O SISTEMA DE HIPERMÍDIAS ADAPTATIVAS E AS FERRAMENTAS DA WEB 2.0: CONSTRUINDO UMA NOVA DIREÇÃO PARA A EDUCAÇÃO A DISTÂNCIA

A Educação a Distância (EaD) encontra-se em um processo contínuo de evolução, principalmente no que diz respeito à tecnologia e aos meios de interação disponíveis. Entretanto, mesmo com todo o avanço obtido até então, grande parte dos Ambientes Virtuais de Aprendizagem (AVAs) existentes são utilizados apenas como repositório de textos e materiais pelos alunos. Diante disto, faz-se necessário, para maximizar os ganhos no processo de ensino e aprendizagem, adequar estas mídias a um funcionamento mais interativo, que possibilite maiores trocas de conhecimento entre os estudantes e os atores do processo educativo. Isto torna-se possível através da criação de AVAs pautados na abordagem dos Sistemas de Hipermídias Adaptativas (SHAs). Neste cenário, o presente trabalho objetiva discutir de que forma os SHAs e as novas ferramentas de aprendizagem dispostas pela web 2.0 podem contribuir para a troca de conhecimentos entre os alunos e os atores do processo educativo. Dessa maneira, foi possível evidenciar que os SHAs têm a capacidade de projetar um espaço de aprendizagem personalizado, de maneira que se promova a adaptação dos conteúdos e recursos de hipermídia de acordo com a necessidade de cada aluno, além de oferecer um ambiente mais interativo de troca e compartilhamento de informações

The implications of diabetic foot health-related with quality of life: A retrospective case control investigation

[Abstract] The diabetes people show a significant presence of foot health problems are usually all over the world, causing in big economic effects for these persons, their families and world population OBJECTIVE: The purpose of this research is to evaluate and relate the impact of foot health associated with the quality of life (QoL) in a group of people with and without diabetes MATERIAL AND METHODS: A total of 150 persons of a mean age of 71.45 ± 11.93 years came to a foot and ankle specialist outpatient center. Self-reported data were medical records where persons'with and without diabetes was evaluated. All findings obtained was compared with scores quality of life using the tool Foot Health Status Questionnaire, spanish version RESULTS: The diabetes group revealed a reduction of QoL linked to overall health and to foot health in particular. Differences among both groups were analyzed by means of a independent Student's t-test samples, displaying a p-value lower than 0.05 statistically significant for the domains of foot pain, foot function footwear and social capacity CONCLUSIONS: Diabetes people recorded a negative influence on the QoL related with foot health, that seems to be linked with the presence of chronic disease in diabetes people

Application of fibrin sealant in patients operated on for differentiated thyroid cancer. What do we improve?

Antecedentes En los últimos años han aparecido diferentes publicaciones que demuestran que los nuevos sellantes adhesivos, como Tissucol®, que son aplicados en el espacio tiroideo reducen las complicaciones locales tras tiroidectomías complejas. Objetivos Mostrar la eficacia del adhesivo de fibrina Tissucol® en la reducción de la estancia hospitalaria postoperatoria de los pacientes intervenidos de carcinoma diferenciado de tiroides en quienes se realizó tiroidectomía total con vaciamiento ganglionar central y unilateral. Material y métodos Realizamos un estudio prospectivo y aleatorizado, durante el periodo comprendido entre mayo de 2009 y octubre de 2013, en pacientes con carcinoma diferenciado de tiroides con metástasis ganglionares cervicales, para la realización de cirugía programada. Se formaron 2 grupos: en los que se utilizó Tissucol® (grupo caso) y en los que no (grupo control). Los pacientes fueron operados por cirujanos especialmente dedicados a patología quirúrgica endocrina, utilizando la misma técnica en todos ellos. Resultados Realizamos 60 tiroidectomías totales con vaciamiento ganglionar: 30 en el grupo caso, que se compararon con 30 del grupo control. No observamos diferencias significativas en la mayoría de las variables estudiadas; no obstante, el grupo caso presentó una menor estancia hospitalaria respecto al grupo control, con una diferencia estadísticamente significativa (p<0.05). Conclusión La aplicación del Tissucol® ha permitido reducir la estancia hospitalaria de los pacientes operados de tiroidectomía total con vaciamiento cervical, lo que representa para el hospital una reducción de costos, sin que ello influya en la aparición de complicaciones relacionadas con la intervención

B-cell regeneration profile and minimal residual disease status in bone marrow of treated multiple myeloma patients

© 2021 by the authors.B-cell regeneration during therapy has been considered as a strong prognostic factor in multiple myeloma (MM). However, the effects of therapy and hemodilution in bone marrow (BM) B-cell recovery have not been systematically evaluated during follow-up. MM (n = 177) and adult (≥50y) healthy donor (HD; n = 14) BM samples were studied by next-generation flow (NGF) to simultaneously assess measurable residual disease (MRD) and residual normal B-cell populations. BM hemodilution was detected in 41 out of 177 (23%) patient samples, leading to lower total B-cell, B-cell precursor (BCP) and normal plasma cell (nPC) counts. Among MM BM, decreased percentages (vs. HD) of BCP, transitional/naïve B-cell (TBC/NBC) and nPC populations were observed at diagnosis. BM BCP increased after induction therapy, whereas TBC/NBC counts remained abnormally low. At day+100 postautologous stem cell transplantation, a greater increase in BCP with recovered TBC/NBC cell numbers but persistently low memory B-cell and nPC counts were found. At the end of therapy, complete response (CR) BM samples showed higher CD19− nPC counts vs. non-CR specimens. MRD positivity was associated with higher BCP and nPC percentages. Hemodilution showed a negative impact on BM B-cell distribution. Different BM B-cell regeneration profiles are present in MM at diagnosis and after therapy with no significant association with patient outcome.This work has been supported by the International Myeloma Foundation-Black Swan Research Initiative, the EuroFlow Consortium (grant LSHB-CT-2006-018708); Centro de Investigación Biomédica en Red de Cáncer (CIBER-ONC; Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain and FONDOS FEDER), numbers: CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480; grant from Bilateral Cooperation Program between Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-CAPES (Brasília/Brazil) and Dirección General de Políticas Universitárias (DGPU)-Ministério de Educación, Cultura y Deportes (Madrid/Spain) number DGPU 311/15; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) numbers: E26/110.105/2014 and E26/102.191/2013; grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico of Brazil (CNPQ), number: 400194/2014-7. R.M.d.P. was supported by a grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/DGPU), number: 000281/2016-06 and CAPES/PROEX 641/2018, Brazil; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro of Brazil (FAPERJ) number: E01/200/537/2018

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America : the ESTAMPA screening study protocol

Q1Q1Introduction Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. Methods and analysis Women aged 30–64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. Ethics and dissemination The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. Trial registration number NCT01881659Revista Internacional - Indexad

Una perspectiva multidisciplinaria

Derivado de la necesidad de fomentar la investigación multidisciplinaria, la Facultad de Economía de la Universidad Autónoma del Estado de México llevó a cabo los días 8 y 9 de septiembre de 2016, el VIII Coloquio de Investigación intitulado “Desarrollo económico, regional y sustentable”. En este magno evento se presentaron 36 ponencias agrupadas en cinco mesas de trabajo: sectores productivos, crecimiento económico y mercado de trabajo; tecnología, innovación y organizaciones; desigualdad regional, pobreza y migración; economía financiera e internacional; y medio ambiente y sociedad. Del material expuesto en el VIII Coloquio, se eligieron 16 investigaciones, mismas que integran este libro. Los estudios presentados en cada uno de los subsiguientes capítulos fueron seleccionados de acuerdo a un proceso de rigurosidad científica, siendo sometidos a dictamen por pares ciegos a partir de la integración de un Comité Académico de expertos. Lo anterior con la finalidad de proporcionar al lector un material de investigación de calidad y solidez científica respecto a temas de trascendencia vinculados con los sectores productivos, la innovación, las organizaciones, la responsabilidad social, la desigualdad, la educación y el medioambiente.Consecuencia de la apertura de los mercados y los preceptos competitivos dictados por la globalización, se manifiesta la necesidad de vincular los diversos saberes provenientes de las ciencias naturales y sociales, con el fin de complementar el conocimiento y generar nuevas formas de visualizar el entorno. A raíz de ello, la investigación multidisciplinaria asume un papel cada vez más importante en los círculos académicos, empresariales y gubernamentales. En este marco, entra en desuso la visualización del individuo como un sujeto atomístico desvinculado del medio ambiente que le rodea. El objetivo de este libro es otorgar una visión multidisciplinaria al estudio de temas económicos incorporando visiones teóricas y empíricas procedentes de las ciencias sociales y naturales. La obra está compuesta por 16 capítulos agrupados en cuatro secciones. La primera parte, conglomera cinco capítulos en torno a los tópicos sectores productivos y crecimiento económico.Facultad de Economía. Universidad Autónoma del Estado de Méxic

B-cell regeneration profile and minimal residual disease status in bone marrow of treated multiple myeloma patients

Simple Summary B-cell regeneration during therapy has been associated with the outcome of multiple myeloma (MM) patients. However, the effects of therapy and hemodilution in bone marrow (BM) B-cell recovery have not been systematically evaluated. Here, we show that hemodilution is present in a significant fraction of MM BM samples, leading to lower total B-cell, B-cell precursor (BCP), and normal plasma cell (nPC) counts. Among MM BM samples, decreased percentages (vs. healthy donors) of BCP, transitional/naive B-cell (TBC/NBC) and nPC populations were observed at diagnosis. BM BCP, but not TBC/NBC, increased after induction therapy. At day+100 post-autolo-gous stem cell transplantation, a greater increase in BCP with recovered TBC/NBC numbers but persistently low memory B-cell and nPC counts were found. At the end of therapy, complete response (CR) BM samples showed higher CD19(-) nPC counts vs. non-CR specimens with no clear association between BM B-cell regeneration profiles and patient outcomes. B-cell regeneration during therapy has been considered as a strong prognostic factor in multiple myeloma (MM). However, the effects of therapy and hemodilution in bone marrow (BM) B-cell recovery have not been systematically evaluated during follow-up. MM (n = 177) and adult (>= 50y) healthy donor (HD; n = 14) BM samples were studied by next-generation flow (NGF) to simultaneously assess measurable residual disease (MRD) and residual normal B-cell populations. BM hemodilution was detected in 41 out of 177 (23%) patient samples, leading to lower total B-cell, B-cell precursor (BCP) and normal plasma cell (nPC) counts. Among MM BM, decreased percentages (vs. HD) of BCP, transitional/naive B-cell (TBC/NBC) and nPC populations were observed at diagnosis. BM BCP increased after induction therapy, whereas TBC/NBC counts remained abnormally low. At day+100 postautologous stem cell transplantation, a greater increase in BCP with recovered TBC/NBC cell numbers but persistently low memory B-cell and nPC counts were found. At the end of therapy, complete response (CR) BM samples showed higher CD19(-) nPC counts vs. non-CR specimens. MRD positivity was associated with higher BCP and nPC percentages. Hemodilution showed a negative impact on BM B-cell distribution. Different BM B-cell regeneration profiles are present in MM at diagnosis and after therapy with no significant association with patient outcome

Long-Term Real-World Effectiveness and Safety of Ustekinumab in Crohn’s Disease Patients: The SUSTAIN Study

Background Large real-world-evidence studies are required to confirm the durability of response, effectiveness, and safety of ustekinumab in Crohn’s disease (CD) patients in real-world clinical practice. Methods A retrospective, multicentre study was conducted in Spain in patients with active CD who had received ≥1 intravenous dose of ustekinumab for ≥6 months. Primary outcome was ustekinumab retention rate; secondary outcomes were to identify predictive factors for drug retention, short-term remission (week 16), loss of response and predictive factors for short-term efficacy and loss of response, and ustekinumab safety. Results A total of 463 patients were included. Mean baseline Harvey-Bradshaw Index was 8.4. A total of 447 (96.5%) patients had received prior biologic therapy, 141 (30.5%) of whom had received ≥3 agents. In addition, 35.2% received concomitant immunosuppressants, and 47.1% had ≥1 abdominal surgery. At week 16, 56% had remission, 70% had response, and 26.1% required dose escalation or intensification; of these, 24.8% did not subsequently reduce dose. After a median follow-up of 15 months, 356 (77%) patients continued treatment. The incidence rate of ustekinumab discontinuation was 18% per patient-year of follow-up. Previous intestinal surgery and concomitant steroid treatment were associated with higher risk of ustekinumab discontinuation, while a maintenance schedule every 12 weeks had a lower risk; neither concomitant immunosuppressants nor the number of previous biologics were associated with ustekinumab discontinuation risk. Fifty adverse events were reported in 39 (8.4%) patients; 4 of them were severe (2 infections, 1 malignancy, and 1 fever). Conclusions Ustekinumab is effective and safe as short- and long-term treatment in a refractory cohort of CD patients in real-world clinical practice

Using Interpretable Machine Learning to Identify Baseline Predictive Factors of Remission and Drug Durability in Crohn’s Disease Patients on Ustekinumab

Ustekinumab has shown efficacy in Crohn's Disease (CD) patients. To identify patient profiles of those who benefit the most from this treatment would help to position this drug in the therapeutic paradigm of CD and generate hypotheses for future trials. The objective of this analysis was to determine whether baseline patient characteristics are predictive of remission and the drug durability of ustekinumab, and whether its positioning with respect to prior use of biologics has a significant effect after correcting for disease severity and phenotype at baseline using interpretable machine learning. Patients' data from SUSTAIN, a retrospective multicenter single-arm cohort study, were used. Disease phenotype, baseline laboratory data, and prior treatment characteristics were documented. Clinical remission was defined as the Harvey Bradshaw Index <= 4 and was tracked longitudinally. Drug durability was defined as the time until a patient discontinued treatment. A total of 439 participants from 60 centers were included and a total of 20 baseline covariates considered. Less exposure to previous biologics had a positive effect on remission, even after controlling for baseline disease severity using a non-linear, additive, multivariable model. Additionally, age, body mass index, and fecal calprotectin at baseline were found to be statistically significant as independent negative risk factors for both remission and drug survival, with further risk factors identified for remission

Guía Mexicana para el Diagnóstico y el Tratamiento de la Urticaria

La urticaria es una enfermedad que padece una quinta parte de la población en algún momento de su vida. Las guías inter- nacionales recientes han propuesto unos cambios de fondo en su diagnóstico y tratamiento, por lo que había la necesidad de crear una guía nacional y multidisciplinaria, con base amplia en los gremios de especialistas y médicos de primer contacto en México. ABSTRACT Urticaria is a disease that a fifth of the population shall suffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups –both specialists and primary health care workers–, necessary in Mexico