28 research outputs found
Análisis del uso de servicios sanitarios por la población colombiana de acuerdo con niveles de atención que incluyen consulta externa y hospitalización/urgencia en relación con variables del entorno sociodemográfico a partir de los datos de la Encuesta Nacional de Salud 2007
La utilización de servicios sanitarios es la descripción del uso de servicios de salud por personas y permite identificar, planificar e intervenir en los Sistemas de Salud. El objetivo de este trabajo es analizar el uso de servicios sanitarios por la población colombiana de acuerdo con niveles de atención que incluyen consulta externa y hospitalización/urgencia en relación con variables del entorno sociodemográfico a partir de los datos de la Encuesta Nacional de Salud 2007. Se tomaron los datos de la ENS2007 se realizó un análisis descriptivo de las variables sociodemográficas y datos propios de la atención. Los datos de la ENS 2007 mostraron una mayor utilización por el sexo femenino y en los extremos de edad, la mayoría de usuarios en la región central/Bogotá DC, 15% de usuarios sin educación y un bajo porcentaje de empleo formal. Las causas más frecuentes de atención de urgencias y hospitalización fueron enfermedad aguda, crónica y lesiones por externalidades. Los datos reflejan inequidades regionales, poco empleo formal y bajo nivel educativo.MaestríaMagister en Salud Public
Consecutive renal biopsy in a cohort of patients with lupus nephritis of the Colombian Caribbean
Background: Renal biopsy is the gold standard for the diagnosis and classification of lupus
nephritis (LN). However, a consecutive biopsy can predict the clinical course and optimize
the therapeutic strategies.
Objectives: To compare the histopathological findings with clinical responses.
Patients and Methods: Thirty patients with active LN were included. Renal biopsies were
performed at the time of diagnosis and subsequently under clinical criteria according to
consensus of Spanish Society of Nephrology. The response to treatment was defined as
complete response, partial responder or non-responder. The histological change in second
biopsy towards LN classes I, II or III/IV-C was defined as histological response (HR).
Results: In initial renal biopsy, 28 (93%) patients showed proliferative LN; III-A or A/C
(n; 7), IV-A or A/C (n: 19) and mixed; III+IV/V (n; 2). LN class V was presented in two
cases. The clinical response was; complete response (10%), partial response (20%), and
non-response (70%). HR was manifested in 37% and non-histologic response in 63% of
patients. Around 33% of patients with complete response/partial response showed active
lesions in the consecutive renal biopsy.
Conclusions: In Colombian Caribbean, LN is aggressive and refractory to treatment. The
consecutive renal biopsy allowed to demonstrate the persistence of the activity of the
lesion in almost half of the patients, which may provide additional information to create
better response criteria. The consecutive renal biopsy is a tool that allows improving the
evaluation of the response to treatment in the LN
Optimizing dialysis dose in the context of frailty: an exploratory study
Introduction Frailty is a multicausal syndrome characterized by a decrease in strength, resistance and physiological function,
which makes the individual vulnerable and dependent, and increases his/her mortality. This syndrome is more prevalent
among older individuals, and chronic kidney disease patients, particularly those on dialysis. Dialysis dose is currently
standardized for hemodialysis (HD) patients regardless of their age and functional status. However, it has been postulated
that the dialysis dose required in older patients, especially frail ones, should be lower, since it could increase their degree
of frailty. Then, the purpose of this study was to evaluate if there would be a correlation between the dose of Kt/V and the
degree of frailty in a population of adult patients on HD.
Materials and methods A cross-sectional study with 82 patients on HD in Barranquilla (Colombia) and Lobos (Argentina)
was conducted. Socio-demographic and laboratory data, as well as dialysis doses (Kt/V) were recorded and scales of fragility,
physical activity, gait and grip strength were applied. Then these data were correlated by a Spearman’s correlation and
a logistic regression.
Results CFS, social isolation, physical activity, gait speed, and prehensile strength tests were outside the reference ranges
in the studied group. No significant correlation was found between dialysis dose and all the above mentioned functional
tests. However, a significant and inverse correlation between physical activity and CFS was documented (score − 1.41 (CI
− 2.1 to − 0.7).
Conclusion No significant correlation was documented between Kt/V value and different parameters of the frailty status, but
this status correlated significantly and inversely with physical activity in this group. Frailty status in hemodialysis patients
was significantly higher in older individuals, although young individuals were not exempt from it
Lesión renal aguda en trabajadores rurales: Una nefropatía por estrés ambiental
Introducción: la nefropatía mesoamericana es una nefropatía túbulo-intersticial cuya etiología aún se desconoce. Sin embargo, se han descrito casos clínicos similares a esta en otras regiones geográficamente distantes y étnicamente diversas. Aun así, todos tienen un factor común: la intensidad del calor y el trabajo físico rural. Objetivo: estudiar si esta entidad podría presentarse entre trabajadores rurales de una región no mesoamericana con condiciones climáticas y laborales similares, en el campo del Caribe colombiano y considerar cuánto podría pesar en su patogénesis la deshidratación repetitiva. Materiales y metodología: se realizó un estudio observacional, basado en un trabajo de campo en una finca de Sitio Nuevo (Colombia) en 28 voluntarios trabajadores rurales (arrozales), a quienes se les tomó peso, presión arterial y muestras de sangre y orina para medir electrolitos y osmolaridad, en 2 momentos del día (mañana y tarde). Resultados: de los 28 trabajadores jóvenes evaluados, 5 (18 %) presentaron aumento significativo de la creatinina sérica durante el día (0,8±0,15 vs 1,2±0,17, p<0,001). El volumen de agua ingerido por los trabajadores fue muy variable (2.861 ± 1.591 cc). Hubo un aumento significativo en los valores de sodio sérico (p<0,001) y osmolaridad urinaria (p=0,01) entre los valores de la mañana y la tarde en estos 5 pacientes. Conclusión: el dieciocho por ciento de los trabajadores evaluados desarrolló parámetros compatibles con daño renal agudo y deshidratación durante la jornada laboral en el campo del Caribe colombiano.Introduction: Mesoamerican nephropathy is a tubule-interstitial nephropathy whose etiology is still unknown. However, clinical cases like Mesoamerican nephropathy have been described in other geographically distant and ethnically diverse regions. Still, they all have a common factor: the intensity of heat and rural physical labor. Objective: To study whether this entity could occur among rural workers in a non-Mesoamerican region with similar climatic and working conditions, in the Colombian Caribbean countryside, and to consider how much repetitive dehydration could weigh in its pathogenesis. Methodology: An observational study was carried out, based on field work in a farm in Sitio Nuevo (Colombia) with 28 rural worker volunteers (rice fields), who were measured for weight, blood pressure, and blood and urine samples to measure electrolytes and osmolarity, at 2 times of the day (morning and evening). Results: Of the 28 young men workers evaluated, 5 (18 %) presented a significant increase in serum creatinine during the day (0.8±0.15 vs 1.2±0.17, p<0.001). The volume of water ingested by the workers was highly variable (2,861 ± 1,591 cc). There was a significant increase in serum sodium (p<0.001), and urinary osmolarity (p=0.01) values between morning and afternoon values in these 5 patients. Conclusions: Eighteen percent (18 %) of the workers evaluated developed parameters compatible with acute kidney injury and dehydration during the workday in the Colombian Caribbean countryside.Fil: Musso, Carlos. Hospital Italiano; ArgentinaFil: Aroca Martínez, Gustavo. Universidad Simon Bolivar.; Venezuela. Clínica de la Costa; ColombiaFil: Avendaño Echavez, Lil. Clínica de la Costa; ColombiaFil: Cadena Bonfanti, Andrés. Universidad Simon Bolivar.; Venezuela. Clínica de la Costa; ColombiaFil: Castillo, Luis. Clínica de la Costa; Colombia. Universidad Simon Bolivar.; VenezuelaFil: González Torres, Henry. Clínica de la Costa; Colombia. Universidad Simon Bolivar.; VenezuelaFil: Conde, Juan C.. Clínica de la Costa; Colombia. Universidad Simon Bolivar.; VenezuelaFil: Navarro Quiroz, Elkin. Universidad Simon Bolivar.; Venezuela. Clínica de la Costa; ColombiaFil: Peña Vargas, William. Clínica de la Costa; ColombiaFil: Hernandez, Sandra. Clínica de la Costa; ColombiaFil: Velez Verbel, María de los Ángeles. Clínica de la Costa; ColombiaFil: Perez, Rafael. Clínica de la Costa; ColombiaFil: Sierra, Angélica. Clínica de la Costa; ColombiaFil: Rua, Zenen. Clínica de la Costa; ColombiaFil: Palmera, Jorge. Clínica de la Costa; ColombiaFil: Terrasa, Sergio Adrian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; Argentin
MicroRNAs overexpressed in Crohn's disease and their interactions with mechanisms of epigenetic regulation explain novel aspects of Crohn's disease pathogenesis
Background In this review, we were interested to identify the wide universe of enzymes associated with epigenetic modifications, whose gene expression is regulated by miRNAs with a high relative abundance in Crohn's disease (CD) affected tissues, with the aim to determine their impact in the pathogenesis and evolution of the disease. Methods We used HMDD and Bibliometrix R-package in order to identify the miRNAs overexpressed in CD. The identified enzymes associated with epigenetic mechanisms and post-translational modifications, regulated by miRNAs upregulated in CD, were analyzed using String v11 database. Results We found 190 miRNAs with great abundance in patients with CD, of which 26 miRNAs regulate the gene expression of enzymes known to catalyze epigenetic modifications involved in essentials pathophysiological processes, such as chromatin architecture reorganization, immune response regulation including CD4+ T cells polarization, integrity of gut mucosa, gut microbiota composition and tumorigenesis. Conclusion The integrated analysis of miRNAs with a high relative abundance in patients with CD showed a combined and superimposed gene expression regulation of enzymes associated with relevant epigenetic mechanisms and that could explain, in part, the pathogenesis of CD
Integrated analysis of microRNA regulation and its interaction with mechanisms of epigenetic regulation in the etiology of systemic lupus erythematosus
The aim of this study was to identity in silico the relationships among microRNAs (miRNAs) and genes encoding transcription factors, ubiquitylation, DNA methylation, and histone modifications in systemic lupus erythematosus (SLE). To identify miRNA dysregulation in SLE, we used miR2Disease and PhenomiR for information about miRNAs exhibiting differential regulation in disease and other biological processes, and HMDD for information about experimentally supported human miRNA-disease association data from genetics, epigenetics, circulating miRNAs, and miRNA-target interactions. This information was incorporated into the miRNA analysis. High-throughput sequencing revealed circulating miRNAs associated with kidney damage in patients with SLE. As the main finding of our in silico analysis of miRNAs differentially expressed in SLE and their interactions with disease-susceptibility genes, post-translational modifications, and transcription factors; we highlight 226 miRNAs associated with genes and processes. Moreover, we highlight that alterations of miRNAs such as hsa-miR-30a-5p, hsa-miR-16-5p, hsa-miR-142-5p, and hsa-miR-324-3p are most commonly associated with post-translational modifications. In addition, altered miRNAs that are most frequently associated with susceptibility-related genes are hsa-miR-16-5p, hsa-miR-374a-5p, hsa-miR-34a-5p, hsa-miR-31-5p, and hsa-miR-1-3p
Integrated analysis of microRNA regulation and its interaction with mechanisms of epigenetic regulation in the etiology of systemic lupus erythematosus
The aim of this study was to identity in silico the relationships among microRNAs (miRNAs) and genes encoding transcription factors, ubiquitylation, DNA methylation, and histone modifications in systemic lupus erythematosus (SLE). To identify miRNA dysregulation in SLE, we used miR2Disease and PhenomiR for information about miRNAs exhibiting differential regulation in disease and other biological processes, and HMDD for information about experimentally supported human miRNA-disease association data from genetics, epigenetics, circulating miRNAs, and miRNA-target interactions. This information was incorporated into the miRNA analysis. High-throughput sequencing revealed circulating miRNAs associated with kidney damage in patients with SLE. As the main finding of our in silico analysis of miRNAs differentially expressed in SLE and their interactions with disease-susceptibility genes, post-translational modifications, and transcription factors; we highlight 226 miRNAs associated with genes and processes. Moreover, we highlight that alterations of miRNAs such as hsa-miR-30a-5p, hsa-miR-16-5p, hsa-miR-142-5p, and hsa-miR-324-3p are most commonly associated with post-translational modifications. In addition, altered miRNAs that are most frequently associated with susceptibility-related genes are hsa-miR-16-5p, hsa-miR-374a-5p, hsa-miR-34a-5p, hsa-miR-31-5p, and hsa-miR-1-3p
Case-Serie of 4 COVID-19 patients hospitalized in an intensive care unit in a hospital institution in Barranquilla, Colombia
Objetivo: Presentar una serie de casos de COVID-19 con requerimiento
de ingreso a Unidad de Cuidados Intensivos. Métodos: La información fue tomada
de las historias clínicas, y su evaluación y diagnóstico fue realizado mediante
estudios paraclínicos en sangre, orina, PCR e imágenes diagnósticas en 4 pacientes
con diferentes comorbilidades y nexo epidemiológico presente para desarrollo de la
enfermedad. El caso 1 desarrolló falla orgánica múltiple, incluyendo injuria renal
aguda con una estancia en UCI de 4 dias antes de su fallecimiento, mientras los
casos 2, 3 y 4 tuvieron una evolución favorable y fueron dados de alta de UCI. Los
cuatro casos fueron manejados con cloroquina 300 mg via oral cada 12 horas y
azitromicina 1 gr via oral cada 24 horas durante 5 dias sin complicaciones ni
toxicidad asociada. Conclusiones: Se requieren estudios multicéntricos rápidos
que orienten científicamente hacia un mejor abordaje diagnóstico y manejo, en el
contexto de una enfermedad con un comportamiento clínico-epidemiologico que
debe estudiarse en profundidad y que probablemente cobrará muchas vidas,
ademas, debido a la ausencia de pruebas diagnósticas rápidas, la utilización de una
clasificación basada en la severidad de lesiones radiológicas llamada CO-RADS
(Covid-19 Imaging Reporting and Data System), podría ser de gran importancia para
instalar de manera temprana los tratamientos farmacológicos disponibles y la
asistencia respiratoria mecánica precoz.Objective: To present a COVID-19 case series with clinical admission
criteria to Intensive Care Unit. Methods: Patients information was obtained from
medical records, and daily clinical evaluation whereas diagnosis was carried out
through paraclinical studies in blood, urine, PCR and diagnostic images in 4 patients
with different comorbidities and epidemiological link for the development of COVID19. The case 1 developed multiple organ failure, including acute kidney injury with
an ICU stay of 4 days before his death, while cases 2, 3 and 4 had a favorable
evolution and were discharged from the ICU. All four cases were managed with
chloroquine 300 mg orally every 12 hours and azithromycin orally every 24 hours for
5 days without complications or associated toxicity. Conclusions: rapid multicenter
studies are required to scientifically guide a better diagnostic and management
approach, in the context of a disease with a clinical-epidemiological behavior that
must be studied in depth and will probably take many lives. In addition, due to the
absence of sufficiently rapid tests, the use of a classification based on the severity
of radiological lesions called CO-RADS (Covid-19 Imaging Reporting and Data
System), could be of great importance to install av
La evolución
A manera de introducción citaremos un fragmento del libro del físico químico Peter Atkins de Oxford, con su interesante libro la creación, en el cual dice:
Llevaré tu mente a un viaje. Es un viaje de entendimiento, que nos llevará al borde del espacio, el tiempo y la comprensión. Durante el mismo discutiré que no hay nada que no pueda ser comprendido, que no hay nada que no pueda ser explicado y que todas las cosas son extraordinariamente simples... Una gran parte del universo no necesita ninguna explicación. Por ejemplo, los elefantes. Una vez que las moléculas han aprendido a competir y a crear otras moléculas a su propia imagen, los elefantes y las cosas que son como los elefantes se encontrarán, a su debido tiempo, vagando por los campos.
En este trabajo trataremos, un tema muy complejo y de por si muy extenso, abarcarlo todo en tan solo unas páginas es más que imposible.
La evolución es un tema muy discutido, son muchas las corrientes que surgen a su alrededor alternativas, científicas, e incluso la religión está relacionada con este tema. El hombre siempre ha querido conocer sus orígenes, dando hipótesis, teorías, religiones, dogmas, mitos y leyendas. Pero la discusión está latente y seguirá así por muchos años. Quiénes somos y de dónde venimos? Una incógnita universal que siempre estará en las mentes de los hombres.
Antes de empezar aclararemos que la teoría que nos parece más satisfactoria, es la Selección Natural de Darwin que expondremos en este trabajo de investigació
Response to pharmacotherapy in patients with membranoproliferative glomerulonephritis in a hospital of Barranquilla, Colombia, between 2007 and 2014
Introducción. La glomerulonefritis membranoproliferativa (GnMP)
es un patrón de lesión glomerular hipercelular mesangial con
adelgazamiento de la membrana basal glomerular y proliferación
endocapilar que está mediado por las inmunoglobulinas o el sistema
del complemento en el mesangio y endotelio capilar.
Objetivo. Evaluar la respuesta a la farmacoterapia en pacientes
diagnosticados con GnMP en una clínica de Barranquilla entre los
años 2007 y 2014.
Materiales y métodos. Estudio de cohorte retrospectivo en el que se
evaluaron 58 pacientes con diagnóstico de GnMP por biopsia renal,
quienes se clasificaron como respondedores y no respondedores.
Se realizó una evaluación de tratamiento estándar según tipo de
GnMP: mediado por complemento y mediado por inmunocomplejos
e inmunofluorescencia negativa a los 6 y 12 meses de tratamiento.
Resultados. La edad promedio de los participantes fue de 35±13 años.
De 58 pacientes, 52% eran mujeres, 63% desarrolló enfermedad renal
crónica (ERC) al año de evaluación, 25.8% logró remisión (22.4%
completa y 3.4% parcial) y 74.2% no logró entrar en remisión.
Conclusión. La GnMP es una causa importante de ERC entre la
población estudiada. La respuesta al tratamiento inmunosupresor no
demostró beneficios estadísticamente significativos, independiente
del tipo de GnMP.Introduction: Membranoproliferative glomerulonephritis (MPGN) is
a pattern of mesangial hypercellular glomerular lesion with thinning of
the glomerular basement membrane and endocapillary proliferation,
mediated by immunoglobulin and the complement system of the
mesangium and capillary endothelium.
Objective: To assess the response to pharmacotherapy in patients
diagnosed with MPGN in a hospital of Barranquilla between 2007
and 2014.
Materials and methods: Retrospective cohort study in which 58
patients diagnosed with MPGN by renal biopsy were assessed and
classified as responsive and non-responsive. A standard treatment
assessment was performed according to the type of MPGN: mediated
by the complement system, mediated by immunocomplexes, and
negative immunofluorescence at 6 and 12 months of treatment.
Results: The average age of the participants was 35±13 years. Of 58
patients, 52% were female, 63% developed chronic kidney disease
(CKD) one year after the assessment, 25.8% achieved remission
(22.4% complete and 3.4% partial) and 74.2% failed to enter remission.
Conclusion: MPGN is one of the most important causes of CKD
among the studied population. Response to immunosuppressant
treatment showed no statistically significant benefits, regardless of
the type of MPGN