Caracterización del compromiso respiratorio en los pacientes con diagnóstico de inmunodeficiencia primaria en un hospital pediátrico de cuarto nivel de la ciudad de Bogotá

Las inmunodeficiencias primarias son alteraciones del sistema inmune que principalmente predispone a infecciones recurrentes, con diversas manifestaciones en varios sistemas y órganos; se realizó un estudio descriptivo con el fin de caracterizar la población que atendemos en cuanto a las manifestaciones clínicas y paraclínicas en el sistema respiratorio, que es el principal sistema afectado por este conjunto de patologías. Se recolecto datos de 4 años de pacientes que tuvieron diagnóstico de inmunodeficiencia primaria, excluyendo causas de inmunodeficiencia secundaria como VIH. Se realizó una base de datos en Excel, donde se registraron unas variables, que posteriormente se analizaron, obteniendo datos relevantes que son comparables a los encontrados en la literatura mundial. El grupo de inmunodeficiencia más frecuente es el constituido por el déficit predominante de anticuerpos y la neumonía constituye la principal manifestación respiratoria, más del 75% de los pacientes habían presentado un episodio de neumonía al momento del diagnóstico; su recurrencia y severidad llevan a la principal secuela: las bronquiectasias (9.6%). El diagnostico precoz y tratamiento adecuado de las IDP disminuirá las recurrencias y secuelas respiratorias, impactando en la morbilidad y mortalidad de nuestros pacientes pediátricos y mejorando su calidad de vida.Abstract: Primary immunodeficiencies are alterations of the immune system that mainly predispose to recurrent infections, with various manifestations in various systems and organ; a descriptive study was carried out in order to characterize the population we serve in terms of clinical and paraclinical manifestations in the respiratory system, which is the main system affected by this set of pathologies. Collecting data from 4 years of patients who had a diagnosis of primary immunodeficiency, excluding causes of secondary immunodeficiency such as HIV. A database was made in Excel, where some variables were recorded, which were subsequently analyzed, obtaining relevant data that are comparable to those found in the world literature,. The most frequent immunodeficiency group is constituted by the predominant deficit of antibodies and pneumonia is the main respiratory manifestation, more than 75% of the patients had presented an episode of pneumonia at the time of diagnosis; its recurrence and severity leads to the main sequel: bronchiectasis (9,6%). Early diagnosis and adequate treatment of IDP will reduce recurrences and respiratory sequelae, impacting the morbidity and mortality of our pediatric patients and improving its quality of life.Otr

Description of a new species of Homonota (Reptilia, Squamata, Phyllodactylidae) from the central region of northern Paraguay

Homonota is a gecko distributed in central and southern South America with 12 species allocated in three groups. In this work, we performed molecular and morphological analyses of samples of Homonota from the central region of northern Paraguay, comparing the data with those of related species of the group: H. horrida and H. septentrionalis. We found strong molecular evidence (based on 16S, Cyt-b, and PRLR gene sequences) to distinguish this lineage as a new species. Morphological statistical analysis showed that females of the three species are different in metric characters (SVL and TL as the most contributing variables), whereas males are less differentiated. No robust differences were found in meristic characters. The most remarkable trait for the diagnosis of the new species is the presence of well-developed keeled tubercles on the sides of the neck, and lack of a white band (crescent-shaped) in the occipital area, which is present in H. horrida and H. septentrionalis. Nevertheless, in our sample, we found three specimens (one juvenile and two young adults) that exhibit the white occipital band. Thus, this character seems only reliable in adults of the new species. The new species is parapatric to H. septentrionalis, both inhabiting the Dry Chaco of Paraguay.Fil: Cacciali Sosa, Pier. Senckenberg Forschungsinstitut Und Naturmuseum; Alemania. Goethe Universitat Frankfurt; Alemania. Instituto de Investigación Biológica del Paraguay; ParaguayFil: Morando, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico para el Estudio de los Ecosistemas Continentales; ArgentinaFil: Avila, Luciano Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico para el Estudio de los Ecosistemas Continentales; ArgentinaFil: Köhler, Gunther. Senckenberg Forschungsinstitut Und Naturmuseum; Alemania. Goethe Universitat Frankfurt; Alemani

Propuesta de un sistema de contabilidad de costos para la empresa pesquera Alpesca SAC

El presente trabajo de investigación es el resultado de nuestras experiencias adquiridas en nuestros actuales centros de trabajo, como parte de la observación de la forma de costeo del producto terminado en una empresa industrial, tratando de plantear una solución al mismo aplicando los conocimientos recibidos de la universidad institución formadora y parte de ellos adquiridos por el enriquecimiento de la experiencia en el día a día de nuestras labores. La finalidad del presente trabajo es dar a conocer la importancia de un sistema de contabilidad de costos en una empresa industrial, cubriendo en forma integral las necesidades de información del ente en lo que hace a la actividad de producción de bienes y servicios, vinculando los recursos utilizados con los productos obtenidos. En el actual marco en el que se desenvuelven las organizaciones económicas y teniendo en cuenta las tendencias que se vislumbran para el nuevo siglo muchas de las cuales ya son aplicadas hoy en empresas de vanguardia, emerge la necesidad de información como principal herramienta para la conducción empresarial. Hoy en día un adecuado sistema de información de costos se ha convertido en una herramienta básica de contabilidad

Construct Validity of the Pig Intestine Model in the Simulation of Laparoscopic Urethrovesical Anastomosis

Introduction: Laparoscopic training models are increasingly important in urology to allow trainees to improve their laparoscopic skills prior to going to the operating room. For a training model to be valid, it must correlate with performance in a real case. The model must also discriminate between experienced and inexperienced subjects. [See PDF for complete abstract

Laparoscopic-Simulator Box: a Simple Design for Surgical Residency Programs to Improve Trainees’ Laparoscopic Skills

Introduction: Since the introduction and evolution of laparoscopic surgery, there have been some concerns related to surgical training in this field. Laparoscopic box trainers and virtual simulators appear as useful devices which have been demonstrating effectiveness in learning surgical skills. However, these tools remain inaccessible for many centers around the world. Our intent is to share our experience in successful design to inspire others in surgical residency programs to build such boxes for training in laparoscopic techniques and also to encourage the use of simulators in educational centers. [See PDF for complete abstract

Assessment of anastomotic leakage: A Novel System for the Training of Surgeons to Perform a Tubular Anastomosis and Objectively Evaluate Anastomotic Leak

Introduction: Dehiscence of the suture line of an anastomosis can lead to reoperation, temporary or permanent stoma, and even sepsis or death. Few techniques for the laboratory training of tubular anastomosis use ex-vivo animal tissues. We describe a novel model that can be used in the laboratory for the training of anastomosis in tubular tissues and objectively assess any anastomotic leak. [See PDF for complete abstract

Treatment of Retinopathy of Prematurity with topical ketorolac tromethamine: a preliminary study

BACKGROUND: Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. It is of variable severity, usually heals with mild or no sequelae, but may progress to blindness from retinal detachments or severe retinal scar formation. This is a preliminary report of the effectiveness and safety of a new and original use of topical ketorolac in preterm newborn to prevent the progression of ROP to the more severe forms of this disease. METHODS: From January 2001 to December 2002, all fifty nine preterm newborns with birthweight less than 1250 grams or gestational age less than 30 weeks of gestational age admitted to neonatal intensive care were eligible for treatment with topical ketorolac (0.25 milligrams every 8 hours in each eye). The historical comparison group included all 53 preterm newborns, with the same inclusion criteria, admitted between January 1999 and December 2000. RESULTS: Groups were comparable in terms of weight distribution, Apgar score at 5 minutes, incidence of sepsis, intraventricular hemorrhage and necrotizing enterocolitis. The duration of oxygen therapy was significantly longer in the control group. In the ketorolac group, among 43 children that were alive at discharge, one (2.3%) developed threshold ROP and cryotherapy was necessary. In the comparison group 35 children survived, and six child (17%) needed cryotherapy (Relative Risk 0.14, 95%CI 0.00 to 0.80, p = 0.041). Adjusting by duration of oxygen therapy did not significantly change these results. Adverse effects attributable to ketorolac were not detected. CONCLUSIONS: This preliminary report suggests that ketorolac in the form of an ophthalmic solution can reduce the risk of developing severe ROP in very preterm newborns, without producing significant adverse side effects. These results, although promising, should be interpreted with caution because of the weakness of the study design. This is an inexpensive and simple intervention that might ameliorate the progression of a disease with devastating consequences for children and their families. We believe that next logical step would be to assess the effectiveness of this intervention in a randomized controlled trial of adequate sample size

Potential species distribution and richness of ixodidae ticks associated with wild vertebrates from Michoacán, Mexico

Ticks are regarded as the most relevant vectors of disease-causing pathogens in domestic and wild animals. The diversity of Ixodidae is known for a very small number of genera. Ixodes are repre- sented by 26 species, and in 2007 the first reported ticks vectors in Mexico for the causal agent of Lyme disease. Recent rise in tick-borne disease in many parts of the world is a phenomenon in need of an explanation. The main objective of the present work was to map at a regional scale (1:2,000,000) of the distribution of ticks of the family Ixodidae that are potentially present on the wild fauna of state of Michoacan, Mexico. We compiled all available literature on ticks at a national level together with complete cartographic and bibliographic georeferenced information of the distribution of hosts in order to build a spatial database in ArcView 3.3. The results indicated that the wild fauna in the state’s territory could potentially include 31 species of ticks of Ixodidae. The map of potential species richness of ixodid ticks on the wild fauna of the state can be categorized into five classes of species richness. The highest potential concentration of ixodid species on wild fauna occurs in the volcanic area of Pico de Tancítaro

Evaluating the design of the Integrated Care for Older People: a theory of change approach

IntroductionGiven the progressive aging of the population, there is an urgent need at the health system level to implement effective models to care for older people (OP). Healthy aging is imperative to reach the Sustainable Development Goals. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) strategy to address this challenge. Implementing ICOPE requires its adaption to a specific context. We propose a pathway for such adaptation through an evaluation of the design of ICOPE; thus, we aim to describe the Theory of Change (ToC) of ICOPE and evaluate it for its implementation in Mexico City.MethodsBased on the WHO and published literature documentation, we drafted an initial ToC for ICOPE. Then, we validated the ToC with experts in ICOPE, after which we evaluated and refined it by discussing the causal pathway, intervention required to activate it, rationale, and assumptions in consecutive workshops with 91 stakeholders and healthcare workers, using the nominal group technique to reach a consensus.ResultsThe resulting ToC has the potential to contribute to healthy aging by three expected impacts: (1) prevention, reversal, or delaying of the decline of intrinsic capacity (IC) in OP; (2) improvement of the quality of life of OP; and (3) increase of disability-free life expectancy. The ICOPE causal pathway had ten preconditions, including the availability of resources, identifying at-risk individuals, available treatments, and evaluating results.DiscussionWe adapted ICOPE to a specific implementation context by evaluating its ToC in a participatory process that allows us to identify challenges and address them, at least in terms of the guidelines to operate the strategy. As ICOPE is an approach for a primary healthcare system, its adoption in a community healthcare program is promising and feasible. Evaluation as a tool could contribute to the design of effective interventions. The evaluation of the design of ICOPE for its implementation contributes to the strength of its potential to improve care for OP. This design for implementing ICOPE has the potential to be applied to similar contexts, for example, in other lower-middle-income countries