Evaluación de intervención de alertas para riesgo cardiovascular por diclofenaco en afiliados al régimen contributivo 2014 -2015

El objetivo fue evaluar la intervención de las alertas en la prescripción de diclofenaco. Estudio observacional, comparativo, post intervención, de un antes después, en pacientes con prescripción de diclofenaco. Se evaluó la intervención de las alertas restrictivas antes y después de su implementación en los pacientes prescritos con diclofenaco y que tenían asociado un diagnóstico de riesgo cardiovascular según CIE 10 o eran mayores de 65 años. Un total de 315.135 transacciones con prescripción de diclofenaco, en 49.355 pacientes promedio mes. El 94,8% (298.674) de las transacciones fueron prescritas por médicos generales.

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

Resonancia magnética cardiaca: medidas lineales y volumétricas en adultos sanos

Introducción: La gran mayoría de las medidas de normalidad utilizadas para la interpretación de resonancia cardiaca son extrapoladas de las medidas de ecocardiografía. Los limitados registros de medidas de normalidad se encuentran ajustados en poblaciones extranjeras, no hay registros en latinoamericanos. Objetivo: Determinar las dimensiones cardiacas utilizando resonancia magnética en una población de personas sin antecedente médicos con repercusión cardiaca para lograr una muestra de valores que permitan ajustar las medidas de normalidad utilizadas por nuestro servicio. Materiales y métodos: se analizaron 45 sujetos sanos con edad comprendida entre los 21 y 45 años, las adquisiciones se realizaron utilizando un equipo de RM de 1,5 teslas, el análisis de las imágenes se realizó mediante el programa Cardiac Volume Vx. Se evaluaron múltiples parámetros morfofuncionales a través de análisis estadístico por medio del sistema SPSS versión 23. Resultados: Mediciones obtenidas de ventrículo izquierdo principales fueron volumen diastólico en mujeres de 62 ml +/- 7.1 y en hombres de 65 ml +/- 11.2 y fracción de eyección de 60 % +/- 5 en mujeres y de 62 % +/- 9 en hombres. En ventrículo derecho el volumen diastólico final se encontró 81.8 ml +/- 14.6 en mujeres y 100 ml +/- 24.8 en hombres y fracción de eyección de 53 % +/- 17 en mujeres y de 45 % +/- 12 en hombres. Volumen de fin de diástole de 50 +/- 12.7 ml en mujeres y de 49 ml +/- 19 ml en hombres y fracción de eyección de aurícula izquierda de 55 % +/- 0.08 en mujeres y de 50 % +/- 0.07 en hombres. Volumen de fin de diástole de 44.1 ml +/- 18.5 en mujeres y de 49.2 ml +/- 22.9 en hombres y fracción de eyección de aurícula derecha de 50 % +/- 11 en mujeres y de 45 % +/- 8 en hombres. Se obtuvieron otras medidas lineales y volumétricas adicionales de cavidades cardiacas y de grandes vasos supracardiacos. Conclusiones: se describen los valores de referencia de los parámetros morfofuncionales de las cavidades cardiacas y de vasos supracardiacos. El sexo fue tenido en cuenta como covariable relacionada con la modificación de los parámetros evaluados. Se sugieren variaciones en las medidas de cavidades cardiacas para la población estudiada relacionada con aclimatación crónica a la altitud de la ciudad de Bogotá.

Incidencia y factores asociados a infección en el primer año postrasplante cardiaco

Objetivo: Determinar la incidencia de las infecciones en el primer año postrasplante cardiaco y los factores asociados a las infecciones en este periodo. Materiales y métodos: Estudio analítico de casos y controles anidados en una cohorte, con los pacientes trasplantados cardiacos en la Fundación Cardioinfantil – Instituto de cardiología desde el año 2005 hasta el 2015. Se realizaron análisis univariados, análisis bivariado entre las variables del estudio y el desenlace para la selección de las variables para el modelo de regresión logística. Resultados: Se presentó una mediana de 54 años de edad en la cohorte, con mayor proporción de hombres (75,8%) y con predominio de la cardiopatía dilatada como indicación de trasplante. La incidencia de infecciones en el primer año postrasplante fue de 45% (30/66). Se encontró mayor riesgo de infección en los primeros tres meses, del 36.3% (IC 95% 23 – 55), mostrando mayor frecuencia de infecciones pulmonares y en piel. Dentro de los organismos aislados más importantes en los primeros tres meses, se encontraron bacilos gram negativos y Aspergillus spp. En el primer año postrasplante la cardiopatía dilatada con un OR 4.7 IC95% (1.3 – 17) y la enfermedad renal crónica con un OR 6.7 IC 95% (1.4 - 32) se asociaron a la presencia de infecciones. Conclusiones: La frecuencia de infecciones en los pacientes trasplantados cardiacos en la Fundación Cardioinfantil IC es similar a la observada en la literatura. La aparición de infecciones en el primer año postrasplante, se asocia a la presencia de cardiopatía dilatada y enfermedad renal crónica.

Tecnologia de iplex massarray aplicado ao diagnóstico de miocardiopatia hipertrófica

A miocardiopatia hipertrófica (MH) é a doença cardíaca genética mais comum, afectando 1:500 indivíduos, apresentando um padrão de transmissão autossómico dominante, com mutações associadas a genes sarcoméricos e não sarcoméricos. A MH apresenta uma variedade de manifestações clínicas, desde indivíduosassintomáticos a indivíduos que manifestam uma progressão da severidade dos sintomas, podendo nalguns casos ocorrer morte súbita. O diagnóstico clínico é realizado por Electrocardiograma e Ecocardiograma. O diagnóstico genético baseia-se na Sequenciação Automática (SA) dos 5 principais genes sarcoméricos MYBPC3, MYH7, TNNT2, TNNI3 e MYL2, sendo considerada uma metodologia bastante dispendiosa e demorada e que não permite a identificação de mutações em cerca de 1/3 dos individuos. A Genotipagem por iPLEX MassARRAY revela-se uma boa alternativa à SA no diagnóstico genético de MH, uma vez que permite a análise de várias amostras em simultâneo, para um elevado número de mutações, num único ensaio, com uma maior rentabilidade de tempo e recursos. Este trabalho teve como objectivo a optimização e a validação desta metodologia, na detecção de 541 mutações em 33 genes, tendo-se verificado que 29 % das reacções multiplex necessitam de ser revistas, quer pelo desenho de novos conjuntos de primers, quer pela sua relocalização no chip.

Rol de los préstamos comerciales en los euromercados (Tema Central)

El intercambio de capitales es esencial en la economía actual, al ser un factor de producción básico que se requiere para poder encarar la producción creciente que demanda un consumo también acrecentado. Los mercados financieros constituyen el lugar en el cual se lleva a cabo el intercambio de capitales. Los euromercados son una clase de estos mercados financieros, dentro de los cuales se realizan una serie de transacciones de financiamiento. Los préstamos otorgados en el marco de los euromercados (denominados europréstamos) se convirtieron en el instrumento más importante de financiamiento para Estados y empresarios privados, no obstante, a raíz de la crisis de la deuda, las condiciones en que se otorgaban los eurocréditos se tornaron restringidas y, por ello, su concesión decreció, lo que produjo una transición desde la intermediación financiera a la desintermediación.

The simple macroeconomics of North and South in EMU. Bruegel Working Paper 2012/12, 30 July 2012

The euro area today consists of a competitive, moderately leveraged North and an uncompetitive, over-indebted South. Its main macroeconomic challenge is to carry out the adjustment required to restore the competitiveness of its southern part and eliminate its excessive public and private debt burden. This paper investigates the relationship between fiscal and competitiveness adjustment in a stylised model with two countries in a monetary union, North and South. To restore competitiveness, South implements a more restrictive fiscal policy than North. We consider two scenarios. In the first, monetary policy aims at keeping inflation constant in the North. The South therefore needs to deflate to regain competitiveness, which worsens the debt dynamics. In the second, monetary policy aims at keeping inflation constant in the monetary union as a whole. This results in more monetary stimulus, inflation in the North is higher, and this in turn helps the debt dynamics in the South. Our main findings are: •The differential fiscal stance between North and South is what determines real exchange rate changes. South therefore needs to tighten more. There is no escape from relative austerity. •If monetary policy aims at keeping inflation stable in the North and the initial debt is above a certain threshold, debt dynamics are perverse: fiscal retrenchment is self-defeating; •If monetary policy targets average inflation instead, which implies higher inflation in the North, the initial debt threshold above which the debt dynamics become perverse is higher. Accepting more inflation at home is therefore a way for the North to contribute to restoring debt sustainability in the South. •Structural reforms in the South improve the debt dynamics if the initial debt is not too high. Again, targeting average inflation rather than inflation in the North helps strengthen the favourable effects of structural reforms.

The French Constitutional Council as the Rottweiler of the Republican Ideal in the Language Field: Does Jurisprudence Really Reflect Reality? EDAP 03/2012, 2012

France is known for being a champion of individual rights as well as for its overt hostility to any form of group rights. Linguistic pluralism in the public sphere is rejected for fear of babelization and Balkanization of the country. Over recent decades the Conseil Constitutionnel (CC) has, together with the Conseil d’État, remained arguably the strongest defender of this Jacobin ideal in France. In this article, I will discuss the role of France’s restrictive language policy through the prism of the CC’s jurisprudence. Overall, I will argue that the CC made reference to the (Jacobin) state-nation concept, a concept that is discussed in the first part of the paper, in order to fight the revival of regional languages in France over recent decades. The clause making French the official language in 1992 was functional to this policy. The intriguing aspect is that in France the CC managed to standardise France’s policy vis-à-vis regional and minority languages through its jurisprudence; an issue discussed in the second part of the paper. But in those regions with a stronger tradition of identity, particularly in the French overseas territories, the third part of the paper argues, normative reality has increasingly become under pressure. Therefore, a discrepancy between the ‘law in courts’ and the compliance with these decisions (‘law in action’) has been emerging over recent years. Amid some signs of opening of France to minorities, this contradiction delineates a trend that might well continue in future.

Reflections on the concept of the central executive

Notes that the central executive lies at the heart of A. D. Baddeley's theory of working memory, but that what it does has been characterized in several different ways. This chapter reviews and brings together various interpretations of central executive functioning. The authors describe an experiment involving a novel cognitive task to point out the restrictive nature of the term 'executive capacity.' The chapter concludes by commenting briefly on the implications of a working memory model in which the executive does not play a major part.

Growth and flowering of petunia and impatiens: effects of competition and reduced water content within a container

The primary objective of this research was to determine how the presence of more than one plant and more than one species in a container influence plant quality, particularly when the volume of water given to the container is reduced. Petunia xhybrida 'Hurrah White' and Impatiens 'Cajun Violet' were chosen as typical bedding plant species. Plants were grown in 2 1 containers either under "100% ETp" (i.e., replacing all the water lost by evapotranspiration in the previous 24 h) or under a moisture-restrictive regime of "25% ETp," in which plants received 25% of the "100% ETp" value. An ancillary experiment investigated whether low watering resulted in floral buds being aborted. Results demonstrated that watering requirements of Petunia under "100% ETp" (i.e., replacing all the water lost by evapotranspiration in the previous 24 h) were on average 30% greater than those of Impatiens. However, when two Petunia plants were growing in the same container, the volume of water required to maintain soil moisture content at container capacity was on average only 10% greater than for a single plant. Under a "25% ETp" regime in which plants received 25% of the "100% ETp" value, flower number, plant height, and flower size were reduced by 50%,33%, and 13%,respectively,in Petunia compared with "100% ETp." For example, flower numbers decreased from an average of 71 to 33 flowers per plant in "100% ETp" and "25% ETp," respectively. Petunia plants in the "25% ETp" regime, however, were more efficient at producing both biomass and flowers in relation to the volume of water applied. Petunia plants that experienced both competition from other plants in the container and lower irrigation rates had enhanced efficiency of flower production (i.e., more flowers per unit biomass). For Impatiens, however, the growing of single plants at "25% ETp" was plausible, but the addition of a Petunia plant at "25% ETp" was detrimental to plant quality (Impatiens flower numbers reduced by 75%).

Coxsackievirus B3-associated myocardial pathology and viral load reduced by recombinant soluble human decay-accelerating factor in mice

Coxsackievirus B3 (CVB3) infection can result in myocarditis, which in turn may lead to a protracted immune response and subsequent dilated cardiomyopathy. Human decay-accelerating factor (DAF), a binding receptor for CVB3, was synthesized as a soluble IgG1-Fc fusion protein (DAF-Fc). In vitro, DAF-Fc was able to inhibit complement activity and block infection by CVB3, although blockade of infection varied widely among strains of CVB3. To determine the effects of DAF-Fc in vivo, 40 adolescent A/J mice were infected with a myopathic strain of CVB3 and given DAF-Fc treatment 3 days before infection, during infection, or 3 days after infection; the mice were compared with virus alone and sham-infected animals. Sections of heart, spleen, kidney, pancreas, and liver were stained with hematoxylin and eosin and submitted to in situ hybridization for both positive-strand and negative-strand viral RNA to determine the extent of myocarditis and viral infection, respectively. Salient histopathologic features, including myocardial lesion area, cell death, calcification and inflammatory cell infiltration, pancreatitis, and hepatitis were scored without knowledge of the experimental groups. DAF-Fc treatment of mice either preceding or concurrent with CVB3 infection resulted in a significant decrease in myocardial lesion area and cell death and a reduction in the presence of viral RNA. All DAF-Fc treatment groups had reduced infectious CVB3 recoverable from the heart after infection. DAF-Fc may be a novel therapeutic agent for active myocarditis and acute dilated cardiomyopathy if given early in the infectious period, although more studies are needed to determine its mechanism and efficacy.

Slicing of soft, flexible solids with industrial applications

Thin slices of soft flexible solids have negligible bending resistance and hence store negligible elastic strain energy; furthermore such offcuts are rarely permanently deformed after slicing. Cutting forces thus depend only on work of separation (toughness work) and friction. These simplifying assumptions are not as restrictive as it might seem, and the mechanics are found to apply to a wide variety of foodstuffs and biological materials. The fracture toughness of such materials may be determined from cutting experiments: the use of scissors instrumented for load and displacement is a popular method where toughness is obtained from the work areas beneath load–displacement plots. Surprisingly, there is no analysis for the variation of forces with scissor blade opening and this paper provides the theory. Comparison is made with experimental results in cutting with scissors. The analysis is generalised to cutting with blades of variable curvature and applied to a commercial food cutting device having a rotating spiral plan form blade. The strong influence of the ‘slice/push ratio’ (blade tangential speed to blade edge normal speed) on the cutting forces is revealed. Small cutting forces are important in food cutting machinery as damage to slices is minimised. How high slice/push ratios may be achieved by choice of blade profile is discussed.

There must be more to development of mindreading and metacognition than passing false belief tasks

We argue that while it is a valuable contribution, Carruthers' Model may be too restrictive to elaborate our understanding of the development of mindreading and metacognition, or to enrich our knowledge of individual differences and psychopathology. To illustrate, we describe pertinent examples where there may be a critical interplay between primitive social-cognitive processes and emerging self-attributions.

Porcine models for the metabolic syndrome, digestive and bone disorders: a general overview

The aim of this review article is to provide an overview of the role of pigs as a biomedical model for humans. The usefulness and limitations of porcine models have been discussed in terms of metabolic, cardiovascular, digestive and bone diseases in humans. Domestic pigs and minipigs are the main categories of pigs used as biomedical models. One drawback of minipigs is that they are in short supply and expensive compared with domestic pigs, which in contrast cost more to house, feed and medicate. Different porcine breeds show different responses to the induction of specific diseases. For example, ossabaw minipigs provide a better model than Yucatan for the metabolic syndrome as they exhibit obesity, insulin resistance and hypertension, all of which are absent in the Yucatan. Similar metabolic/physiological differences exist between domestic breeds (e.g. Meishan v. Pietrain). The modern commercial (e.g. Large White) domestic pig has been the preferred model for developmental programming due to the 2- to 3-fold variation in body weight among littermates providing a natural form of foetal growth retardation not observed in ancient (e.g. Meishan) domestic breeds. Pigs have been increasingly used to study chronic ischaemia, therapeutic angiogenesis, hypertrophic cardiomyopathy and abdominal aortic aneurysm as their coronary anatomy and physiology are similar to humans. Type 1 and II diabetes can be induced in swine using dietary regimes and/or administration of streptozotocin. Pigs are a good and extensively used model for specific nutritional studies as their protein and lipid metabolism is comparable with humans, although pigs are not as sensitive to protein restriction as rodents. Neonatal and weanling pigs have been used to examine the pathophysiology and prevention/treatment of microbial-associated diseases and immune system disorders. A porcine model mimicking various degrees of prematurity in infants receiving total parenteral nutrition has been established to investigate gut development, amino acid metabolism and non-alcoholic fatty liver disease. Endoscopic therapeutic methods for upper gastrointestinal tract bleeding are being developed. Bone remodelling cycle in pigs is histologically more similar to humans than that of rats or mice, and is used to examine the relationship between menopause and osteoporosis. Work has also been conducted on dental implants in pigs to consider loading; however with caution as porcine bone remodels slightly faster than human bone. We conclude that pigs are a valuable translational model to bridge the gap between classical rodent models and humans in developing new therapies to aid human health.

Exploring social barriers to adaptation: insights from Western Nepal

As the challenges and opportunities posed by climate change become increasingly apparent, the need for facilitating successful adaptation and enhancing adaptive capacity within the context of sustainable development is clear. With adaptation high on the agenda, the notion of limits and barriers to adaptation has recently received much attention within both academic and policymaking spheres. While emerging literature has been quick to depict limits and barriers in terms of natural, financial, or technologic processes, there is a clear shortfall in acknowledging social barriers to adaptation. It is against such a backdrop that this paper sets out to expose and explore some of the underlying features of social barriers to adaptation, drawing on insights from two case studies in the Western Nepal. This paper exposes the significant role of cognitive, normative and institutional factors in both influencing and prescribing adaptation. It explores how restrictive social environments can limit adaptation actions and influence adaptive capacity at the local level, particularly for the marginalised and socially excluded. The findings suggest a need for greater recognition of the diversity and complexity of social barriers, strategic planning and incorporation at national and local levels, as well as an emphasis on tackling the underlying drivers of vulnerability and social exclusion.