Rotura de aislante de electrodo de marcapasos por atrapamiento subclavio. Reporte de caso

We present the case of an 82-year-old male patient with a history of single-chamber pacemaker implantation 7 years ago, due to third-degree atrioventricular block, who experienced presyncope. Telemetry showed a warning of possible electrode lead damage and ventricular noise input coinciding with capture failure, so the entire pacing system was programmed to be replaced. During the intervention, breakage of the electrode insulator was observed. The subclavian approach can cause damage to the electrode due to entrapment in the soft tissues it passes through before entering the venous system and iterative stretching. Insulator breakage may manifest as loss of capture and presence of noise on the electrocardiogram, drop in lead impedance, and suggestive radiographic images. The axillary approach is a safe and effective option and is therefore recommended for transvenous lead implantation.Se presenta el caso de un paciente varón de 82 años con antecedente de implante de marcapasos unicameral hace 7 años, por bloqueo auriculoventricular de tercer grado, que experimenta presíncopes. En la telemetría se encuentró alerta de posible daño de cable electrodo y entrada de ruido ventricular que coincide con falla de captura, por lo que se programó reemplazo de todo el sistema de estimulación. Durante la intervención se observó rotura del aislante del electrodo. El abordaje subclavio puede ocasionar daño en el electrodo por atrapamiento en los tejidos blandos que atraviesa antes de ingresar al sistema venoso y estiramiento iterativo. La rotura del aislante se puede manifestar como pérdida de captura y presencia de ruido en el electrocardiograma, caída de la impedancia del cable e imágenes radiográficas sugerentes. El abordaje axilar es una opción segura y eficaz, por lo que se recomienda para el implante de cables transvenosos

Rol del docente en el proceso de evaluación formativa en el entorno virtual

Debido a los cambios en el sistema educativo originado por la COVID-19, los docentes y estudiantes se vieron en la necesidad de cambiar el escenario de la enseñanza y aprendizaje a uno remoto; Por tal motivo, el estudio tuvo como objetivo interpretar el rol de los docentes en el proceso de evaluación formativa en el entorno virtual. Se utilizó un enfoque cualitativo de diseño hermenéutico. La muestra estuvo conformada por seis docentes expertos en evaluación formativa. Se utilizó como técnica una entrevista con preguntas semiestructuradas. Para el análisis interpretativo se hizo uso del Atlas Ti. Los resultados evidenciaron que el docente debe propiciar la interacción a través de diversas dinámicas, ejercicios y preguntas que provoquen esa interacción y propicien el clima de confianza hacia el estudiante. En conclusión, es necesario potenciar la interacción estudiante-maestro para una adecuada verificación en la construcción de los aprendizajes.Campus At

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Información acerca del consumo periconcepcional de ácido fólico en puérperas atendidas en el Instituto Nacional Materno Perinatal

Introducción: El consumo de ácido fólico (AF) es de gran importancia en la etapa periconcepcional por los beneficios que representa para el feto, en especial en la prevención de los defectos del cierre del tubo neural. Objetivo: Describir la información sobre el consumo periconcepcional de ácido fólico en las puérperas del Instituto Nacional Materno Perinatal (INMP), durante el mes de junio de 2016. Metodología: Estudio descriptivo, en 252 puérperas hospitalizadas en el INMP, a quienes se les realizó una encuesta, la cual fue complementada con datos de historias clínicas. Resultados: Del total de puérperas, el 29,37% sabía que debe consumir ácido fólico tres meses antes del embarazo; un 53,17% sabía que el ácido fólico debe ser consumido durante todo el embarazo; y sólo el 36,11% sabía que el consumo a prevenir los defectos del tubo neural. Sobre las fuentes de información, la más frecuente fue el profesional de salud con 76,39%, familiares y/o amigos con 47,22%, y el internet con un 23,61%. Los medios de información más comunes fueron la consulta de planificación familiar en el 30,00% de los casos; las charlas educativas, también con 30%; y la consulta ginecológica con 20,90%. Conclusiones: Los conocimientos acerca del consumo periconcepcional de AF son muy bajos, a pesar de la información brindada por los profesionales de la salud que las puérperas manifiestan haber recibido antes y durante la gestación. Es necesario complementar las actividades educativas con talleres o actividades de sensibilización multidisciplinaria

Revista del Museo Nacional N° 27

El Museo Nacional, dirigido por Luis E. Valcárcel desde 1931, publicó la Revista del Museo Nacional a partir del año 1932. El presente volumen N° XXVII, fue publicado en 1958. Contenido: “La Etnohistoria del Perú Antiguo”, por Luis E. Valcárcel – “Contactos foráneos en la Arquitectura de la Costa Central”; por Louis M. Stumer – “Antroponimias Indígenas”, por José M. B. Farfán – “Quechuismos. Su ubicación y Reconstrucción Etimológica (Continuación)”,por José M. B. Farfán – “Diccionario Kkechuwa-Español. (Apéndice N° 5), por Jorge A. Lira – “Palabras del mochica”, por Augusto Orrego R. – “El Inca Garcilaso en quechua (Traducción de Rafael Aguilar)” – “Prácticas Funerarias en la Comunidad de Virú”, por Humberto Ghersi Barrera – “Notas elementales sobre el arte popular religioso y la cultura mestiza de Huamanga”, por José María Arguedas – “De Santiago Matamoros a Santiago mata-indios”, por Eniillo Choy – “Dos documentos sobre Obrajes de Huamanga”, por Emilio Mendizál Losack – Necrología: Paul Rivet

Revista del Museo Nacional N° 26

El Museo Nacional, dirigido por Luis E. Valcárcel desde 1931, publicó la Revista del Museo Nacional a partir del año 1932. El presente volumen N° XXVI, fue publicado en 1957. Contenido: “La vida rural en el Perú”, por Luis E. Valcárcel – “Un español en las Indias: Cieza de León”, por André Coyne – “Estudios de Nuestras Lenguas Indígenas”, por José M. B. Farfán – “La Interrogación en la Lengua Quechua”, por J. M. B. Farfán – “Quechuismos. Su Ubicación y Reconstrucción Etimología”, por J. M. B. Fartán – “Diccionario Kkechuwa-Español, por Jorge A. Lira – “Evolución de las Comunidades Indígenas. El Valle del Mantaro y la ciudad de Huancayo”, por José María Arguedas – “Trasfondo Económico en la Conquista Española de América”, por Emilio Choy – “La propiedad en la Isla de Taquile (Lago Titicaca)”, por José Matos – “Cerámica negra de estilo Maranga”, por Louis M. Stumer – “Hallazgos de artefactos de piedra en el Perú y los problemas del poblamiento de América, por Gerhard Schroeder – “Pinturas rupestres de Pizacoma”, por José M. Franco Inojosa