Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography

BACKGROUND: Obesity is a major health problem due to its high prevalence. The relationship between obesity and cardiovascular disease is unclear. Some studies agree that certain conditions associated with obesity, such as physical inactivity or cardiovascular risk factors, are responsible for cardiovascular risk excess among obese people. Carotid intima-media thickness and carotid plaques (CP) have been associated with cardiovascular adverse events in healthy populations, and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients. However, there are no studies correlating subclinical atherosclerosis and adverse events (AE) in obese subjects. AIM: To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography (EE). METHODS: From January 1, 2006 to December 31, 2010, 2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography. Exclusion criteria included previous vascular disease, left ventricular ejection fraction < 50%, positive EE, significant valvular heart disease and inferior to submaximal EE. An AE was defined as all-cause mortality, myocardial infarction and cerebrovascular accident. Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus. RESULTS: Of the 652 patients who fulfilled the inclusion criteria, 226 (34.7%) had body mass indexes ≥ 30 kg/m2, and 76 of them (33.6%) had CP. During a mean follow-up time of 8.2 (2.1) years, 27 AE were found (11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1% (0.6), 95.1% (1.4) and 86.5% (2.7), respectively. In univariate analysis, CP predicted AE [hazard ratio (HR) 2.52, 95% confidence interval (CI) 1.17-5.46; P = 0.019]. In multivariable analysis, the presence of CP remained a predictor of AE (HR 2.26, 95%CI 1.04-4.95, P = 0.041). Other predictors identified were glomerular filtration rate (HR 0.98, 95%CI 0.96-0.99; P = 0.023), peak metabolic equivalents (HR 0.83, 95%CI 0.70-0.99, P = 0.034) and moderate mitral regurgitation (HR 5.02, 95%CI 1.42-17.75, P = 0.012). CONCLUSION: Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE. These patients could benefit from aggressive prevention measures

Comunicación educación un campo de resistencias

El presente libro obedece a la imperiosa necesidad de desplegar la potencia de la Facultad de Ciencias de la Comunicación en la Corporación Universitaria Minuto de Dios -UNIMINUTO, de otras comunidades académicas y de los espacios de movimiento social interesados en deconstruir los discursos de comunicación y educación desde la perspectiva del pensamiento crítico. En este caso entendemos potencia como la fuerza individual y colectiva capaz de rebasar la racionalidad dominante en la sociedad contemporánea, colonizada por la economía como única mirada del mundo; esto es, potencia como ímpetu insospechado por el poder. Por otra parte, el libro tiene como eje articulador el concepto de resistencia, definido este como el acto de recrear la realidad a partir de las posibilidades que ofrece la comunicación, para generar producción de sentido y dinamizar el cambio social. Propone realizar el ejercicio de concebir el mundo desde una perspectiva diferente a la hegemónica y de crear multiplicidades que trabajen unidas, reconociendo sus diferencias pero vinculándose en un “lugar común” del cual, cada una de ellas, regrese a su lugar cotidiano transformada por la acción colectiva del campo de Comunicación - Educación

Comunicación educación un campo de resistencias

El presente libro obedece a la imperiosa necesidad de desplegar la potencia de la Facultad de Ciencias de la Comunicación en la Corporación Universitaria Minuto de Dios -UNIMINUTO, de otras comunidades académicas y de los espacios de movimiento social interesados en deconstruir los discursos de comunicación y educación desde la perspectiva del pensamiento crítico. En este caso entendemos potencia como la fuerza individual y colectiva capaz de rebasar la racionalidad dominante en la sociedad contemporánea, colonizada por la economía como única mirada del mundo; esto es, potencia como ímpetu insospechado por el poder. Por otra parte, el libro tiene como eje articulador el concepto de resistencia, definido este como el acto de recrear la realidad a partir de las posibilidades que ofrece la comunicación, para generar producción de sentido y dinamizar el cambio social. Propone realizar el ejercicio de concebir el mundo desde una perspectiva diferente a la hegemónica y de crear multiplicidades que trabajen unidas, reconociendo sus diferencias pero vinculándose en un “lugar común” del cual, cada una de ellas, regrese a su lugar cotidiano transformada por la acción colectiva del campo de Comunicación - Educación

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Advances in the Nonpharmacological Treatment of Atrial Fibrillation

Atrial fibrillation is a very frequent arrhythmia in our daily clinical practice, either isolated or associated with other heart diseases. It has high relevance as it can act as a decompensating agent of other heart diseases or damage the myocardium itself. Traditionally, the treatment of atrial fibrillation has been based on rhythm and rate control and also the treatment of its complications. To rhythm control, electrical or pharmacological cardioversion has been used, and different groups of bradycardizing drugs have been used for rate control. Anticoagulation is the most relevant treatment to prevent thromboembolic phenomena secondary to atrial fibrillation. However, with the recent development of endovascular procedures, the use of ablation to maintain sinus rhythm in this kind of patients has been increased displacing the use of other treatment strategies. Therefore, in this chapter, we would review the present evidence in the use of ablation techniques as atrial fibrillation treatment

Mecánica De Fluidos - CI170 - 202101

Descripción: Curso de especialidad en la carrera de ingeniería civil es de carácter teórico ¿ práctico, está orientado a lograr que el estudiante de Ingeniería Civil obtenga los suficientes conocimientos en el manejo de las ecuaciones para el diseño de las estructuras hidráulicas y el manejo de los modelos hidráulicos; además de identificar y analizar las propiedades de los fluidos y su comportamiento en el diseño de estructuras hidráulicas. Propósito: El cambio climático nos presenta grandes retos en el futuro sobretodo en el comportamiento del agua, lo que requiere diferentes estructuras hidráulicas para su manejo y protección de desastres. 1El curso de Mecánica De Fluidos es la base de la Línea hidráulica de la Carrera de ingeniería Civil y cobra importancia porque los alumnos conocen las propiedades y ecuaciones que gobiernan el comportamiento del fluido. De este modo, tienen las herramientas necesarias para que los estudiantes puedan comprender en el futuro el estudio del flujo en conductos abiertos y cerrados, tales como: Canales, tuberías, ríos, flujo en medio poroso, flujo sobre barcos y aviones, entre otros. El curso contribuye con el desarrollo de la competencia general de Pensamiento Innovador a nivel de logro 2 y la competencia específica ABET de Experimentación a nivel de logro 2. Cuenta con los prerrequisitos de Dinámica y Ecuaciones Diferenciales y Algebra Lineal

Where Brain, Body and World Collide

The production cross section of electrons from semileptonic decays of beauty hadrons was measured at mid-rapidity (|y| &lt; 0.8) in the transverse momentum range 1 &lt; pt &lt; 8 Gev/c with the ALICE experiment at the CERN LHC in pp collisions at a center of mass energy sqrt{s} = 7 TeV using an integrated luminosity of 2.2 nb^{-1}. Electrons from beauty hadron decays were selected based on the displacement of the decay vertex from the collision vertex. A perturbative QCD calculation agrees with the measurement within uncertainties. The data were extrapolated to the full phase space to determine the total cross section for the production of beauty quark-antiquark pairs

Alpha-protein kinase 3 (ALPK3) truncating variants are a cause of autosomal dominant hypertrophic cardiomyopathy.

The aim of this study was to determine the frequency of heterozygous truncating ALPK3 variants (ALPK3tv) in patients with hypertrophic cardiomyopathy (HCM) and confirm their pathogenicity using burden testing in independent cohorts and family co-segregation studies. In a discovery cohort of 770 index patients with HCM, 12 (1.56%) were heterozygous for ALPK3tv [odds ratio(OR) 16.11, 95% confidence interval (CI) 7.94-30.02, P = 8.05e-11] compared to the Genome Aggregation Database (gnomAD) population. In a validation cohort of 2047 HCM probands, 32 (1.56%) carried heterozygous ALPK3tv (OR 16.17, 95% CI 10.31-24.87, P  Heterozygous ALPK3tv are pathogenic and segregate with a characteristic HCM phenotype