Trasplante de páncreas : proceso asistencial integrado

Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Igualdad, Salud y Políticas Sociales/ Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados).

Plan Andaluz de Cuidados Paliativos, 2008-2012

Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Igualdad, Salud y Políticas Sociales / Ciudadanía / Quiénes somos / Planes y Estrategias)

La primacia de la pràctica en la filosofia de l’últim Wittgenstein

Amb aquest treball ens proposem bàsicament fer una lectura de De la certesa, el veritablement darrer text de Ludvig Wittgenstein atès que les seves últimesentrades van ser escrites tot just dos dies abans de morir. Avui comença a ser acceptada la idea que Wittgenstein no va escriure dues sinó tres obres majors. El relat estàndard que parla de dos Wittgensteins (el del Tractatus i el de les Investigacions) va essent qüestionat o si més no matisat, a mesura que va creixent l’interès pels últims textos de Wittgenstein i en particular pel text que ens ocupa. El nostre treball de recerca serà doncs, una lectura de De la certesa, convençuts com estem de la seva rellevància, tant pel què fa a la comprensióde la pròpia filosofia de Wittgenstein i la seva evolució, com pel què fa a algunes qüestions centrals en el debat de l’epistemologia contemporània. Ensproposem dir alguna cosa sobre l’obra en si mateixa, el seu lloc en el corpuswittgensteinià, i sobre la rellevància dels seus plantejaments en el debat actual al voltant de l’escepticisme i el relativisme

Planificación anticipada de las decisiones : guía de apoyo para los profesionales

Publicado en la web de la Consejería de Igualdad, Salud y Políticas Sociales: Consejería de Salud y Bienestar Social / Profesionales / Nuestro Compromiso por la Calidad / Planificación Anticipada de las Decisiones. Guía de Apoyo para profesionales / Planificación Anticipada de las Decisiones. Guía de Apoyo para profesionales )

Genetic variation in the Cytbgene of human cerebral Taenia soliumcysticerci recovered from clinically and radiologically heterogeneous patients with neurocysticercosis

Neurocysticercosis (NC) is a clinically and radiologically heterogeneous parasitic disease caused by the establishment of larval Taenia solium in the human central nervous system. Host and/or parasite variations may be related to this observed heterogeneity. Genetic differences between pig and human-derived T. solium cysticerci have been reported previously. In this study, 28 cysticerci were surgically removed from 12 human NC patients, the mitochondrial gene that encodes cytochrome b was amplified from the cysticerci and genetic variations that may be related to NC heterogeneity were characterised. Nine different haplotypes (Ht), which were clustered in four haplogroups (Hg), were identified. Hg 3 and 4 exhibited a tendency to associate with age and gender, respectively. However, no significant associations were found between NC heterogeneity and the different T. solium cysticerci Ht or Hg. Parasite variants obtained from patients with similar NC clinical or radiological features were genetically closer than those found in groups of patients with a different NC profile when using the Mantel test. Overall, this study establishes the presence of genetic differences in the Cytb gene of T. solium isolated from human cysticerci and suggests that parasite variation could contribute to NC heterogeneity.

Age-Related Macular Degeneration: Clinical Findings following Treatment with Antiangiogenic Drugs.

Purpose. To survey the management of patients with neovascular age-related macular degeneration (nvAMD) in Spain. Methods. An observational retrospective multicenter study was conducted. The variables analyzed were sociodemographic characteristics, foveal and macular thickness, visual acuity (VA), type of treatment, number of injections, and the initial administration of a loading dose of an antiangiogenic drug. Results. 208 patients were followed up during 23.4 months in average. During the first and second years, patients received a mean of 4.5 ± 1.8 and 1.6 ± 2.1 injections of antiangiogenic drugs, and 5.4 ± 2.8 and 3.6 ± 2.2 follow-up visits were performed, respectively. The highest improvement in VA was observed at 3 months of follow-up, followed by a decrease in the response that stabilized above baseline values until the end of the study. Patients who received an initial loading dose presented greater VA gains than those without. Conclusions. Our results suggest the need for a more standardized approach in the management and diagnosis of nvAMD receiving VEGF inhibitors. To achieve the visual outcomes reported in pivotal trials, an early diagnosis, proactive approach (more treating than follow-up visits), and a close monitoring might be the key to successfully manage nvAMD.

Cortisol salival como indicador de estrés fisiológico en niños y adultos; revisión sistemática.

Salivary cortisol is a steroid hormone that is produced in the hypothalamic-pituitary-adrenal axis and secreted into saliva when persons are under stress. High levels of cortisol in saliva can be produced by many different factors, including obesity and certain psychological disorders. The articles selected for inclusion in this review were identified using Google Scholar and Medline, and this search obtained a total of 57 items. The validity of these studies was established according to the degree of evidence presented, by citations and by their applicability to the healthcare context in Spain. Specifically, this review takes into consideration studies of salivary cortisol and stress in children and adults, and those examining the relation between high levels of salivary cortisol and other disorders such as anxiety, attention-deficit/hyperactivity disorder, social phobia or emotional deprivation. These studies show that salivary cortisol is a clear indicator of stress in both children and adults. High levels of this hormone in saliva are associated with the following main consequences: reduced immune function, affecting healing and thus prolonging recovery time; delayed growth in children; increased blood pressure and heart rate in both children and adults.

A delphi study to detect deficiencies and propose actions in real life treatment of neovascular age-related macular degeneration.

Purpose. Spanish retina specialists were surveyed in order to propose actions to decrease deficiencies in real-life neovascular age macular degeneration treatment (nv-AMD). Methods. One hundred experts, members of the Spanish Vitreoretinal Society (SERV), were invited to complete an online survey of 52 statements about nv-AMD management with a modified Delphi methodology. Four rounds were performed using a 5-point Linkert scale. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations. Results. Eighty-seven specialists completed all the Delphi rounds. Once major potential deficiencies in real-life nv-AMD treatment were identified, 15 recommendations were developed with a high level of agreement. Consensus statements to reduce the burden of the disease included the use of treat and extend regimen and to reduce the amount of diagnostic tests during the loading phase and training technical staff to perform these tests and reduce the time between relapse detection and reinjection, as well as establishing patient referral protocols to outside general ophthalmology clinics. Conclusion. The level of agreement with the final recommendations for nv-AMD treatment among Spanish retinal specialist was high indicating that some actions could be applied in order to reduce the deficiencies in real-life nv-AMD treatment.

Gene duplication, population genomics, and species-level differentiation within a tropical mountain shrub.

Gene duplication leads to paralogy, which complicates the de novo assembly of genotyping-by-sequencing (GBS) data. The issue of paralogous genes is exacerbated in plants, because they are particularly prone to gene duplication events. Paralogs are normally filtered from GBS data before undertaking population genomics or phylogenetic analyses. However, gene duplication plays an important role in the functional diversification of genes and it can also lead to the formation of postzygotic barriers. Using populations and closely related species of a tropical mountain shrub, we examine 1) the genomic differentiation produced by putative orthologs, and 2) the distribution of recent gene duplication among lineages and geography. We find high differentiation among populations from isolated mountain peaks and species-level differentiation within what is morphologically described as a single species. The inferred distribution of paralogs among populations is congruent with taxonomy and shows that GBS could be used to examine recent gene duplication as a source of genomic differentiation of nonmodel species.

Estimation of the viscoelastic properties of vessel walls using a computational model and Doppler ultrasound

Human arteries affected by atherosclerosis are characterized by altered wall viscoelastic properties. The possibility of noninvasively assessing arterial viscoelasticity in vivo would significantly contribute to the early diagnosis and prevention of this disease. This paper presents a noniterative technique to estimate the viscoelastic parameters of a vascular wall Zener model. The approach requires the simultaneous measurement of flow variations and wall displacements, which can be provided by suitable ultrasound Doppler instruments. Viscoelastic parameters are estimated by fitting the theoretical constitutive equations to the experimental measurements using an ARMA parameter approach. The accuracy and sensitivity of the proposed method are tested using reference data generated by numerical simulations of arterial pulsation in which the physiological conditions and the viscoelastic parameters of the model can be suitably varied. The estimated values quantitatively agree with the reference values, showing that the only parameter affected by changing the physiological conditions is viscosity, whose relative error was about 27% even when a poor signal-to-noise ratio is simulated. Finally, the feasibility of the method is illustrated through three measurements made at different flow regimes on a cylindrical vessel phantom, yielding a parameter mean estimation error of 25%.

A note on the convergence to competitive equilibria in economies with moral hazard

We examine the conditions under which competitive equilibria can beobtained as the limit, when the number of strategic traders getslarge, of Nash equilibria in economies with asymmetric informationon agents' effort and possibly imperfect observability of agents'trades. Convergence always occur when either effort is publiclyobserved (no matter what is the information available tointermediaries on agents' trades); or effort is private informationbut agents' trades are perfectly observed; or no information at allis available on agents' trades. On the other hand, when eachintermediary can observe its trades with an agent, but not theagent's trades with other intermediaries, the (Nash) equilibriawith strategic intermediaries do not converge to any of thecompetitive equilibria, for an open set of economies. The source ofthe difficulties for convergence is the combination of asymmetricinformation and the restrictions on the observability of tradeswhich prevent the formation of exclusive contractual relationshipsand generate barriers to entry in the markets for contracts.

Aspectos reproductivos del pulpo (Octopus mimus) en el área de Callao

Brinda información sobre los resultados de la estimación de la talla media de primera madurez y desove, así como la determinación del ciclo reproductivo del pulpo Octopus mimus. Los datos utilizados corresponden a muestreos de la pesquería artesanal en el área del Callao entre enero 1998 y enero 1999.

Crucero de investigación del calamar gigante BIC SNP-2 9903-04, 23 marzo al 12 abril 1999

Presenta los resultados del crucero de Investigación del calamar gigante, realizado a bordo del BIC SNP-2, del 23 de marzo al 12 de abril de 1999, de Puerto Pizarro al Callao, con el objeto de recopilar información actualizada sobre el estado biológico poblacional del recurso y las condiciones oceanográficas en el área y período de estudio.

Aspectos biológico - Pesqueros del “calamar común”, Loligo gahi d’Orbigny, 1835 en el área del Callao durante 1996 y 1997

El Calamar común, Loligo gahi (Cephalopoda: Loliginidae) es una especie comercialmente importante en la pesquería artesanal de la costa peruana. Este estudio tiene como objetivo determinar aspectos biológicos de esta especie y su relación con la estacionalidad de la pesquería. Los especímenes se obtuvieron a partir de los desembarques de la pesquería artesanal del puerto de Callao en 1996-1997. Fue hallada la estructura de tallas de los individuos muestreados y su relación longitud - peso. La variación de diferentes índices reproductivos durante 1996 y 1997 se analizaron a fin de determinar el pico de desove. La estimación de la edad se hizo usando tanto datos de frecuencia de tallas, de este mismo período, como del conteo de anillos de crecimiento en estatolitos. Se detallan los aspectos mas significantes de la pesquería artesanal de L. gahi en Callao y se presenta la variación del CPUE en 1996. Los resultados sugieren que el ciclo de vida de L. gahi es parecido al que se describió en las Islas Malvinas (Falkland). El pico de desove se determinó en la primavera, con picos secundarios en el otoño e invierno. El modelo de crecimiento que mejor se ajusta a los datos es una función potencial y el tiempo de vida es aproximadamente de un año. Las fechas de eclosión fueron retrocalculadas en los meses de primavera, verano y otoño. La variación del Indice Gonadosomático (IGS) observada durante 1996 mostró los mismos picos pero uno o dos meses antes.