Terapéutica biológica en la psoriasis

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Clinical effectiveness of pneumococcal vaccination against acute myocardial infarction and stroke in people over 60 years: the CAPAMIS study, one-year follow-up

<p>Abstract</p> <p>Background</p> <p>Conflicting results have been recently reported evaluating the relationship between pneumococcal vaccination and the risk of thrombotic vascular events. This study assessed the clinical effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV23) against acute myocardial infarction and ischaemic stroke in older adults.</p> <p>Methods</p> <p>Population-based prospective cohort study conducted from December 1, 2008 until November 30, 2009, including all individuals ≥ 60 years-old assigned to nine Primary Care Centres in Tarragona, Spain (N = 27,204 individuals). Primary outcomes were hospitalisation for acute myocardial infarction and/or ischaemic stroke. All cases were validated by checking clinical records. The association between pneumococcal vaccination and the risk of each outcome was evaluated by Multivariable Cox proportional-hazard models (adjusted by age, sex, influenza vaccine status, presence of comorbidities and cardiovascular risk factors).</p> <p>Results</p> <p>Cohort members were followed for a total of 26,444 person-years, of which 34% were for vaccinated subjects. Overall incidence rates (per 1000 person-years) were 4.9 for myocardial infarction and 4.6 for ischaemic stroke. In the multivariable analysis, vaccination was associated with a marginally significant 35% lower risk of stroke (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.42-0.99; <it>p </it>= 0.046). We found no evidence for an association between pneumococcal vaccination and reduced risk of myocardial infarction (HR: 0.83; 95% CI: 0.56-1.22; <it>p </it>= 0.347).</p> <p>Conclusions</p> <p>Our data supports a benefit of PPV23 against ischaemic stroke among the general population over 60 years, suggesting a possible protective role of pneumococcal vaccination against some acute thrombotic events.</p

El virus de la inmunodeficiencia humana como causa de patología renal

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CSF LPV concentrations and viral load in viral suppressed patients on LPV/r monotherapy given once daily

Introduction: Plasma trough concentrations of lopinavir (LPV) given as LPV/r 800/200 mg once daily (OD) are reduced in comparison with 400/100 mg twice daily (BID). While OD dosage of LPV/r is sufficient to achieve viral suppression in plasma, data about drug penetration and viral suppression in central nervous system (CNS) is needed, mainly if LPVr is used as maintenance monotherapy strategy in selected patients. The objective of this study was to evaluate CSF HIV‐1 RNA and CSF LPV concentrations in patients receiving LPV/r monotherapy OD (LPVrMOD). Material and Methods: This is a cross‐sectional sub‐study within a prospective, open‐label pilot simplification study to evaluate the efficacy and safety of LPV/rMOD in virologically suppressed patients previously receiving a BID LPV/r monotherapy regimen (LPV/rMBID), the “Kmon study” (NCT01581853). To assess LPV concentrations and HIV‐1 RNA in CSF, a lumbar puncture (LP) was performed in a subgroup of patients after at least one month of LPVrMOD treatment. Plasma‐paired samples of all patients were also obtained. HIV‐1 RNA was determined by real‐time PCR (limit of detection 40 copies/mL). Liquid chromatography‐tandem mass spectrometry (Tandem labs, NJ) was used to determine CSF and blood plasma LPV concentrations. Results: Nine patients were included. Median (range) age was 48 (34–56) years, median CD4 cell count 672 (252–1,408) cells/mL, median nadir CD4 count 125 (35–537) cells/mL and 40% of subjects were HCV‐positive. Before starting LPV/rMOD median time on a LPV/r‐containing regimen and on LPV/rMBID were 9 (4–11) years and 15 (7–24) months respectively, median time with undetectable HIV viral load was 5 (3–12) years and 2 patients had a previous documented blip. LP was performed a median of 24 (8–36) weeks after starting LPV/rMOD and 24 (11–28) hours after the last LPV/rMOD dose CSF and plasma HIV RNA was 40 copies/mL in all patients. Median LPV CSF concentration was 9.78 (1.93–78.3) ng/mL, median LPV plasma concentration 1,103 (377–16,700) ng/mL and median LPV CSF/plasma ratio 0.3% (0.1–1.2). Conclusions: No CSF viral escape was detected and LPV concentrations were above the IC50 for wtHIV‐1 (1.9 ng/mL). However, as concentrations were close to IC50 in some patients, a careful clinical follow up of patients receiving this regimen would be advisable. Larger longitudinal studies will be helpful for a better understanding of the CNS antiviral activity of LPVr monotherapy

Micronuclei detection by flow cytometry as a high-throughput approach for the genotoxicity testing of nanomaterials

Thousands of nanomaterials (NMs)-containing products are currently under development or incorporated in the consumer market, despite our very limited understanding of their genotoxic potential. Taking into account that the toxicity and genotoxicity of NMs strongly depend on their physicochemical characteristics, many variables must be considered in the safety evaluation of each given NM. In this scenario, the challenge is to establish high-throughput methodologies able to generate rapid and robust genotoxicity data that can be used to critically assess and/or predict the biological effects associated with those NMs being under development or already present in the market. In this study, we have evaluated the advantages of using a flow cytometry-based approach testing micronucleus (MNs) induction (FCMN assay). In the frame of the EU NANoREG project, we have tested six different NMs-namely NM100 and NM101 (TiO2NPs), NM110 (ZnONPs), NM212 (CeO2NPs), NM300K (AgNPs) and NM401 (multi-walled carbon nanotubes (MWCNTs)). The obtained results confirm the ability of AgNPs and MWCNTs to induce MN in the human bronchial epithelial BEAS-2B cell line, whereas the other tested NMs retrieved non-significant increases in the MN frequency. Based on the alignment of the results with the data reported in the literature and the performance of the FCMN assay, we strongly recommend this assay as a reference method to systematically evaluate the potential genotoxicity of NMs

Efectividad de la iniciativa privada en la priorización de proyectos de inversión pública a nivel local en el marco del régimen de obras por impuestos

En el periodo 2008, el Congreso de la República aprobó la Ley N°29230, Ley que impulsa la inversión pública regional y local con participación del sector privado, incorporando el innovador mecanismo de Obras por Impuestos. En el año 2012, a través de su Reglamento aprobado mediante Decreto Supremo N°133-2012-EF, facultan al sector privado la presentación de propuestas de priorización de proyectos de inversión pública con carácter de petición de gracia, posibilitando su intervención en la fase de programación del ciclo de proyecto de inversión, sujeto a la aprobación del Concejo Regional, Provincial o Municipal. La presente investigación tiene como objeto de estudio evaluar en qué medida las propuestas de priorización de proyectos de inversión a nivel local presentadas por el sector privado en el marco del régimen de obras por impuestos, impactan en la localidad, considerando su aporte al cierre de brechas de infraestructura y/o servicios públicos básicos. Para tal fin, los autores de la presente investigación han elaborado la “herramienta multicriterio para la priorización de proyectos de inversión pública con enfoque territorial”, que permitirá identificar los proyectos prioritarios, razón por la cual el diseño del actual documento es de carácter aplicado; asimismo, considerándose que no se han manipulado los eventos, el estudio es ex post facto o no experimental. La investigación inicia con un alcance exploratorio al no haberse desarrollado investigaciones idénticas o similares al objeto de estudio. Al efectuarse el estudio ex post facto, la investigación es descriptiva puesto que no se han manipulado variables, describiéndose tal como se observan. El enfoque es cuantitativo puesto que se han utilizado datos estadísticos, teniendo como principal fuente de información a diversos estudios realizados por el Instituto Nacional de Estadística e Informática; y cualitativo, al recolectarse datos sin medición numérica y entrevistas semiestructuradas

Edad gestacional neonatal y patrones de crecimiento en niños menores de 24 meses atendidos en el Policlínico Policial de Huancayo, Junín-2019

En la actualidad la edad infantil constituye el periodo más trascendente en la vida del ser humano, la marca por completo. De la calidad sanitaria, nutricional, psicológica y educativa en la que el niño se desarrolle va a depender en gran parte su calidad de vida en la edad adulta. Todos estos factores siguen siendo de gran importancia en la adolescencia y los primeros años del adulto joven (1). Los niños representan el futuro, y su crecimiento y desarrollo saludable deben ser una de las máximas prioridades para todas las sociedades. Los niños y los recién nacidos en particular son especialmente vulnerables frente a la malnutrición y enfermedades infecciosas, que son prevenibles o tratables en su mayoría (OMS, 2019). Durante los primeros años de vida, y en particular desde el embarazo hasta los 3 años, los niños necesitan nutrición, protección y estimulación para que su cerebro se desarrolle correctamente. Los progresos recientes en el campo de la neurociencia aportan nuevos datos sobre el desarrollo cerebral durante esta etapa de la vida. Gracias a ellos, sabemos que en los primeros años, el cerebro de los bebés forma nuevas conexiones a una velocidad asombrosa (3)