Factores de riesgo para la malignidad de los pólipos vesiculares en dos hospitales públicos de perú

Introducción: los pólipos de vesícula biliar, benignos y malignos, en la mayoría de pacientes tienen un diagnóstico generalmente incidental; a través de estudios de imágenes, que no se pueden distinguir con precisión según su grado de malignidad. Objetivo: determinar los factores de riesgo para la malignidad de los pólipos vesiculares en dos hospitales públicos peruanos. Metodología: estudio de cohorte retrospectiva, de datos secundarios, en colecistectomizados del 2004 al 2012 en un hospital de Lima y otro de Callao. Se definió como pólipo maligno según el tipo histopatológico de adenocarcinoma. Se obtuvieron los riesgos relativos y sus intervalos de confianza del 95 % (IC 95 %). Además, mediante curvas ROC (característica operativa del receptor), se obtuvieron la sensibilidad y especificidad según el tamaño de pólipo. Resultados: de las 368 biopsias, 26 (7 %) fueron adenocarcinomas. La mediana del tamaño de los pólipos fue de 4 mm (rango: 1-65 mm), 176 (51 %) tuvieron múltiples pólipos y 85 (23 %) tuvieron litiasis biliar asociada. En el análisis multivariado, se incrementó el riesgo de malignidad por cada milímetro del tamaño del pólipo en 26 % (IC 95 %: 14 %-40 %, valor p < 0,001) y del tamaño de la pared vesicular en 182 % (IC 95 %:46 %-445 %, valor p: 0,002), ajustados por la edad del paciente, la litiasis y el tamaño vesicular. Para un tamaño de 6 mm se tuvo una sensibilidad de 81 % y especificidad del 85 %. Conclusión: se concluye que el tamaño del pólipo y el grosor de la pared vesicular estuvieron asociados con la malignidad de pólipos vesiculares

Educar en derechos humanos : un espacio para el juego

Proyecto Aula Activa: Juegos Cooperativos para la educación para la paz Guía didáctica Colección: Jugando para la paz Material didáctico gratuito Editora Evelyn Cerdas AgüeroEsta guía didáctica titulada “Educar en derechos humanos un espacio para el juego” forma parte del proyecto Aula activa: juegos educativos para la educación para la paz del Instituto de Estudios Latinoamericanos (IDELA). Este proyecto busca fomentar en el estudiantado un proceso de cambio en la aprehensión y vivencia de los derechos humanos de manera que logren reconstruir actitudes, aprender valores y desarrollar habilidades susceptibles de ejercitarse en su interacción diaria, por medio de conductas y actitudes coherentes con el respeto de los derechos humanos y la construcción de una cultura de paz. En este participan estudiantes del curso Espacios Lúdicos para la Educación en Derechos Humanos del Instituto de Estudios Latinoamericanos. Autores: Chacón Campos Stephanie González Camacho Ana Lucía Loría Cubillo Marco Oconitrillo Arce Yuliana Quesada Sancho Fabiola Adrián Barrantes Aguilar Karina Díaz Monge Edith Jiménez Venegas Valeria Moya Pereira Nicolás Salas Ruíz Ericka Sánchez Morera Raúl Hidalgo Perez Stephen Mekbel Ashley Pereira Mónica Cordero Ramírez Jennifer Matarrita Corrales Pamela Brenes Navarro Elvira Mena Brenes Daniela Murillo Orozco Susan Solano Monge Francisco Suarez Pérez Carlos González Leandro Priscilla López Rojas. Carolina Montero Iyara Vargas Lobo Evelyn Figueroa Elizondo Anne Hübner Jacqueline Valencia González Miriam Lizbeth Velázquez Ávila Valerie Calderón Jennifer Campos Jessica Ochoa Monserrath Navarro Ericka Lewis Carolina Rojas Jazmín Arroyo Calderón Melany Arroyo Calderón Mónica Brenes Luna María Sofía Haug Cordero María José Redondo Ríos Ayleen Cascante Zúñiga Marta Azofeifa Matamoros Melanie Guillén Miranda Scarleth Luca Brenes David Valverde Murillo María Castro Arce Natalia Chacón Muñoz Hazel Campos Hernández María José Garita Barahona Raquel González Hernández Laura Ramos Solórzano Gisselle Porras Víquez Pedro ChaverríThis didactic guide entitled "Educating in human rights, a space for play" is part of the project Active Classroom: educational games for peace education of the Institute of Latin American Studies (IDELA). This project seeks to foster in students a process of change in the understanding and experience of human rights so that they can rebuild attitudes, learn values and develop skills that can be exercised in their daily interaction, through behaviors and attitudes consistent with respect for human rights and the construction of a culture of peace. Students from the course Playful Spaces for Human Rights Education of the Institute of Latin American Studies participate in this one. Authors: Chacón Campos Stephanie González Camacho Ana Lucía Loría Cubillo Marco Oconitrillo Arce Yuliana Quesada Sancho Fabiola Adrian Barrantes Aguilar Karina Díaz Monge Edith Jimenez Venegas Valeria Moya Pereira Nicolás Salas Ruíz Ericka Sánchez Morera Raúl Hidalgo Perez Stephen Mekbel Ashley Pereira Mónica Cordero Ramírez Jennifer Matarrita Corrales Pamela Brenes Navarro Elvira Mena Brenes Daniela Murillo Orozco Susan Solano Monge Francisco Suarez Perez Carlos González Leandro Priscilla Lopez Rojas Carolina Montero Iyara Vargas Lobo Evelyn Figueroa Elizondo Anne Hübner Jacqueline Valencia González Miriam Lizbeth Velázquez Ávila Valerie Calderon Jennifer Campos Jessica Ochoa Monserrath Navarro Ericka Lewis Carolina Rojas Jazmin Arroyo Calderon Melany Arroyo Calderon Mónica Brenes Luna María Sofía Haug Cordero María José Redondo Ríos Ayleen Cascante Zúñiga Marta Azofeifa Matamoros Melanie Guillén Miranda Scarleth Luca Brenes David Valverde Murillo María Castro Arce Natalia Chacón Muñoz Hazel Campos Hernández María José Garita Barahona Raquel González Hernández Laura Ramos Solórzano Gisselle Porras Víquez Pedro ChaverríInstituto de Estudios Latinoamericano

Protección internacional de refugiados en el sur de Sudamérica

Por una iniciativa del ACNUR, el Instituto de Políticas Públicas en Derechos Humanos del Mercosur y el Centro de Derechos Humanos de la UNLa, numerosos especialistas de los países del cono sur, presentan sus análisis, propuestas y normativas sobre la protección de los derechos humanos y la protección de las personas refugiadas

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

BACKGROUND: The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. METHODS: We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. RESULTS: At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P &lt; .001). CONCLUSIONS: Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora