Uveítis pediática no infecciosa, una experiencia de una cohorte colombiana

Resumen: •Antecedentes: La uveítis pediátrica no infecciosa tiene el potencial de desencadenar severas complicaciones visuales y su manejo farmacológico convencional está asociado a importantes efectos secundarios. 1 Infliximab (INF) y Adalimumab (ADA), son dos medicamentos biológicos disponibles para el manejo de la uveítis pediátrica refractaria. Se unen específicamente al TNFα y previenen la unión del mismo con los receptores celulares; interacción directamente implicada en el proceso inflamatorio y el subsecuente daño tisular. 2,3 •Métodos: Se realizó estudio de tipo cohorte retrospectiva mediante revisión de historias clínicas de 35 pacientes pediátricos diagnosticados con uveítis durante los años 2009-2015. Se comparó control de la inflamación ocular, tiempo de respuesta y eventos adversos en pacientes tratados con ADA o INF con dosis bajas de Metotrexate vs. Metotrexate (MTX) como única terapia. •Resultados: El 45.7% de la población estudiada correspondía al sexo femenino, cuya edad promedio de inicio de síntomas y de diagnósticos fue de 9 años. El 80% de los casos fueron uveítis idiopáticas, seguido por Vogt-Koyanagi-Harada (8,5%) y AIJ (5,7%). El 91,4% presentó compromiso ocular bilateral y se documentaron 2 casos de ambliopía. El 12,9% de los pacientes que recibieron MTX como tratamiento de primera línea requirieron escalonamiento terapéutico por presentar eventos adversos (Elevación de enzimas hepáticas e intolerancia gastrointestinal (GI)). El tiempo promedio para alcanzar control de la inflamación con MTX fue 9 semanas, y para Adalimumab fue de 8,75 semanas (P: 0,90). Se comparó la capacidad de controlar la inflamación del MTX vs Anti-TNF, y no se observaron diferencias significativas (P: 0.88).

Desenlaces clínicos del cuidado perioperatorio de reemplazos articulares según grupos relacionados de diagnóstico en un hospital de cuarto nivel

Introducción Los Grupos Relacionados de Diagnóstico (GRD) se han usado para determinar la calidad de la atención en varios sistemas de salud. Esto ha llevado a que se obtengan resultados en el mejoramiento continuo de la atención y del cuidado. El objetivo de este estudio es determinar desenlaces clínicos de los pacientes a quienes se les había realizado reemplazo de articulares según la complejidad clínica definida mediante GRD. Métodos Se realizó un estudio longitudinal descriptivo en el cual se incluyeron todos los pacientes que tuvieron cirugía de reemplazo total de hombro, cadera y rodilla entre 2012 y 2014. Se realizó la estratificación de los pacientes de acuerdo a tres niveles de complejidad dados por el sistema de GRD y se determinaron las proporciones de pacientes para las variables de estancia hospitalaria, enfermedad trombo-embólica, cardiovascular e infección del sitio operatorio. Resultados Se realizaron en total 886 reemplazos articulares de los cuales 40 (4.5%) presentaron complicaciones. Los eventos más frecuentes fueron las complicaciones coronarias, con una presencia de 2.4%. El GRD1, sin complicaciones ni comorbilidades, fue el que presentó mayor número de eventos. La estancia hospitalaria fue de 3.8 a 9.3 días para todos los reemplazos. Conclusiones Contrario a lo planteado en la hipótesis de estudio, se encontró que el primer GRD presentó el mayor número de complicaciones, lo que puede estar relacionado con el tamaño del grupo. Es necesario realizar nuevas investigaciones que soporten el uso de los GRD como herramienta para evaluar desenlaces clínicos.

El inmigrante, una herramienta un invasor: análisis de la construcción intersubjetiva de la imagen del trabajador mexicano en los Estados Unidos de América

Esta monografía estudia la historia de la relación laboral entre Estados Unidos y México, analizando bajo el Constructivismo de Wendt, cómo, desde finales del S.XIX se desarrollan procesos políticos bilaterales, que, siguiendo las tendencias del contexto productivo multilateral, construyen un imaginario intersubjetivo de la fuerza laboral mexicana, inicialmente como una herramienta para el modelo de producción agroindustrial y, posteriormente, como un invasor en periodos de recesión económica. Utilizando al trabajador inmigrante, como mano de obra barata o como chivo expiatorio se ha establecido un imaginario en las dos naciones que, por su connotación negativa, impulsan movimientos civiles de reivindicación. Desde mediados del S.XX estas asociaciones civiles trabajan, transnacionalmente, para cambiar la imagen y reestructurar los factores que los estimularon, históricamente a convertirse en actores del Sistema Internacional.

Características clínicas de las uveítis en pacientes pediátricos en dos centros de referencia oftalmológica en Bogotá

Introducción: La de uveítis pediátrica tiene una prevalencia mundial de aproximadamente 30 casos por 100.000 y constituye la segunda causa de ceguera en niños en Colombia. Sin embargo, no existen estudios que caractericen esta entidad en nuestro medio. Materiales y Métodos: Estudio retrospectivo, observacional, descriptivo, mediante la revisión de historias clínicas de pacientes pediátricos con diagnóstico de uveítis en la Fundación Oftalmológica Nacional y en un centro privado de consulta oftalmológica en Bogotá entre enero de 2000 y julio de 2013. Resultados: Se describe un total de 311 pacientes pediátricos con diagnóstico de uveítis, 51.8% niñas. La edad promedio de presentación fue de 10.1 años. La uveítis posterior fue la más frecuente (57.8%), siendo más común de aparición insidiosa (87.5%) y crónica (78.1%). La etiología más frecuente fue infecciosa (58.2%) causada por toxoplasmosis (76.8%). Se encontró una diferencia estadísticamente significativa entre la agudeza visual de la uveítis anterior (20/67) e intermedia (20/69), en comparación con la uveítis posterior (20/417) y panuveítis (20/209) (p <0,05). Discusión: Los datos de este estudio proporcionan el primer reporte de las características clínicas de la uveítis en pacientes pediátricos en Colombia, donde las uveítis infecciosas son la primera causa de esta entidad. Este estudio mejorará el conocimiento de la uveítis en nuestro medio, así como es un instrumento para el desarrollo de políticas públicas para la población pediátrica colombiana, con el fin de mejorar los resultados del tratamiento de estos pacientes.

Análisis de la política exterior norteamericana hacia Turquía, en materia de seguridad, y su influencia en el Kurdistán. Periodo 2003-2009

Este estudio tiene como objetivo analizar los elementos que articulan la Política Exterior de los Estados Unidos hacia Turquía, en materia de seguridad, y su influencia en el Kurdistán, ya que en el periodo 2003-2009 se presentaron acontecimientos que marcaron la vida política, económica, militar y social de la región del Medio Oriente, caracterizado por la presencia de los Estados Unidos. Esta investigación se desarrollara de acuerdo con el modelo de monografía, para dar un análisis teórico sobre el tema delimitado anteriormente. Se espera que el presente estudio sirva para que el lector comprenda las diferentes actuaciones de los Estados Unidos en el escenario internacional, para la consecución de sus intereses y que tenga un acercamiento en las diferentes relaciones entre los Estados para entender mejor los acontecimientos que se presentaron en el periodo a analizar.

La fiesta del Chivo: Trujillo entre la autoridad patriarcal y la imagen salvaje de la nación (Dossier: Novela, historia y nación en América Latina)

En La Fiesta del Chivo, de Mario Vargas Llosa, el autor representa al dictador de la República Dominicana, Rafael Leonidas Trujillo, como un híbrido entre la autoridad patriarcal y la burocracia autoritaria. La reflexión que la autora propone se centra en la observación de la relación entre representaciones de la credibilidad del gobernante en el pueblo dominicano y las pretendidas “realidades”, referentes de estas representaciones en la novela, es decir, la relación entre la ficción literaria y la pretendida lectura cultural de la legitimidad del poder en la cultura popular. Una aproximación a esta siempre inconclusa relación entre la representación y su objeto y a las pretensiones de adecuación entre ambas nos permite observar la relativización de la violencia que forma parte de la mencionada representación literaria.

Decadal Prediction. Can It Be Skillful?

A new field of study, “decadal prediction,” is emerging in climate science. Decadal prediction lies between seasonal/interannual forecasting and longer-term climate change projections, and focuses on time-evolving regional climate conditions over the next 10–30 yr. Numerous assessments of climate information user needs have identified this time scale as being important to infrastructure planners, water resource managers, and many others. It is central to the information portfolio required to adapt effectively to and through climatic changes. At least three factors influence time-evolving regional climate at the decadal time scale: 1) climate change commitment (further warming as the coupled climate system comes into adjustment with increases of greenhouse gases that have already occurred), 2) external forcing, particularly from future increases of greenhouse gases and recovery of the ozone hole, and 3) internally generated variability. Some decadal prediction skill has been demonstrated to arise from the first two of these factors, and there is evidence that initialized coupled climate models can capture mechanisms of internally generated decadal climate variations, thus increasing predictive skill globally and particularly regionally. Several methods have been proposed for initializing global coupled climate models for decadal predictions, all of which involve global time-evolving three-dimensional ocean data, including temperature and salinity. An experimental framework to address decadal predictability/prediction is described in this paper and has been incorporated into the coordinated Coupled Model Intercomparison Model, phase 5 (CMIP5) experiments, some of which will be assessed for the IPCC Fifth Assessment Report (AR5). These experiments will likely guide work in this emerging field over the next 5 yr.

Effects of manure and fertilizer on grain yield, soil carbon and phosphorus in a 13-year field trial in semi-arid Kenya

Long-term indicators of soil fertility were assessed by measuring grain yield, soil organic carbon (SOC) and soil Olsen phosphorous for a P-deficient soil. In one set of treatments, goat manure was applied annually for 13 years at 0, 5 and 10 t ha(-1), and intercrops of sorghum/cowpea, millet/green gram and maize/pigeonpea were grown. Yield depended on rainfall and trends with time were not identifiable. Manure caused an upward trend in SOC, but 10 t ha(-1) manure did not give significantly more SOC than 5 t ha(-1). Only 10 t ha(-1) manure increased Olsen P. Measurements of both SOC and Olsen P are recommended. In another set of treatments, manure was applied for four years; the residual effect lasted another seven to eight years when assessed by yield, SOC and Olsen P Treatment with mineral fertilizers provided the same rates of N and P as 5 t hat manure and yields from manure and fertilizer were similar. Fertilizer increased Olsen P but not SOC. Management systems with occasional manure application and intermediate fertilizer applications should be assessed. Inputs and offtakes of C, N and P were measured for three years. Approximately 16, 25 and 11% of C, N and P respectively were stabilized into soil organic matter from 5 t ha(-1) a(-1) manure. The majority of organic P was fixed as soil inorganic P.

Effect of manure application on crop yield and soil chemical properties in a long-term field trial of semi-arid Kenya

The sustainability of cereal/legume intercropping was assessed by monitoring trends in grain yield, soil organic C (SOC) and soil extractable P (Olsen method) measured over 13 years at a long-term field trial on a P-deficient soil in semi-arid Kenya. Goat manure was applied annually for 13 years at 0, 5 and 10 t ha(-1) and trends in grain yield were not identifiable because of season-to-season variations. SOC and Olsen P increased for the first seven years of manure application and then remained constant. The residual effect of manure applied for four years only lasted another seven to eight years when assessed by yield, SOC and Olsen P. Mineral fertilizers provided the same annual rates of N and P as in 5 t ha(-1) manure and initially ,gave the same yield as manure, declining after nine years to about 80%. Therefore, manure applications could be made intermittently and nutrient requirements topped-up with fertilizers. Grain yields for sorghum with continuous manure were described well by correlations with rainfall and manure input only, if data were excluded for seasons with over 500 mm rainfall. A comprehensive simulation model should correctly describe crop losses caused by excess water.

The effectiveness of adapted rumen fluid versus PEG to ferment tannin-containing substrates in vitro

This study investigated the potential of the goat's ruminal adaptation to reduce the negative effect of tannins on in vitro fermentation. Rumen fluid was obtained from goats fed a mixture of tannin-containing tree fruits (adapted rumen fluid) or tannin-free commercial protein supplements (unadapted rumen fluid) for 85 days. Dry, mature fruits of Acacia nilotica, Acacia erubescens, Acacia erioloba, Dichrostachys cinerea and Piliostigma thonningii were used as substrates for the in vitro fermentation. The effectiveness of adapted rumen fluid to ferment tannin-containing substrates was compared to the extent of fermentation when tannins were inactivated with polyethylene glycol (PEG), a known tannin-binding agent. Adapted rumen fluid (P < 0.05) increased gas production from all five substrates between 15.8% and 73.7%. In A. nilotica, D. cinerea and P thonningii, this increase was less than that obtained through PEG treatment. When PEG was added to adapted rumen fluid a further improvement in extent of fermentation was observed in four out of the five fruit samples. The largest PEG effect when incubated with adapted rumen fluid was observed in A. nilotica (43.1%) and D. cinerea (42.9%) fruits. It is concluded that some tannin-rich feedstuffs may still benefit from treatment even when these are offered to adapted animals. (c) 2006 Elsevier B.V. All rights reserved.

The effect of wilting and soaking Eupatorium adenophorum on its digestibility in vitro and voluntary intake by goats

An experiment was conducted to determine what effect simple treatments might have on the voluntary intake by goats in Nepal of Eupatorium adenophorum, an invasive weed that is usually only consumed by goats to a very limited extent. Samples of E. adenophorum were collected and either untreated, soaked for 2 h or wilted for 2 h before being oven dried (60 degrees C) and ground. Soaking and wilting had little effect on the chemical composition of E. adenophorum, but did increase (P=0.036) its in vitro organic matter degradability, by approximately 8%. The short-term intake rate (STIR) of treated and untreated E. adenophorum was then estimated with eight goats. Soaking time (from 2 to 24 h) was not related to STIR (r = -0.111, P=0.198), but the time E. adenophorum was left to wilt (from 2 to 48h), was positively related to STIR (r=0.521, P<0.001), with values of STIR (g dry matter/min kg goat liveweight(0.75)) being 0.405, 0.649,1.058, S.E.M. 0.088 for E. adenophorum, that had been wilted for 0, 24 and 48 h respectively (P<0.001). Liveweight change of goats and voluntary intake of E. adenophorum by goats was then estimated with 24 goats. E. adenophorum was fed either unwilted, or wilted for 24 or 48 h. It was fed as the sole forage or as a 3:1 mixture (dry matter basis) with Ficus cunia. There was a linear (P<0.001) and quadratic (P<0.01) increase in the intake of total forage and E. adenophorum with wilting time of E. adenophorum. Offering Ficus cunia increased total forage intake, but decreased E. adenophorum intake (P<0.05). After four weeks, there was virtually no change in goat liveweight and no significant difference between treatments. The results suggest that wilting E adenophorum for 24 h could increase its intake by goats, and thereby increase its usefulness, as a potential source of forage in the dry season of Nepal, when forage scarcity is a common constraint to livestock production. (C) 2007 Elsevier B.V. All rights reserved.

Dichrostachys cinerea and Acacia nilotica fruits as dry season feed supplements for goats in a semi-arid environment: Summary of a DFID funded project in Zimbabwe

Indehiscent fruits of six tree species, common in Matabeleland were examined in in vitro and in vivo trials. The results for two of them, Acacia nilotica and Dichrostachys cinerea are presented here. Acacia nilotica-contained more total phenolics than D. cinerea, but less nitrogen (N) and fibre (ADF and NDF). After 48 h incubation, in vitro OMD of both species was increased by PEG and NaOH or wood ash treatment, except when NaOH or wood ash were used in combination with PEG with D. cinerea fruits. DM intake, DMD were lowest and N-retention negative in goats fed A. nilotica as supplement. However when fed a supplement of D. cinerea, untreated or treated with PEG or NaOH, digestibility and N-retention were highest, and similar to a commercial goat meal, with the untreated fruit. In a trial in which milking does were supplemented with D. cinerea fruits, for 65 before and 65 days after kidding, kid birthweight and weaning weight were increased by supplementation. Deaths of twin-born kids were lowest in the supplemented but unmilked group. Supplementation with D. cinerea fruit resulted in improved goat performance. The only treatment applied of practical significance, wood ash, is currently being tested in an in vivo study. More research is required on detoxification of tannins, especially with A. nilotica. (c) 2005 Elsevier B.V. All rights reserved.

An assessment of the potential consumption impacts of WHO dietary norms in OECD countries

The member countries of the World Health Organization (WHO) have recently endorsed its global strategy on diet, physical activity and health. The strategy emphasises the need to limit the consumption of saturated fats and trans-fatty acids, salt and sugars, and to increase consumption of fruits and vegetables in order to combat the growing burden of non-communicable diseases. This paper attempts a broad quantitative assessment of the consumption impacts of these norms in OECD countries using a mathematical programming approach. We find that adherence to the WHO norms would involve a significant decrease in the consumption of vegetable oils (30%), dairy products (28%), sugar (24%), animal fats (30%) and meat (pig meat, 13.5%, mutton and goat 14.5%) and a significant increase in the human consumption of cereals (31%), fruits (25%) and vegetables (21%). (c) 2005 Elsevier Ltd. All rights reserved.

Calcium removal from milk by ion exchange

Calcium removal, using Duolite C433 ion exchange resin, was faster from permeate than from milk. Almost all calcium could be removed, suggesting a fairly rapid conversion from both soluble calcium phosphate and from micellar calcium to ionic calcium. Calcium reduction from milk is accompanied by an increase in pH, a reduction in ionic calcium, an increase in ethanol stability and an increase in the rennet coagulation time. There is a gradual increase in the average casein micelle size with calcium removal, up to a point where the micelle size increases dramatically. Zeta potential becomes more negative with calcium removal. At higher levels of calcium removal, the changes are not reversible, on reducing pH to its original value. For goat's milk, over the range 0-20% total calcium removal, relatively small reductions in total calcium gave rise to proportionally larger reductions in ionic calcium in a ratio of about 1:3.2.