Características clínicas y sociodemográficas de pacientes colombianos con Síndrome de Sjögren solo y asociado a otras enfermedades autoinmunes

Introducción: Dado que una de las principales comorbilidades asociadas al síndrome de Sjögren es la presencia de otra enfermedad autoinmune, el objetivo de este estudio fue investigar la frecuencia de poliautoinmunidad en pacientes con síndrome de Sjögren y evaluar sus factores asociados. Métodos: Este fue un estudio de corte transversal en el que 410 pacientes con síndrome de Sjögren (por criterios del Consenso Americano-Europeo, incluyendo biopsia positiva) fueron sistemáticamente incluidos e investigados para la presencia de otra enfermedad autoinmune. Los datos recogidos fueron evaluados mediante análisis de regresión logística y el índice de Rogers y Tanimoto para evaluar factores asociados y agrupamiento. Resultados: Hubo 134 (32.6%) de pacientes con síndrome de Sjögren y otra enfermedad autoinmune. La enfermedad tiroidea autoinmune, artritis reumatoide, lupus eritematosos sistémico y enfermedad inflamatoria intestinal fueron observados en un 21.5%, 8.3%, 7.6% y 0.7% respectivamente. Hubo 35 (8.5%) pacientes con síndrome autoinmune múltiple. El hábito de fumar, historia previa de abortos, positividad de los anticuerpos antinucleares (ANAS) y una mayor duración de la enfermedad fueron los factores de riesgo más fuertes para el desarrollo de poliautoinmunidad. Discusión: Este estudio da a conocer la alta prevalencia de poliautoinmunidad en una población bien definida de pacientes con síndrome de Sjögren, los factores asociados para el desarrollo de esta complicación y su patrón de agrupamiento. Estos resultados pueden servir para definir enfoques plausibles para estudiar los mecanismos comunes de las enfermedades autoinmunes.

Aislamiento de venas pulmonares en el Centro Internacional de Arritmias ‘Andrea Natale’ - Fundación Cardio infantil

Introducción: El Aislamiento de Venas Pulmonares (AVP) es un procedimiento de alto costo al cual son sometidos pacientes con riesgo cardiovascular elevado. Requiere un alto grado de especialización en el personal médico y paramédico que lo ejecuta, con curvas de aprendizaje que sobrepasan los dos años de formación académica y entrenamiento específico. Metodología: Se realizó un estudio de cohorte retrospectivo, donde se incluyeron 88 sujetos sometidos al procedimiento en el lapso comprendido entre el 1º de enero y el 31 de diciembre de 2013, con el objetivo de evaluar su proceso de atención en el Centro Internacional de Arritmias ‘Andrea Natale’ de la FCI – Instituto de Cardiología. Se realizó análisis de regresión lineal y logística múltiple. Resultados: Se encontró que en el 97,73%% de los pacientes el diagnóstico principal era algún tipo de Fibrilación Auricular (FA); a su vez, la comorbilidad más frecuente fue HTA en el 30,68% y ningún paciente presentaba enfermedad coronaria, no hubo diferencias significativas por sexo. La complicación peri operatoria tuvo una incidencia del 3,41%, el 22,73% requirió ingreso a UCI con un promedio de días estancia 0,25+0,51. El 98,86% de la población estudiada recibió educación pos procedimiento acerca de sus cuidados y signos de alarma. Los factores encontrados en el estudio que afectan la duración del procedimiento y la estancia hospitalaria son las interconsultas pre procedimiento, el manejo médico de la cardiomiopatía de base y el uso de anti agregantes plaquetarios pre procedimiento; los cuales, son puntos por mejorar previo al ingreso o programación del paciente para ser llevado a AVP. Discusión: Como recomendaciones específicas se destacan: La necesidad de incluir en el protocolo de preparación para ablación de venas pulmonares la realización de interconsultas a las especialidades requeridas, antes de su ingreso para la realización del procedimiento. Es importante que el paciente que lo amerite haga parte de un programa de falla cardiaca previamente al procedimiento

Factores pronósticos al desarrollo de mutaciones relacionadas con resistencia antiretroviral secundaria en pacientes colombianos viviendo con VIH

Las mutaciones secundarias de resistencia al manejo antiretroviral es una realidad, y determina el éxito o fracaso del manejo del VIH. En Colombia, los casos de resistencia asociadas a mutaciones han aumentado. Para determinar esta condición en nuestra población, se realiza un estudio de tipo casos y controles, en pacientes VIH manejados en una IPS especializada en manejo y seguimiento de la enfermedad. Toman 71 pacientes con fracaso terapéutico por resistencia antiretroviral, y se documentaron las mutaciones confirmadas con Genotipo, pacientes que han manejado los diferentes esquemas antirretrovirales, y se comparan con pacientes controles que no desarrollaron resistencia a pesar de haber recibido un manejo antiretroviral similar e iniciado al mismo tiempo. Se busca evidenciar factores predictivos para controlar presencia de estas mutaciones a futuro. El estudio encontró que en ambos grupos, no existen diferencias significativas en cuanto a género, preferencia sexual, uso de psicoactivos, nivel social y las etapas de la enfermedad clasificadas según CDC. Observando que los pacientes con resistencia al tratamiento, eran más jóvenes que los controles (OR: 0,891; p> 0,001), y con una menor carga viral al momento del diagnóstico. La adecuada adherencia al tratamiento, se mostró como un factor protector al desarrollo de resistencia (OR: 0,030, p< 0,000). Se evidencia que existe mayor riesgo de generación de mutaciones en pacientes jóvenes. Respecto a los tipos de mutaciones evidenciadas por genotipos, se describen múltiples mutaciones, observando mutaciones para inhibidores de la transcriptasa reversa nucleosidos (33 mutaciones) y no nucleosidos (32 mutaciones), principalmente M184V en INTR (81%) y K103N en INNTR (40%), mutaciones para inhibidores de proteasa (57 mutaciones), principalmente L24I (40%); esta prevalencia de mutaciones son similares a estudios realizados y descritos en la literatura médica (1)

Factores asociados a infección de fracturas abiertas de extremidades por accidentes de tránsito. Bogotá, 2012-2013

Los traumatismos por accidentes de tránsito, constituyen un problema de salud pública, a nivel mundial. Las lesiones más frecuentes son las fracturas de extremidades (84.3%). Las fracturas tienen un elevado riesgo de presentar infecciones, secuelas e incapacidades permanentes. Objetivo : Determinar si los factores asociados con la patología (lugar de fractura, clasificación de fractura, comorbilidades del paciente) y/o los factores relacionados con la atención médica (uso de profilaxis antibiótica diferente al protocolo institucional, tiempo prolongado para remisión, demoras en manejo quirúrgico) se asocian a mayor probabilidad de presentar infección de fracturas abiertas, en población mayor a 15 años, atendidos por accidente de tránsito, en una clínica de Bogotá de tercer nivel especializada en atención de SOAT, durante el período Octubre de 2012 a Octubre de 2013. Metodología: Estudio de casos y controles no apareado, relación 1:3, conformado por 43 casos (fracturas abiertas infectadas) y 129 controles (fracturas abiertas no infectadas). Resultados: La edad media de los casos fue de 39.42 +/- 16.82 años (med=36 años) y la edad media de los controles fue de 33.15 +/- 11.78 años (med=30 años). El 83.7% de los casos y el 78.3% de los controles corresponden al sexo masculino. Predominaron los accidentes en motocicleta en el 81.4% de los casos y el 86% de los controles. En el análisis bivariado se encuentra que la edad mayor a 50 años (p=0.042), una clasificación de la fractura grado IIIB o IIIC (p=0.02), cumplimiento del protocolo antibiótico institucional según el grado de fractura (p=0.014) y un tiempo mayor a 24 horas desde el momento del accidente al centro especializado en trauma (p=0.035) se asociaron significativamente con infección de la fractura abierta. En el análisis multivariado se encuentra únicamente que la clasificación de la fractura grado IIIB o IIIC se asocia con infección de la fractura OR 2.6 IC95% (1.187 – 5.781) (p=0.017). La duración de hospitalización fue mayor en los casos (32.37+/- 22.92 días, med=26 días) que en los controles (8.81 +/- 7.52 días, med=6 días) (p<0.001). El promedio de lavados quirúrgicos fue mayor en los casos (4.85±4.1, med=4.0) que en el grupo control (1.94±1.26, med=2) (p<0.001). Conclusiones: La infección posterior a una fractura abierta, implica costos elevados de atención con hospitalizaciones prolongadas y mayor frecuencia de intervenciones quirúrgicas como se evidencia en el presente estudio. Se debe fortalecer el sistema de remisión y contra remisión para acortar los tiempos de inicio de manejo especializado de los pacientes con fracturas abiertas. Se debe incentivar dentro de las instituciones, el cumplimiento de protocolos de profilaxis antibiótica según el grado de la fractura para disminuir el riesgo de complicación infecciosa.

Emotion recognition in multiple sclerosis

The effect of multiple sclerosis (MS) on the ability to identify emotional expressions in faces was investigated, and possible associations with patients’ characteristics were explored. 56 non-demented MS patients and 56 healthy subjects (HS) with similar demographic characteristics performed an emotion recognition task (ERT), the Benton Facial Recognition Test (BFRT), and answered the Hospital Anxiety and Depression Scale (HADS). Additionally, MS patients underwent a neurological examination and a comprehensive neuropsychological evaluation. The ERT consisted of 42 pictures of faces (depicting anger, disgust, fear, happiness, sadness, surprise and neutral expressions) from the NimStim set. An iViewX high-speed eye tracker was used to record eye movements during ERT. The fixation times were calculated for two regions of interest (i.e., eyes and rest of the face). No significant differences were found between MS and HC on ERT’s behavioral and oculomotor measures. Bivariate and multiple regression analyses revealed significant associations between ERT’s behavioral performance and demographic, clinical, psychopathological, and cognitive measures.

As Perceções de Justiça Organizacional no Sistema de Recompensas e a sua Influência na Satisfação no Trabalho : Estudo de Caso INATEL

Em face das transformações impostas pela globalização da economia as organizações necessitam de se adaptar às novas exigências para se tornarem mais competitivas e consequentemente devem procurar um melhor relacionamento com os seus colaboradores, de forma a aumentar os seus níveis de satisfação no trabalho. Neste sentido, o presente estudo tem como objetivo determinar quais as dimensões de justiça organizacional que, num contexto do sistema de recompensas, são identificadas pelos trabalhadores e qual a sua influência na satisfação no trabalho. Para o efeito foi efetuada uma revisão de literatura sobre as temáticas em estudo, que permitiu a elaboração dos instrumentos de medida das diferentes dimensões de justiça organizacional, bem como da satisfação do trabalho. Para esta última temática foi utilizado um instrumento de medida sobejamente testado: o Job Satisfaction Survey de Spector (1985). Deste modo, nesta investigação foi aplicada uma metodologia descritiva quantitativa através de um questionário que integra as duas temáticas anteriormente referidas (justiça organizacional e satisfação no trabalho), que foi aplicado a cento e trinta e nove colaboradores na Sede da Fundação INATEL. Da análise dos coeficientes de regressão múltipla obtidos para as três dimensões de justiça organizacional (distributiva, procedimental e interaccional) verifica-se que a justiça distributiva revelou ser o preditor significativo da satisfação no trabalho. Já no que se refere às dimensões de justiça procedimental e justiça interaccional os resultados obtidos permitem concluir que estas dimensões não têm influência sobre a satisfação no trabalho.

Including a time-of-year effect in the analysis of a matched case-control study

Motivated by a matched case-control study to investigate potential risk factors for meningococcal disease amongst adolescents, we consider the analysis of matched case-control studies where disease incidence, and possibly other risk factors, vary with time of year. For the cases, the time of infection may be recorded. For controls, however, the recorded time is simply the time of data collection, which is shortly after the time of infection for the matched case, and so depends on the latter. We show that the effect of risk factors and interactions may be adjusted for the time of year effect in a standard conditional logistic regression analysis without introducing any bias. We also show that, if the time delay between data collection for cases and controls is constant, provided this delay is not very short, estimates of the time of year effect are approximately unbiased. In the case that the length of the delay varies over time, the estimate of the time of year effect is biased. We obtain an approximate expression for the degree of bias in this case. Copyright © 2004 John Wiley & Sons, Ltd.

Influence-matrix diagnostic of a data assimilation system

The influence matrix is used in ordinary least-squares applications for monitoring statistical multiple-regression analyses. Concepts related to the influence matrix provide diagnostics on the influence of individual data on the analysis - the analysis change that would occur by leaving one observation out, and the effective information content (degrees of freedom for signal) in any sub-set of the analysed data. In this paper, the corresponding concepts have been derived in the context of linear statistical data assimilation in numerical weather prediction. An approximate method to compute the diagonal elements of the influence matrix (the self-sensitivities) has been developed for a large-dimension variational data assimilation system (the four-dimensional variational system of the European Centre for Medium-Range Weather Forecasts). Results show that, in the boreal spring 2003 operational system, 15% of the global influence is due to the assimilated observations in any one analysis, and the complementary 85% is the influence of the prior (background) information, a short-range forecast containing information from earlier assimilated observations. About 25% of the observational information is currently provided by surface-based observing systems, and 75% by satellite systems. Low-influence data points usually occur in data-rich areas, while high-influence data points are in data-sparse areas or in dynamically active regions. Background-error correlations also play an important role: high correlation diminishes the observation influence and amplifies the importance of the surrounding real and pseudo observations (prior information in observation space). Incorrect specifications of background and observation-error covariance matrices can be identified, interpreted and better understood by the use of influence-matrix diagnostics for the variety of observation types and observed variables used in the data assimilation system. Copyright © 2004 Royal Meteorological Society

Bryophyte diversity and community structure on thatched roofs of the Holnicote Estate, Somerset, U.K.

We investigated patterns of bryophyte species richness and community structure, and their relation to roof variables, on thatched roofs of the Holnicote Estate, South Somerset. Thirty-two bryophyte species were recorded from 28 sampled roofs, including the globally rare and endangered thatch moss, Leptodontium gemmascens. Multiple regression analyses revealed that thatch age has a highly significant positive effect on the number of species present, accounting for nearly half the observed variation in species richness after removal of outliers. Aspect has a slight and marginally significant effect on species diversity (accounting for an additional 6% of variation), with north-facing samples having slightly more species. Age also has a significant impact on total bryophyte cover after removal of outlying observations. TWINSPAN analysis of bryophyte cover data suggests the existence of at least five discrete communities. Simple Discriminant Analyses indicate that these communities occupy different ecological subspaces as defined by the measured roof variables, with pitch, aspect and thatch age emerging as especially significant attributes. Contingency Analysis indicates that some communities are disfavoured by water reed as compared to wheat straw. The findings are significant for understanding the structure of bryophyte communities, for evaluating the effect of bryophyte cover on thatch performance, and for conservation of thatch communities, especially those harbouring rare species.

European CMBS pricing: bond, mortgage and real estate characteristics

The recent global economic crisis is often associated with the development and pricing of mortgage-backed securities (i.e. MBSs) and underlying products (i.e. sub-prime mortgages). This work uses a rich database of MBS issues and represents the first attempt to price commercial MBSs (i.e. CMBSs) in the European market. Our results are consistent with research carried out in the US market and we find that bond-, mortgage-, real estate-related and multinational characteristics show different degrees of significance in explaining European CMBS spreads at issuance. Multiple linear regression analysis using a databank of CMBSs issued between 1997 and 2007 indicates a strong relationship with bond-related factors, followed by real estate and mortgage market conditions. We also find that multinational factors are significant, with country of issuance, collateral location and access to more liquid markets all being important in explaining the cost of secured funding for real estate companies. As floater coupon tranches tend to be riskier and exhibit higher spreads, we also estimate a model using this sub-set of data and results hold, hence reinforcing our findings. Finally, we estimate our model for both tranches A and B and find that real estate factors become relatively more important for the riskier investment products.

The effect of nonlinearity in CO2 heating rates on the attribution of stratospheric ozone and temperature changes

An analysis of the attribution of past and future changes in stratospheric ozone and temperature to anthropogenic forcings is presented. The analysis is an extension of the study of Shepherd and Jonsson (2008) who analyzed chemistry-climate simulations from the Canadian Middle Atmosphere Model (CMAM) and attributed both past and future changes to changes in the external forcings, i.e. the abundances of ozone-depleting substances (ODS) and well-mixed greenhouse gases. The current study is based on a new CMAM dataset and includes two important changes. First, we account for the nonlinear radiative response to changes in CO2. It is shown that over centennial time scales the radiative response in the upper stratosphere to CO2 changes is significantly nonlinear and that failure to account for this effect leads to a significant error in the attribution. To our knowledge this nonlinearity has not been considered before in attribution analysis, including multiple linear regression studies. For the regression analysis presented here the nonlinearity was taken into account by using CO2 heating rate, rather than CO2 abundance, as the explanatory variable. This approach yields considerable corrections to the results of the previous study and can be recommended to other researchers. Second, an error in the way the CO2 forcing changes are implemented in the CMAM was corrected, which significantly affects the results for the recent past. As the radiation scheme, based on Fomichev et al. (1998), is used in several other models we provide some description of the problem and how it was fixed.

Ozone database in support of CMIP5 simulations: results and corresponding radiative forcing

A continuous tropospheric and stratospheric vertically resolved ozone time series, from 1850 to 2099, has been generated to be used as forcing in global climate models that do not include interactive chemistry. A multiple linear regression analysis of SAGE I+II satellite observations and polar ozonesonde measurements is used for the stratospheric zonal mean dataset during the well-observed period from 1979 to 2009. In addition to terms describing the mean annual cycle, the regression includes terms representing equivalent effective stratospheric chlorine (EESC) and the 11-yr solar cycle variability. The EESC regression fit coefficients, together with pre-1979 EESC values, are used to extrapolate the stratospheric ozone time series backward to 1850. While a similar procedure could be used to extrapolate into the future, coupled chemistry climate model (CCM) simulations indicate that future stratospheric ozone abundances are likely to be significantly affected by climate change, and capturing such effects through a regression model approach is not feasible. Therefore, the stratospheric ozone dataset is extended into the future (merged in 2009) with multimodel mean projections from 13 CCMs that performed a simulation until 2099 under the SRES (Special Report on Emission Scenarios) A1B greenhouse gas scenario and the A1 adjusted halogen scenario in the second round of the Chemistry-Climate Model Validation (CCMVal-2) Activity. The stratospheric zonal mean ozone time series is merged with a three-dimensional tropospheric data set extracted from simulations of the past by two CCMs (CAM3.5 and GISSPUCCINI)and of the future by one CCM (CAM3.5). The future tropospheric ozone time series continues the historical CAM3.5 simulation until 2099 following the four different Representative Concentration Pathways (RCPs). Generally good agreement is found between the historical segment of the ozone database and satellite observations, although it should be noted that total column ozone is overestimated in the southern polar latitudes during spring and tropospheric column ozone is slightly underestimated. Vertical profiles of tropospheric ozone are broadly consistent with ozonesondes and in-situ measurements, with some deviations in regions of biomass burning. The tropospheric ozone radiative forcing (RF) from the 1850s to the 2000s is 0.23Wm−2, lower than previous results. The lower value is mainly due to (i) a smaller increase in biomass burning emissions; (ii) a larger influence of stratospheric ozone depletion on upper tropospheric ozone at high southern latitudes; and possibly (iii) a larger influence of clouds (which act to reduce the net forcing) compared to previous radiative forcing calculations. Over the same period, decreases in stratospheric ozone, mainly at high latitudes, produce a RF of −0.08Wm−2, which is more negative than the central Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report (AR4) value of −0.05Wm−2, but which is within the stated range of −0.15 to +0.05Wm−2. The more negative value is explained by the fact that the regression model simulates significant ozone depletion prior to 1979, in line with the increase in EESC and as confirmed by CCMs, while the AR4 assumed no change in stratospheric RF prior to 1979. A negative RF of similar magnitude persists into the future, although its location shifts from high latitudes to the tropics. This shift is due to increases in polar stratospheric ozone, but decreases in tropical lower stratospheric ozone, related to a strengthening of the Brewer-Dobson circulation, particularly through the latter half of the 21st century. Differences in trends in tropospheric ozone among the four RCPs are mainly driven by different methane concentrations, resulting in a range of tropospheric ozone RFs between 0.4 and 0.1Wm−2 by 2100. The ozone dataset described here has been released for the Coupled Model Intercomparison Project (CMIP5) model simulations in netCDF Climate and Forecast (CF) Metadata Convention at the PCMDI website (http://cmip-pcmdi.llnl.gov/).

Influence of dietary protein intake and glycemic index on the association between TCF7L2 HapA and weight gain

BACKGROUND: Genetic polymorphisms of transcription factor 7-like 2 (TCF7L2) have been associated with type 2 diabetes and BMI. OBJECTIVE: The objective was to investigate whether TCF7L2 HapA is associated with weight development and whether such an association is modulated by protein intake or by the glycemic index (GI). DESIGN: The investigation was based on prospective data from 5 cohort studies nested within the European Prospective Investigation into Cancer and Nutrition. Weight change was followed up for a mean (±SD) of 6.8 ± 2.5 y. TCF7L2 rs7903146 and rs10885406 were successfully genotyped in 11,069 individuals and used to derive HapA. Multiple logistic and linear regression analysis was applied to test for the main effect of HapA and its interaction with dietary protein or GI. Analyses from the cohorts were combined by random-effects meta-analysis. RESULTS: HapA was associated neither with baseline BMI (0.03 ± 0.07 BMI units per allele; P = 0.6) nor with annual weight change (8.8 ± 11.7 g/y per allele; P = 0.5). However, a previously shown positive association between intake of protein, particularly of animal origin, and subsequent weight change in this population proved to be attenuated by TCF7L2 HapA (P-interaction = 0.01). We showed that weight gain becomes independent of protein intake with an increasing number of HapA alleles. Substitution of protein with either fat or carbohydrates showed the same effects. No interaction with GI was observed. CONCLUSION: TCF7L2 HapA attenuates the positive association between animal protein intake and long-term body weight change in middle-aged Europeans but does not interact with the GI of the diet.

Absence of Association of Metabolic Syndrome with PPARGC1A, PPARG and UCP1 Gene Polymorphisms in Asian Indians

The objective of this study was to evaluate the association of PPARG coactivator1 alpha (PPARGC1A), peroxisome proliferator activated receptor gamma (PPARG), and uncoupling protein1 (UCP1) gene polymorphisms with the metabolic syndrome (MS) in an Asian Indian population. Nine common polymorphisms were genotyped via polymerase chain reaction restriction fragment length polymorphism and direct sequencing in 950 normal glucose-tolerant subjects and 550 type 2 diabetic subjects, chosen randomly from the Chennai Urban Rural Epidemiological Study, an ongoing population based study in Southern India. Among the 9 polymorphisms examined, only the Thr394Thr variant of the PPARGC1A gene was significantly associated with diabetes and obesity. The genotype frequency of GA of Thr394Thr variant was 16% (138/887) in the nonMS group and 22% (136/613) in the MS group, and this genotype frequency was significantly higher with MS both in males (p = 0.01) and females (p = 0.05), compared to the without-MS group. Logistic regression analysis revealed that the odds ratio for MS for the susceptible genotype GA of Thr394Thr was 1.411 [95% CI: 1.03-1.84, p = 0.012]. In the multiple logistic regression analysis, however, there was no association of this polymorphism as an independent factor with MS. Hence, the study shows that the polymorphisms in the PPARGC1A, PPARG and UCP1 genes are not associated with MS in Asian Indians.

Medieval foreign exchange: a time series analysis

This chapter applies rigorous statistical analysis to existing datasets of medieval exchange rates quoted in merchants’ letters sent from Barcelona, Bruges and Venice between 1380 and 1310, which survive in the archive of Francesco di Marco Datini of Prato. First, it tests the exchange rates for stationarity. Second, it uses regression analysis to examine the seasonality of exchange rates at the three financial centres and compares them against contemporary descriptions by the merchant Giovanni di Antonio da Uzzano. Third, it tests for structural breaks in the exchange rate series.