PREVALENCIA DE LA HIPERTENSION PULMONAR COMO COMPLICACION EN PACIENTES CON ENFERMEDAD RENAL CRONICA TERMINAL EN HEMODIALISIS EN EL HOSPITAL GENERAL DE ECATEPEC “DR. JOSE MARIA RODRIGUEZ”

RESUMEN ANTECEDENTES: La Enfermedad Renal Crónica presenta múltiples complicaciones Cardiovasculares y de estas una de las menos estudiadas es la HIPERTENSION PULMONAR, la cual se presenta más aun en los pacientes con terapia sustitutiva de Hemodiálisis. MATERIAL Y METODOS: Se realizó un estudio Descriptivo, Retrospectivo y Transversal. En base al estudio de 46 pacientes que se encuentran con el diagnostico de Enfermedad Renal Crónica Terminal en terapia sustitutiva de la función renal a base de Hemodiálisis a los cuales se les realizo un Ecocardiograma Transtoracico Tisular y Pulsado para valorar la existencia de hipertensión pulmonar. RESULTADOS: De los 46 pacientes en Hemodiálisis, solo uno fue excluido del estudio por presentar datos compatibles con hipocinesia miocardica, así un total de 45 estudios fueron incluidos. Se reporta que 13 pacientes (19.11%) No presentaron hipertensión Pulmonar y que 55 pacientes (80.88%) presentaron hipertensión pulmonar, de los cuales 41 pacientes (74.54%%) siendo hipertensión Pulmonar Leve, 11 pacientes (20%) de hipertensión Pulmonar Moderada y 3 paciente (5.45%) de hipertensión Pulmonar Severa. CONCLUSIONES: De los pacientes de la Unidad de Hemodiálisis del Hospital General de Ecatepec “Dr. José María Rodríguez” un alto porcentaje (Incidencia) presentan hipertensión pulmonar y que estos se encuentran Sub-diagnosticados

ASOCIACION DEL INDICE NEUTROFILO-LINFOCITO Y MORTALIDAD EN PACIENTES CON ENFERMEDAD RENAL CRONICA EN HEMODIALISIS DEL HOSPITAL GENERAL DE ECATEPEC DR JOSE MA RODRIGUEZ

ANTECEDENTES: La enfermedad renal crónica (ERC) es un proceso multifactorial de carácter progresivo e irreversible que frecuentemente conduce a un estado terminal, aumentando la mortalidad cardiovascular, es por ello que se han buscado diversos marcadores de inflamación (Il-6,IL-10, PCR, FNT-) siendo el índice neutrófilo-linfocito (INL) un marcador de estudio de fácil acceso y bajo costo. MATERIAL Y METODOS: se realizó un estudio descriptivo, retrospectivo, transversal, no controlado de 55 pacientes con tratamiento sustitutivo en hemodiálisis a los cuales se les tomó química sanguínea y citometría hemática realizandose cálculo de índice neutrófilo linfocito comparado con otros marcadores. RESULTADOS: las comorbilidades mayormente asociadas fueron diabetes, hipertensión y tabaquismo, se realizo el cálculo del INL, encontrandose una media de 3.4 (p=0.092) para pacientes sobrevivientes y 3.69 para pacientes que fallecieron;la albúmina (p=0.004) con significancia estadistica.CONCLUSIONES: dado que el INL no mostro significancia estadística, siendo el único marcador la albumina que se puede relacionar como predictor de inflamación y asociación con mortalida

The Effect of the Stretch-Shortening Cycle in the Force–Velocity Relationship and Its Association With Physical Function in Older Adults With COPD

This study aimed to evaluate the effect of the stretch-shortening cycle (SSC) on different portions of the force–velocity (F–V) relationship in older adults with and without chronic obstructive pulmonary disease (COPD), and to assess its association with physical function. The participants were 26 older adults with COPD (79 ± 7 years old; FEV1 = 53 ± 36% of predicted) and 10 physically active non-COPD (77 ± 4 years old) older adults. The F–V relationship was evaluated in the leg press exercise during a purely concentric muscle action and compared with that following an eccentric muscle action at 10% intervals of maximal unloaded shortening velocity (V0). Vastus lateralis (VL) muscle thickness, pennation angle (PA), and fascicle length (FL) were assessed by ultrasound. Habitual gait speed was measured over a 4-m distance. COPD subjects exhibited lower physical function and concentric maximal muscle power (Pmax) values compared with the non-COPD group (both p < 0.05). The SSC increased force and power values among COPD participants at 0–100 and 1–100% of V0, respectively, while the same was observed among non-COPD participants only at 40–90 and 30–90% of V0, respectively (all p < 0.05). The SSC induced greater improvements in force, but not power, among COPD compared with non-COPD subjects between 50 and 70% of V0 (all p < 0.05). Thus, between-group differences in muscle power were not statistically significant after the inclusion of the SSC (p > 0.05). The SSC-induced potentiation at 50–100% of V0 was negatively associated with physical function (r = -0.40–0.50), while that observed at 80–100% of V0 was negatively associated with VL muscle thickness and PA (r = -0.43–0.52) (all p < 0.05). In conclusion, older adults with COPD showed a higher SSC-induced potentiation compared with non-COPD subjects, which eliminated between-group differences in muscle power when performing SSC muscle actions. The SSC-induced potentiation was associated with lower physical function, VL muscle thickness, and VL PA values. The SSC-induced potentiation may help as a compensatory mechanism in those older subjects with a decreased ability to produce force/power during purely concentric muscle actions

Propuesta de mejora del Sistema Interno de Garantía de Calidad de la Facultad de Medicina

La garantía de calidad en el ámbito universitario puede considerarse como la atención sistemática, estructurada y continua a las titulaciones ofertadas. La garantía de calidad se compromete a poner en marcha los medios que aseguren y demuestren la calidad de los programas formativos que se desarrollan en cada una de las titulaciones ofrecidas por la Universidad y así cumplir con la obligación que tiene con la sociedad. El presente proyecto nace como fruto de la responsabilidad adquirida para el cumplimiento de las funciones encomendadas y, con el objetivo de seguir adoptando una estrategia de mejora continua de la calidad de la docencia y satisfacción de los colectivos implicados en el proceso de enseñanza-aprendizaje (Profesorado, Estudiantes y PAS)

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Production of He-4 and (4) in Pb-Pb collisions at root(NN)-N-S=2.76 TeV at the LHC

Results on the production of He-4 and (4) nuclei in Pb-Pb collisions at root(NN)-N-S = 2.76 TeV in the rapidity range vertical bar y vertical bar <1, using the ALICE detector, are presented in this paper. The rapidity densities corresponding to 0-10% central events are found to be dN/dy4(He) = (0.8 +/- 0.4 (stat) +/- 0.3 (syst)) x 10(-6) and dN/dy4 = (1.1 +/- 0.4 (stat) +/- 0.2 (syst)) x 10(-6), respectively. This is in agreement with the statistical thermal model expectation assuming the same chemical freeze-out temperature (T-chem = 156 MeV) as for light hadrons. The measured ratio of (4)/He-4 is 1.4 +/- 0.8 (stat) +/- 0.5 (syst). (C) 2018 Published by Elsevier B.V.Peer reviewe

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

PRINCIPALES BACTERIAS GRAM (-) EN NEUMONIA TARDIA ASOCIADA A VENTILACION MECANICA, EN EL HGE “DR JOSE MA. RODRIGUEZ”

RESUMEN ANTECEDENTES: Las enfermedades nosocomiales son complicaciones comunes de la asistencia hospitalaria, una de ellas, la Neumonía Asociada a Ventilación Mecánica, si bien no es la más frecuente de ellas, es una de las que tiene mayor mortalidad de no ser tratada a tiempo, iniciar tratamiento empírico dependiendo de la microbiología especifica de nuestra unidad de trabajo es de vital importancia para disminuir los días de ventilación asistida, las posibles complicaciones a largo plazo así como la mortalidad, disminuyendo los costos tanto para los pacientes como para la institución en general. MATERIAL Y METODOS: Se realizó un estudio Observacional, Retrospectivo, Transversal, Analítico y Descriptivo. En base al estudio de 63 pacientes que se encontraron con el diagnostico de Neumonía Asociada a Ventilación Mecánica, ingresados en los servicios de Medicina Interna y Unidad de Cuidados Intensivos Adultos, realizando en todos ellos un cultivo de secreción bronquial, con agente GRAM Negativo, independientemente del diagnóstico de ingreso. RESULTADOS: En nuestra muestra de pacientes con Neumonía Asociada a Ventilación Mecánica, los agentes gram negativos más comunes asociados a esta patologia son en primer lugar Acinetobacter Baumannii con un 22.22%, seguido de Escherichia Coli en un 15.87% y en tercer lugar Pseudomonas aeruginosa con un 14.28%. RECOMENDACIONES: Todo paciente con ventilación mecánica invasiva, que exceda las 48 horas, con un score CPIS mayor a 6, se debe solicitar un cultivo de expectoración bronquial. Es de importancia el inicio de un manejo antibiotico empirico en base a las recomendaciones de las guias internacionales. Fomentar la creacion de estrategias estadarizadas para el tratamiento de la neumonia asociada a ventilacion mecanica