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)

Protección miocárdica con custodiol y trastornos de la osmolalidad

En análisis retrospectivo evaluamos 91 pacientes llevados a cirugía cardiaca entre 2013 y 2014 en la Fundación Cardioinfantil, en quienes se administro Custodiol, analizando los niveles de sodio y osmolalidad plasmática efectiva antes, durante y después del procedimiento quirúrgico. Nosotros evaluamos la relación entre administración de Custodiol y cambios en el sodio y osmolalidad plasmática del paciente llevado a cirugía cardiaca.

Demand of children in Colombia : guessing or planning

El artículo analiza los determinantes de la presencia de hijos no deseados en Colombia. Se utiliza la información de la Encuesta Nacional de Demografía y Salud (ENDS, 2005), específicamente para las mujeres de 40 años o más. Dadas las características especiales de la variable que se analiza, se utilizan modelos de conteo para verificar si determinadas características socioeconómicas como la educación o el estrato económico explican la presencia de hijos no deseados. Se encuentra que la educación de la mujer y el área de residencia son determinantes significativos de los nacimientos no planeados. Además, la relación negativa entre el número de hijos no deseados y la educación de la mujer arroja implicaciones clave en materia de política social.

Gender differences on sexual behavior and school inputs: evidence from Bogota

This paper explores the correlation between school factors and the differentiated results on sexual behavior between boys and girls in Bogota. A school stratified propensity score matching was per-formed to match each boy of the sample with the most similar girls in individual, household and school characteristics. A regression analysis was performed to estimate the correlation between school factors and the main outcomes, namely sexual status, condom use in last intercourse, teenage childbearing and age at first intercourse. Boys - in relation to girls - begin earlier their sexual life, report larger use of condom and lower incidence of teenage childbearing. These differences are correlated with sex education at school, and teacher’s characteristics age, education level and pedagogy degree. The results suggest that the content of sex education that is delivered to girls at school is not complete or accurate and that teachers play a key role to reduce this gender bias

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.

Diferencia entre tratamientos en pacientes con angioma cavernoso del tallo cerebral en el instituto nacional de neurología y neurocirugía Manuel Velasco Suárez

Introducción: la historia natural de la hemorragia en el tallo cerebral secundaria a un angioma cavernoso es benigna. Sin embargo, el riesgo de recurrencia y de mayor discapacidad parece incrementarse con el tiempo a pesar del tratamiento recibido; hecho que plantea dudas acerca de si el manejo quirúrgico de estas lesiones ofrece mayor beneficio sobre el manejo médico después del primer evento hemorrágico. El objetivo del estudio fue evaluar el riesgo de resangrado y el grado de discapacidad final en los angiomas cavernosos del tallo cerebral según el tratamiento recibido. Métodos: estudio observacional, analítico tipo cohorte. Se incluyeron pacientes con un primer sangrado en el tallo cerebral secundario a angioma cavernoso que fueron tratados en el Instituto Nacional de Neurología y Neurocirugía (INNN) de Ciudad de México. Resultados: noventa y nueve (99) pacientes fueron incluidos en un periodo de 25 años (1990-2015). Treinta y siete (37) recibieron tratamiento quirúrgico y sesenta y dos (62) recibieron tratamiento médico tras su primer sangrado. El promedio de edad fue de 38 años (DS: 14,17) para el grupo que recibió tratamiento médico y 36 años (DS: 12,82) para los que recibieron tratamiento quirúrgico. La incidencia acumulada de resangrado para el tratamiento médico fue de 5,1 por 100 años/persona y para el tratamiento quirúrgico de 3,9 por 100 años/persona (p = 0,016). Se realizó un análisis estratificado donde no se encontró ninguna asociación entre resangrado y edad o sexo del paciente. Se evaluó la discapacidad final con la escala de Rankin (mRs) sin encontrar diferencias significativas entre tratamientos (p=0.77). Por último, se realizó un modelo explicativo de regresión logística binaria donde se encontró que la edad superior a 55 años (OR: 2.19 IC 95%: 1.67-47,6), el tamaño mayor a 15 mm (OR: 2,5 IC 95%: 3,8-45,9) y la recurrencia del sangrado (OR: 1,7 IC 95%: 1,63-18,7) son factores asociados a un desenlace desfavorable en cuanto a discapacidad final. Discusión y Conclusiones: en los pacientes con angioma cavernoso del tallo cerebral que han presentado un primer evento de sangrado no se encontró una diferencia estadísticamente significativa entre el tratamiento médico o quirúrgico al evaluar la discapacidad funcional con la escala de Rankin modificada, a pesar de evidenciar una diferencia significativa en la incidencia acumulada de resangrado por grupos de tratamiento. El tamaño de la lesión, la recurrencia del sangrado y la edad superior a 55 años son factores asociados a un desenlace desfavorable en este grupo de pacientes.

La influencia del autoconcepto en el rendimiento académico en estudiantes universitarios. 'The influence of self-concept on academic achievement in university students'.

Resumen tomado de la publicación. Con el apoyo económico del departamento MIDE de la UNED. Incluye anexo con el cuestionario utilizado para la realización del estudio

Imagem de São Tomé e Principe do ponto de vista do Turismo

RESUMO: Esta dissertação visa dar uma contribuição para o desenvolvimento do turismo de STP (São Tomé e Príncipe). Foram consideradas variáveis como a experiência turística, satisfação turística, imagem turística e a intenção de recomendar a região/país, de modo a aferir as percepções dos turistas estrangeiros relativamente à avaliação da imagem turística, atendendo que o país possui um conjunto de características naturais para a prática do turismo. Neste contexto, foi aplicado um inquérito aos turistas na capital de S.Tomé (nomeadamente em, hotéis, residenciais, restaurantes, bares e no Aeroporto Internacional de São Tomé) entre os meses de Março a Maio de 2010. O estudo desenvolvido tem duas vertentes, a exploratório/descritivo e conclusiva, com ênfase na análise do tipo qualitativo e quantitativo. Utilizou-se igualmente a análise de regressão, a qual permitiu perceber a relação entre as variáveis identificadas, constatando-se que a percepção de imagem global, o passa-palavra positiva e a intenção de voltar depende da identidade do local e dos alimentos e bebidas. ABSTRACT: This dissertation aims to make a contribution to the development of tourism STP (Sao Tome and Principe). Several variables were regarded, such as the tourism experience, tourist satisfaction, tourism image and intention to recommend the region / country in order to gauge the perceptions of foreign tourists with regards to the evaluation of the tourism image, given that the country has a set of natural features for practice tourism. In this context, a survey was administered to tourists in the capital of São Tome and Principe, including hotels, guesthouses, restaurants, bars and the international airport of São Tomé during the months of March to May 2010. The developed study has two components, exploratory / descriptive and conclusive, with emphasis on qualitative and quantitative analysis. It is also used regression analysis, which allowed us to perceive the relationship between the variables identified, noting that the perception of global image, the positive word of mouth and intention to return depends on the identity of the place and food and beverages.

A influência da competência emocional no desempenho académico de adolescentes do ensino secundário

O nosso trabalho tem como objectivo principal responder à questão fundamental: A competência emocional influencia o desempenho académico em adolescentes do ensino secundário? Para o efeito, os instrumentos utilizados foram: o questionário de Competência Emocional, adaptado ao contexto português por Lima Santos e Faria (2001), as pautas de notas dos alunos tendo em vista identificar o género, ano escolar e as idades dos alunos. Depois de obtida a autorização para a utilização do questionário, procedemos à sua aplicação sendo que a amostra foi constituída por 191 estudantes a frequentar o Ensino Secundário na Escola Secundária Dr. João de Araújo Correia, com idades compreendidas entre os 14 e 19 anos, no início do ano letivo, setembro de 2011. Após a recolha de dados procedemos à sua análise, a partir do programa SPSS, versão 19.0 para o Windows, cingindo-nos à análise descritiva das variáveis Género, Idade e Ano Escolar; análise descritiva da turma; análise descritiva das notas da disciplina de português e matemática; análise descritiva das questões do questionário de competência emocional; análise descritiva das dimensões do questionário; comparação de Médias das três Dimensões do questionário de competência emocional; análise de Regressão Linear e análise de Médias Através dos Itens e Variáveis Sociodemográficas e Escolares. Os resultados apontaram para a existência de diferenças estatisticamente significativas em relação à nota de Português no que diz respeito à EE (Expressão Emocional). Os alunos cujas notas de português são mais baixas apresentam valores mais baixos também na EE. Por outro lado, a nota de matemática era a única preditora da EE, explicando 4.3% da variância. Assim, a relação entre competência emocional e o desempenho académico verificou-se em relação à dimensão da Expressão Emocional. Por outro lado, em função do género, idade e escolaridade apenas se verificaram diferenças significativas para os itens da Expressão Emocional. Na relação entre o desempenho académico relativamente às disciplinas de português e matemática, comparativamente com a competência emocional apenas se verificou relação na dimensão - Expressão Emocional.

The response of tropospheric circulation to perturbations in lower-stratospheric temperature

A multiple regression analysis of the NCEP-NCAR reanalysis dataset shows a response to increased solar activity of a weakening and poleward shift of the subtropical jets. This signal is separable from other influences, such as those of El Nino-Southern Oscillation (ENSO) and the North Atlantic Oscillation (NAO), and is very similar to that seen in previous studies using global circulation models (GCMs) of the effects of an increase in solar spectral irradiance. The response to increased stratospheric (volcanic) aerosol is found in the data to be a weakening and equatorward shift of the jets. The GCM studies of the solar influence also showed an impact on tropospheric mean meridional circulation with a weakening and expansion of the tropical Hadley cells and a poleward shift of the Ferrel cells. To understand the mechanisms whereby the changes in solar irradiance affect tropospheric winds and circulation, experiments have been carried out with a simplified global circulation model. The results show that generic heating of the lower stratosphere tends to weaken the subtropical jets and the tropospheric mean meridional circulations. The positions of the jets, and the extent of the Hadley cells, respond to the distribution of the stratospheric heating, with low-latitude heating forcing them to move poleward, and high-latitude or latitudinally uniform heating forcing them equatorward. The patterns of response are similar to those that are found to be a result of the solar or volcanic influences, respectively, in the data analysis. This demonstrates that perturbations to the heat balance of the lower stratosphere, such as those brought about by solar or volcanic activity, can produce changes in the mean tropospheric circulation, even without any direct forcing below the tropopause.

Bryozoan populations reflect nutrient enrichment and productivity gradients in rivers

1. The hypothesis that nutrient enrichment will affect bryozoan abundance was tested using two complementary investigations; a field-based method determining bryozoan abundance in 20 rivers of different nutrient concentrations by deploying statoblast (dormant propagule) traps and an experimental laboratory microcosm study measuring bryozoan growth and mortality. These two methods confirmed independently that increased nutrient concentrations in water promote increases in the biomass of freshwater bryozoans. 2. Statoblasts of the genus Plumatella were recorded in all rivers, regardless of nutrient concentrations, demonstrating that freshwater bryozoans are widespread. Concentrations of Plumatella statoblasts were high in rivers with high nutrient concentrations relative to those with low to moderate nutrient concentrations. Regression analyses indicated that phosphorus concentrations, in particular, significantly influenced statoblast concentrations. 3. Concentrations of Lophopus crystallinus statoblasts were also higher in sites characterised by high nutrient concentrations. Logistic regression analysis revealed that the presence of L. crystallinus statoblasts was significantly associated with decreasing altitude and increasing phosphorus concentrations. This apparently rare species was found in nine rivers (out of 20), seven of which were new sites for L. crystallinus. 4. Growth rates of Fredericella sultana in laboratory microcosms increased with increasing nutrient concentration and high mortality rates were associated with low nutrient concentrations. 5. Our results indicate that bryozoans respond to increasing nutrient concentrations by increased growth, resulting in higher biomasses in enriched waters. We also found that an important component of bryozoan diets can derive from food items lacking chlorophyll a. Finally, bryozoans may be used as independent proxies for inferring trophic conditions, a feature that may be especially valuable in reconstructing historical environments by assessing the abundance of statoblasts in sediment cores.

Why are some handaxes symmetrical? Testing the influence of handaxe morphology on butchery effectiveness

The morphology of Acheulean handaxes continues to be a subject of debate amongst Lower Palaeolithic archaeologists, with some arguing that many handaxes are over-engineered for a subsistence function alone. This study aims to provide an empirical foundation for these debates by testing the relationship between a range of morphological variables, including symmetry, and the effectiveness of handaxes for butchery. Sixty handaxes were used to butcher 30 fallow deer by both a professional and a non-professional butcher. Regression analysis on the resultant data set indicates that while frontal symmetry may explain a small amount of variance in the effectiveness of handaxes for butchery, a large percentage of variance remains unexplained by symmetry or any of the other morphological variables under consideration.

Observed trends and teleconnections of the Siberian high: A recently declining center of action

This study investigates variability in the intensity of the wintertime Siberian high (SH) by defining a robust SH index (SHI) and correlating it with selected meteorological fields and teleconnection indices. A dramatic trend of -2.5 hPa decade(-1) has been found in the SHI between 1978 and 2001 with unprecedented (since 1871) low values of the SHI. The weakening of the SH has been confirmed by analyzing different historical gridded analyses and individual station observations of sea level pressure (SLP) and excluding possible effects from the conversion of surface pressure to SLP. SHI correlation maps with various meteorological fields show that SH impacts on circulation and temperature patterns extend far outside the SH source area extending from the Arctic to the tropical Pacific. Advection of warm air from eastern Europe has been identified as the main mechanism causing milder than normal conditions over the Kara and Laptev Seas in association with a strong SH. Despite the strong impacts of the variability in the SH on climatic variability across the Northern Hemisphere, correlations between the SHI and the main teleconnection indices of the Northern Hemisphere are weak. Regression analysis has shown that teleconnection indices are not able to reproduce the interannual variability and trends in the SH. The inclusion of regional surface temperature in the regression model provides closer agreement between the original and reconstructed SHI.

Selenium supplementation of lactating dairy cows: Effect on selenium concentration in blood, milk, urine and feces

The objectives were to determine effects of graded levels of selenized yeast derived from a specific strain of Saccharomyces cerevisiae (CNCM I-3060) on animal performance and in selenium concentrations in the blood, milk, feces, and urine of dairy cows compared with sodium selenite; and to provide preliminary data on the proportion of selenium as selenomethionine in the milk and blood. Twenty Holstein cows were used in a 5 × 5 Latin square design study in which all cows received the same total mixed rations, which varied only in source or concentration of dietary selenium. There were 5 experimental treatments. Total dietary selenium of treatment 1, which received no added selenium, was 0.15 mg/kg of dry matter, whereas values for treatments 2, 3, and 4, derived from selenized yeast, were 0.27, 0.33, and 0.40 mg/kg of dry matter, respectively. Treatment 5 contained 0.25 mg of selenium obtained from sodium selenite/kg of dry matter. There were no significant treatment effects on animal performance, and blood chemistry and hematology showed few treatment effects. Regression analysis noted significant positive linear effects of increasing dietary selenium derived from selenized yeast on selenium concentrations in the milk, blood, urine, and feces. In addition, milk selenium results indicated improved bioavailability of selenium from selenized yeast, compared with sodium selenite. Preliminary analyses showed that compared with sodium selenite, the use of selenized yeast increased the concentration of selenomethionine in the milk and blood. There was no indication of adverse effects on cow health associated with the use of selenized yeast.

Soil moisture mediates association between the winter North Atlantic Oscillation and summer growth in the Park Grass Experiment

Several aspects of terrestrial ecosystems are known to be associated with the North Atlantic Oscillation (NAO) through effects of the NAO on winter climate, but recently the winter NAO has also been shown to be correlated with the following summer climate, including drought. Since drought is a major factor determining grassland primary productivity, the hypothesis was tested that the winter NAO is associated with summer herbage growth through soil moisture availability, using data from the Park Grass Experiment at Rothamsted, UK between 1960 and 1999. The herbage growth rate, mean daily rainfall, mean daily potential evapotranspiration (PE) and the mean and maximum potential soil moisture deficit (PSMD) were calculated between the two annual cuts in early summer and autumn for the unlimed, unfertilized plots. Mean and maximum PSMD were more highly correlated than rainfall or PE with herbage growth rate. Regression analysis showed that the natural logarithm of the herbage growth rate approximately halved for a 250 mm increase in maximum PSMD over the range 50-485 mm. The maximum PSMD was moderately correlated with the preceding winter NAO, with a positive winter NAO index associated with greater maximum PSMD. A positive winter NAO index was also associated with low herbage growth rate, accounting for 22% of the interannual variation in the growth rate. It was concluded that the association between the winter NAO and summer herbage growth rate is mediated by the PSMD in summer.