Epidemiology and control of malaria in Colombia

Malaria is currently one of the most serious public health problems in Colombia with an endemic/epidemic transmission pattern that has maintained endemic levels and an average of 105,000 annual clinical cases being reported over the last five years. Plasmodium vivax accounts for approximately 70% of reported cases with the remainder attributed almost exclusively to Plasmodium falciparum. A limited number of severe and complicated cases have resulted in mortality, which is a downward trend that has been maintained over the last few years. More than 90% of the malaria cases in Colombia are confined to 70 municipalities (about 7% of the total municipalities of Colombia), with high predominance (85%) in rural areas. The purpose of this paper is to review the progress of malaria-eradication activities and control measures over the past century within the eco-epidemiologic context of malaria transmission together with official consolidated morbidity and mortality reports. This review may contribute to the formulation of new antimalarial strategies and policies intended to achieve malaria elimination/eradication in Colombia and in the region.

Atypical Vascular Involvement in a Case of Behçet's Disease.

Introduction. Behçet's disease (BD) is a form of vasculitis of unknown etiology which is rare in our environment. It is characterized by a variety of clinical manifestations and usually affects young adults. Recurrent oral and genital ulcers are a characteristic and extremely frequent symptom, but mortality is linked with more significant symptoms such as aortic pseudoaneurysm, pulmonary pseudoaneurysm, and cerebral venous thrombosis. Patient and Method. We present a case of a young male with atypical BD and severe polyvascular involvement (previous cerebral venous thrombosis and current peripheral venous thrombosis, acute ischemia, and peripheral arterial pseudoaneurysm) who required urgent surgical intervention due to a symptomatic external iliac pseudoaneurysm. Result. The pseudoaneurysm was successfully treated, we performed an iliofemoral bypass, and we treated it with steroids and immunosuppressive therapy. Conclusions. These rare clinical manifestations highlight the importance of considering BD in young patients, even in usual cases of vascular intervention, whether arterial or venous in nature.

Utility of the mini-cog for detection of cognitive impairment in primary care: data from two spanish studies.

Objectives. To study the utility of the Mini-Cog test for detection of patients with cognitive impairment (CI) in primary care (PC). Methods. We pooled data from two phase III studies conducted in Spain. Patients with complaints or suspicion of CI were consecutively recruited by PC physicians. The cognitive diagnosis was performed by an expert neurologist, after formal neuropsychological evaluation. The Mini-Cog score was calculated post hoc, and its diagnostic utility was evaluated and compared with the utility of the Mini-Mental State (MMS), the Clock Drawing Test (CDT), and the sum of the MMS and the CDT (MMS + CDT) using the area under the receiver operating characteristic curve (AUC). The best cut points were obtained on the basis of diagnostic accuracy (DA) and kappa index. Results. A total sample of 307 subjects (176 CI) was analyzed. The Mini-Cog displayed an AUC (±SE) of 0.78 ± 0.02, which was significantly inferior to the AUC of the CDT (0.84 ± 0.02), the MMS (0.84 ± 0.02), and the MMS + CDT (0.86 ± 0.02). The best cut point of the Mini-Cog was 1/2 (sensitivity 0.60, specificity 0.90, DA 0.73, and kappa index 0.48 ± 0.05). Conclusions. The utility of the Mini-Cog for detection of CI in PC was very modest, clearly inferior to the MMS or the CDT. These results do not permit recommendation of the Mini-Cog in PC.

Angiographic demonstration of neoangiogenesis after intra-arterial infusion of autologous bone marrow mononuclear cells in diabetic patients with critical limb ischemia.

Critical limb ischemia in diabetic patients is associated with high rates of morbidity and mortality. Suboptimal responses to the available medical and surgical treatments are common in these patients, who also demonstrate limited vascular homeostasis. Neovasculogenesis induced by stem cell therapy could be a useful approach for these patients. Neovasculogenesis and clinical improvement were compared at baseline and at 3 and 12 months after autologous bone marrow-derived mononuclear cell (BMMNC) transplantation in diabetic patients with peripheral artery disease. We conducted a prospective study to evaluate the safety and efficacy of intra-arterial administration of autologous BMMNCs (100-400 × 10(6) cells) in 20 diabetic patients with severe below-the-knee arterial ischemia. Although the time course of clinical effects differed among patients, after 12 months of follow-up all patients presented a notable improvement in the Rutherford-Becker classification, the University of Texas diabetic wound scales, and the Ankle-Brachial Index in the target limb. The clinical outcome was consistent with neovasculogenesis, which was assessed at 3 months by digital subtraction angiography and quantified by MetaMorph software. Unfortunately, local cell therapy in the target limb had no beneficial effect on the high mortality rate in these patients. In diabetic patients with critical limb ischemia, intra-arterial perfusion of BMMNCs is a safe procedure that generates a significant increase in the vascular network in ischemic areas and promotes remarkable clinical improvement.

Contribution to Asterisk Open Source Project

With this final master thesis we are going to contribute to the Asterisk open source project. Asterisk is an open source project that started with the main objective of develop an IP telephony platform, completely based on Software (so not hardware dependent) and under an open license like GPL. This project was started on 1999 by the software engineer Mark Spencer at Digium. The main motivation of that open source project was that the telecommunications sector is lack of open solutions, and most of the available solutions are based on proprietary standards, which are close and not compatible between them. Behind the Asterisk project there is a company, Digum, which is the project leading since the project was originated in its laboratories. This company has some of its employees fully dedicated to contribute to the Asterisk project, and also provide the whole infrastructure required by the open source project. But the business of Digium isn't based on licensing of products due to the open source nature of Asterisk, but it's based on offering services around Asteriskand designing and selling some hardware components to be used with Asterisk. The Asterisk project has grown up a lot since its birth, offering in its latest versions advanced functionalities for managing calls and compatibility with some hardware that previously was exclusive of proprietary solutions. Due to that, Asterisk is becoming a serious alternative to all these proprietaries solutions because it has reached a level of maturity that makes it very stable. In addition, as it is open source, it can be fully customized to a givenrequirement, which could be impossible with the proprietaries solutions. Due to the bigness that is reaching the project, every day there are more companies which develop value added software for telephony platforms, that are seriously evaluating the option of make their software fully compatible withAsterisk platforms. All these factors make Asterisk being a consolidated project but in constant evolution, trying to offer all those functionalities offered by proprietaries solutions. This final master thesis will be divided mainly in two blocks totally complementaries. In the first block we will analyze Asterisk as an open source project and Asterisk as a telephony platform (PBX). As a result of this analysis we will generate a document, written in English because it is Asterisk project's official language, which could be used by future contributors as an starting point on joining Asterisk. On the second block we will proceed with a development contribution to the Asterisk project. We will have several options in the form that we do the contribution, such as solving bugs, developing new functionalities or start an Asterisk satellite project. The type of contribution will depend on the needs of the project on that moment.

Reasons for deploying an e-reader loan service at the UOC Library

The presentation will focus on the reasons for deploying an e-reader loan service at a virtual university library as a part of an e-learning support system to aid user mobility, concentration of documentary and electronic resources, and ICT skills acquisition, using the example of the UOC pilot project and its subsequent consolidation. E-reader devices at the UOC are an extension of the Virtual Campus. They are offered as a tool to aid user mobility, access to documentary and electronic resources, and development of information and IT skills. The e-reader loan service began as a pilot project in 2009 and was consolidated in 2010. The UOC Library piloted the e-reader loan service from October to December 2009. The pilot project was carried out with 15 devices and involved 37 loans. The project was extended into 2010 with the same number of devices and 218 loans (October 2010). In 2011 the e-reader loan service is to involve 190 devices, thus offering an improved service. The reasons for deploying an e-reader loan service at the UOC are the following: a) to offer library users access to the many kinds of learning materials available at the UOC through a single device that facilitates student study and learning; b) to enhance access to and use of the e-book collections subscribed to by the UOC Library; c) to align with UOC strategy on the development of learning materials in multiple formats, and promote e-devices as an extension of the UOC Virtual Campus, and d) to increase UOC Library visibility within and beyond the institution. The presentation will conclude with an analysis of the key issues to be taken into account at a university library: the e-reader market, the unclear business and license model for e-book contents, and the library's role in promoting new reading formats to increase use of e-collections.

How to manage a virtual library?

Introduction. The Andalusian Public Health System Virtual Library (Biblioteca Virtual del Sistema Sanitario Público de Andalucía, BV-SSPA) was created in June 2006, after being determined by the II Quality Plan in the key process Guarantee the Knowledge Exchange into the Health System which was established by the Strategy IV, Knowledge Management, 2005-2008. It is a government strategy with its own budget and management with the aim of rationalizing the subscriptions into the Andalusian Health System and democratizing the health professional access to qualify scientific information, regardless of the professional workplace. Andalusia is a wide region with more than 8 million inhabitants, more than 90,000 health professionals for 41 hospitals, 1,500 primary healthcare centres, and 12 centres for non-medical attention purposes, and the Virtual Library was created to cover all this Health Services. Before the creation of the BV-SSPA every centre had its own budget and management decisions concerning scientific resources, with the creation of the BV-SSPA both management and budget were centralized. Objectives. With this work we pretend to analyze if the results after these five years have reached the expectations from an economic point of view and determine if really we can offer a benefit to the Andalusian Professional and Society in general. We will demonstrate the following: - The BV-SSPA supposed a cost reduction. It meant cost-effectiveness. - It resulted in Economics of Scale, as we have every year more resources and services investing a minor proportional amount of money. - In terms of Efficiency it implemented more services than the System had before its creation, we a lower budget. Methods. The BV-SSPA was appointed the only intermediary for contracting electronic resources destined to the Andalusian Health System. This had some consequences which should be analyzed: - Hospitals were not allowed to subscribe any resources. - Services offered for the whole System. - A remote access system was created. - Tools to give more visibility to the Public Health System were developed. - Negotiations techniques changed as the BV-SSPA is stronger than individual hospitals. Results. - The amount of 2,431 electronic reviews, 8 data bases and other scientific information resources at the disposal of the Andalusian Health System Professionals and available worldwide requiring only an internet connection. Before the BV-SSPA, 5,267 titles were subscribed by hospital and 2,967 of them were subscribed repeatedly (by two or more hospitals), this represented more than 55%. The rationalization of the subscription investment has been reached. - The establishment of several important scientific services for the whole territory of Andalusia, not only big hospitals. - The use of appropriate tools through a Web 2.0 and Social Media to be acknowledged by most National Health Professionals. Conclusions. It has been demonstrated that the BV-SSPA has become the Central Unit for purchasing, offering librarian services and a reference for users in terms of knowledge management, but from the point of view of business it has also obtained the following results: - Cost-Effectiveness: Its budget for subscriptions is lower than the hospital former one in a 30% and now more electronic resources are available. - Economics of Scale: Near 95,000 health professionals can access this Virtual Library in 2010. Before its creation Professionals for small hospital and Primary Care centres were not able to access to scientific information subscribed by big hospitals. - Efficiency Besides the central electronic purchasing, services were created for the System, without increasing the expenses: - Remote access to all the library resources independent of the user’s location. The BV-SSPA usage increased in a 147% in 2008, when it was installed. - The Document Supply Service implemented in 2009. - The Institutional Repository which contains the whole intellectual, scientific production generated by the Andalusian Public Health Professionals as a result of their healthcare, research or managing activity. - The creation of an application developed by the BV-SSPA to study the Andalusian Health System Scientific Production. - The visibility of the Andalusian Health System reached thanks to the BV-SSPA, through the numerous events in which it participates and organizes such as the 2nd. European National Digital Libraries of Health Conferences and the National Conference of Health Science Information and Documentation held in Cadiz in 2010; and its profile in social media where it can be contacted by citizens and health professionals all over the world. - Negotiation with electronic resource suppliers is much more advantageous as the BV-SSPA is stronger to deal with them thanks to its consolidated budget, its managing independence and its visibility.

Plerixafor and granulocyte colony-stimulating factor for first-line steady-state autologous peripheral blood stem cell mobilization in lymphoma and multiple myeloma: results of the prospective PREDICT trial.

In Europe, the combination of plerixafor + granulocyte colony-stimulating factor is approved for the mobilization of hematopoietic stem cells for autologous transplantation in patients with lymphoma and myeloma whose cells mobilize poorly. The purpose of this study was to further assess the safety and efficacy of plerixafor + granulocyte colony-stimulating factor for front-line mobilization in European patients with lymphoma or myeloma. In this multicenter, open label, single-arm study, patients received granulocyte colony-stimulating factor (10 μg/kg/day) subcutaneously for 4 days; on the evening of day 4 they were given plerixafor (0.24 mg/kg) subcutaneously. Patients underwent apheresis on day 5 after a morning dose of granulocyte colony-stimulating factor. The primary study objective was to confirm the safety of mobilization with plerixafor. Secondary objectives included assessment of efficacy (apheresis yield, time to engraftment). The combination of plerixafor + granulocyte colony-stimulating factor was used to mobilize hematopoietic stem cells in 118 patients (90 with myeloma, 25 with non-Hodgkin's lymphoma, 3 with Hodgkin's disease). Treatment-emergent plerixafor-related adverse events were reported in 24 patients. Most adverse events occurred within 1 hour after injection, were grade 1 or 2 in severity and included gastrointestinal disorders or injection-site reactions. The minimum cell yield (≥ 2 × 10(6) CD34(+) cells/kg) was harvested in 98% of patients with myeloma and in 80% of those with non-Hodgkin's lymphoma in a median of one apheresis. The optimum cell dose (≥ 5 × 10(6) CD34(+) cells/kg for non-Hodgkin's lymphoma or ≥ 6 × 10(6) CD34(+) cells/kg for myeloma) was harvested in 89% of myeloma patients and 48% of non-Hodgkin's lymphoma patients. In this prospective, multicenter European study, mobilization with plerixafor + granulocyte colony-stimulating factor allowed the majority of patients with myeloma or non-Hodgkin's lymphoma to undergo transplantation with minimal toxicity, providing further data supporting the safety and efficacy of plerixafor + granulocyte colony-stimulating factor for front-line mobilization of hematopoietic stem cells in patients with non-Hodgkin's lymphoma or myeloma.

The Andalusian Public Health System Virtual Library. Four years on

The Andalusian Public Health System Virtual Library (Biblioteca Virtual del Sistema Sanitario Público de Andalucía, BV-SSPA) set up in June 2006 was determined by the II Quality Plan 2005-2008. It consists of a regional government action with the aim of democratizing the health professional access to quality scientific information, regardless of the professional workplace. Andalusia is a region with more than 8 million inhabitants, with 92,000 health professionals for 41 hospitals, 1,500 primary healthcare centres, and 10 centres for non-medical attention purposes. • To obtain documentary resources for health professionals. • To help citizens to find health information. • To coordinate the Andalusian Health Documentary centres. • To establish strategic agreements with organizations. • To contribute to the Knowledge Management Development • The BV-SSPA acquires in a centralised way, all of the information resources for the whole system. • It offers services for all professionals: o Document Supply Service o Online Learning o User service • Remote access to these resources and services. • Communication and marketing plan to promote the knowledge and use of the BV-SSPA. Presently the BV-SSPA has reached: • The subscription of 2,431 electronic reviews, 8 data bases and other scientific information resources. • The establishment of the Document Supply Service, which focuses all the article orders from and for the Andalusian Public Health System. • The starting up for the online learning platform. • The introduction of the user service and virtual reference service in beta mode. • The use of appropriate tools, as the meta-researcher and the link resolver, which allow the presentation of resources and services in a tidy, easily findable way, through a Web 2.0 page where the user can take part with his contributions and where his offers and suggestion are gathered. • Access to the resources, for the Andalusian Health Professionals worldwide requiring only an internet connection. Andalusian Health Professionals have access to the greatest Health Science Electronic Resources Collection in Spain. The BV-SSPA has become the undisputed medium for the Health Research and Clinical Healthcare in our region, being consolidated as the Knowledge Manager into the Andalusian Public Health System. In 2010, it faces new projects such as the institutional repository creation, HypatiaSalud; the analysis of our research activity; and the drafting of a normalised licence model for the contracting of electronic resources.

Resistin regulates pituitary lipid metabolism and inflammation in vivo and in vitro.

The adipokine resistin is an insulin-antagonizing factor that also plays a regulatory role in inflammation, immunity, food intake, and gonadal function and also regulates growth hormone (GH) secretion in rat adenopituitary cells cultures with the adipokine. Although adipose tissue is the primary source of resistin, it is also expressed in other tissues, including the pituitary. The aim of this study is to investigate the possible action of resistin on the lipid metabolism in the pituitary gland in vivo (rats in two different nutritional status, fed and fast, treated with resistin on acute and a chronic way) and in vitro (adenopituitary cell cultures treated with the adipokine). Here, by a combination of in vivo and in vitro experimental models, we demonstrated that central acute and chronic administration of resistin enhance mRNA levels of the lipid metabolic enzymes which participated on lipolysis and moreover inhibiting mRNA levels of the lipid metabolic enzymes involved in lipogenesis. Taken together, our results demonstrate for the first time that resistin has a regulatory role on lipid metabolism in the pituitary gland providing a novel insight in relation to the mechanism by which this adipokine can participate in the integrated control of lipid metabolism.

Andalusian Health e-Library

The Andalusian Health e-Library (Biblioteca Virtual del Sistema Sanitario Público de Andalucía, BV-SSPA) set up in June 2006 allows health professionals to access the most prestigious resources to facilitate decisiontaking, healthcare, teaching and research activities. It is considered the undisputed medium for health research and clinical healthcare in Andalusia, being consolidated as the Health Knowledge Manager in the region.

Circadian rhythms in insect disease vectors

Organisms from bacteria to humans have evolved under predictable daily environmental cycles owing to the Earth’s rotation. This strong selection pressure has generated endogenous circadian clocks that regulate many aspects of behaviour, physiology and metabolism, anticipating and synchronising internal time-keeping to changes in the cyclical environment. In haematophagous insect vectors the circadian clock coordinates feeding activity, which is important for the dynamics of pathogen transmission. We have recently witnessed a substantial advance in molecular studies of circadian clocks in insect vector species that has consolidated behavioural data collected over many years, which provided insights into the regulation of the clock in the wild. Next generation sequencing technologies will facilitate the study of vector genomes/transcriptomes both among and within species and illuminate some of the species-specific patterns of adaptive circadian phenotypes that are observed in the field and in the laboratory. In this review we will explore these recent findings and attempt to identify potential areas for further investigation.

Accumulation of scandium in plasma in patients with chronic renal failure.

Scandium (Sc) is an element with many industrial applications, but relatively little is known about its physiological and/or toxicological effects, and very little data are available concerning the role of Sc in chronic renal failure (CRF). This paper examines the changes in plasma levels of Sc in predialysis patients with CRF and the relationship with blood parameters. The participants in this trial were 48 patients with CRF in predialysis and 53 healthy controls. Erythrocyte, haemoglobin, and haematocrit counts in blood were determined, and levels of creatinine, urea, uric acid, albumin, total protein and Sc were measured in plasma. The glomerular filtration rate (GFR) was calculated using the Cockcroft-Gault index. The CRF patients were found to have higher plasma levels of creatinine, urea, uric acid, albumin, total protein, and Sc and a lower GFR than that the controls. Scandium in plasma was positively correlated with creatinine and plasma urea and negatively correlated with GFR, haemoglobin, and haematocrit and was associated with the risk of lower levels of erythrocytes, haemoglobin, and haematocrit. CRF was associated with increases in the circulating levels of scandium.

Role of mental disorders in nosocomial infections after hip fracture treatment.

The association between mental disorders (MDs) and iatrogenic complications after hip fracture surgery has been poorly studied. Among iatrogenic complications, nosocomial infections (NIs) are a major factor in hip fracture surgery. The aim of this paper was to determine whether patients with a MD and a hip fracture develop more NIs after hip surgery than patients with no MD. We studied 912 patients who underwent surgery for a hip fracture (223 patients with a MD who underwent surgery for a hip fracture and 689 control patients without a MD who also underwent surgery for a hip fracture) and followed them after surgery. Univariable and multivariable analyses were performed using simple and multiple logistic regression analysis (confidence interval, crude and adjusted odds ratios, and P value). We found that MDs, gender, and comorbidities were not associated with a higher risk of developing a NI after surgery for a hip fracture. Only age increases the risk of a NI.