Utilidad del d��mero D en el diagnóstico de tromboembolismo pulmonar en la Fundación Santa Fé de Bogotá

INTRODUCCIÓN: El diagnóstico de Tromboembolismo Pulmonar (TEP) ha sido un reto clínico a pesar de los avances en modalidades diagnósticas y opciones terapéuticas, el TEP permanece como una entidad sub diagnosticada y letal. La medición en sangre del D��mero D, con punto de corte de 500 mcg/L, por lo tanto es una excelente prueba de tamizaje para los pacientes en el departamento de urgencias . Esta evaluación inicial debe ser complementada con la realización de angioTAC de tórax, decisión que debe ser tomada precozmente con el fin de evitar complicaciones que amenacen la vida METODOLOGIA: Se realizo un estudio de prueba diagnóstica retrospectivo donde se revisaron las historias clínicas de 109 pacientes adultos de la Fundación Santa Fe de Bogotá en quienes se realizo angioTAC de tórax con protocolo para TEP, con probabilidad diagnóstica de Tromboembolismo Pulmonar Baja o Intermedia por criterios de Wells y que además tengan D��mero D. Se calculo la sensibilidad y especificidad del D��mero D teniendo en cuenta la probabilidad clínica pre test calculada por criterios de Wells, y se calcularon likelihood ratio positivo y negativo para cada punto de corte de D��mero D. RESULTADOS: El estudio mostro una sensibilidad del 100% para valores de D��mero D menores de 1100 mcg/L, en pacientes con baja probabilidad, y sensibilidad de 100% para valores menores de 700 mcg/L en pacientes con probabilidad intermedia. DISCUSIÓN: Pacientes con baja probabilidad pre test por criterios de Wells con valores de D��mero D menores de 1100 mcg/L y de probabilidad intermedia con valores menores de 700 mcg/L no requieren estudios adicionales, lo cual disminuye de manera importante la toma de angioTAC y reduce costos de atención.

Adherencia a criterios de pertinencia de revascularización coronaria del colegio americano de cardiología, servicio de hemodinamia Fundación Cardioinfantil- Bogotá 2011

Titulo: Adherencia a criterios de pertinencia de revascularización coronaria del colegio americano de cardiología 2009, en el servicio de hemodinámica de la fundación cardioinfantil Bogotá 2011. Introducción: La enfermedad cardiovascular es la principal causa de morbimortalidad a nivel mundial, teniendo mayor prevalencia enfermedad coronaria. Existen guías especificas para el manejo de esta enfermedad sin embargo su aplicación se entorpece por factores diversos. Este estudio quiere evaluar la adherencia, en el laboratorio de hemodinamia de la Fundación Cardioinfantil, a las guías de pertinencia de intervencionismo coronario de la ACCF (American college of cardiology foundation). Objetivo General: Evaluar el nivel de adherencia a criterios de pertinencia de revascularización coronaria del colegio americano de cardiología 2009, en el servicio de hemodinámia de la fundación cardioinfantil Bogotá 2011. Métodos: Se revisaron 200 historias clínicas pacientes con diagnóstico de síndrome coronario agudo, llevados a intervención coronaria, según características de pacientes , intervención, y nivel de adherencia se clasifico la intervención como apropiada, incierta e inadecuada . Resultados: De la población analizada, el 71% (n=142) de las intervenciones fueron clasificados como apropiadas, 20% (N=40) como inapropiadas y 8,5% (n=17) como inciertas. Los desenlaces y complicaciones no tuvieron asociación estad��sticamente significativa (p> 0,005) con la adherencia a los criterios de pertinencia. Conclusiones: Respecto a la literatura existente el número de intervenciones inapropiadas es mayor en la FCI, comparado con estudios practicados en América Latina y Norte América, sin embargo una adherencia del 80 %, ubica a esta institución en un adecuado nivel de adherencia.

Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia

A causa de los conflictos armados, como el de Colombia, se han desplazado por la fuerza a millones de personas, entre ellas una importante parte de la población infantil. Este estudio tuvo como objetivo evaluar la salud mental de los niños desplazados internos en edad preescolar en Bogotá Colombia, e identificar los determinantes de la salud mental en estos niños. Métodos: Estudio transversal realizado entre 279 niños que asisten a cuatro jardines infantiles en un barrio marginal de Bogotá. La salud mental infantil se evaluó con el instrumento validado de Comportamiento Infantil (CBCL) 1,5-5 años, aplicados a padres y cuidadores. Se realizo un análisis univariado y multivariado de regresión logística para evaluar la asociación entre el desplazamiento y la salud mental de los niños y para identificar las relaciones con la salud mental en los niños desplazados. Resultados: los Niños desplazados (n = 90) se identificaron con más frecuencia sobre los puntos de corte límite para las escalas CBCL que los no desplazados (n = 189) (por ejemplo, problemas totales 46,7 vs 22,8%;p \ 0,001). La asociación entre el desplazamiento y la presencia de problemas CBCL totales se mantuvo después del ajuste por factores socio-demográficos (OR Ajustado 3.3 del 95%: 1,5; 6,9). Donde la salud mental del cuidador explica en parte la asociación. En los niños desplazados, la salud mental del cuidador (p \ 0,01) y el funcionamiento familiar (p \ 0,01) se asociaron independientemente con la salud mental de los niños. La exposición a eventos traumáticos y el apoyo social también se asociaron con la salud mental del niño, sin embargo, las asociaciones no fueron independientes. Conclusión: En este barrio marginal de Bogotá, los niños en edad preescolar registrados como desplazados internos presentan peor salud mental que los no desplazados. El funcionamiento familiar y la salud mental del cuidador fueron fuerte e independientemente asociados con la salud mental de los niños y niñas desplazados.

Análisis de la incidencia de la Teoría de la Identidad Colectiva en la posición de la Liga Árabe frente al reconocimiento de Somalilandia como Estado independiente

Esta Monografía se centra en mostrar cómo el intento por conservar la identidad colectiva de la Liga de los Estados Árabes impide ceder ante el deseo de Somalilandia de ser reconocida como Estado independiente.

Cooperación Sur-Sur: Análisis de su impacto en la transformación del régimen internacional de la OCDE en materia de cooperación internacional

Las relaciones de cooperación Sur-Sur revoluciona las lógicas tradicionales que dieron base al régimen de la cooperación internacional expedido desde la OCDE. La diferencia entre los donantes llamados “DAC” y los socios “No-DAC” en referencia a los Estados miembros del Comité de Asistencia al Desarrollo establece dos lógicas de cooperación internacional que se contraponen en sus dinámicas pero comparten un objetivo: el desarrollo. Estos dos tipos de relaciones de cooperación se diferencian en cuatro aspectos: calidad de los actores implicados, dirección de la relación, tipo de intercambio y presencia o ausencia del Principio de Condicionalidad. A diferencia de las relaciones de cooperación Norte-Sur donde se establece una relación unidireccional entre el donante y el receptor, canal utilizado para el flujo crediticio y financiero (bien sea a través de créditos o de subvenciones), las relaciones de cooperación Sur-Sur establecen una relación bidireccional. Esta bidireccionalidad hace que la cooperación internacional se convierta en una herramienta de poder relativo para aquellos actores que carecían de peso en el sistema internacional. La carta fundamental de los Estados con economías emergentes será darle voz a aquellos que no la han tenido. A través de relaciones que se catalogan como asociaciones estratégicas, entre sujetos con un similar nivel de desarrollo, el Principio de Condicionalidad como rector de la relación de cooperación, desaparece. Asi, la formación del Grupo de Tareas para la Cooperación Sur-Sur adscrito al DAC es una muestra del cambio estructural del régimen de la cooperación internacional, y más aún, de las dinámicas tradicionales del sistema internacional.

Análisis de la producción escrita en revistas internacionales especializadas en terapia ocupacional (American Journal of Occupational Therapy – Canadian Journal of Occupational Therapy) sobre el concepto de desempeño ocupacional en el periodo comprendido entre 1996 – 2006

En todas las etapas de la vida, las personas se encuentran influenciadas por el ambiente, el cual es un facilitador o inhibidor para el desarrollo de sus actividades, permitiéndole elegir qué ocupaciones desea desempeñar de acuerdo a sus intereses y habilidades. Es por ello que el presente trabajo sustenta el objeto de estudio por medio de la revisión, análisis y reflexión de textos especializados en terapia ocupacional en el periodo comprendido entre 1996 – 2006, en las revistas Canadiense y Americana de Terapia Ocupacional, encontradas en la Biblioteca Ciencias de la Salud de la Universidad del Rosario.

Factores asociados a mortalidad en pacientes colombianos con enfermedades autoinmunes en la unidad de cuidado intensivo, de un hospital de tercer nivel en Bogotá Colombia

Antecedentes: El interés en las enfermedades autoinmunes (EA) y su desenlace en la unidad de cuidado intensivo (UCI) han incrementado debido al reto clínico que suponen para el diagnóstico y manejo, debido a que la mortalidad en UCI fluctúa entre el 17 – 55 %. El siguiente trabajo representa la experiencia de un año de nuestro grupo en un hospital de tercer nivel. Objetivo: Identificar factores asociados a mortalidad particulares de los pacientes con enfermedades autoinmunes que ingresan a una UCI, de un hospital de tercer nivel en Bogotá, Colombia. Métodos: El uso de análisis de componentes principales basado en el método descriptivo multivariado y análisis de múltiple correspondencia fue realizado para agrupar varias variables relacionadas con asociación significativa y contexto clínico común. Resultados: Cincuenta pacientes adultos con EA con una edad promedio de 46,7 ± 17,55 años fueron evaluados. Los dos diagnósticos más comunes fueron lupus eritematoso sistémico y esclerosis sistémica, con una frecuencia de 45% y 20% de los pacientes respectivamente. La principal causa de admisión en la UCI fue la infección seguido de actividad aguda de la EA, 36% y 24% respectivamente. La mortalidad durante la estancia en UCI fue del 24%. El tiempo de hospitalización antes de la admisión a la UCI, el choque, soporte vasopresor, ventilación mecánica, sepsis abdominal, Glasgow bajo y plasmaféresis fueron factores asociados con mortalidad. Dos fenotipos de variables fueron definidos relacionadas con tiempo en la UCI y medidas de soporte en UCI, las cuales fueron asociadas supervivencia y mortalidad. Conclusiones: La identificación de factores individuales y grupos de factores por medio del análisis de componentes principales permitirá la implementación de medidas terapéutica de manera temprana y agresiva en pacientes con EA en la UCI para evitar desenlaces fatales.

Nest Boxes Facilitate Local-Scale Conservation of Common Goldeneye (Bucephala clangula) and Bufflehead (Bucephala albeola) in Alberta, Canada

We tested the general predictions of increased use of nest boxes and positive trends in local populations of Common Goldeneye (Bucephala clangula) and Bufflehead (Bucephala albeola) following the large-scale provision of nest boxes in a study area of central Alberta over a 16-year period. Nest boxes were rapidly occupied, primarily by Common Goldeneye and Bufflehead, but also by European Starling (Sturnus vulgaris). After 5 years of deployment, occupancy of large boxes by Common Goldeneye was 82% to 90% and occupancy of small boxes by Bufflehead was 37% to 58%. Based on a single-stage cluster design, experimental closure of nest boxes resulted in significant reductions in numbers of broods and brood sizes produced by Common Goldeneye and Bufflehead. Occurrence and densities of Common Goldeneye and Bufflehead increased significantly across years following nest box deployment at the local scale, but not at the larger regional scale. Provision of nest boxes may represent a viable strategy for increasing breeding populations of these two waterfowl species on landscapes where large trees and natural cavities are uncommon but wetland density is high.

Understanding mixing efficiency in the oceans. Do the nonlinearities of the equation of state matter?

There exist two central measures of turbulent mixing in turbulent stratified fluids that are both caused by molecular diffusion: 1) the dissipation rate D(APE) of available potential energy APE; 2) the turbulent rate of change Wr, turbulent of background gravitational potential energy GPEr. So far, these two quantities have often been regarded as the same energy conversion, namely the irreversible conversion of APE into GPEr, owing to the well known exact equality D(APE)=Wr, turbulent for a Boussinesq fluid with a linear equation of state. Recently, however, Tailleux (2009) pointed out that the above equality no longer holds for a thermally-stratified compressible, with the ratio ξ=Wr, turbulent/D(APE) being generally lower than unity and sometimes even negative for water or seawater, and argued that D(APE) and Wr, turbulent actually represent two distinct types of energy conversion, respectively the dissipation of APE into one particular subcomponent of internal energy called the "dead" internal energy IE0, and the conversion between GPEr and a different subcomponent of internal energy called "exergy" IEexergy. In this paper, the behaviour of the ratio ξ is examined for different stratifications having all the same buoyancy frequency N vertical profile, but different vertical profiles of the parameter Υ=α P/(ρCp), where α is the thermal expansion coefficient, P the hydrostatic pressure, ρ the density, and Cp the specific heat capacity at constant pressure, the equation of state being that for seawater for different particular constant values of salinity. It is found that ξ and Wr, turbulent depend critically on the sign and magnitude of d��/dz, in contrast with D(APE), which appears largely unaffected by the latter. These results have important consequences for how the mixing efficiency should be defined and measured in practice, which are discussed.

Prebiotic effects: metabolic and health benefits

The different compartments of the gastrointestinal tract are inhabited by populations of micro-organisms. By far the most important predominant populations are in the colon where a true symbiosis with the host exists that is a key for well-being and health. For such a microbiota, 'normobiosis' characterises a composition of the gut 'ecosystem' in which micro-organisms with potential health benefits predominate in number over potentially harmful ones, in contrast to 'dysbiosis', in which one or a few potentially harmful micro-organisms are dominant, thus creating a disease-prone situation. The present document has been written by a group of both academic and industry experts (in the ILSI Europe Prebiotic Expert Group and Prebiotic Task Force, respectively). It does not aim to propose a new definition of a prebiotic nor to identify which food products are classified as prebiotic but rather to validate and expand the original idea of the prebiotic concept (that can be translated in 'prebiotic effects'), defined as: 'The selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host.' Thanks to the methodological and fundamental research of microbiologists, immense progress has very recently been made in our understanding of the gut microbiota. A large number of human intervention studies have been performed that have demonstrated that dietary consumption of certain food products can result in statistically significant changes in the composition of the gut microbiota in line with the prebiotic concept. Thus the prebiotic effect is now a well-established scientific fact. The more data are accumulating, the more it will be recognised that such changes in the microbiota's composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health. The review is divided in chapters that cover the major areas of nutrition research where a prebiotic effect has tentatively been investigated for potential health benefits. The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system. Confirming the studies in adults, it has been demonstrated that, in infant nutrition, the prebiotic effect includes a significant change of gut microbiota composition, especially an increase of faecal concentrations of bifidobacteria. This concomitantly improves stool quality (pH, SCFA, frequency and consistency), reduces the risk of gastroenteritis and infections, improves general well-being and reduces the incidence of allergic symptoms such as atopic eczema. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Promising beneficial effects have been demonstrated in some preliminary studies, including changes in gut microbiota composition (especially increase in bifidobacteria concentration). Often associated with toxic load and/or miscellaneous risk factors, colon cancer is another pathology for which a possible role of gut microbiota composition has been hypothesised. Numerous experimental studies have reported reduction in incidence of tumours and cancers after feeding specific food products with a prebiotic effect. Some of these studies (including one human trial) have also reported that, in such conditions, gut microbiota composition was modified (especially due to increased concentration of bifidobacteria). Dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase Ca absorption as well as bone Ca accretion and bone mineral density. Recent data, both from experimental models and from human studies, support the beneficial effects of particular food products with prebiotic properties on energy homaeostasis, satiety regulation and body weight gain. Together, with data in obese animals and patients, these studies support the hypothesis that gut microbiota composition (especially the number of bifidobacteria) may contribute to modulate metabolic processes associated with syndrome X, especially obesity and diabetes type 2. It is plausible, even though not exclusive, that these effects are linked to the microbiota-induced changes and it is feasible to conclude that their mechanisms fit into the prebiotic effect. However, the role of such changes in these health benefits remains to be definitively proven. As a result of the research activity that followed the publication of the prebiotic concept 15 years ago, it has become clear that products that cause a selective modification in the gut microbiota's composition and/or activity(ies) and thus strengthens normobiosis could either induce beneficial physiological effects in the colon and also in extra-intestinal compartments or contribute towards reducing the risk of dysbiosis and associated intestinal and systemic pathologies.

Post-abscission, pre-dispersal seeds of Digitalis purpurea remain in a developmental state that is not terminated by desiccation ex planta

Seed quality may be compromised if seeds are harvested before natural dispersal (shedding). It has been shown previously that slow or delayed drying can increase potential quality compared with immediate rapid drying. This study set out to investigate whether or not there is a critical moisture content, below which drying terminates maturation events for seeds harvested after mass maturity but before dispersal. Seeds of foxglove (Digitalis purpurea) in the post-abscission pre-dispersal phase were held at between 15 and 95 % RH for 4 or 8 d, with or without re-hydration to 95 % RH for a further 4 d, before drying to equilibrium at 15 % RH. In addition, dry seeds were primed for 48 h at -1 MPa. Subsequent seed longevity was assessed at 60 % RH and 45 degrees C. Rate of germination and longevity were improved by holding seeds at a wide range of humidities after harvest. Longevity was further improved by re-hydration at 95 % RH. Priming improved the longevity of the seeds dried immediately after harvest, but not of those first held at 95 % RH for 8 d prior to drying. Maturation continued ex planta in these post-abscission, pre-dispersal seeds of D. purpurea dried at 15-80 % RH at a rate correlated positively with RH (cf. ageing of mature seeds). Subsequent re-hydration at 95 % RH enabled a further improvement in quality. Priming seeds initially stored air-dry for 3 months also allowed maturation events to resume. However, once individual seeds within the population had reached maximum longevity, priming had a negative impact on their subsequent survival.

In vitro evaluation of fibrolytic enzymes as additives for maize (Zea mays L.) silage - I. Effects of ensiling temperature, enzyme source and addition level

A series of experiments was completed to investigate the impact of addition of enzymes at ensiling on in vitro rumen degradation of maize silage. Two commercial products, Depot 40 (D, Biocatalysts Ltd., Pontypridd, UK) and Liquicell 2500 (L, Specialty Enzymes and Biochemicals, Fresno, CA, USA), were used. In experiment 1, the pH optima over a pH range 4.0-6.8 and the stability of D and L under changing pH (4.0, 5.6, 6.8) and temperature (15 and 39 degreesC) conditions were determined. In experiment 2, D and L were applied at three levels to whole crop maize at ensiling, using triplicate 0.5 kg capacity laboratory minisilos. A completely randomized design with a factorial arrangement of treatments was used. One set of treatments was stored at room temperature, whereas another set was stored at 40 degreesC during the first 3 weeks of fermentation, and then stored at room temperature. Silages were opened after 120 days. Results from experiment I indicated that the xylanase activity of both products showed an optimal pH of about 5.6, but the response differed according to the enzyme, whereas the endoglucanase activity was inversely related to pH. Both products retained at least 70% of their xylanase activity after 48 h incubation at 15 or 39 degreesC. In experiment 2, enzymes reduced (P < 0.05) silage pH, regardless of storage temperature and enzyme level. Depol 40 reduced (P < 0.05) the starch contents of the silages, due to its high alpha-amylase activity. This effect was more noticeable in the silages stored at room temperature. Addition of L reduced (P < 0.05) neutral detergent fiber (NDF) and acid detergent fiber (ADF) contents. In vitro rumen degradation, assessed using the Reading Pressure Technique (RPT), showed that L increased (P < 0.05) the initial 6 h gas production (GP) and organic matter degradability (OMD), but did not affect (P > 0.05) the final extent of OMD, indicating that this preparation acted on the rumen degradable material. In contrast, silages treated with D had reduced (P < 0.05) rates of gas production and OMD. These enzymes, regardless of ensiling temperature, can be effective in improving the nutritive quality of maize silage when applied at ensiling. However, the biochemical properties of enzymes (i.e., enzymic activities, optimum pH) may have a crucial role in dictating the nature of the responses. (C) 2003 Elsevier B.V. All rights reserved.

Dichrostachys cinerea and Acacia nilotica fruits as dry season feed supplements for goats in a semi-arid environment: Summary of a DFID funded project in Zimbabwe

Indehiscent fruits of six tree species, common in Matabeleland were examined in in vitro and in vivo trials. The results for two of them, Acacia nilotica and Dichrostachys cinerea are presented here. Acacia nilotica-contained more total phenolics than D. cinerea, but less nitrogen (N) and fibre (ADF and NDF). After 48 h incubation, in vitro OMD of both species was increased by PEG and NaOH or wood ash treatment, except when NaOH or wood ash were used in combination with PEG with D. cinerea fruits. DM intake, DMD were lowest and N-retention negative in goats fed A. nilotica as supplement. However when fed a supplement of D. cinerea, untreated or treated with PEG or NaOH, digestibility and N-retention were highest, and similar to a commercial goat meal, with the untreated fruit. In a trial in which milking does were supplemented with D. cinerea fruits, for 65 before and 65 days after kidding, kid birthweight and weaning weight were increased by supplementation. Deaths of twin-born kids were lowest in the supplemented but unmilked group. Supplementation with D. cinerea fruit resulted in improved goat performance. The only treatment applied of practical significance, wood ash, is currently being tested in an in vivo study. More research is required on detoxification of tannins, especially with A. nilotica. (c) 2005 Elsevier B.V. All rights reserved.

Reproduction recovery of the crustacean Daphnia magna after chronic exposure to ibuprofen

In mammals, the pharmaceutical ibuprofen (IB), a non-steroidal anti-inflammatory drug, primarily functions by reversibly inhibiting the cyclooxygenase (COX) pathway in the synthesis of eicosanoids (e.g. prostaglandins). Previous studies suggest that IB may act in a similar manner to interrupt production of eicosanoids reducing reproduction in the model crustacean Daphnia magna. On this basis withdrawal of IB should lead to the recovery of D. magna reproduction. Here we test whether the effect of IB is reversible in D. magna, as it is in mammals, by observing reproduction recovery following chronic exposure. D. magna (5-days old) were exposed to a range of IB concentrations (0, 20, 40 and 80 mg l(-1)) for 10 days followed by a 10 day recovery period in uncontaminated water. During the exposure period, individuals exposed to higher concentrations produced significantly fewer offspring. Thereafter, IB-stressed individuals produced offspring faster during recovery, having similar average population growth rates (PGR) (1.15-1.28) to controls by the end of the test. It appears that maternal daphnids are susceptible to IB during egg maturation. This is the first recorded recovery of reproduction in aquatic invertebrates that suffered reproductive inhibition during chronic exposure to a chemical stressor. Our results suggest a possible theory behind the compensatory fecundity that we referred to as 'catch-up reproduction'.