La ganadería ante escenarios complejos.

La calidad de las contribuciones, producto de la pluma de especialistas en los temas tratados, el presente es un libro que esperamos, basándonos en la importancia de los temas tratados, sea de utilidad y abone a la reflexión de los estudiosos de la ganadería mexicana y, por supuesto, en beneficio de las familias ganaderas y de los consumidores de sus productos.este libro refleja en muchos sentidos la situación de la ganadería mexicana, a la que se le están demandando mayor producción y productividad, que los procesos productivos tengan la menor huella ecológicposible, que los alimentos sean inocuos, que se abatan costos de producción y, cada vez aumentan las presiones de diversos grupos para, que se incluyan los protocolos de bienestar animal, solamente por citar algunos de los retos que tiene. Algunas de estas demandas son complementarias, otras se contraponen, lo que hace valiosos a los estudios que desde las ciencias sociales se realizan y, desde diversas ópticas, se hagan propuestas de política pública balanceadas que consideren lo mejor de cada enfoque, pero sin desechar por completo los antagónicos.Universidad Autónoma Chaping

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Mortalidad por peritonitis secundaria en el Hospital General Docente ¨Dr. Agostinho Neto¨ de Guantánamo. Factores determinantes

Introduction: the factors that determine the prognosis of the patient with peritonitis are not always known in the intensive care unit. Objective: to determine the determinants of mortality due to secondary peritonitis in this unit at the Hospital "Dr. Agostinho Neto during the years 2014 - 2016. Method: a prospective, longitudinal, and analytical study was conducted of all the patients admitted to the ICU for secondary peritonitis in the years 2014 - 2016 (n = 70), which were grouped according to graduates alive or deceased. The variables most related to the probability of the patient's death and the most frequent in the deceased were specified. The absolute risk (AR) of each variable was calculated. Results: the most frequent factors were: fever (n = 53), systemic inflammatory response syndrome (n = 51) and left leukocytosis / deviation (n = 51); the factors most likely to determine death were multiorgan failure (RA 17.8), fecaloid peritoneal fluid (RA 7.8) and septic shock (RA 7.3). Conclusion: The factors that determine mortality due to secondary peritonitis: diffuse peritonitis, presence of multi-organ failure, hypoxemia ≤ 85 mmHg / or Sp02 ≤ 90%, age ≥ 60 years, intra-abdominal pressure after surgery ≥ 21 cm H2O (15 mmHg) , symptoms ≥ 24 h before surgery, septic shock, fecaloid peritoneal fluid, colonic origin of peritonitis.Introducción: en la unidad de cuidados intensivos no siempre se conocen los factores que determinan el pronóstico del paciente con peritonitis. Objetivo: precisar los factores determinantes de la mortalidad por peritonitis secundaria en esta unidad en el Hospital “Dr. Agostinho Netoˮ durante los años 2014 – 2016. Método: se realizó un estudio analítico prospectivo, y longitudinal, de todos los pacientes ingresadosen la citada UCI por peritonitis secundaria en los años 2014 – 2016 (n = 70), los que se agruparon según fueran egresados vivos o fallecidos. Se precisaron las variables más relacionadas con la probabilidad de que el paciente falleciera y las más frecuentes en los fallecidos. Se calculó el riesgo absoluto (RA) de cada variable. Resultados: los factores más frecuentes fueron: fiebre (n=53), Síndrome respuesta inflamatoria sistémica (n=51) y la leucocitosis/desviación izquierda (n=51); los factores con mayor probabilidad de determinar la muerte fueron: fallo multiorgánico (RA 17.8), fluido peritoneal fecaloideo (RA 7.8) y el shock séptico (RA 7.3). Conclusión: Los factores que determinan la mortalidad por peritonitis secundaria son: la peritonitis difusa, presencia de fallo multiorgánico, hipoxemia ≤ 85 mmHg y/o Sp02 ≤ 90%, edad ≥ 60 años, presión intrabdominal poscirugía ≥ 21 cm H2O (15 mmHg), síntomas ≥ 24 h antes de cirugía, shock séptico, fluido peritoneal fecaloideo, origen colónico de la peritonitis

Calidad de la atención médica al infarto del miocardio. Guantánamo, 2001

Se reflexiona acerca de la calidad del proceso atencional al paciente con infarto del miocardio en el municipio de Guantánamo (Policlínica Docente Comunitaria “Omar Ranedo Pubillones”, Hospital General Docente “Dr. Agostinho Neto”) durante el primer semestre del 2001. Se precisan criterios de estructura, proceso y resultados de la atención evaluada. Se establece que la calidad de  la atención objeto de estudio durante el 2001 en las mencionadas instituciones no es satisfactoria. Las deficiencias se relacionan con imprecisiones en los componentes de estructura y proceso, las que impactan significativamente en los resultados de la calidad. Se identifican insuficiencias en la organización y control de la actividad y en  la competencia profesional del médico general integral respecto a los aspectos relacionados con la atención al paciente isquémico. Se declaran las variables influyentes en la calidad de esta  atención, entra las que, fundamentalmente, se destacan las características del profesional. Se establecen otras consideraciones en relación con el problema científico que se aborda

Consideraciones sobre el proceso de atención médica al infarto del miocardio en el nivel primario de salud. Guantánamo, 2001

Se precisan los resultados del proceso atencional al paciente con infarto del miocardio en el municipio de Guantánamo (Policlínica Docente Comunitaria “Omar Ranedo Pubillones”) durante el primer semestre de 2001. Las unidades de análisis se seleccionan mediante un muestreo aleatorio, sistemático y por estratos (n=132 pacientes) e incluyen el total de médicos generales integrales y cardiólogos que laboran en el servicio (n=44). La técnica de recolección de la información se fundamenta en entrevistas a pacientes y profesionales, auditorías a historias clínicas de pacientes, evaluación de la competencia profesional, criterios de expertos, entre otras. La calidad de la atención no es satisfactoria; las deficiencias se relacionan con imprecisiones en los componentes de estructura y proceso, las que impactan significativamente en los resultados de la calidad. Se plantean otras conclusiones y consideraciones con relación al problema científico que se aborda

Predictores de atonía uterina

A retrospective case-control study in order to identify obstetric variables epidemiological, clinical and associated with the likelihood of obstetric hysterectomy for uterine atony postpartum period immediately at the General Teaching "Dr. Agostinho Neto" Hospital Guantanamo between 2013 was conducted and 2014. 54 cases and 108 controls were enrolled. Univariety description was applied and multivariate logistic regression and diagnostic validity and safety is said to predict the event. Personal history of diabetes mellitus and previous postpartum bleeding had a significantly higher incidence in patients who have undergone hysterectomy for uterine atony. Diabetes mellitus, polyhydramnios, the dysfunctional labor, preeclampsia, retroplacental hematoma, chorioamnionitis and volume of bleeding during childbirth than 1000 ml represent an increased risk to suffer varying uterine atony and emergency peripartum hysterectomy (HEPP). Diabetes mellitus, chorioamnionitis and volume of bleeding during childbirth than 1000 ml HEPP were predictors of uterine atony with acceptable diagnostic validity and safety.Se realizó un estudio retrospectivo caso control con el propósito de identificar variables epidemiológicas, clínicas y obstétricas asociadas a la probabilidad de sufrir una histerectomía obstétrica por atonía uterina en el periodo postparto inmediato en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo entre 2013 y 2014. Se enrolaron 54 casos y 108 controles. Se aplicó descripción univariada y multivariada por regresión logística y se precisó la validez y seguridad diagnóstica para predecir el evento. Los antecedentes personales de diabetes mellitus y de sangramiento postparto previo tuvieron una incidencia notablemente mayor en las pacientes histerectomizadas por atonía uterina. La diabetes mellitus, el polihidramnios, el trabajo de parto disfuncional, preeclampsia, hematoma retroplacentario, corioamnionitis y el volumen de sangramiento durante el parto superior a 1000 ml representan un riesgo incrementado variable para sufrir atonía uterina e histerectomía de emergencia periparto (HEPP). La diabetes mellitus, la corioamnionitis y el volumen de sangramiento durante el parto superior a 1000 ml resultaron predictores de HEPP por atonía uterina con validez y seguridad diagnósticas aceptables

Predictores de atonía uterina

A retrospective case-control study in order to identify obstetric variables epidemiological, clinical and associated with the likelihood of obstetric hysterectomy for uterine atony postpartum period immediately at the General Teaching "Dr. Agostinho Neto" Hospital Guantanamo between 2013 was conducted and 2014. 54 cases and 108 controls were enrolled. Univariety description was applied and multivariate logistic regression and diagnostic validity and safety is said to predict the event. Personal history of diabetes mellitus and previous postpartum bleeding had a significantly higher incidence in patients who have undergone hysterectomy for uterine atony. Diabetes mellitus, polyhydramnios, the dysfunctional labor, preeclampsia, retroplacental hematoma, chorioamnionitis and volume of bleeding during childbirth than 1000 ml represent an increased risk to suffer varying uterine atony and emergency peripartum hysterectomy (HEPP). Diabetes mellitus, chorioamnionitis and volume of bleeding during childbirth than 1000 ml HEPP were predictors of uterine atony with acceptable diagnostic validity and safety.Se realizó un estudio retrospectivo caso control con el propósito de identificar variables epidemiológicas, clínicas y obstétricas asociadas a la probabilidad de sufrir una histerectomía obstétrica por atonía uterina en el periodo postparto inmediato en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo entre 2013 y 2014. Se enrolaron 54 casos y 108 controles. Se aplicó descripción univariada y multivariada por regresión logística y se precisó la validez y seguridad diagnóstica para predecir el evento. Los antecedentes personales de diabetes mellitus y de sangramiento postparto previo tuvieron una incidencia notablemente mayor en las pacientes histerectomizadas por atonía uterina. La diabetes mellitus, el polihidramnios, el trabajo de parto disfuncional, preeclampsia, hematoma retroplacentario, corioamnionitis y el volumen de sangramiento durante el parto superior a 1000 ml representan un riesgo incrementado variable para sufrir atonía uterina e histerectomía de emergencia periparto (HEPP). La diabetes mellitus, la corioamnionitis y el volumen de sangramiento durante el parto superior a 1000 ml resultaron predictores de HEPP por atonía uterina con validez y seguridad diagnósticas aceptables

Una mirada crítica a las consideraciones preanalíticas de gases sanguíneos

Introduction: one of the least discussed issues and that little is understood about it, is patient safety. It has recently become a ubiquitous and controversial issue, especially for some medical organizations.Objective: to systematize theoretical references related to the particularities of the process of sample taking and analysis of blood gases.Method: the main elements that gravitate in this phase are analyzed for the blood gas analysis, as well as the influence that these can have on the quality of the results and the clinical and laboratory practices to optimize it.Development: the preanalytical phase is the one that precedes the performance of a trial or laboratory study and includes the preparation of the patient, the preparation of the analysis request and the care for obtaining the samples. The attention that the attending physician and laboratory staff give to this phase is directly proportional to the quality of the results that will be obtained.Conclusions: the analysis of pH and blood gases should always be considered as an emergency study. The sample should not remain for more than ten minutes at room temperature and when the analysis takes more than 15 minutes, the sample should be stored in ice water.Introdução: uma das questões menos discutidas e que pouco é entendido sobre isso, é a segurança do paciente. Tornou-se recentemente uma questão onipresente e controversa, especialmente para algumas organizações médicas.Objetivo: sistematizar referenciais teóricos relacionados às particularidades do processo de coleta de amostras e análise de gases sangüíneos.Método: os principais elementos que gravitam nesta fase são analisados para a gasometria, assim como a influência que estes podem ter na qualidade dos resultados e nas práticas clínicas e laboratoriais para otimizá-la.Desenvolvimento: a fase pré-analítica é aquela que precede a realização de uma pesquisa ou estudo laboratorial e inclui a preparação do paciente, a elaboração do pedido de análise e o cuidado para obtenção das amostras. A atenção que o médico assistente e o pessoal de laboratório dão a essa fase é diretamente proporcional à qualidade dos resultados que serão obtidos.Conclusões: a análise do pH e dos gases sanguíneos deve ser sempre considerada como um estudo de emergência. A amostra não deve permanecer por mais de dez minutos em temperatura ambiente e quando a análise demora mais de 15 minutos, a amostra deve ser armazenada em água gelada.Introducción: uno de los asuntos menos discutidos y que poco se entiende del mismo, es la seguridad del paciente. Hace poco tiempo se ha convertido en un tema ubicuo y polémico, especialmente para algunas organizaciones médicas.Objetivo: sistematizar referentes teóricos relacionados con las particularidades del proceso de toma de muestray análisis de los gases en sangre.Método: se revisan los principales elementos que gravitan en esta fase para el análisis de los gases sanguíneos, así como la influencia que estos pueden tener en la calidad de los resultados y las prácticas clínicas y de laboratorio para optimizarla.Desarrollo: la fase preanalítica es aquella que antecede a la realización de un ensayo o estudio de laboratorio e incluye la preparación del paciente, la confección de la solicitud de análisis y los cuidados para la obtención de las muestras. La atención que el médico de asistencia y el personal del laboratorio concedan a esta fase es directamente proporcional a la calidad de los resultados que se obtendrán.Conclusiones: el análisis de pH y gases sanguíneos deben ser considerados siempre como un estudio de urgencia. La muestra no debe permanecer por más de diez minutos a temperatura ambiente y cuando el análisis demore más de 15 minutos, la muestra deberá ser conservada en agua con hielo