Endocarditis crónica sobre válvula protésica por propionibacterium acnes: de sus manifestaciones clínicas a sus características fisiopatológicas

Tesis doctoral leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 13 de Octubre 201

Percepciones de un grupo de mujeres de la ciudad de Bogotá sobre pornografía

Trabajo de InvestigaciónPara analizar la percepción que tienen algunas mujeres en Bogotá sobre la pornografía se consideraron variables como edad y estrato socio-económico. Inicialmente se efectuó revisión teórica, para luego plantear algunas categorías orientadoras y la aplicación de entrevistas a profundidad, logrando comprender información para el análisis de resultados donde se encontró entre otras cosas el estado civil como otra variable importante.INTRODUCCIÓN 1. ANTECEDENTES TEÓRICOS Y EMPÍRICOS 2. OBJETIVOS 3. MÉTODO 4. RESULTADOS 5. DISCUSIÓN REFERENCIAS APENDICESPregradoPsicólog

Diagnóstico de los emprendedores industriales apoyados por entidades de fortalecimiento empresarial en la Provincia de Tundama

This article describes the diagnosis made to those industrial en- trepreneurs who received support from business strengthening entities in the province of Tundama, located in the department of Boyacá. The development of this project was carried out in three phases: the first consisted of the identification of the entrepreneu- rs of the province under study, finding a database of 107 entrepre- neurs but in reality 84 entrepreneurs were part of the development of this project; The second phase consisted of carrying out a busi- ness diagnosis, using the BUNT methodology (Business Development Using New Technology -NTNF- Norway) - (Suesta, 2008), which consists of knowing the current state of the companies in key areas of the organization as: strategic, organizational, production, technology, marketing, financial and environment. Finally, in the third phase, follow-up and control strategies aimed at entrepreneurs with the purpose of achieving business development are proposed, based on the characterization carried.  El presente artículo describe el diagnóstico realizado a aquellos empren- dedores industriales que recibieron apoyo por parte de las entidades de fortalecimiento empresarial en la provincia de Tundama, ubicada en el departamento de Boyacá. El desarrollo del presente proyecto se realizó en tres fases: la primera, consistió en la identificación de los emprendedores de la provincia objeto de estudio, encontrando una base de datos de 107 emprendedores pero que en realidad 84 emprendedores formaron parte del desarrollo de este proyecto; la segunda fase consistió en la realización de un diagnóstico empresarial, utilizando la metodología BUNT(Business development Using New Technology -NTNF- Noruega) - (Suesta, 2008), la cual consiste en cono- cer el estado actual de las empresas en áreas claves de la organización como: estratégica, organizacional, producción, tecnología, mercadeo, financiera y entorno. Finalmente, en la tercera fase se proponen estrategias de seguimiento y control dirigida a los emprendedores con el propósito de lograr el desarrollo empresarial, lo anterior, basado en la caracterización realizada para tal fin

Quantification of vitamin d: from research to clinical practice

Las formas biológicamente activas de la vitamina D se han convertido en elementos de gran relevancia en la práctica clínica y la investigación, por lo tanto, su análisis se ha incrementado en años recientes. La vitamina D tiene un papel esencial en la regulación del metabolismo del calcio y fósforo; adicionalmente, esta vitamina es considerada un posible factor preventivo para diversas enfermedades crónicas como la diabetes mellitus tipo 2, algunos tipos de cáncer, cardiovasculares, autoinmunes, enfermedad pulmonar obstructiva crónica y la pre-eclampsia. Debido al posible papel en estas enfermedades y a los pocos estudios comparativos que se han realizado entre éstas y los niveles de vitamina D, los investigadores y clínicos están interesados en usar técnicas confiables y específicas que permitan determinar las concentraciones de vitamina D en el plasma. Sin embargo, no se ha establecido cuál es el mejor biomarcador que refleja la suficiencia de vitamina D y su función, ni tampoco cuál es la mejor técnica para su adecuada cuantificación. El objetivo de esta revisión es describir brevemente el metabolismo de la vitamina D y los retos que existen para su adecuada cuantificación con fines de investigación traslacional.The analysis of the biologically active forms of vitamin D has increased in the last decades, becoming a relevant tool in the clinical practice and investigation. Vitamin D plays an essential role in regulating the metabolism of calcium and phosphorous. In addition, this vitamin is considered a potential preventive factor in a wide range of chronical diseases such as cardiovascular and autoimmune diseases, different kinds of cancer, type 2 diabetes, chronical obstructive pulmonary disease, and pre-eclampsia. Due to the possible role that vitamin D has in these diseases and the few existing comparative studies which have been conducted between these diseases and the vitamin D levels, clinicians and researchers are interested in using reliable and specific techniques to quantify the concentrations of vitamin D in plasma. Nevertheless, in the scientific literature reviewed have not been established which is the best biomarker that indicates the sufficiency and function of vitamin D nor which is the most appropriate technique for adequate quantification. The goal of this review is to briefly describe the metabolism of vitamin D and the current challenges for its proper quantification and use in translational research

Role of asymptomatic bacteriuria on early periprosthetic joint infection after hip hemiarthroplasty. BARIFER randomized clinical trial

[Purpose] To evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture.[Methods] Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. Primary outcome: early-PJI after HHA.[Results] Five hundred ninety-four patients enrolled (mean age 84.3); 152(25%) with ASB (77 treated with fosfomycin-trometamol/75 controls) and 442(75%) without. Despite the study closed without the intended sample size, ASB was not predictive of early-PJI (OR: 1.06 [95%CI: 0.33–3.38]), and its treatment did not modify early-PJI incidence (OR: 1.03 [95%CI: 0.15–7.10]). [Conclusions] Neither preoperative ASB nor its treatment appears to be risk factors of early-PJI after HHA. ClinicalTrials.gov Identifier: Eudra CT 2016-001108-47.This work was supported by the Spanish Clinical Research Network (SCReN), co-finaced by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, through the project PI15/02161 and by the Plan Nacional de I+D+i 2013-016 and ISCIIII, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003)-co-financed by European Development Regional Fund “A way to achieve Europe,” Operative program Intelligent Growth 2014-2020.Peer reviewe

Quality control of human biological material for use in research

El material biológico humano proporciona información valiosa sobre niveles de metabolitos asociados con el desarrollo de cierto tipo de enfermedades, por tanto es una herramienta importante para monitorear respuestas a tratamientos e incluso identiicar nuevos mecanismos de intervención. Los procedimientos a los que se expone el material biológico desde su obtención hasta su fase analítica, son denominados variables pre-analíticas, las cuales, pueden tener un efecto directo en la detección de metabolitos y por consiguiente sobre resultados de proyectos de investigación, en particular en ausencia de procesos estandarizados que garanticen el control de calidad del material biológico. La presente nota técnica tiene como inalidad resaltar algunos puntos críticos que deben ser parametrizados en las bio-colecciones con ines de investigación, para garantizar altos estándares de calidad y reproducibilidad en estudios observacionales, en donde se minimice cualquier tipo de sesgo ocasionado por las variables pre-analíticas. Así mismo, identiicar la importancia en el desarrollo de biobancos con ines de investigación en nuestro país para contar con material biológico humano de alta calidad.Human biological material provides valuable information about levels of metabolites associated with the development of certain diseases, becoming an important tool for monitoring responses to treatment or even identifying new intervention mechanisms. The procedures to what the biological material are exposed from their preparation to their analytical phase are called pre-analytical variables, which can have a direct effect on the detection of metabolites, and therefore, on the results of the research projects, particularly in the absence of standardized processes that confirm the quality control of the biological material. This technical note highlights some critical points that must be parameterized in the biocollections for research purposes to ensure high standards of quality and reproducibility in observational studies, where any kind of bias caused by the pre-analytical variables is minimized. In addition, it is intended to identify the importance of the development of biobanks for research purposes in our country in order to have human biological material of high qualit

Prosthetic shoulder joint infection by Cutibacterium acnes: does rifampin improve prognosis? a retrospective, multicenter, observational study.

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Caracterización clínica de los pacientes con malformaciones del desarrollo cortical, atendidos en la consulta de neuropediatría de la Liga Central contra la Epilepsia de Bogotá y el Hospital de la Misericordia

Las malformaciones del desarrollo cortical son entidades conocidas como causa de epilepsia de difícil control, pero se desconoce su papel en otras alteraciones del neurodesarrollo de los pacientes que las presentan. Este estudio buscó caracterizar una población con este diagnóstico, captados en la consulta de neuropediatría de dos instituciones de referencia de la ciudad de Bogotá. Se confirmó la presencia de MDC por neurorradióloga en 36 pacientes, con edades entre 3 meses y 29 años, 50% hombres, 80% con epilepsia. Fueron comparados los grupos con y sin alteración cognoscitiva, encontrando que el primer grupo presentó MDC más extensas. El control de crisis de quienes presentaban epilepsia fue alrededor del 40% en ambos grupos. El 22% presentaban alteraciones comportamentales, todos con déficit cognitivo. / Abstract. The Malformations of the Cerebral Cortex (MCC) are known entities as the cause of epilepsy of difficult control, but its role is unknown in other neurodevelopment problems. This work aims at characterizing a population with this diagnosis, with data collected in the pediatric neurology consultation in two the institutions point of reference in Bogotá city. The presence of MCC was confirmed in 36 patients by neuroradiologist, aged between 3 months and 29 years, 50% male, 80% with epilepsy. The groups with and without cognitive behavioral alteration were compared, finding that the first group presented larger MCC. The crisis management of those with epilepsy was about 40% in both groups. 22% had behavioral alterations, all of them with cognitive deficit.Otr