Consumo de antihipertensivos en tres años consecutivos en el Hospital Universitario “Manuel Fajardo”

Introducción: El estudio fármaco-económico del consumo de antihipertensivos (AH) en una institución de salud deviene en importante indicador de eficiencia y retroalimentación de las posibles implicaciones de su uso para los facultativos. Objetivo: Caracterizar los niveles de empleo de antihipertensivos en nuestro medio como indicador del uso racional de medicamentos por parte de los profesionales de la salud con facultad prescriptiva. Materiales y método: Se realizó un estudio observacional, descriptivo, retrospectivo y longitudinal en el Hospital “Manuel Fajardo” en La Habana, durante los años 2012, 2013 y 2014. El universo estuvo determinado por todos los antihipertensivos que tuvieron indicación facultativa intrahospitalaria en los años comprendidos (N=14). No se utilizó técnica de muestreo, pues se emplearon todos los antihipertensivos en uno u otro análisis dentro de la investigación. Los datos se obtuvieron en la farmacia del hospital, en los índices de consumo de estos medicamentos por los pacientes hospitalizados, así como el costo unitario en moneda nacional de cada droga. Resultados: El antihipertensivo más utilizado fue el Enalapril (80340 unidades). Los siete medicamentos más empleados significaron un costo cercano a los cien mil pesos. Conclusiones: Los antihipertensivos más empleados durante los años del estudio fueron el Enalapril, la Espironolactona y el Captopril, cabe referir que el primero de estos generó el mayor gasto económico.AbstractIntroduction: The drug-economic study of the consumption of antihypertensives (AH) in a health institution becomes an important indicator of efficiency and feedback of the possible implications of its use for doctors. Objective: To characterize the levels of antihypertensive use in our environment as an indicator of the rational use of medicines by health professionals with a prescriptive capacity. Materials and methods: An observational, descriptive, retrospective and longitudinal study was conducted at the "Manuel Fajardo" Hospital in Havana, during the years 2012, 2013 and 2014. The universe was determined by all antihypertensive patients who had an inhospital Years included (N = 14). No sampling technique was used, since all antihypertensives were used in one or the other analysis within the investigation. The data were obtained at the hospital pharmacy, the rates of consumption of these drugs by hospitalized patients, as well as the unit cost in national currency of each drug. Results: The most commonly used antihypertensive was Enalapril (80,340 units). The seven most used drugs meant a cost close to one hundred thousand pesos. Conclusions: The most commonly used antihypertensive agents during the study years were Enalapril, Spironolactone and Captopril. It is worth noting that the first of these drugs generated the highest economic expenditure.

Lymphocyte Profile and Immune Checkpoint Expression in Drug-Induced Liver Injury: An Immunophenotyping Study

The identification of specific HLA risk alleles in drug-induced liver injury (DILI) points toward an important role of the adaptive immune system in DILI development. In this study, we aimed to corroborate the role of an adaptive immune response in DILI through immunophenotyping of leukocyte populations and immune checkpoint expressions. Blood samples were collected from adjudicated DILI (n = 12), acute viral hepatitis (VH; n = 13), acute autoimmune hepatitis (AIH; n = 9), and acute liver injury of unknown etiology (n = 15) at day 1 (recognition), day 7, and day >30. Blood samples from patients with nonalcoholic fatty liver disease (NAFLD; n = 20) and healthy liver controls (HLCs; n = 54) were extracted at one time point. Leukocyte populations and immune checkpoint expressions were determined based on cell surface receptors, except for CTLA-4 that was determined intracellularly, using flow cytometry. At recognition, DILI demonstrated significantly higher levels of activated helper T-cell (P < 0.0001), activated cytotoxic T-cells (P = 0.0003), Th1 (P = 0.0358), intracellular CTLA-4 level in helper T-cells (P = 0.0192), and PD-L1 presenting monocytes (P = 0.0452) than HLC. These levels approached those of HLC over time. No significant differences were found between DILI and VH. However, DILI presented higher level of activated helper T-cells and CTLA-4 than NAFLD and lower PD-L1 level than AIH. Our findings suggest that an adaptive immune response is involved in DILI in which activated CD4+ and CD8+ play an important role. Increased expression of negative immune checkpoints is likely the effect of peripheral tolerance regulation.The present study has been supported by grants of Instituto de Salud Carlos III cofounded by Fondo Europeo de Desarrollo Regional – FEDER (contract numbers: PI19/00883, PI16/01748, P18-RT-3364-2020, and PT20/000127). CIBERehd and Plataforma ISCiii Ensayos Clínicos are funded by Instituto de Salud Carlos III. Funding for open access charge: Universidad de Málaga/CBUA. The funding sources had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report, or in the decision to submit the manuscript for publication

Estudios históricos 7 : arquitectura y diseño

1 archivo PDF (160 páginas)Compilación de doce conferencias de excelencia académica presentadas en el Seminario de Historia de la Arquitectura y del Diseño en el siglo XX, UAM-UNAM. Éstas se organizan, en una primera parte, como investigaciones referidas a la historia de la Arquitectura y del diseño en México y a la globalización ... y, en segunda, al resto del mundo: Reino Unido, Bilbao, Berlín, Barcelona, Alemania

Evaluation of diagnostic and prognostic candidate biomarkers in drug-induced liver injury vs. other forms of acute liver damage

Aims Detection and characterization of idiosyncratic drug-induced liver injury (DILI) currently rely on standard liver tests, which are suboptimal in terms of specificity, sensitivity and prognosis. Therefore, DILI diagnosis can be delayed, with important consequences for the patient. In this study, we aimed to evaluate the potential of osteopontin, cytokeratin-18 (caspase-cleaved: ccK18 and total: K18), α-glutathione-S-transferase and microRNA-122 as new DILI biomarkers. Methods Serial blood samples were collected from 32 DILI and 34 non-DILI acute liver injury (ALI) cases and a single sample from 43 population controls without liver injury (HLC) and analysed using enzyme-linked immunosorbent assay (ELISA) or single-molecule arrays. Results All biomarkers differentiated DILI and ALI from HLC with an area under receiver operator characteristic curve (AUC) value of >0.75 but were less efficient in distinguishing DILI from ALI, with ccK18 (0.79) and K18 (0.76) demonstrating highest potential. However, the AUC improved considerably (0.98) for ccK18 when comparing DILI and a subgroup of autoimmune hepatitis cases. Cytokeratin-18, microRNA-122 and α-glutathione-S-transferase correlated well with traditional transaminases, while osteopontin correlated most strongly with the international normalized ratio (INR). Conclusions ccK18 appears promising in distinguishing DILI from autoimmune hepatitis but less so from other forms of acute liver injury. Osteopontin demonstrates prognostic potential with higher levels detected in more severe cases regardless of aetiology.Consejería de Salud y Familia de la Junta de Andalucía, Grant/Award Numbers: PI 0274-2016, P18-RT-3364; Instituto de Salud Carlos III (ISCIII) cofounded by Fondo Europeo de Desarrollo Regional - FEDER, Grant/Award Numbers: PI19/00883, PI18/00901, UMA18-FEDERJA-193; Universidad de Málaga/CBUA for open access charge: Universidad de Málaga / CBUA. Funding for open access charge: Universidad de Málaga / CBU

Pandêmon Nosêma. Una revisión historiográfica de cómo las sociedades respondieron ante las epidemias a lo largo de la historia

A historiographic review of the main epidemic episodes suffered by humanity from Prehistory to the 20th century is carried out, with the aim of analyzing the incidence that successive infectious-contagious diseases had in different societies at each time, regarding four study variables: social, economic, political and mentalities.&nbsp; Keywords Disease, population, poverty, crisis, social stigma, manipulation.Se realiza una revisión historiográfica de los principales episodios epidémicos sufridos por la humanidad desde la Prehistoria hasta el siglo XX, con el propósito de analizar la incidencia que han tenido las sucesivas enfermedades infecto-contagiosas en las diferentes sociedades en cada época, atendiendo a cuatro variables de estudio: la social, la económica, la política y la esfera de las mentalidades. Palabras clave Enfermedad, población, pobreza, crisis, estigmatización, manipulación

Pandêmon Nosêma. Una revisión historiográfica de cómo las sociedades respondieron ante las epidemias a lo largo de la historia

A historiographic review of the main epidemic episodes suffered by humanity from Prehistory to the 20th century is carried out, with the aim of analyzing the incidence that successive infectious-contagious diseases had in different societies at each time, regarding four study variables: social, economic, political and mentalities.&nbsp; Keywords Disease, population, poverty, crisis, social stigma, manipulation.Se realiza una revisión historiográfica de los principales episodios epidémicos sufridos por la humanidad desde la Prehistoria hasta el siglo XX, con el propósito de analizar la incidencia que han tenido las sucesivas enfermedades infecto-contagiosas en las diferentes sociedades en cada época, atendiendo a cuatro variables de estudio: la social, la económica, la política y la esfera de las mentalidades. Palabras clave Enfermedad, población, pobreza, crisis, estigmatización, manipulación

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Systematic Collaborative Reanalysis of Genomic Data Improves Diagnostic Yield in Neurologic Rare Diseases

Altres ajuts: Generalitat de Catalunya, Departament de Salut; Generalitat de Catalunya, Departament d'Empresa i Coneixement i CERCA Program; Ministerio de Ciencia e Innovación; Instituto Nacional de Bioinformática; ELIXIR Implementation Studies (CNAG-CRG); Centro de Investigaciones Biomédicas en Red de Enfermedades Raras; Centro de Excelencia Severo Ochoa; European Regional Development Fund (FEDER).Many patients experiencing a rare disease remain undiagnosed even after genomic testing. Reanalysis of existing genomic data has shown to increase diagnostic yield, although there are few systematic and comprehensive reanalysis efforts that enable collaborative interpretation and future reinterpretation. The Undiagnosed Rare Disease Program of Catalonia project collated previously inconclusive good quality genomic data (panels, exomes, and genomes) and standardized phenotypic profiles from 323 families (543 individuals) with a neurologic rare disease. The data were reanalyzed systematically to identify relatedness, runs of homozygosity, consanguinity, single-nucleotide variants, insertions and deletions, and copy number variants. Data were shared and collaboratively interpreted within the consortium through a customized Genome-Phenome Analysis Platform, which also enables future data reinterpretation. Reanalysis of existing genomic data provided a diagnosis for 20.7% of the patients, including 1.8% diagnosed after the generation of additional genomic data to identify a second pathogenic heterozygous variant. Diagnostic rate was significantly higher for family-based exome/genome reanalysis compared with singleton panels. Most new diagnoses were attributable to recent gene-disease associations (50.8%), additional or improved bioinformatic analysis (19.7%), and standardized phenotyping data integrated within the Undiagnosed Rare Disease Program of Catalonia Genome-Phenome Analysis Platform functionalities (18%)

2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research