Implementación de un centro de diagnóstico tomográfico en la ciudad de Puerto Maldonado - Madre de Dios

El presente trabajo de investigación tiene como propósito desarrollar y evaluar un plan de negocios en el campo de la radiología, como lo es la implementación de un Centro Tomográfico en la ciudad de Puerto Maldonado. Para el lo es necesario analizar el micro y macroentorno de Puerto Maldonado y la región de Madre de Dios, donde se pudo identificar que la única competencia directa para el Centro Tomográfico son los hospitales del gobierno, tanto del MINSA como de ESSALUD; no existiendo una oferta privada del servicio tomográfico en la zona de Madre de Dios

Gap between development and democracy at the subnational level. Santander case study

Esta tesis busca explorar para el nivel subnacional la interacción entre el nivel de desarrollo socioeconómico y funcionamiento del régimen político. En concreto, evalúa si las teorías de la modernización pueden explicar el estado de las democracias a nivel subnacional, como se ha visto en varios países a lo largo de los años, o si, por el contrario, el nivel de desarrollo económico no tiene la relación esperada con la calidad de la democracia. Para ser más concretos, se tratará de revelar las condiciones bajo las cuales existe una relación paradójica entre democracia y desarrollo en Santander, caracterizada por la existencia de crecimiento económico, disminución de la pobreza y elecciones ininterrumpidas, pero con una democracia de baja calidad dominada por unas pocas familias, clanes o partidos políticos cuyo ejercicio de gobierno viene acompañado de prácticas semiilegales, corruptas y abiertamente clientelares.This thesis seeks to explore at the subnational level the interaction between the level of socioeconomic development and the functioning of the political regime. Specifically, it evaluates whether modernization theories can explain the state of democracies at the subnational level, as has been seen in several countries over the years, or if, on the contrary, the level of economic development does not have the expected relationship with the quality of democracy. To be more specific, we will try to reveal the conditions under which there is a paradoxical relationship between democracy and development in Santander, characterized by the existence of economic growth, reduction in poverty and uninterrupted elections, but with a low quality democracy dominated by a few families, clans or political parties whose exercise of government is accompanied by semi-illegal, corrupt and openly clientelistic practices.Universidad del Rosari

Resultads despues de radiocirugía gamma en meningiomas intraventriculares

Background Intraventricular meningiomas (IVMs) are rare tumors with considerable treatment-associated morbidity due to their challenging location. Treatment with stereotactic radiosurgery (SRS) is sparsely reported in the literature. We describe our experience over the last 35 years using Gamma knife radiosurgery (GKRS) for IVMs. Methods We retrospectively reviewed the GKRS database identifying 2501 meningiomas treated at the University of Pittsburgh Medical Center over the last 35 years. Nineteen patients with (12 males, mean age = 53.2 years, range 14–84) 20 IVMs were identified. Headache was the most frequent presenting symptom (N = 12), and the trigone of the lateral ventricle was the most common location (N = 18). The median tumor volume was 4.8 cc (range, 0.8–17). The median margin dose was 14 Gy (range, 12–25) delivered at 50% isodose line. Results At a median follow-up of 63.1 months (range, 6–322.4) symptom control was achieved in 18 (94.7%) patients. The overall progression-free survival (PFS) was 95% at 5 years, and 85% at 10-years. After Log-rank test, patients who underwent GKRS within 12 months after diagnosis (vs. ≥ 12 months, X2: 4.455, p = 0.035), patients treated with primary GKRS without prior biopsy (vs. prior biopsy, X2: 4.000, p = 0.046), and patients with WHO grade I meningioma (vs. WHO II, X2: 9.000, p = 0.003) had a longer PFS. Imaging showed peritumoral edema in seven cases at a median of 10.5 (range, 6.13–24.3) months after GKRS. Only three of these patients were symptomatic and were successfully managed with oral medications. Cox´s regression revealed that a V12Gy ≥ 10 cc [HR: 10.09 (95% CI: 2.11–48.21), p = 0.004], and tumor volume ≥ 8 cc [HR: 5.87 (95% CI: 1.28–26.97), p = 0.023] were associated with a higher risk of peritumoral edema. Conclusion GKRS is an effective and safe management option for intraventricular meningiomas. Early GKRS should be considered as a primary management modality for small and medium sized IVM and adjuvant management for residual IVMs.Background Intraventricular meningiomas (IVMs) are rare tumors with considerable treatment-associated morbidity due to their challenging location. Treatment with stereotactic radiosurgery (SRS) is sparsely reported in the literature. We describe our experience over the last 35 years using Gamma knife radiosurgery (GKRS) for IVMs. Methods We retrospectively reviewed the GKRS database identifying 2501 meningiomas treated at the University of Pittsburgh Medical Center over the last 35 years. Nineteen patients with (12 males, mean age = 53.2 years, range 14–84) 20 IVMs were identified. Headache was the most frequent presenting symptom (N = 12), and the trigone of the lateral ventricle was the most common location (N = 18). The median tumor volume was 4.8 cc (range, 0.8–17). The median margin dose was 14 Gy (range, 12–25) delivered at 50% isodose line. Results At a median follow-up of 63.1 months (range, 6–322.4) symptom control was achieved in 18 (94.7%) patients. The overall progression-free survival (PFS) was 95% at 5 years, and 85% at 10-years. After Log-rank test, patients who underwent GKRS within 12 months after diagnosis (vs. ≥ 12 months, X2: 4.455, p = 0.035), patients treated with primary GKRS without prior biopsy (vs. prior biopsy, X2: 4.000, p = 0.046), and patients with WHO grade I meningioma (vs. WHO II, X2: 9.000, p = 0.003) had a longer PFS. Imaging showed peritumoral edema in seven cases at a median of 10.5 (range, 6.13–24.3) months after GKRS. Only three of these patients were symptomatic and were successfully managed with oral medications. Cox´s regression revealed that a V12Gy ≥ 10 cc [HR: 10.09 (95% CI: 2.11–48.21), p = 0.004], and tumor volume ≥ 8 cc [HR: 5.87 (95% CI: 1.28–26.97), p = 0.023] were associated with a higher risk of peritumoral edema. Conclusion GKRS is an effective and safe management option for intraventricular meningiomas. Early GKRS should be considered as a primary management modality for small and medium sized IVM and adjuvant management for residual IVMs

Especial: Melatonina ¿medicamento o suplemento dietario? Riesgos y regulación en Latinoamérica

Este artículo es realizado por un grupo de expertos en Farmacología dentro de Latinoamérica, donde se encuentran representando a Uruguay: Ángel Leal: Centro de Información de Medicamentos, Unidad Académica de Farmacología y Terapéutica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Uruguay y Maite Inthamoussu Fernández: Centro de Información de Medicamentos, Unidad Académica de Farmacología y Terapéutica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Es una publicación original de: Red de Centros de Información de Medicamentos de Latinoamérica y el Caribe. Melatonina ¿medicamento o suplemento dietario? Riesgos y regulación en Latinoamérica. 2024; Año XII;(16):1-23. Disponible en: www.redcimlac.netEl grupo de trabajo sobre evaluación de medicamentos (GEM) de la Red CIMLAC, produce una vez más un informe sobre las evidencias en materia de seguridad sobre un fármaco seleccionado. En este caso se evalúan diferentes aspectos de la melatonina, en cuanto a su regulación, disponibilidad y como estos condicionan su seguridad. Este producto es utilizado principalmente como un tratamiento para el insomnio. Su autorización comercial, es variable en todo el mundo, aprobada en algunos casos como medicamento y en otros como suplemento dietario, realidad a la cual no escapa América Latina. La información de seguridad proviene en su mayor parte de su aprobación como medicamento, e involucra a trastornos neurológicos, psiquiátricos, endocrinos, de otros sistemas e intoxicaciones. La dualidad de su comercialización ha producido un incremento en su utilización, en muchos casos en usos no aprobados y por plazos superiores a los recomendados, con el consiguiente aumento de notificaciones de intoxicación y una gran preocupación. Uno de los principales objetivos de la Red CIMLAC es colaborar con el uso racional de los medicamentos para mejorar la calidad de atención apoyando a la comunidad, a los profesionales de salud y las autoridades reguladoras. Deseamos que el presente informe responda a estas expectativas y permita que la mejor información disponible contribuya con otro objetivo como es la seguridad del paciente. Esperamos que la lectura sea de provecho y quedamos a la espera de vuestros aportes críticos o sugerencias que nos permitan seguir creciendo como red. Como siempre, la lectura crítica y sus comentarios son bienvenidos

FhaA plays a key role in mycobacterial polar elongation and asymmetric growth

Mycobacteria, including pathogens like Mycobacterium tuberculosis, exhibit unique growth patterns and cell envelope structures that challenge our understanding of bacterial physiology. This study sheds light on FhaA, a conserved protein in Mycobacteriales, revealing its pivotal role in coordinating cell envelope biogenesis and asymmetric growth. The elucidation of the FhaA interactome in living mycobacterial cells reveals its participation in the protein network orchestrating cell envelope biogenesis and cell elongation/division. By manipulating FhaA levels, we uncovered its influence on cell morphology, cell envelope organization, and the localization of peptidoglycan biosynthesis machinery. Notably, fhaA deletion disrupted the characteristic asymmetric growth of mycobacteria, highlighting its importance in maintaining this distinctive feature. Our findings position FhaA as a key regulator in a complex protein network, orchestrating the asymmetric distribution and activity of cell envelope biosynthetic machinery. This work not only advances our understanding of mycobacterial growth mechanisms but also identifies FhaA as a potential target for future studies on cell envelope biogenesis and bacterial growth regulation. These insights into the fundamental biology of mycobacteria may pave the way for novel approaches to combat mycobacterial infections addressing the ongoing challenge of diseases like tuberculosis in global health. IMPORTANCE Mycobacterium tuberculosis, the bacterium responsible for tuberculosis, remains a global health concern. Unlike most well-studied model bacilli, mycobacteria possess a distinctive and complex cell envelope, as well as an asymmetric polar growth mode. However, the proteins and mechanisms that drive cell asymmetric elongation in these bacteria are still not well understood. This study sheds light on the role of the protein FhaA in this process. Our findings demonstrate that FhaA localizes at the septum and asymmetrically to the poles, with a preference for the fast-growing pole. Furthermore, we showed that FhaA is essential for population heterogeneity and asymmetric polar elongation and plays a role in the precise subcellular localization of the cell wall biosynthesis machinery. Mycobacterial asymmetric elongation results in a physiologically heterogeneous bacterial population which is important for pathogenicity and response to antibiotics, stressing the relevance of identifying new factors involved in these still poorly characterized processes.ANII: FCE_1_2014_1_104045ANII: POS_NAC_2012_1_8824ANII: POS_NAC_2015_1_109755ANII: POS_FCE_2015_1_1005186ANII: POS_FCE_2020__100918

Canine obesity, overweight, and adipokine serum concentration are associated with hematological, biochemical, hormonal, and cardiovascular markers

Background: Canine obesity is an increasingly concerning issue that negatively impacts dogs’ health, quality of life, and lifespan. Aim: This study aimed to evaluate the adipokine profiles of overweight (OW) and obese (OB) dogs and their associations with various hematological, biochemical, hormonal, and cardiovascular markers. Methods: A total of 84 dogs were classified according to their body condition scores as normal weight (NW), OW, or OB, and were subsequently subjected to blood pressure measurement, blood testing, and urine sampling. Results: The findings revealed that OB dogs had higher serum concentrations of leptin and resistin while exhibiting lower levels of adiponectin when compared to NW dogs. Additionally, they showed higher systolic blood pressure. Serum creatinine levels were lower in OB dogs, and urinary specific gravity was reduced in both OW and OB dogs compared to their NW counterparts. Furthermore, total leukocyte counts and neutrophil counts were elevated in OW and OB dogs. The study also found that serum insulin levels were positively correlated with triglycerides, cholesterol, and C-reactive protein. Conclusion: Canine obesity is reflected in altered adipokine concentrations and is associated with insulin resistance, as well as changes in renal function, protein metabolism, and hematological markers

Increased expression of interferon-stimulated gene 15 (ISG15) in cervical cells on day 14 of pregnancy in Holstein heifers

In cattle, expression of IFN-stimulated genes in the female reproductive tract has been reported as an early pregnancy diagnostic tool, as early as d 17 of pregnancy. The hypothesis of this study was that expression of ISG15 in the cervix of pregnant heifers is increased on d 14 of pregnancy. The objective was to compare the expression of ISG15 in cervical cells between pregnant and cyclic heifers (control, sham-inseminated) on d 14, 16, and 18 after insemination (d 0). Holstein heifers were submitted to an estrus synchronization protocol and inseminated with extender only (“control,” n = 6), or with regular semen (n = 15). Heifers were classified as pregnant (n = 10) by ultrasound at d 30 through the detection of a viable embryo with a heartbeat. Blood samples from the coccygeal vein were collected to determine serum progesterone concentrations on d 14, 16, and 18. The expression of ISG15 and PGR in cervical cells collected through cytobrush was measured on d 14, 16, and 18. A receiver operating characteristic (ROC) curve was calculated to quantify the pregnancy diagnostic accuracy of ISG15 and PGR expression. The expression levels of ISG15 in cervical cells were significantly greater in pregnant compared with control heifers on d 14, and remained greater on d 16 and 18, whereas differences in PGR were observed only on d 18. Scatter plots and ROC analyses showed the most accurate prediction of pregnancy for ISG15 on d 16. In conclusion, cervical cells express greater ISG15 mRNA in pregnant versus control heifers as early as d 14 postinsemination, with the best accuracy on d 16

Motivações hedônicas, eudaimônicas e extrínsecas para práticade exercício físico : modelo de medida e redes nomológicas

O exercício contribui para o desenvolvimento pessoal, assim como sentir prazer na atividade física pode aumentar a adesão e a motivaçãopara a prática. Desse modo, o estudo teve como objetivo adaptar a Escala de Motivações Hedônica, Eudaimônica e Extrínseca no Exercício (HEEMA) para a população brasileira e estimar evidências de validade baseadas na estrutura interna, relação com outras variáveis e precisão. A amostra foi composta por 232 atletas, com idades entre 18 e 67 anos, de diferentes gêneros. A análise confirmatória demonstrou a adequação da estrutura oblíqua de três fatores, todos com bons indicadores de precisão, semelhante a proposta original. As motivações hedônicase eudaimônica relacionaram-se positivamente com mindfulness, satisfação das necessidades psicológicas básicas e paixão harmoniosa pelo exercício. A motivação extrínseca relacionou-se positivamente com frustração das necessidades psicológicas básicas e paixão obsessiva. Os resultados sugerem que a HEEMA é uma medida adequada para avaliar diferentes motivações nos atletas brasileiros.El ejercicio contribuye al desarrollo personal, al igual que experimentar placer en la actividad física puede aumentar la adherencia y la motivación para la práctica. Por lo tanto, el estudio tuvo como objetivo adaptar la Escala de Motivaciones Hedónicas, Eudaimónicas y Extrínsecas en el Ejercicio (HEEMA) para la población brasileña y estimar evidencias de validez basadas en la estructura interna, relación con otras variables y precisión. La muestra estuvo compuesta por 232 atletas, con edades entre 18 y 67años, de diferentes géneros. El análisis confirmatorio demostró la adecuación de la estructura oblicua de tres factores, todos con buenos indicadores de precisión, similar a la propuesta original. Las se relacionaron positivamente con la atención plena, la satisfacción de las necesidades psicológicas básicas y la pasión armoniosa por el ejercicio. La motivación extrínseca se relaciona positivamente con la frustración de las necesidades psicológicas básicas y la pasión obsesiva. Los resultados sugieren que la HEEMA es una medida adecuada para evaluar diferentes motivaciones en los atletas brasileños.The exercise contributes to personal development, just as experiencing pleasure in physical activity can increase adherence and motivation for practice. Thus, the study aimed to adapt the Hedonic, Eudaimonic, and Extrinsic Motivations in Exercise Scale (HEEMA) for the Brazilian population and estimate validity evidence based on internal structure, relationship with other variables, and precision. The sample consisted of 232 athletes, aged between 18 and 67, of different genders. Confirmatory analysis demonstrated the adequacy of the oblique three-factor structure, all with good indicators of precision, similar to the original proposal. Hedonic and eudaimonic motivations were positively related to mindfulness, satisfaction of basic psychological needs, and harmonious passion for exercise. Extrinsic motivation was positively related to frustration of basic psychological needs and obsessive passion. The results suggest that the HEEMA is an appropriate measure for assessing different motivations in Brazilian athletes

Caracterización patológica y cinética de diseminación e inmunogenicidad de la infección por Leptospira spp. autóctonas en un modelo experimental bovino

El objetivo de este trabajo fue determinar la capacidad de infección a través de mucosas, cinética de diseminación, inmunogenicidad y el cuadro lesional de cuatro variantes de Leptospira spp. autóctonas: Leptospira noguchii sg Autumnalis, Leptospira interrogans sg Pomona sv Kennewicki, Leptospira borgpetersenii sg Sejroe sv Hardjo y Leptospira interrogans sg Canicola sv Canicola, en un modelo experimental bovino. Para esto se utilizaron 20 terneras Braford de tres meses de edad, de madres/terneras seleccionadas con test serológico y molecular negativo a leptospira; divididas en 5 grupos (cuatro infectantes y un grupo control). Se inoculó por vía intranasal e intraconjuntival simultáneamente las distintas variantes a cada grupo (n=4) y fueron evaluadas durante 21 días post-infección (p.i). Ninguna de las variantes ocasionó enfermedad aguda y lesiones macroscópicas en las terneras en los 21 p.i. Histológicamente, se observó nefritis, hepatitis, miocarditis y colecistitis linfohistiocitaria, en los cuatro grupos infectantes. En la tinción de Warthin-Starry se observaron leptospiras en la luz de túbulos renales en animales infectados con las cuatro variantes. Se observó inmunomarcación positiva en riñón, hígado y vesícula biliar. Las cuatro variantes estudiadas fueron detectadas por qPCR y cultivo microbiológico en riñón, hígado y orina. Además, la variante Kennewicki fue detectada por qPCR y cultivo en sangre y la variante Autumnalis se detectó mediante qPCR y cultivos en útero. Se logró obtener cultivos puros de la variante Kennewicki de muestras de orina; y de la variante Canicola de muestras de orina, hígado y riñón. En cuanto a la serología (MAT), se detectaron títulos de anticuerpos en los cuatro grupos infectantes. En conclusión, las cuatro variantes utilizadas demostraron ser infectivas, inmunogénicas y presentaron un patrón sistémico de infección, sin embargo, no desencadenaron enfermedad clínica ni lesiones macroscópicas en 21 días p.i. A nivel histopatológico, se observó colecistitis, lesión reportada anteriormente en humanos afectados por leptospirosis pero que no había sido descrita en bovinos

Compresión del nervio radial tras fijación con placa volar: un caso de diagnóstico por ecografía

Fraturas do rádio distal são comuns, especialmente em idosos, e geralmente apresentam excelentes resultados com fixação de placa volar. No entanto, complicações como inflamação, ruptura do tendão e compressão do nervo podem ocorrer. O ultrassom é a melhor ferramenta de diagnóstico para identificar danos ao tendão e ao nervo relacionados ao parafuso. Apresentamos o caso de uma mulher de 56 anos reporta estar a quatro meses com dor no punho direito acompanhada de “choques” que passou por cirurgia há três anos para uma fratura do rádio distal.Distal radius fractures are common, especially in the elderly, and typically have excellent outcomes with volar plate fixation. However, complications such as inflammation, tendon rupture, and nerve compression can occur. Ultrasound is the best diagnostic tool for identifying screw-related tendon and nerve damage. We present a case of a 56-year-old woman who presents with four months of right wrist pain accompanied by “shocks which underwent surgery three years ago for a distal radius fracture.Las fracturas del radio distal son frecuentes, especialmente en ancianos, y suelen tener excelentes resultados con la fijación con placa volar. Sin embargo, pueden producirse complicaciones como inflamación, rotura de tendones y compresión nerviosa. La ecografía es la mejor herramienta diagnóstica para identificar daños en los tendones y nervios relacionados con los tornillos. Presentamos el caso de una mujer de 56 años que presenta dolor en la muñeca derecha de cuatro meses de evolución acompañado de “shocks” y que fue operada hace tres años por una fractura del radio distal