Capacidad predictiva del euroscore II en una cohorte de pacientes de cirugía cardiovascular en una institución de cuarto nivel de Bogotá

El EuroSCORE II es una de las escalas más empleadas como predictor de riesgo de mortalidad en los servicios de cirugía cardiovascular. Esta ha sido validada en diferentes hospitales alrededor del mundo demostrando una adecuada capacidad de discriminación. El objetivo de este estudio fue evaluar el valor predictivo de la escala de riesgo EuroSCORE II en los pacientes sometidos a Cirugía Cardiovascular en una institución de cuarto nivel de Bogotá. Metodología: Estudio de prueba diagnóstica observacional y retrospectivo de la cohorte de pacientes en una institución de cuarto nivel durante los años 2012 a 2014. Se realizó el cálculo del EuroSCORE II para cada paciente, comparando la mortalidad predicha versus la observada, de forma global y por grupo de riesgo. Resultados: Del total de la población que tuvo intervención cardiaca mayor en una institución de cuarto nivel en la cohorte estudiada se presentaron 58 casos de muerte en los treinta días posteriores a la intervención, que corresponde al 7,46%. La mortalidad esperada calculada con el EuroSCORE II fue del 9,26%, lo cual indica un buen poder de predicción para esta población. Por otro lado, la curva ROC evidencia con un valor de 0.757 del área bajo la curva, que el modelo El EuroSCORE II es un buen modelo predictivo con un adecuado valor de discriminación. Se evidenció que las variables estado crítico preoperatorio y función del ventrículo izquierdo tienen mayor peso estadístico en nuestra población objeto, con una significancia del 0,001, seguido de infarto agudo de miocardio, sexo y peso de la intervención con una significancia del 0,01. Adicionalmente, el Euroscore II tiene mejor valor predictivo cuando se realiza un solo procedimiento o revascularización, en comparación a cuando se realiza procedimientos mixtos. Se recomienda realizar un estudio multicéntrico donde se incluyan pacientes con diferentes características demográficas

Carcinoma de tiroides una verdadera pandemia?

El diagnóstico de cáncer de tiroides se ha incrementado y las posibilidades de detección de una enfermedad subclínica son altas, toda vez que disponemos de herramientas de detección más sensibles y de fácil acceso. Por ende, el clínico requiere conocer la historia natural del nódulo tiroideo y del carcinoma papilar de tiroides de bajo riesgo para brindar a su paciente el mejor tratamiento basado en la evidencia clínica. El objetivo de esta revision es reconocer los elementos clínicos que han condicionado el aumento inusitado de casos de cáncer de tiroides. Conclusión: El sobrediagnóstico del cáncer de tiroides es una realidad, que se posibilita por el uso extendido de biopsia por aspiración con aguja fina ((BACAF)) después de la detección de un nódulo tiroideo, en gran parte de manera incidental, sin acarrear la mayoría de las veces un mejor pronóstico después de su tratamiento.

Predicting the profile of nutrients available for absorption: from nutrient requirement to animal response and environmental impact

Current feed evaluation systems for dairy cattle aim to match nutrient requirements with nutrient intake at pre-defined production levels. These systems were not developed to address, and are not suitable to predict, the responses to dietary changes in terms of production level and product composition, excretion of nutrients to the environment, and nutrition related disorders. The change from a requirement to a response system to meet the needs of various stakeholders requires prediction of the profile of absorbed nutrients and its subsequent utilisation for various purposes. This contribution examines the challenges to predicting the profile of nutrients available for absorption in dairy cattle and provides guidelines for further improved prediction with regard to animal production responses and environmental pollution. The profile of nutrients available for absorption comprises volatile fatty acids, long-chain fatty acids, amino acids and glucose. Thus the importance of processes in the reticulo-rumen is obvious. Much research into rumen fermentation is aimed at determination of substrate degradation rates. Quantitative knowledge on rates of passage of nutrients out of the rumen is rather limited compared with that on degradation rates, and thus should be an important theme in future research. Current systems largely ignore microbial metabolic variation, and extant mechanistic models of rumen fermentation give only limited attention to explicit representation of microbial metabolic activity. Recent molecular techniques indicate that knowledge on the presence and activity of various microbial species is far from complete. Such techniques may give a wealth of information, but to include such findings in systems predicting the nutrient profile requires close collaboration between molecular scientists and mathematical modellers on interpreting and evaluating quantitative data. Protozoal metabolism is of particular interest here given the paucity of quantitative data. Empirical models lack the biological basis necessary to evaluate mitigation strategies to reduce excretion of waste, including nitrogen, phosphorus and methane. Such models may have little predictive value when comparing various feeding strategies. Examples include the Intergovernmental Panel on Climate Change (IPCC) Tier II models to quantify methane emissions and current protein evaluation systems to evaluate low protein diets to reduce nitrogen losses to the environment. Nutrient based mechanistic models can address such issues. Since environmental issues generally attract more funding from governmental offices, further development of nutrient based models may well take place within an environmental framework.

Nectar resource diversity organises flower-visitor community structure

Communities of nectar-producing plants show high spatio-temporal variation in the patterns of volume and concentration presentation. We illustrate a novel approach for quantifying nectar reward structures in complex communities, demonstrating that nectar resource diversity (defined as the variety of nectar volume-concentration combinations available) may be a fundamental factor organising nectarivore communities. In a series of diverse bee and entomophilous flower communities in Israel, our measure of nectar resource diversity alone explains the majority of variation in bee species richness, while other nectar variables (volume, concentration, energy value, and water content) have little predictive value per se. The new measure of nectar resource diversity is highly correlated with floral species richness and particularly with the species richness of annuals, yet it is additive in its effect on bee diversity. We conclude that relying solely upon measurements of mean nectar volume and mean nectar concentration overlooks a key characteristic of community-level reward structure, nectar resource diversity, so that previous studies may have failed to identify an important determinant of flower-visitor community structure.

Progress in the genetics of common obesity and type 2 diabetes

The prevalence of obesity and diabetes, which are heritable traits that arise from the interactions of multiple genes and lifestyle factors, continues to rise worldwide, causing serious health problems and imposing a substantial economic burden on societies. For the past 15 years, candidate gene and genome-wide linkage studies have been the main genetic epidemiological approaches to identify genetic loci for obesity and diabetes, yet progress has been slow and success limited. The genome-wide association approach, which has become available in recent years, has dramatically changed the pace of gene discoveries. Genome-wide association is a hypothesis-generating approach that aims to identify new loci associated with the disease or trait of interest. So far, three waves of large-scale genome-wide association studies have identified 19 loci for common obesity and 18 for common type 2 diabetes. Although the combined contribution of these loci to the variation in obesity and diabetes risk is small and their predictive value is typically low, these recently identified loci are set to substantially improve our insights into the pathophysiology of obesity and diabetes. This will require integration of genetic epidemiological methods with functional genomics and proteomics. However, the use of these novel insights for genetic screening and personalised treatment lies some way off in the future.

Resilience in crisis reconsidered: the need for values against relativist ethics

The need for a reconsideration of resilience from both a positive and a normative point of view can be discussed using some of the lessons and conclusions drawn from individual resilience studied by psychologists in an educational context. The main point made in this article is that unless we want to approach resilience as a feature which is exogenously given in each population and society and whose dynamics, if any, are not subject to deliberate actions and policies, we need a framework for the evaluation of resilience as a social good. Relying on the hope that resilience is necessarily built in our societies as a force guaranteeing convergence to a socially desirable point of social evolution may be too optimistic and even counterproductive, because it may lead us to an inefficient or biased political and regulatory decision making. When the effect of policies and actions at a national or international level take into account the dynamic effect of such actions on resilience itself, one cannot blindly rely on the goodness of the process any more. This is mainly because resilience is not uniformly embodied in all societies and it does not have a globally positive social value by itself. The issue of socially valuing the options available beyond market-price valuations becomes fundamental in this context.

Procalcitonin is useful in identifying bacteraemia among children with pneumonia

Empirical antibiotic use is prescribed in managing children with pneumonia worldwide. We assessed the usefulness of procalcitonin (PCT) and interferon-alpha (IFN-alpha) in differentiating viral from bacterial pneumonia. Among 159 hospitalized children, pneumonia was diagnosed based on clinical complaints plus pulmonary infiltrate. Aetiology was investigated for 9 viruses and 4 atypical and 3 typical bacteria. PCT and IFN-alpha were measured in the serum sample collected on admission. Eight patients had bacteraemic infections, 38 had non-bacteraemic typical infections, and 19 patients had atypical bacterial infections. Viral and unknown aetiology was established in 57 (36%) and 34 (21%) cases, respectively. Three patients with bacterial infection without collected blood culture were excluded. IFN-alpha (IU/ml) was detectable in 20 (13%) cases. The difference among median PCT values of the bacteraemic (4.22; 1.56-7.56), non-bacteraemic typical bacterial (1.47; 0.24-4.07), atypical bacterial (0.18; 0.06-1.03) and only viral (0.65; 0.11-2.22) subgroups was significant (p = 0.02). PCT was >= 2 ng/ml in 52 (33%) cases. The presence of IFN-alpha was associated with PCT <2 ng/ml (90% vs. 64%, p = 0.02). The negative predictive value (95% confidence interval) of PCT >= 2 ng/ml was 95% (89-100%), 89% (78-100%), 93% (85-100%) for differentiation of bacteraemic from viral, atypical bacterial and non-bacteraemic typical bacterial infection, respectively, and 58% (49-68%) for differentiation between bacterial and viral infection. PCT may be useful in identifying bacteraemia among children hospitalized with community-acquired pneumonia. IFN-alpha was uncommonly detected.

Patterns of Antibodies Against Latent and Lytic Antigens of Human Herpesvirus 8 in an Endemic Population and Patients With Kaposi`s Sarcoma in Mozambique

The patterns of antibodies against latent and lytic antigens of human herpesvirus 8 (HHV-8) were assessed using immunofluorescence assays of samples from 155 persons seropositive for HHV-8 seen at public health centers and 24 patients with Kaposi`s sarcoma (KS) from Mozambique. Of the 155 persons without KS, 48(31%) had antibodies against latent antigens only, 29 (18.7%) had antibodies against lytic antigens only, and 78 (50.3%) had antibodies against both types of antigen. The HHV-8 antibody titer tended to increase with age until age 40, after which it began to decrease. High titers of antibodies against latent and lytic antigens of HHV-8 were detected mostly in persons co-infected with HIV, and these increased titers could have a predictive value. All patients with KS except four patients who were seronegative for HHV-8 had elevated titers of HHV-8 antibodies, predominantly against latent antigens. The data suggest the potential for an increase in the development of KS in this endemic area for HHV-8. J. Med. Virol. 82:1576-1581, 2010. (C) 2010 Wiley-Liss, Inc.

Existence of secondary bifurcations or isolas for PDEs

In this paper, we introduce a method to conclude about the existence of secondary bifurcations or isolas of steady state solutions for parameter dependent nonlinear partial differential equations. The technique combines the Global Bifurcation Theorem, knowledge about the non-existence of nontrivial steady state solutions at the zero parameter value and explicit information about the coexistence of multiple nontrivial steady states at a positive parameter value. We apply the method to the two-dimensional Swift-Hohenberg equation. (C) 2011 Elsevier Ltd. All rights reserved.

Estudo de caso-controle para desenvolvimento e validação de um questionário de avaliação de abuso sexual em crianças

Objetivos: Desenvolver e validar instrumento que auxilie o pediatra a determinar a probabilidade de ocorrência do abuso sexual em crianças. Métodos: Estudo de caso-controle com 201 crianças que consultaram em ambulatórios de pediatria e locais de referência para vítimas de abuso sexual, entre março e novembro de 2004: grupo caso (com suspeita ou revelação de abuso sexual) e grupo controle (sem suspeita de abuso sexual). Aplicou-se, junto aos responsáveis, um questionário com 18 itens e cinco opções de respostas segundo a escala Likert, abordando comportamento, sintomas físicos e emocionais apresentados pelas crianças. Excluíram-se nove crianças sem controle esfincteriano e um item respondido por poucas pessoas. A validade e consistência interna dos itens foram avaliadas com obtenção de coeficientes de correlação (Pearson, Spearman e Goodman-Kruskal), coeficiente α de Cronbach e cálculo da área da curva ROC. Calculou-se, após, a razão de verossimilhança (RV) e os valores preditivo positivos (VPP) para os cinco itens do questionário que apresentaram os melhores desempenhos. Resultados: Obteve-se um questionário composto pelos cinco itens que melhor discriminaram crianças com e sem abuso sexual em dois contextos. Cada criança recebeu um escore resultante da soma das respostas com pesos de 0 a 4 (amplitude de 0 a 20), o qual, através do teorema de Bayes (RV), indicou sua probabilidade pós-teste (VPP) de abuso sexual. Conclusões: O instrumento proposto é útil por ser de fácil aplicação, auxiliando o pediatra na identificação de crianças vítimas de abuso sexual. Ele fornecerá, conforme o escore obtido, a probabilidade (VPP) de abuso sexual, orientando na conduta de cuidado à criança.

Identificação do linfonodo-sentinela em pacientes com carcinoma de colo uterino invasor estádio I-B 1

Objetivo: determinar a viabilidade da identificação do linfonodo-sentinela em pacientes com câncer invasor de colo uterino estádio Ib1. Material e Métodos: 16 pacientes consecutivas com câncer de colo uterino agendadas para histerectomia radical com linfadenectomia pélvica bilateral realizaram estudo para detecção de linfonodo-sentinela. Onze pacientes injetaram 1 mCi de tecnécio 99 (99Tc) em quatro pontos do estroma superficial do colo uterino ao redor do tumor, às 12, 3, 6 e 9 h ( 16 horas antes da cirurgia ). No dia da cirurgia, as pacientes foram submetidas ao mapeamento linfático com gamma-probe e azul patente injetado nos mesmos pontos que o 99Tc.Cinco pacientes realizaram a detecção apenas com azul patente. Resultados: foi detectado pelo menos um (1 a 3 por paciente) linfonodo-sentinela em cada uma das 15 pacientes (93,7 %) que realizaram a técnica combinada.Foi detectado pelo menos 1 linfonodo-sentinela em 4 pacientes ( 80% )com azul patente apenas. A maioria dos linfonodos-sentinela foi localizada nas regiões: obturadora (37 %), ilíaca externa (22,2 %) e inter-ilíacas (18,5 %). Seis pacientes (40 %) tiveram linfonodos-sentinela bilaterais. Dos 27 linfonodos-sentinela detectados, 11 (40,7 %) foram detectados pelo corante, 9 (33,3%) pela radioatividade e 7 (26 %) pela radioatividade e corante. O índice de detecção intra-operatória com o gamma-probe foi de 90,9 % ( 11 pacientes ). Destes, 7 linfonodos foram azul e quente (31,8 %), 6 linfonodos foram apenas azuis (27,2 %) e 9 linfonodos foram apenas quentes (40,9 %). A sensibilidade, especificidade e valor preditivo negativo para a detecção do linfonodo-sentinela foram 100%, 85,7 % e 100 % respectivamente. Conclusão: A combinação do radiofármaco 99Tc e azul patente é efetiva na detecção do linfonodosentinela em câncer de colo uterino inicial.

Velocidade da marcha como preditor de fragilidade em uma amostra populacional de idosos brasileiros

Gait speed has been described as a predictive indicator of important adverse outcomes in older populations. Among the criteria to evaluate frailty, gait speed has been identified as the most reliable predictor of fragility, practical and low cost. Objective: This study assesses the discriminating capability of gait speed in determining the presence of fragility in the elderly community in northeast of Brazil. Method: We performed an observational analytic study with a transversal character with a sample of 391 community-living elders, aged 65 years or older, of both sexes, in the city of Santa Cruz-RN. Participants were interviewed using a multidimensional questionnaire to obtain sociodemographic information, physical-related and mental health-related information. The unintentional weight loss, muscle weakness, self-reported exhaustion, slow gait and low-physical activity were considered to evaluate the frailty syndrome. Gait velocity was measured as the time taken to walk the middle 4,6 meters of 8,6 meters (excluding 2 meters to warm-up phase and 2 meters to deceleration phase).We calculate the sensitivity and specificity of gait speed test in different cutoff points for the test run time, from which ROC curve was constructed as a measure of test predictive value to identify frail elders. The prevalence of frailty in Santa Cruz-RN was 17.1%. The gait speed test accuracy was 71%when speed is below 0,91m/s. Among women, the gait speed test accuracy was 80%(gait speed below 0.77m/s) and among men, the test accuracy was 86% (gait spend below 0,82%) (p<0,0001).Conclusion: our findings have clinical relevance when we consider that the detection of frailty presence by the gait speed test can be observed in elderly men and women by a simple, cheap and efficient exam

TSH and TPOAB as predictors of thyroid disease in diabetic patients

We tested the values of antithyroid peroxidase antibody and thyrotropin levels for the development of thyroid dysfunction in 109 diabetic patients. Baseline thyrotropin level was a predictor of thyroid dysfunction in diabetic patients, excluding nodular disease. The antithyroid peroxidase antibody had no predictive value for thyroid dysfunction.

Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

OBJETIVO: Estudar os padrões clínicos, radiológicos e histopatológicos da biópsia transbrônquica (BTB) utilizados para a confirmação diagnóstica em pacientes com suspeita clinica de doença pulmonar intersticial (DPI) atendidos em um hospital universitário de nível terciário. MÉTODOS: Os prontuários, laudos radiológicos e de biópsias transbrônquicas de todos os pacientes com suspeita de DPI submetidos a BTB entre janeiro de 1999 e dezembro de 2006 no Hospital das Clínicas de Botucatu, localizado na cidade de Botucatu (SP), foram revisados. RESULTADOS: Foram incluídos no estudo 56 pacientes. Desses, 11 (19,6%) apresentaram o diagnóstico definitivo de fibrose pulmonar idiopática (FPI), que foi significativamente maior nos casos nos quais DPI era uma possibilidade diagnóstica em comparação com aqueles nos quais DPI era a principal suspeita (p = 0,011), demonstrando a contribuição da BTB para a definição diagnóstica dessas doenças. O exame histopatológico dessas biópsias revelou que 27,3% dos pacientes com FPI apresentavam o padrão de pneumonia organizante, o que pode sugerir doença mais avançada. O padrão histológico indeterminado foi o mais frequente, refletindo a característica periférica da FPI. Entretanto, o padrão fibrose apresentou alta especificidade e alto valor preditivo negativo. Para os padrões sugestivos de FPI em TC, a curva ROC indicou que a melhor relação entre sensibilidade e especificidade ocorreu com a presença de cinco alterações radiológicas, sendo o aspecto de favo de mel fortemente sugestivo de FPI (p = 0,01). CONCLUSÕES: Nas DPIs, a TC de tórax deve ser sempre realizada e a BTB usada em situações individualizadas, conforme a suspeita e distribuição das lesões.

Crescimento relativo e composição do ganho de tecidos na carcaça de bubalinos Mediterrâneo jovens abatidos com diferentes pesos

Utilizaram-se 32 bubalinos machos não-castrados, da raça Mediterrâneo, divididos aleatoriamente em cinco categorias. Os animais de uma categoria foram abatidos imediatamente, enquanto os demais foram alimentados, à vontade, com ração contendo 70% de concentrado (na matéria seca) e abatidos ao atingirem 450, 480, 510 ou 540 kg de peso corporal. Adotou-se a equação de regressão do logaritmo da quantidade corporal de carcaça e de seus tecidos (muscular, adiposo e ósseo) em função do logaritmo do peso de corpo vazio. A carcaça apresentou valor de alometria, o que indica desenvolvimento proporcionalmente igual ao do peso corporal vazio. Derivando as equações, obtiveram-se as equações de predição da participação dos componentes corporais no ganho de 1 kg de peso de corpo vazio. Na carcaça, o tecido adiposo teve maior impulso de crescimento em idade mais tardia, enquanto os tecidos ósseo e muscular tiveram maior impulso para crescimento em idade mais precoce.