Distribución de estadios de OLGA y OLGIM según edad y estado del Helicobacter pylori en un hospital público nivel III en Lima, Perú

Introducción. El sistema operativo de evaluación de gastritis (OLGA) y el enlace operativo sobre la evaluación de metaplasia intestinal gástrica (OLGIM) proporcionan una evaluación del riesgo de desarrollar cáncer gástrico. Objetivo. Evaluar la distribución de estadios del OLGA y OLGIM por edad y presencia del Helicobacter pylori. Material y métodos. Se estudiaron 197 sujetos sometidos a una endoscopía digestiva alta electiva. La presencia del H. pylori y los cambios histológicos se evaluaron utilizando el sistema actualizado de Sídney. Los estadios III y IV del OLGA/OLGIM se consideraron estadios de alto riesgo. Resultados. La tasa del H. pylori fue del 56,85% (112/197). Los casos de OLGA/OLGIM de alto riesgo fueron poco frecuentes: 7/112 (6,5%) casos del OLGA en el grupo del H. pylori positivo y 6/85 (7%) en el del H. pylori negativo; 5 (4,4%) casos del OLGIM en el H. pylori positivo y 6 (7%) en el H. pylori negativo. La proporción de estadios avanzados del OLGA y OLGIM aumentó con la edad (p < 0,001). No se encontró el OLGA de alto riesgo antes de los 40 años independientemente de la presencia del H. pylori, pero aumentó a 16,2%, 10,3%, 17,3% y 40,8% en sujetos en la cuarta, quinta, sexta y séptima década de vida respectivamente. El OLGIM de alto riesgo mostró una tendencia similar: 0% antes de los 40 años y hasta 22,6% en personas de 70 años. Conclusiones. Los casos del OLGA/OLGIM de alto riesgo son infrecuentes antes de los 40 años y aumentan significativamente con la edad. No se evidenció relación con la presencia del H. pylori. Según estos protocolos solamente la quinta parte de los pacientes requeriría estrictamente un control endoscópico.Campus Lima Centr

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Xipe totek. Revista del Departamento de Filosofía y Humanidades, núm. 108

En este número, continúa el análisis de Jorge Manzano sobre las objeciones que varios filósofos hacen a la crítica de Henri Bergson sobre la idea de la nada. Por otra parte, desde un abordaje de la experiencia de la angustia en Hegel, Kierkegaard y Heidegger, Irving Josaphat Montes observa que a la “contemplación de la libertad absoluta le es inherente la contemplación de la nada absoluta”. Incluye una refleción sobre las conferencias sobre la Universidad y la Compañía de Jesús y la primera parte de la investigación que reconstruye el largo camino recorrido por el Ejército Zapatista de Liberación Nacional en el campo de las luchas indígenas desde 1994 hasta las actividades recientes del Congreso Nacional Indígena

Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes: a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial

Background After acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1.4-1.8 mmol/L with ezetimibe or statins reduces cardiovascular events in patients with an acute coronary syndrome and diabetes. However, the efficacy and safety of further reduction in LDL cholesterol with an inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) after acute coronary syndrome is unknown. We aimed to explore this issue in a prespecified analysis of the ODYSSEY OUTCOMES trial of the PCSK9 inhibitor alirocumab, assessing its effects on cardiovascular outcomes by baseline glycaemic status, while also assessing its effects on glycaemic measures including risk of new-onset diabetes

Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab.

Background: Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipoprotein cholesterol is uncertain. Methods: The ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) compared the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin therapy. Primary outcome was major adverse cardiovascular events (MACE; coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, hospitalization for unstable angina). Associations between baseline apoB or apoB at 4 months and MACE were assessed in adjusted Cox proportional hazards and propensity score–matched models. Results: Median follow-up was 2.8 years. In proportional hazards analysis in the placebo group, MACE incidence increased across increasing baseline apoB strata (3.2 [95% CI, 2.9–3.6], 4.0 [95% CI, 3.6–4.5], and 5.5 [95% CI, 5.0–6.1] events per 100 patient-years in strata 35–<50, and ≤35 mg/dL, respectively). Compared with propensity score–matched patients from the placebo group, treatment hazard ratios for alirocumab also decreased monotonically across achieved apoB strata. Achieved apoB was predictive of MACE after adjustment for achieved low-density lipoprotein cholesterol or non–high-density lipoprotein cholesterol but not vice versa. Conclusions: In patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, MACE increased across baseline apoB strata. Alirocumab reduced MACE across all strata of baseline apoB, with larger absolute reductions in patients with higher baseline levels. Lower achieved apoB was associated with lower risk of MACE, even after accounting for achieved low-density lipoprotein cholesterol or non–high-density lipoprotein cholesterol, indicating that apoB provides incremental information. Achievement of apoB levels as low as ≤35 mg/dL may reduce lipoprotein-attributable residual risk after acute coronary syndrome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01663402.gov; Unique identifier: NCT01663402.URL: https://www