Extracción de catarata mediante la técnica de facoemulsificación con implante de lente intraocular

Fundamento: La facoemulsificación es la técnica quirúrgica más aceptada en la actualidad para la cirugía de catarata. Objetivo: Describir los resultados de la cirugía de catarata mediante la técnica de facoemulsificación. Metodología: Se realizó un estudio descriptivo, longitudinal y prospectivo en 115 ojos de pacientes con diagnóstico de catarata operados en el Hospital General Provincial Camilo Cienfuegos, entre julio 2009 y agosto 2015. Se analizaron las variables: edad, sexo, tipo de catarata, agudeza visual sin corrección y mejor corregida, tipo de lente intraocular empleado y posición del mismo, complicaciones transoperatorias y posoperatorias. Resultados: El grupo etario que prevaleció fue el de 60 años y más con 47 %, hubo un predominio de féminas sobre masculinos para un 55,7 %; se halló un 53 % de catarata relacionada con la edad, se encontró un 45,2 % de pacientes con agudeza visual preoperatoria de 0.1 a 0.3 de visión; en cuanto a la agudeza visual posoperatoria, a los siete días ya un 13 % alcanzó la unidad de visión, situación que cambió al mes con un 27 %; ya con la agudeza visual mejor corregida se observó un 86,1 % de pacientes con una visión de 1.0 y con visión de 0.8 a 0.9 para un 6,8 %, lo que evidenció la mejoría en la misma. La complicación transoperatoria más frecuente fue el surge y la posquirúrgica, la opacidad de cápsula posterior, aunque en ambos casos el mayor por ciento de pacientes no las presentó. Conclusiones: Se constató una mejoría importante de la agudeza visual sin corregir y con corrección después de la cirugía con un menor número de complicaciones. DeCS: EXTRACCIÓN DE CATARATA; FACOEMULSIFICACIÓN; CRISTALINO; AGUDEZA VISUAL. Palabras clave: Catarata y cirugía; extracción de catarata; facoemulsificación; cristalino; lente intraocular; agudeza visual. ABSTRACT Background: Phacoemulsification is the most widely accepted surgical technique for cataract surgery. Objective: To describe the results of cataract surgery using the phacoemulsification technique.  Methodology: A descriptive, longitudinal and prospective study was carried out in 115 eyes of patients with cataract diagnosis operated at the General Provincial Hospital Camilo Cienfuegos between July 2009 and August 2015. The following variables were analyzed: age, sex, type of cataract, visual acuity uncorrected and best corrected, type of intraocular lens used and position of it, trans operatory and post operatory complications. Results: The age group that prevailed was 60 years and over with 47 %, there was a predominance of females over males for 55.7 %; 53 % of age related to cataract was found; 45.2 % of patients with preparatory visual acuity of 0.1 to 0.3 of vision were found; in the post operatory visual acuity, at seven days and 13 % reached the vision unit, a situation that changed a month with 27 %; and with the best corrected visual acuity was observed 86.1 % of patients with a vision of 1.0 and with a vision of 0.8 to 0.9 for 6.8 %, which evidenced the improvement in it. The most frequent trans operatory complication was the surge and post operatory, the posterior capsule opacity, although in both cases the greater percent of patients did not present them. Conclusions: There was a significant improvement in uncorrected visual acuity and correction after surgery with fewer complications. DeSH: CATARACT EXTRACTION; PHACOEMULSIFICATION LENS; CRYSTALLINE; VISUAL ACUITY. Keywords: cataract and surgery; cataract extraction; phacoemulsification; lens; crystalline; intraocular; visual acuity

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1000 cases of unexplained pediatric hepatitis in children have been reported worldwide, including 278 cases in the UK 1. Here we report investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator subjects, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in liver, blood, plasma or stool from 27/28 cases. We found low levels of Adenovirus (HAdV) and Human Herpesvirus 6B (HHV-6B), in 23/31 and 16/23 respectively of the cases tested. In contrast, AAV2 was infrequently detected at low titre in blood or liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T-cells and B-lineage cells. Proteomic comparison of liver tissue from cases and healthy controls, identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and in severe cases HHV-6B, may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Background: The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. Methods: This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Findings: Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years IQR 17–43) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio HR 2·26 95% CI 1·32–3·89). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 1·08–1·95). Most patients were unvaccinated (32 078 74·0% across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 95% CI 0·47–8·05 and for hospital admission or emergency care attendance 1·58 0·69–3·61) were similar to the HRs for unvaccinated patients (2·32 1·29–4·16 and 1·43 1·04–1·97; p=0·82 for both) but the precision for the vaccinated subgroup was low. Interpretation: This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Background: The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. Methods: This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Findings: Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. Interpretation: This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant. Funding: Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Aportes a la consolidación del conectivismo como enfoque pedagógico para el desarrollo de procesos de aprendizaje

Este artículo reflexiona sobre el conectivismo como un enfoque pedagógico para el desarrollo de procesos de aprendizaje que se pueden generar desde las tecnologías de la información y la comunicación aplicadas a la educación. Se presenta como una alternativa pedagógica que ha pasado por una serie de debates epistemológicos acerca de su carácter teórico y valor pedagógico para transformar las prácticas educativas tradicionales. La metodología que se utilizó fue la revisión documental y recoge las principales investigaciones acerca del conectivismo que se han realizado en países de Latinoamérica, de Estados Unidos y de españa entre otros, y que son referenciadas en diversas bases de datos, como Redalyc, Dialnet, Springer y Scopus. En los resultados se presentan las diferentes discusiones teóricas y conceptuales acerca del conectivismo haciendo énfasis en los aportes que ha tenido para la consolidación de nuevas corrientes pedagógicas y educativas, para el desarrollo de procesos de aprendizaje

Aportes a la consolidación del conectivismo como estrategia pedagógica para mejorar procesos de aprendizaje

Este artículo reflexiona sobre el conectivismo como un enfoque pedagógico para el desarrollo de procesos de aprendizaje que se pueden generar desde las tecnologías de la información y la comunicación aplicadas a la educación. Se presenta como una alternativa pedagógica que ha pasado por una serie de debates epistemológicos acerca de su carácter teórico y valor pedagógico para transformar las prácticas educativas tradicionales. La metodología que se utilizó fue la revisión documental y recoge las principales investigaciones acerca del conectivismo que se han realizado en países de Latinoamérica, de Estados Unidos y de españa entre otros, y que son referenciadas en diversas bases de datos, como Redalyc, Dialnet, Springer y Scopus. En los resultados se presentan las diferentes discusiones teóricas y conceptuales acerca del conectivismo haciendo énfasis en los aportes que ha tenido para la consolidación de nuevas corrientes pedagógicas y educativas, para el desarrollo de procesos de aprendizaje

Connectivism and its application through web 2.0 tools: configuration of a learning network for the production of scientific articles

El presente trabajo de profundización, aborda la teoría del conectivismo desde diferentes enfoques teóricos para el desarrollo de una propuesta pedagógica que contribuya a la mejora en la producción de artículos científicos, como parte esencial en el desarrollo de las competencias para la sociedad de la información con las que deben contar los estudiantes de tecnología de la Universidad Distrital Francisco José de Caldas. La propuesta pedagógica se desarrolla en el marco de la materia “producción y comprensión de textos II”. Y promueve la configuración de una red de aprendizaje por medio del uso de diferentes herramientas web 2.0, que se consolidan en una cartilla digital para la creación de artículos científicos por parte de los estudiantes.The present work of deepening, approaches the theory of connectivism from different theoretical approaches for the development of a pedagogical proposal that contributes to the improvement in the production of scientific articles, as an essential part in the development of competencies for the information society with which must be counted by the technology students of the Francisco José de Caldas District University. The pedagogical proposal is developed within the framework of the subject "production and comprehension of texts II". And it promotes the configuration of a learning network through the use of different web 2.0 tools, which are consolidated into a digital primer for the creation of scientific articles by student

Renovación urbana central para la alcaldía Municipal de Flandes- Tolima

El presente trabajo tiene como objetivo el proceso de renovación y modernización urbana de la ciudad de Flandes –Tolima. Para contribuir con el mejoramiento urbanístico, se propone la renovación urbana en el área central de Flandes, buscando mejorar de la calidad urbana en el sector y mostrar una imagen diferente de la ciudad. El municipio de Flandes conserva las estructuras más antiguas en la zona central, lo que representa la urgencia de renovación. El deterioro en que se encuentran las áreas y la falta de mantenimientos generales que representan condiciones de peligro material que puede provocar derrumbamiento. Para este problemática se propone el proceso de renovación urbana para la alcaldía municipal de Flandes con el fin generar calidad de vida social y ambiental, que por consiguiente es un tema contemplado en la administración política actual, lo cual da viabilidad al análisis de la propuesta en busca de una mejor imagen e identidad para la población, Dando lugar a la conservación de los habitantes y de las actividades existentes, mejorando las condiciones habitacionales, y el nivel de infraestructura. Las administraciones gubernamentales deciden desarrollar la renovación urbana de la ciudad, para generar impactos que se obtendrán para el mejoramiento de la calidad de vida social y del medio ambiente. Los procesos de renovación producen la modificación del uso de suelo para lo cual se utilizan procesos y mecanismos que detienen el deterioro físico y ambiental. La renovación urbana es un tipo de emprendimiento social cuando la ciudad resulta antigua para las demandas actuales de la población donde se contemplan la eliminación, remodelación y modificación de construcciones y edificaciones viejas para satisfacer el déficit habitacional del incremento poblacional