Cambio de paradigmas en la educación superior en México, ante la pandemia de COVID 19: Mudança de paradigmas no ensino superior no México em face da pandemia da COVID 19

 El covid 19 irrumpió en la vida del país de manera abrupta, en marzo del 2020, trayendo consigo, grandes desafíos para la educación superior en México. Atento a lo anterior, la pandemia ofrece la gran oportunidad de replantear el cambio de paradigmas que debe experimentar la educación universitaria mexicana con el propósito de preparar a los estudiantes para la vida actual y futura, en consonancia con las consecuencias que el coronavirus obliga a enfrentar. El presente trabajo tiene como objetivo exponer algunas reflexiones acerca de los cambios que resultan necesarios para actualizar la educación superior en México, a fin de estar en condiciones de responder a los retos que plantea la nueva realidad impuesta por la pandemia, lo cual implica, brindar a los estudiantes universitarios una educación integral, esto es, prepararlos como futuros profesionistas, pero también como futuros ciudadanos, con una educación menos académica y más práctica, orientada hacia la comprensión del mundo que los rodea; en otras palabras, formar personas maduras, analíticas y críticas, interesadas por los asuntos de su entorno social

El worker como tema de la seguridad social en México: Trabalhador como questão de segurança social no México

La seguridad social nace con la finalidad de salvaguardar la integridad física de las personas, y con ello contrarrestar la desigualdad que había existido desde siglos atrás, desde su origen tuvo por objetivo garantizar principalmente el derecho a la atención médica, en la actualidad en México y en el mundo se ha garantizado este derecho y se han sumado otros derechos como son el acceso a pensiones, derecho a vivienda, derecho a una vida mejor

Pediatric Thrombolysis: A Practical Approach

The incidence of pediatric venous thromboembolic disease is increasing in hospitalized children. While the mainstay of treatment of pediatric thrombosis is anticoagulation, reports on the use of systemic thrombolysis, endovascular thrombolysis, and mechanical thrombectomy have steadily been increasing in this population. Thrombolysis is indicated in the setting of life- or limb-threatening thrombosis. Thrombolysis can rapidly improve venous patency thereby quickly ameliorating acute signs and symptoms of thrombosis and may improve long-term outcomes such as postthrombotic syndrome. Systemic and endovascular thrombolysis can result in an increase in minor bleeding in pediatric patients, compared with anticoagulation alone, and major bleeding events are a continued concern. Also, endovascular treatment is invasive and requires technical expertise by interventional radiology or vascular surgery, and such expertise may be lacking at many pediatric centers. The goal of this mini-review is to summarize the current state of knowledge of thrombolysis/thrombectomy techniques, benefits, and challenges in pediatric thrombosis

Correlation among Hemolysis Biomarkers in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

Hemolysis is a common complication associated with mortality on extracorporeal membrane oxygenation (ECMO). Plasma-free hemoglobin (PFH) is the most commonly used biomarker reported for hemolysis on ECMO. This test is not readily available at all institutions, and other more readily available tests may indicate hemolysis nearly as well or as well as PFH. The purpose of this study was to study the correlation of other biomarkers of hemolysis to PFH on ECMO. All patients younger than 21 years placed on ECMO in a quaternary children's hospital between January 2013 and December 2016 were included in the study; biomarkers (urine hemoglobin [U-Hb], PFH, lactate dehydrogenase [LDH], aspartate aminotransferase [AST], gross hemolysis, and red cell distribution width (RDW)) were collected from the medical record. Descriptive statistics and repeated bivariate analyses were determined using SPSS 22.0. The median age on day 0 of ECMO was 29 days (.08 years) (IQR: 2; 319 days (.005; .875 years)). The median weight was 3.9 kg (IQR: 2.8; 8.6), and the median total duration of the ECMO run was 10.48 days (IQR: 4.25; 14), with 82% of all the patients being on venoarterial ECMO. There was no correlation between hematuria on urinalysis and the level of PFH (p = .338). There was a statistically significant positive correlation between PFH and the following respective biomarkers: gross hemolysis on the routine chemistry studies (p < .01, Rho = .439), AST (p < .01, Rho = .439), RDW (p < .01, Rho = .190), LDH (p < .01, Rho = .584), and AST (when associated elevated alanine transaminase (ALT) levels were censored) (p < .01, Rho = .552). U-Hb correlated poorly with PFH. The serum biomarkers AST (in the absence of ALT elevation) and LDH can be useful surrogates for PFH to quantify hemolysis on ECMO in pediatric patients

Consensus guidelines for diagnosis and management of anemia in epidermolysis bullosa

BACKGROUND: Anemia is a common complication of severe forms of epidermolysis bullosa (EB). To date, there are no guidelines outlining best clinical practices to manage anemia in the EB population. The objective of this manuscript is to present the first consensus guidelines for the diagnosis and management of anemia in EB. RESULTS: Due to the lack of high-quality evidence, a consensus methodology was followed. An initial survey exploring patient preferences, concerns and symptoms related to anemia was sent to EB patients and their family members. A second survey was distributed to EB experts and focused on screening, diagnosis, monitoring and management of anemia in the different types of EB. Information from these surveys was collated and used by the panel to generate 26 consensus statements. Consensus statements were sent to healthcare providers that care for EB patients through EB-Clinet. Statements that received more than 70% approval (completely agree/agree) were adopted. CONCLUSIONS: The end result was a series of 6 recommendations which include 20 statements that will help guide management of anemia in EB patients. In patients with moderate to severe forms of EB, the minimum desirable level of Hb is 100 g/L. Treatment should be individualized. Dietary measures should be offered as part of management of anemia in all EB patients, oral iron supplementation should be used for mild anemia; while iron infusion is reserved for moderate to severe anemia, if Hb levels of > 80-100 g/L (8-10 g/dL) and symptomatic; and transfusion should be administered if Hb is < 80 g/L (8 g/dL) in adults and < 60 g/L (6 g/dL) in children

Effect of monoclonal antibodies on eNOS activation by VEGF.

<p>Bovine aortic endothelial cells were incubated with vehicle, monoclonal antibody (mAb) 3F8 (A, 2μg/ml), 1N11 (B, 10 μg/ml), 2aG4 (C, 10 μg/ml) or 3J05 (D, 10 μg/ml) for 30 min, and NOS activity was then determined in their continued absence or presence by quantifying [¹⁴C]-L-arginine to [¹⁴C]-L-citrulline conversion without (basal) or with added VEGF (100 ng/ml) over 15 min. (N = 3–6, mean±SEM, *p<0.05 vs. no VEGF, †p<0.05 vs. no mAb.).</p

Effect of monoclonal antibodies (mAb) on eNOS inhibition by 3F8 or aPL.

<p>The impact of mAb’s 2aG4 (A, B, 200 μg/ml) or 1N11 (C-I, 200 μg/ml) on the antagonism of VEGF stimulation of eNOS by either 3F8 (A, C, H, 2 μg/ml) or aPL (B,D-G, I 100 μg/ml) was determined in bovine aortic endothelial cells (A-G) or human aortic endothelial cells (H, I). This was accomplished by quantifying [¹⁴C]-L-arginine to [¹⁴C]-L-citrulline conversion without (basal) or with added VEGF (100 ng/ml) over 15 min. Antibodies were present during 30 min preincubations and during the NOS activity incubations. Studies of 1N11 action on eNOS antagonism by aPL were performed with aPL from 4 different patients. (N = 3–6, mean±SEM, *p<0.05 vs. no VEGF, †p<0.05 vs. VEGF alone, ‡p<0.05 vs. no 1N11.).</p

Effect of 1N11 on cultured endothelial cell migration impairment by 3F8 or aPL, and on aPL blunting of carotid artery reendothelialization in vivo.

<p>(A) Bovine aortic endothelial cells (BAEC) were incubated without or with 3F8 (2 μg/ml) and either C44 or 1N11 (200 μg/ml), and cell migration induced by VEGF (100 ng/ml) over 16h was assessed by scratch assay. (B) BAEC were incubated with NHIgG or aPL (100 μg/ml) in the presence of C44 or 1N11 (200 μg/ml), and cell migration induced by VEGF (100 ng/ml) over 16h was assessed by scratch assay. (In A and B, N = 8, mean±SEM, *p<0.05 vs. no VEGF, †p<0.05 vs. no 1N11). (C-E) Human aortic endothelial cells (HAEC) were incubated with or without 3F8 (2 μg/ml) or with NHIgG versus aPL (100 μg/ml) in the presence of C44 or 1N11 (200 μg/ml), and cell migration induced by VEGF (100 ng/ml) over 16h was assessed by scratch assay. Representative images of migrating cells are shown in C. (In D and E, N = 5–10, mean±SEM, *p<0.05 vs. no VEGF, †p<0.05 vs. no 1N11). (F, G) Male C57Bl/6 mice (10–12 weeks old) were coinjected with NHIgG or aPL (100 μg/mouse) and either C44 or 1N11 (100 μg/mouse) 24 h before, on the day of carotid artery thermal injury, and 24 and 48 h after injury. Reendothelialization was assessed by evaluating intimal layer Evans blue dye incorporation 72h postinjury. (F) Representative images of the carotid artery intimal surface. (G) Summary data for the area of remaining denudation at 72 h, expressed in arbitrary units. (N = 4–5, *p<0.05 vs. NHIgG, †p<0.05 vs. C44).</p

Effect of 1N11 on 3F8 binding to β2-GPI, and on β2-GPI-ApoER2 complex formation induced by 3F8 or aPL.

<p>(A) Binding of biotinylated monoclonal antibodies (C44, 1N11 and 3F8) to immobilized human β2-GPI (A) on phosphatidylserine-coated 96-well plates was evaluated (N = 4, mean±SEM, *p<0.05 vs. C44 control.) (B) Increasing concentrations of unlabeled 1N11 were added concurrently with biotinylated 3F8 (10 nM), and 3F8 binding to human β2-GPI was quantified (N = 6–8, *p<0.05 vs. no 1N11). (C) Endothelial cells were incubated in the absence or presence of control IgG or 3F8 (1 μg/ml), without or with 1N11 added (200 μg/ml) for 30 min, ApoER2 was immunoprecipitated, and the presence of ApoER2 and β2-GPI in the immunoprecipitates was evaluated by immunoblotting. (D) Coimmunprecipitation experiments were also performed evaluating β2-GPI and ApoER2 interaction in the absence or presence of NHIgG or aPL (100 μg/ml), without or with 1N11 added. Findings in C and D were confirmed in 2 independent experiments.</p