Etude du développement de la réponse humorale dirigée contre la capsule polysaccharidique de Streptococcus suis et Streptococcus du groupe B

Streptococcus suis et Streptococcus du groupe B (GBS) sont deux bactéries encapsulées qui induisent des pathologies similaires chez l’homme et/ou l’animal, incluant septicémies et méningites. La capsule polysaccharidique (CPS) est un facteur de virulence clé de ces deux pathogènes et les anticorps (Ac) anti-CPS présentent un bon potentiel protecteur. Néanmoins, ces molécules sont faiblement immunogéniques et les mécanismes de la génération de la réponse humorale anti-CPS demeurent méconnus. L’objectif principal de cette thèse était d’évaluer les caractéristiques et les mécanismes du développement de la réponse Ac dirigée spécifiquement contre les CPS de S. suis et GBS, ainsi que l’effet de la biochimie de la CPS dans cette réponse. Nous avons étudié S. suis types 2 et 14 et GBS types III et V, dont les CPS présentent plusieurs similarités dans leurs compositions et leurs structures, incluant la présence d’acide sialique, un sucre potentiellement immunosuppresseur, tout en possédant une antigénicité propre. Nous avons tout d’abord analysé la nature de la réponse Ac anti-CPS sérique face à la bactérie entière. Les souris infectées par S. suis développent une réponse très faible (S. suis type 2) voire insignifiante (S. suis type 14) de profil isotypique restreint à l’IgM et sont incapables de monter une réponse mémoire efficace face à une seconde infection. Un profil similaire est obtenu chez le porc infecté par S. suis type 2. On détecte des titres d’IgM anti-CPS significatifs chez les souris infectées par GBS (type III ou V). Toutefois, la magnitude de la réponse reste globalement faible et aucune commutation de classe n’est observée. Nous avons ensuite examiné l’influence de la biochimie de la CPS sur ces profils de réponse en conduisant des expériences avec la CPS hautement purifiée de ces pathogènes. Tandis que la CPS de GBS type III administrée aux souris conserve des propriétés immunogéniques similaires à celles observées durant l’infection par la bactérie intacte, les CPS de S. suis type 2 et GBS type V perdent toute capacité à induire une réponse Ac spécifique. L’analyse de l’interaction in vitro des CPS avec les cellules dendritiques (DC) murines, des acteurs clés dans la détection des pathogènes et l’orchestration des réponses immunitaires subséquentes, révèle que ces molécules stimulent la production de niveaux conséquents de chémokines via différents récepteurs. Néanmoins, les CPS sont inaptes à induire la sécrétion de cytokines et elles interfèrent avec la capacité des DC à exprimer BAFF, une cytokine clé dans la différenciation des lymphocytes B en plasmocytes. L’utilisation de CPS chimiquement désialylées démontre que l’acide sialique ne joue aucun rôle immunosuppresseur majeur dans le développement de la réponse Ac dirigée contre les CPS purifiées de S. suis ou GBS, ni sur l’interaction des CPS avec les DC in vitro, ni sur profil de la réponse in vivo. D’autres propriétés biochimiques intrinsèques à ces CPS seraient responsables de l’inaptitude de l’hôte infecté à monter une réponse Ac adéquate et les identifier constituera un outil précieux pour une meilleure compréhension de l’immunopathogénèse de S. suis et GBS ainsi que pour développer des moyens de lutte efficaces contre ces bactéries.

Biochemical Effect of Dicarboxylic Acids on Oxalate Metabolism in Experimental Rats and Studies on Oxalate Degrading Bacteria

The current study is an attempt to find a means of lowering oxalate concentration in individuals susceptible to recurrent calcium oxalate stone disease.The formation of renal stone composed of calcium oxalate is a complex process that remains poorly understood and treatment of idiopathic recurrent stone formers is quite difficult and this area has attracted lots of research workers. The main objective of this work are to study the effect of certain mono and dicarboxylic acids on calcium oxalate crystal growth in vitro, isolation and characterization of oxalate degrading bacteria, study the biochemical effect of sodium glycollate and dicarboxylic acids on oxalate metabolism in experimental stone forming rats and To investigate the effect of dicarboxylic acids on oxalate metabolism in experimental hyperoxaluric rats. Oxalic acid is one of the most highly oxidized organic compound widely distributed in the diets of man and animals, and ingestion of plants that contain high concentration of oxalate may lead to intoxication. Excessive ingestion of dietary oxalate may lead to hyperoxaluria and calcium oxalate stone disease.The formation of calcium oxalate stone in the urine is dependent on the saturation level of both calcium and oxalate. Thus the management of one or both of these ions in individuals susceptible to urolithiasis appears to be important. The control of endogenous oxalate synthesis from its precursors in hyperoxaluric situation is likely to yield beneficial results and can be a useful approach in the medical management of urinary stones. A variety of compounds have been investigated to curtain endogenous oxalate synthesis which is a crucial factor, most of these compounds have not proved to be effective in the in vivo situation and some of them are not free from the toxic effect. The non-operative management of stone disease has been practiced in ancient India in the three famous indigenous systems of medicine, Ayurveda, Unani and Siddha, and proved to be effective.However the efficiency of most of these substances is still questionable and demands further study. Man as well as other mammals cannot metabolize oxalic acid. Excessive ingestion of oxalic acid can arise from oxalate rich food and from its major metabolic precursors, glycollate, glyoxylate and ascorbic acid can lead to an acute oxalate toxicity. Increasedlevels of circulating oxalate, which can result in a variety of diseases including renal failure and oxalate lithiasis. The ability to enzymatically degrade oxalate to less noxious Isubstances, formate and CO2, could benefit a great number of individuals including those afflicted with hyperoxaluria and calcium oxalate stone disease.

Energy Management in Wireless Sensor Networks: A Crosslayer,Channel Adaptive Approach Towards Performance Optimization

The proliferation of wireless sensor networks in a large spectrum of applications had been spurered by the rapid advances in MEMS(micro-electro mechanical systems )based sensor technology coupled with low power,Low cost digital signal processors and radio frequency circuits.A sensor network is composed of thousands of low cost and portable devices bearing large sensing computing and wireless communication capabilities. This large collection of tiny sensors can form a robust data computing and communication distributed system for automated information gathering and distributed sensing.The main attractive feature is that such a sensor network can be deployed in remote areas.Since the sensor node is battery powered,all the sensor nodes should collaborate together to form a fault tolerant network so as toprovide an efficient utilization of precious network resources like wireless channel,memory and battery capacity.The most crucial constraint is the energy consumption which has become the prime challenge for the design of long lived sensor nodes.

Dielectric properties of certain biological materials at microwave frequencies.

In the medical field, microwaves play a larger role for treatment than diagnosis. For the detection of diseases by microwave methods, it is essential to know the dielectric properties of biological materials. For the present study, a cavity perturbation technique was employed to determine the dielectric properties of these materials. Rectangular cavity resonators were used to measure the complex permittivity of human bile, bile stones, gastric juice and saliva. The measurements were carried out in the S and J bands. It is observed that normal and infected bile have different dielectric constant and loss tangent. Dielectric constant of infected bile and gastric juice varies from patient to patient. Detection and extraction of bile stone with possible method of treatment is also discussed.

Survey of coral lagoons of Laksbadweep Atolls using line intercept transect (LIT) technique

The present study aims at surveying the coral lagoons of four islands viz. Kavarathi, Kalpeni, Kadmat and Agathi, which include quantitative survey of the major benthic forms using Line Intercept Transect (LIT) technique and hydrographical study of these lagoon waters The distribution of PHC in the lagoons has also been followed to understand, the effects of introduction of flat bottomed ferry boats to the islands.From a biological monitoring stand point for the assessment of manmade disturbance of the coral reefs, it IS highly essential to identify faunal assemblages which will contain 'flag-stones' specIes as indicators of such disturbances. Among the known faunal assemblages In coral reefs the most diverse groups of sensitive species belongs to bryozoan assemblage. Therefore, the most common species of bryozoans distributed along the atolls and reef flats were collected and described in this work Along with this, bryozoans associated with coral from other parts of Indian ocean have also been added so as to provide a comprehensive picture of the distribution of bryozoans in the coral reefs.

Ecotoxic Metal Records and its Degree of Geochemical Symphony in the Niche of Cochin Estuarine System- A Theraptic Perspective

The heavy metal contamination in the environment may lead to circumstances like bioaccumulation and inturn biomagnification. Hence cheaper and effective technologies are needed to protect the precious natural resources and biological lives. A suitable technique is the one which meets the technical and environmental criteria for dealing with a particular remediation problem and should be site-specific due to spatial and climatic variations and it may not economically feasible everywhere. The search for newer technologies for the environmental therapy, involving the removal of toxic metals from wastewaters has directed attention to adsorption, based on metal binding capacities of various adsorbent materials. Therefore, the present study aim to identify and evaluate the most current mathematical formulations describing sorption processes. Although vast amount of research has been carried out in the area of metal removal by adsorption process using activated carbon few specific research data are available in different scientific institutions. The present work highlights the seasonal and spatial variations in the distribution of some selected heavy metals among various geochemical phases of Cochin Estuarine system and also looked into an environmental theraptic/remedial approach by adsorption technique using activated charcoal and chitosan, to reduce and thereby controlling metallic pollution. The thesis has been addressed in seven chapters with further subdivisions. The first chapter is introductory, stating the necessity of reducing or preventing water pollution due to the hazardous impact on environment and health of living organisms and drawing it from a careful review of literature relevant to the present study. It provides a constricted description about the study area, geology, and general hydrology and also bears the major objectives and scope of the present study.

“Hydro Geochemical Quality Assessment of Groundwater – A General Perspective”

People in several parts of the world as well in India countenance an immense confront to meet the basic needs of water. The crisis is not due to lack of fresh water but its availability in adequate superiority. Environmental quality objectives should be developed in order to define acceptable loads on the terrain. There has been a number of initiatives in water quality monitoring but the next step towards improving its quality hasn’t taken the required pace. Today, there is a growing need to create awareness among citizens on the different technologies available for improving the water quality. Monitoring facilitate to apprehend how land and water use distress the quality of water and assist in estimating the extent of pollution. Once these issues are recognized, people can work towards local solutions to manage the indispensable resource effectively. Ground waters are extremely precious resources and in many countries together with India they represent the most important drinking water supply. They are generally microbiologically pure and, in most cases, they do not need any treatment. This communiqué is intended to act as a channel on the various paraphernalia and techniques accessible for groundwater quality assessment and suggesting the assured precautionary measures to embark on environment management. This learning is imperative considering that groundwater as the exclusive source of drinking water in the region which not makes situation alarming but also calls for immediate attention. The scope of this work is somewhat vast. Water quality in Ernakulam district is getting deteriorated due to the fast growth of urbanization. The closure of several water bodies due to land development and construction prevents infiltration of rainwater into the ground and hence recharge the aquifers. Most of the aquifers are getting polluted from the industrial effluents and chemicals and fertilizers used in agriculture. Such serious issues require proper monitoring of groundwater and steps are to be taken for remedial measures. This study helps in the total protection of the rich resource of groundwater and its sustainability. Socio-economic aspect covered could be used for conducting further individual case studies and to suggest remedial measures on a scientific basis. The specific study taken up for 15 sites can be further extended to the sources of pollution, especially industrial and agriculture

“Studies on new base materials for microcellular soles"

The most important part of any footwear is the sole (or sole and heel) which withstands all the hannful external factors such as rouglmess of the ground or road, sharp objects, thorns and stones, heat, dampness and cold during walking. The properties desirable in soling material, therefore, would be 1. lightness 2. resistance to wear and tear for long service life 3. flexibility/softness for wearing comfort 4. thennal insulation Rubber soling surpasses all other soling materials in better performance and lower cost. Because MC sole is soft and very light, and has good abrasion resistance, flex properties and set behaviour it has become very popular all over the world and demand for better quality product is ever increasing. Due to the traditional approach adopted by the footwear industry in foot wear design, the rubber based footwear export surprisingly contributes only a small percentage. The essence of success for any industry lies in the expansion of the export market. Microcellular soles are manufactured for the last three decades without much change in the traditional design and colour pattern. In recent years domestic customers have also started demanding better quality products. In view of the changing taste of the customer and growing competition from other countries, substantial improvement in the export potential will require new base materials for regular or fashion rubber based footwears. The main objective of the present study is to develop new base materials for making MC soles with good quality, viz., light weight, durability and bright colours

Channel Adaptive MAC Protocol with Traffic-Aware Distributed Power Management in Wireless Sensor Networks-Some Performance Issues

In Wireless Sensor Networks (WSN), neglecting the effects of varying channel quality can lead to an unnecessary wastage of precious battery resources and in turn can result in the rapid depletion of sensor energy and the partitioning of the network. Fairness is a critical issue when accessing a shared wireless channel and fair scheduling must be employed to provide the proper flow of information in a WSN. In this paper, we develop a channel adaptive MAC protocol with a traffic-aware dynamic power management algorithm for efficient packet scheduling and queuing in a sensor network, with time varying characteristics of the wireless channel also taken into consideration. The proposed protocol calculates a combined weight value based on the channel state and link quality. Then transmission is allowed only for those nodes with weights greater than a minimum quality threshold and nodes attempting to access the wireless medium with a low weight will be allowed to transmit only when their weight becomes high. This results in many poor quality nodes being deprived of transmission for a considerable amount of time. To avoid the buffer overflow and to achieve fairness for the poor quality nodes, we design a Load prediction algorithm. We also design a traffic aware dynamic power management scheme to minimize the energy consumption by continuously turning off the radio interface of all the unnecessary nodes that are not included in the routing path. By Simulation results, we show that our proposed protocol achieves a higher throughput and fairness besides reducing the delay

Photoschaltbare Azobenzol-modifizierte selbstorganisierte Monoschichten auf Gold(111)-Oberflächen

Für die Entwicklung photoschaltbarer selbstorganisierter Monoschichten (SAMs) auf Gold(111)-Oberflächen wurden neue Azobenzol-terminierte Asparagussäure - und Liponsäurederivate synthetisiert. Um den Einfluss lateraler Wasserstoffbrückenbindungen auf Qualität und Orientierungsordnung der Schichten zu untersuchen, wurden Monolagen, die durch amid- und esterverknüpfte Verbindungen gebildet wurden, miteinander verglichen. Die Filmbildung aus der Lösung wurde in situ durch optische Frequenzverdopplung (SHG) untersucht und die Photoreaktivität mittels Kontaktwinkelmessungen, Oberflächen-Plasmonenresonanz (SPR) und Ellipsometrie verfolgt. SAMs auf Gold wurden außerdem mit Hilfe von Röntgenphotoelektronenspektroskopie (XPS), Nahkanten-Reflexions-Röntgenabsorptionsspektroskopie (NEXAFS) und Infrarot-Reflexionsabsorptionsspektroskopie (IRRAS) charakterisiert, um die Filmqualität, die Bindung ans Substrat und Orientierungsordnung im Film zu ermitteln. Da die Chemisorption auf polykristallinem Gold formal der Koordinationschemie von 1,2-Dithiolan-Derivaten gegenüber nullwertigen Edelmetall-Zentralatomen entspricht, wurden etliche Pt-Komplexe durch oxidative Addition an [Pt(PPh3)4] dargestellt. Im Zusammenhang mit der Darstellung der Asparagussäure wurde die Kristallstruktur von [pipH]2[WS4] und der neuen Verbindungen [pipH]3[WS4](HS) und [pipH]4[WS4][WOS3] (pip = Piperidin) bestimmt. Wasserstoffbrückenbindungen zwischen den Piperidinium-Kationen und den Thiowolframat-Anionen spielen eine dominante strukturelle Rolle.

Heat stress response for physiological traits in dairy and dual purpose cattle populations on phenotypic and genetic scales

The main objective of this thesis was to determine the potential impact of heat stress (HS) on physiological traits of lactating cows and semen quality of bulls kept in a temperate climate. The thesis is comprised of three studies. An innovative statistical modeling aspect common to all three studies was the application of random regression methodology (RRM) to study the phenotypic and genetic trajectory of traits in dependency of a continuous temperature humidity index (THI). In the first study, semen quality and quantity traits of 562 Holstein sires kept on an AI station in northwestern Germany were analyzed in the course of THI calculated from data obtained from the nearest weather station. Heat stress was identified based on a decline in semen quality and quantity parameters. The identified general HS threshold (THI = 60) and the thermoneutal zone (THI in the range from 50 to 60) for semen production were lower than detected in studies conducted in tropical and subtropical climates. Even though adult bulls were characterized by higher semen productivity compared to younger bulls, they responded with a stronger semen production loss during harsh environments. Heritabilities (low to moderate range) and additive genetic variances of semen characteristics varied with different levels of THI. Also, based on genetic correlations genotype, by environment interactions were detected. Taken together, these findings suggest the application of specific selection strategies for specific climate conditions. In the second study, the effect of the continuous environmental descriptor THI as measured inside the barns on rectal temperatures (RT), skin temperatures (ST), vaginal temperatures (VT), respiration rates (RR), and pulse rate (PR) of lactating Holstein Friesian (HF) and dual-purpose German black pied cattle (DSN) was analyzed. Increasing HS from THI 65 (threshold) to THI 86 (maximal THI) resulted in an increase of RT by 0.6 °C (DSN) and 1 °C (HF), ST by 3.5 °C (HF) and 8 °C (DSN), VT by 0.3 °C (DSN), and RR by 47 breaths / minute (DSN), and decreased PR by 7 beats / minute (DSN). The undesired effects of rising THI on physiological traits were most pronounced for cows with high levels of milk yield and milk constituents, cows in early days in milk and later parities, and during summer seasons in the year 2014. In the third study of this dissertation, the genetic components of the cow’s physiological responses to HS were investigated. Heat stress was deduced from indoor THI measurements, and physiological traits were recorded on native DSN cows and their genetically upgraded crosses with Holstein Friesian sires in two experimental herds from pasture-based production systems reflecting a harsh environment of the northern part of Germany. Although heritabilities were in a low range (from 0.018 to 0.072), alterations of heritabilities, repeatabilities, and genetic components in the course of THI justify the implementation of genetic evaluations including heat stress components. However, low repeatabilities indicate the necessity of using repeated records for measuring physiological traits in German cattle. Moderate EBV correlations between different trait combinations indicate the potential of selection for one trait to simultaneously improve the other physiological attributes. In conclusion, bulls of AI centers and lactating cows suffer from HS during more extreme weather conditions also in the temperate climate of Northern Germany. Monitoring physiological traits during warm and humid conditions could provide precious information for detection of appropriate times for implementation of cooling systems and changes in feeding and management strategies. Subsequently, the inclusion of these physiological traits with THI specific breeding values into overall breeding goals could contribute to improving cattle adaptability by selecting the optimal animal for extreme hot and humid conditions. Furthermore, the recording of meteorological data in close distance to the cow and visualizing the surface body temperature by infrared thermography techniques might be helpful for recognizing heat tolerance and adaptability in cattle.

Memory Hierarchy Hardware-Software Co-design in Embedded Systems

The memory hierarchy is the main bottleneck in modern computer systems as the gap between the speed of the processor and the memory continues to grow larger. The situation in embedded systems is even worse. The memory hierarchy consumes a large amount of chip area and energy, which are precious resources in embedded systems. Moreover, embedded systems have multiple design objectives such as performance, energy consumption, and area, etc. Customizing the memory hierarchy for specific applications is a very important way to take full advantage of limited resources to maximize the performance. However, the traditional custom memory hierarchy design methodologies are phase-ordered. They separate the application optimization from the memory hierarchy architecture design, which tend to result in local-optimal solutions. In traditional Hardware-Software co-design methodologies, much of the work has focused on utilizing reconfigurable logic to partition the computation. However, utilizing reconfigurable logic to perform the memory hierarchy design is seldom addressed. In this paper, we propose a new framework for designing memory hierarchy for embedded systems. The framework will take advantage of the flexible reconfigurable logic to customize the memory hierarchy for specific applications. It combines the application optimization and memory hierarchy design together to obtain a global-optimal solution. Using the framework, we performed a case study to design a new software-controlled instruction memory that showed promising potential.

El neuromarketing : la llave de la caja de pandora

Actualmente el Marketing a desarrollado conjuntamente con las neurociencia una técnica llamada Neuromarketing, la cual explora el cerebro humano para resolver interrogantes que lleven a las organizaciones a conocer más a profundidad al ser humano, sus gustos, deseos, necesidades y motivadores de compra. Esto implica cuestionarnos sobre los valores éticos y morales que se deben aplicar en la utilización de este tipo de tecnologías, las cuales descubren los secretos más preciados del ser humano y lo hacen vulnerable frente a una sociedad que muchas veces actúa “sin cuartel” en busca de beneficios económicos y materiales, olvidado la integridad, la libertad y el respeto por la figura humana. En esta tesis se recorrerá brevemente tanto el Marketing Moderno como la aplicación del neuromarketing y el alcance que hoy tiene este para poder cuestionar y proponer soluciones frente a la ética y la moral que deben limitar y guiar el buen uso de esta maravillosa herramienta para el Marketing.

Valor diagnostico de la colangioresonancia para la detección de coledocolitiasis en pancreatitis aguda Hospital Mederi-Bogotá

La pancreatitis aguda (PA) es una patología clínica común que abarca un espectro desde leve hasta fatal, donde se produce una inflamación del páncreas por auto digestión enzimática con grado variable de compromiso sistémico. Es una emergencia abdominal grave con una mortalidad del 9-23%. En el 40% de los casos de pancreatitis aguda se encuentra que es de origen biliar. La prevalencia de enfermedad biliar a nivel mundial en adultos varía entre 5,9% y 21,9%, con grandes variaciones geográficas y regionales, se encuentran en el 12% de los hombres y el 24% de las mujeres. La prevalencia aumenta con la edad. Latinoamérica es una región con alta prevalencia. En pacientes con colelitiasis del 5-15 % tienen coledocolitiasis. La alta prevalencia de la patología biliar en nuestro país hace que esta sea una causa frecuente de consulta médica por dolor abdominal. El factor común presente en la gran mayoría de las enfermedades de la vía biliar es la Colelitiasis. La complicación más frecuente, la Coledocolitiasis, se ha reportado con cifras hasta de un 20% y como complicación de esta la pancreatitis. La pancreatitis aguda de origen biliar (PAB) es causada por una obstrucción transitoria o persistente de la ampolla de Váter por barro biliar o por cálculos. En el diagnostico de la PAB se emplean métodos invasivos como la colangiopancreaticografia endoscópica retrograda (CPRE) la cual trae consigo morbilidad y mortalidad asociada y métodos no invasivos como la colangiopancreaticografia magnética (CRM) que emerge como modalidad prometedora en el diagnostico y manejo de la PAB en centros de tercer y cuarto nivel de complejidad. El manejo actual de la PAB es la remoción de la obstrucción del conducto biliar común (CBC) seguida de su tratamiento definitivo, la colecistectomía o CPRE con papilotomia. En nuestro país no se han publicado estudios con datos locales acerca de la utilidad de la CRM para la detección de coledocolitiasis, en las guías de manejo de coledocolitiasis de la asociación colombiana de cirugía publicadas en el año 2004, hace referencia de la utilidad de la CRM para el diagnostico de esta entidad tomando como base una revisión sistemática de estudios publicados en Medline, Pubmed y Cocrane los cuales no incluyen experiencia a nivel nacional. En este estudio pretendimos determinar cuáles son los pacientes que se benefician de la realización de CRM temprana en el marco de la PAB leve para la detección de coledocolitiasis.

Comparación de CPRE temprana y tardia en pacientes con pancreatitis aguda severa de origen biliar

INTRODUCCION: La obstrucción biliar es la principal causa de pancreatitis aguda y su curso es moderado a leve aunque un 20% desarrollan formas severas. La remoción de los cálculos por CPRE se ha empleado como terapéutica aunque su rol es controversial y no se ha demostrado su utilidad en forma temprana. El propósito de este estudio es observar la evolución de los pacientes con PASB en quienes se realice CPRE con respecto al curso de la enfermedad. METODOLOGIA: Estudio retrospectivo observacional descriptivo en pacientes con PASB llevados a CPRE. Entre junio y octubre de 2012 se encontraron 72 pacientes con PASB y patrón biliar obstructivo, 49 (68.06%) en los cuales se realizo de forma temprana (antes de 72 horas) y 23 (31,94 %) de forma tardía (después de las 72 horas). RESULTADOS: No se encontraron diferencias en la morbilidad entre los dos grupos observados. Se encontró una mayor incidencia de PASB en mujeres, no hubo complicaciones asociadas al procedimiento y no hubo mortalidad asociada en ninguno de los grupos. DISCUSION: El estudio no muestra que la realización de CPRE tardía influya de forma desfavorable en los pacientes con PASB. Se encontró mayor incidencia de PASB en mujeres y edad media de 61 años. Deben realizarse mas estudios como el presente con un mayor número de pacientes para demostrar que no hay aumento en la morbimortalidad en los pacientes que sean llevados a CPRE después de 72 horas de inicio de los síntomas y poder generar recomendaciones de manejo locales.