Utilidad Diagnóstica de la Gammagrafía Paratiroidea como Método de Identificación Prequirúrgica de Glándulas Paratiroideas Anómalas en Relación a los Hallazgos Intraoperatorios, en Pacientes Sometidos a Paratiroidectomía en el HNCASE-ESSALUD, Arequipa 2013 – 2019

Con este trabajo se desea comparar la exactitud diagnóstica de la gammagrafía paratiroidea como método de localización prequirúrgica de glándulas paratiroideas anómalas en relación a los hallazgos intraoperatorios, en pacientes sometidos a paratiroidectomía, tanto subtotal, como la exéresis única del adenoma paratiroideo. Se realizará una evaluación de las historias clínicas desde el año 2013 al 2019 para tomar los datos necesarios a estudiar: edad, sexo, comorbilidades (patología renal asociada), presencia o no de clínica asociada a hiperparatiroidismo, diagnóstico bioquímico de hiperparatiroidismo (valores séricos de Calcio, Parathormona y fósforo), resultados de la gammagrafía paratiroidea con Tc 99m Sestamibi, y los hallazgos intraoperatorios descritos en el informe operatorio; con lo que se desea conocer la precisión de la gammagrafía paratiroidea preoperatoria en la identificación de las glándulas paratiroideas anómalas. Palabras clave: paratiroidectomía, gammagrafía paratiroidea preoperatoria. ABSTRACT With this paper, I want to compare the parathyroid scintigraphy diagnostic accuracy as a presurgical localization method of abnormal parathyroid glands and the intraoperative findings, in patients who underwent parathyroidectomy, subtotal as well as the ectomy of a single adenoma. An evaluation of clinical records will be carried out from the year 2013 to 2019 to take the necessary data to be studied: age, sex, comorbidities (renal pathology related), presence or not of clinic signs of hyperparathyroidism, biochemichal diagnostic of hyperparathyroidism (seric values of Calcium, parathormone an phosphorus), parathyroid scintigraphy results with Tc 99m Sestamibi, and the intraoperative findings described in the operative report; with wich is expected to know the preoperative parathyroid scintigraphy accuracy in identifying the abnormal parathryroid glands. Key words: Parathyroidectomy, preoperative parathyroid scintigraphy.Trabajo académic

Utilidad Diagnóstica de la Gammagrafía Paratiroidea como Método de Identificación Prequirúrgica de Glándulas Paratiroideas Anómalas en Relación a los Hallazgos Intraoperatorios, en Pacientes Sometidos a Paratiroidectomía en el HNCASE-ESSALUD, Arequipa 2013 – 2019

Trabajo académicoCon este trabajo se desea comparar la exactitud diagnóstica de la gammagrafía paratiroidea como método de localización prequirúrgica de glándulas paratiroideas anómalas en relación a los hallazgos intraoperatorios, en pacientes sometidos a paratiroidectomía, tanto subtotal, como la exéresis única del adenoma paratiroideo. Se realizará una evaluación de las historias clínicas desde el año 2013 al 2019 para tomar los datos necesarios a estudiar: edad, sexo, comorbilidades (patología renal asociada), presencia o no de clínica asociada a hiperparatiroidismo, diagnóstico bioquímico de hiperparatiroidismo (valores séricos de Calcio, Parathormona y fósforo), resultados de la gammagrafía paratiroidea con Tc 99m Sestamibi, y los hallazgos intraoperatorios descritos en el informe operatorio; con lo que se desea conocer la precisión de la gammagrafía paratiroidea preoperatoria en la identificación de las glándulas paratiroideas anómalas. Palabras clave: paratiroidectomía, gammagrafía paratiroidea preoperatoria. ABSTRACT With this paper, I want to compare the parathyroid scintigraphy diagnostic accuracy as a presurgical localization method of abnormal parathyroid glands and the intraoperative findings, in patients who underwent parathyroidectomy, subtotal as well as the ectomy of a single adenoma. An evaluation of clinical records will be carried out from the year 2013 to 2019 to take the necessary data to be studied: age, sex, comorbidities (renal pathology related), presence or not of clinic signs of hyperparathyroidism, biochemichal diagnostic of hyperparathyroidism (seric values of Calcium, parathormone an phosphorus), parathyroid scintigraphy results with Tc 99m Sestamibi, and the intraoperative findings described in the operative report; with wich is expected to know the preoperative parathyroid scintigraphy accuracy in identifying the abnormal parathryroid glands. Key words: Parathyroidectomy, preoperative parathyroid scintigraphy

Environment of Peace: Security in a New Era of Risk

The environmental crisis is increasing risks to security and peace worldwide, notably in countries that are already fragile. Indicators of insecurity such as the number of conflicts, the number of hungry people and military expenditure are rising; so are indicators of environmental decline, climate change, biodiversity, pollution and other areas. In combination, the security and environmental crises are creating compound, cascading, emergent, systemic and existential risks. Without profound changes in approach by institutions of authority, risks will inevitably proliferate quickly.Environment of Peace: Security in a New Era of Risk surveys the evolving risk landscape and documents a number of developments that indicate a pathway to solutions––in international law and policy, in peacekeeping operations and among non-governmental organizations. It finds that two principal avenues need to be developed: (a) combining peacebuilding and environmental restoration, and (b) effectively addressing the underlying environmental issues. It also analyses the potential of existing and emerging pro-environment measures for exacerbating risks to peace and security. The findings demonstrate that only just and peaceful transitions to more sustainable practices can be effective––and show that these transitions also need to be rapid.Environment of Peace: Security in a New Era of Risk offers policy principles and recommendations for navigating this new era of risk. A longer report setting out the evidence base in detail will be published later this year

Environment of Peace: Security in a New Era of Risk

The environmental crisis is increasing risks to security and peace worldwide, notably in countries that are already fragile. Indicators of insecurity such as the number of conflicts, the number of hungry people and military expenditure are rising; so are indicators of environmental decline, climate change, biodiversity, pollution and other areas. In combination, the security and environmental crises are creating compound, cascading, emergent, systemic and existential risks. Without profound changes in approach by institutions of authority, risks will inevitably proliferate quickly.Environment of Peace: Security in a New Era of Risk surveys the evolving risk landscape and documents a number of developments that indicate a pathway to solutions––in international law and policy, in peacekeeping operations and among non-governmental organizations. It finds that two principal avenues need to be developed: (a) combining peacebuilding and environmental restoration, and (b) effectively addressing the underlying environmental issues. It also analyses the potential of existing and emerging pro-environment measures for exacerbating risks to peace and security. The findings demonstrate that only just and peaceful transitions to more sustainable practices can be effective––and show that these transitions also need to be rapid.Environment of Peace: Security in a New Era of Risk offers policy principles and recommendations for navigating this new era of risk. A longer report setting out the evidence base in detail will be published later this year

Quorum sensing network in clinical strains of A. baumannii : AidA is a new quorum quenching enzyme

Acinetobacter baumannii is an important pathogen that causes nosocomial infections generally associated with high mortality and morbidity in Intensive Care Units (ICUs). Currently, little is known about the Quorum Sensing (QS)/Quorum Quenching (QQ) systems of this pathogen. We analyzed these mechanisms in seven clinical isolates of A. baumannii. Microarray analysis of one of these clinical isolates, Ab1 (A. baumannii ST-2-clon-2010), previously cultured in the presence of 3-oxo-C12-HSL (a QS signalling molecule) revealed a putative QQ enzyme (α/β hydrolase gene, AidA). This QQ enzyme was present in all nonmotile clinical isolates (67% of which were isolated from the respiratory tract) cultured in nutrient depleted LB medium. Interestingly, this gene was not located in the genome of the only motile clinical strain growing in this medium (A. baumannii strain Ab421-GEIH-2010 [Ab7], isolated from a blood sample). The AidA protein expressed in E. coli showed QQ activity. Finally, we observed downregulation of the AidA protein (QQ system attenuation) in the presence of HO (ROS stress). In conclusion, most of the A. baumannii clinical strains were not surface motile (84%) and were of respiratory origin (67%). Only the pilT gene was involved in surface motility and related to the QS system. Finally, a new QQ enzyme (α/β hydrolase gene, AidA protein) was detected in these strains