closed) poleward of the northern cusp.

Assessment of the consistency of H2O line intensities over the near-infrared using sun-pointing ground-based Fourier transform spectroscopy

We report on the consistency of water vapour line intensities in selected spectral regions between 800–12,000 cm−1 under atmospheric conditions using sun-pointing Fourier transform infrared spectroscopy. Measurements were made across a number of days at both a low and high altitude field site, sampling a relatively moist and relatively dry atmosphere. Our data suggests that across most of the 800–12,000 cm−1 spectral region water vapour line intensities in recent spectral line databases are generally consistent with what was observed. However, we find that HITRAN-2008 water vapour line intensities are systematically lower by up to 20% in the 8000–9200 cm−1 spectral interval relative to other spectral regions. This discrepancy is essentially removed when two new linelists (UCL08, a compilation of linelists and ab-initio calculations, and one based on recent laboratory measurements by Oudot et al. (2010) [10] in the 8000–9200 cm−1 spectral region) are used. This strongly suggests that the H2O line strengths in the HITRAN-2008 database are indeed underestimated in this spectral region and in need of revision. The calculated global-mean clear-sky absorption of solar radiation is increased by about 0.3 W m−2 when using either the UCL08 or Oudot line parameters in the 8000–9200 cm−1 region, instead of HITRAN-2008. We also found that the effect of isotopic fractionation of HDO is evident in the 2500–2900 cm−1 region in the observations.

Inter-hemispheric mesospheric coupling in a comprehensive middle atmosphere model

Observations of noctilucent clouds have revealed a surprising coupling between the winter stratosphere and the summer polar mesopause region. In spite of the great distance involved, this inter-hemispheric link has been suggested to be the principal reason for both the year-to-year variability and the hemispheric differences in the frequency of occurrence of these high-altitude clouds. In this study, we investigate the dynamical influence of the winter stratosphere on the summer mesosphere using simulations from the vertically extended version of the Canadian Middle Atmosphere Model (CMAM). We find that for both Northern and Southern Hemispheres, variability in the summer polar mesopause region from one year to another can be traced back to the planetary-wave flux entering the winter stratosphere. The teleconnection pattern is the same for both positive and negative wave-flux anomalies. Using a composite analysis to isolate the events, it is argued that the mechanism for interhemispheric coupling is a feedback between summer mesosphere gravity-wave drag (GWD) and zonal wind, which is induced by an anomaly in mesospheric cross-equatorial flow, the latter arising from the anomaly in winter hemisphere GWD induced by the anomaly in stratospheric conditions.

Climatology and predictability of the late summer stratospheric zonal wind turnaround over Vanscoy, Saskatchewan

A climatology of the late summer stratospheric zonal wind turnaround phenomenon is presented, with a particular focus on the behaviour over the Meteorological Service of Canada’s balloon-launching site at Vanscoy, Saskatchewan (52°N, 107°W). Turnaround refers to the change in sign of the zonal wind velocity and occurs twice each year at stratospheric mid-latitudes, in early spring and in late summer. The late summer turnaround is of particular interest to the high-altitude ballooning community because it offers the ideal conditions for launch, but it is also an interesting dynamical phenomenon in its own right. It is studied here using both the National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) reanalysis and the United Kingdom Meteorological Office (MetO) analysis products as well as climate simulation data from the Canadian Middle Atmosphere Model (CMAM). The phenomenon and its interannual variability are documented. The predictability of the late summer turnaround over Vanscoy is investigated using both statistical averages and autocorrelation analysis. From the statistical averages, it is found that during every year since 1993, the period from 26 August to 5 September has contained appropriate launch dates. From the autocorrelation analysis, it is found that stratospheric zonal wind anomalies can persist for a month or more during most of the summer, but there is a predictability horizon at the end of the summer — just before turnaround