FACTORES DE RIESGO PARA TUBERCULOSIS PULMONAR MULTIDROGORESISTENTE EN LA REGIÓN LA LIBERTAD, PERÚ.

RESÚMENSe determinó los factores de riesgo en pacientes con tuberculosis pulmonar multidrogoresistente de la Región La Libertad, Perú en 73 pacientes que tenían tuberculosis multidrogoresistente considerados como casos y 219 pacientes con tuberculosis sensible considerados como controles. Los datos de infección positiva a M. tuberculosis, así como de su condición de resistente o sensible al tratamiento convencional se obtuvieron de los registros de la Estrategia Sanitaria de Prevención y Control de la Tuberculosis. El promedio de edad para el grupo de casos fue 37 años, el género masculino constituyó el 56.2% y el género femenino el 43.8%. El promedio de edad para el grupo control fue 38 años, el género masculino constituyó el 66.7% y el género femenino el 33.3%. El antecedente de fracaso a esquema primario, contacto de pacientes con tuberculosis multidrogoresistente, drogadicción, irregularidad o abandono de tratamiento, diabetes mellitus y multitratado de tuberculosis presentaron asociación estadísticamente significativa con tuberculosis multidrogoresistente. Los factores de riesgo para tuberculosismultidrogoresistente encontrados en el presente estudio coinciden con los factores mostrados en trabajos de otros lugares del país y del extranjero, pero con diferencias en las magnitudes de asociación.Palabras clave: Factores de riesgo; tuberculosis multidrogoresistente, La Libertad - PerúABSTRACTRisk factorsin patients with pulmonary multidrug-resistant tuberculosis of the Region La Libertad, Peru on seventy-three patients who had considered cases multidrug-resistant tuberculosis and two hundred and nineteen patients with sensitive tuberculosis were considered controls were determined. Positive infection data to M. tuberculosis, as well as, its status as resistant or sensitive to conventional treatment was obtained from the records of the Health Strategy for Prevention and Control of Tuberculosis. The average age for the study group was 37 years, the male gender accounted for 56.2% and 43.8% female gender. The average age for the control group was 38 years, the male gender accounted for 66.7% and 33.3% female gender. The history of failure with primary scheme treatment, contact of patients with multidrug-resistant tuberculosis, drug addiction, irregularity or cessation of treatment, diabetes mellitus and multi-treated tuberculosis were the factors with the strongest association to multidrug-resistant tuberculosis. Risk factors for multidrug-resistant tuberculosis found in the present study are consistent with the factors shown in others research in the country and foreign, but with differences in the magnitudes of association.Keyword: Risk factors, multidrug-resistant tuberculosis, La Libertad-Perú

Principales características epidemiológicas de la tuberculosis pulmonar multidrogoresistente en la Región La Libertad- Perú.

Se investigó las principales características epidemiológicas: edad, género, procedencia y esquemas de tratamiento de pacientes con tuberculosis pulmonar multidrogoresistente, de la Región La Libertad entre Enero 2008 y Diciembre del 2009. Se obtuvieron resultados confirmatorios de tuberculosis pulmonar multidrogoresistente en 96 pacientes (11.7%). El promedio de edad de pacientes con tuberculosis pulmonar multidrogoresistente fue de 37.5 años, predominaron los pacientes de sexo masculino (54.2 %) en relación a las pacientes de sexo femenino (45.8 %). La mayoría de pacientes procedieron de los distritos de Trujillo y del Porvenir. El número de casos tuberculosis pulmonar multidrogoresistente propuestos para iniciar tratamiento como casos de tuberculosismultidrogoresistente por el Comité de Evaluación de Retratamientos Intermedio fue mayor que los casos confirmados con prueba de sensibilidad para el mismo periodo de tiempo. Los esquemas de tratamiento estandarizado e individualizado fueron los que mas se indicaron; además el 9.7% de pacientes no iniciaron tratamiento. La tuberculosis pulmonar multidrogoresistente es un serio problema de Salud Pública en la Región La Libertad sobre todo en los distritos de Trujillo y el Porvenir.Palabras clave: Tuberculosis multidrogoresistente; características epidemiológica

EVALUACIÓN DE LA VIDEOBRONCOSCOPIA FLEXIBLE EN EL HOSPITAL REGIONAL DOCENTE DE TRUJILLO LA LIBERTAD – PERÚ

Se realizó un estudio descriptivo transversal para evaluar la utilidad de la videobroncoscopía en el diagnóstico de las enfermedades neumológicas prevalentes en pacientes del Hospital Regional Docente de Trujillo entre Junio del 2011 y Diciembre del 2012. Se sistematizaron los datos en la hoja de cálculo Excel 2010; se procedió al análisis estadístico de frecuencias mediante el paquete de análisis estadístico para ciencias sociales (SPSS) 20. De los 151 pacientes que ingresaron al estudio 87 (57.6%) fueron de sexo masculino y 64 (42.4%) del sexo femenino. La edad promedio fue de 50 años, con un rango de 16 a 92 años. Procedieron de consultorios externos 60 pacientes (39.7%), 79 pacientes (52.3%) de hospitalización del servicio de neumología, 12 pacientes (7.9%) de otros servicios. Los hallazgos broncoscópicos anormales se evidenciaron en los bronquios y parénquima pulmonar de 150 pacientes (99.3 %) y en la laringe de 01 paciente (0.7 %). Se informaron hallazgos broncoscópicos los cuales correspondieron 99 (65.6%) a signos inflamatorios agudos (SIA); 34 (22.5%) a signos indirectos de neoplasia (ST); 24 (15.9%) a signos inflamatorios crónicos (SIC); 17 (11.3%) a ectasia bronquial (BQ); 12 (7.9 %) a signos de sangrado (SGD); 10 (6.6%) a broncorrea (B); 6 (4.0%) a antracosis 1 (0.7%)y a granuloma laríngeo 1 (0.7%). Se identificaron gérmenes comunes en 11 pacientes (7.3%). A 104 pacientes se les solicitó baciloscopías y cultivos de BK en los cuales se identificó al Mycobacterium tuberculosis en 40 pacientes (26,5%). De los 151 pacientes a 104 se les solicitó estudio citológico de Papanicolaou (PAP), en 11 (7.3%) se evidenciaron células sospechosas de neoplasia (CSN). A 29 pacientes se realizaron toma de biopsias para estudio de anatomía patológica; los resultados anatomopatológicos más frecuentes fueron: bronquitis más inflamación crónica 11 (7.3%), bronquitis más inflamación aguda 05 (3.3%), adenocarcinoma bronquial 5 (3.3%). Los resultados corroboran la utilidad de la videobroncoscopía flexible en el Hospital Regional Docente de Trujillo, siendo su mayor aporte el diagnóstico temprano de enfermedades infecciosas como la tuberculosis posibilitando su tratamiento también precoz con los importantes beneficios epidemiológicos.Palabras clave: videobroncoscopía, bronquitis, signos inflamatoriosABSTRACTA cross-sectional study was performed to evaluate the usefulness of videobronchoscopy in diagnosing pneumological diseases on patients of the “Hospital Regional Docente de Trujillo” from June 2011 to December 2012. Data was organized in Excel 2010 spreadsheets. Frequency statistical analysis was performed using the Statistical Package for the Social Sciences ver. 20 (SPSS 20). Out of 151 patients, 87 (57.6%) were male and 64 (42.4%) were females. Average age of the patients was 50 years, ranging from 16 to 92 years. There were 60 (39.7%) outpatients, 79 (52.3%) in-patients from the Pulmonology Department and 12 (7.9%) patients from other services. Abnormal bronchoscopic findings were demonstrated in the bronchial and pulmonary parenchyma of 150 patients (99.3%) and in one (0.7%) patient's larynx. Bronchoscopic findings were attributed to the following causes: 99 (65.6%) of them to acute inflammatory signs (SIA), 34 (22.5%) to indirect signs of neoplasia (ST), 24 (15.9%) to chronic inflammatory signs (SIC), 17 (11.3%) to bronchial ectasia (BQ), 12 (7.9%) to bleeding (SGD) 10 (6.6%) to bronchorrhea (B), 6 (4.0%) to anthracosis 01 (0.7%) to laryngeal granuloma 01 (0.7%). Common germs were identified in 11 patients (7.3%). 104 patients were requested BK smears and cultures in which mycobacterium tuberculosis was identified in 40 patients (26.5%). Out of 151 admitted patients, 104 were requested a cytology Papanicolaou (PAP) and 11 (7.3%) showed suspicious cells of neoplasia (CSN). Biopsies were taken in 29 patients for pathology study, the most frequent pathological findings were: bronchitis with chronic inflammation 11 (7.3%), bronchitis with acute inflammation 05 (3.3%), bronchial adenocarcinoma 5 (3.3%). Results corroborate importance of using flexible videobronchoscopy at “Hospital Regional Docente de Trujillo”, and its main contribution the early diagnosis of infectious diseases such as tuberculosis enabling early treatment with major epidemiological benefits.Keywords: videobronchoscopy, bronchitis, inflammatory signsRecibido: 02 de Febrero de 2015Aceptado: 25 de Julio de 201

Patrones de resistencia a fármacos antituberculosos de primera línea en la región La Libertad -Perú.

Se investigó los patrones de resistencia a fármacos antituberculosos de primera línea en pacientes con tuberculosis pulmonar de la Región La Libertad obteniéndose resultados de 997 pruebas de sensibilidad entre Enero 2008 y Diciembre 2010. El 25.2% de las pruebas de sensibilidad presentaron patrones de resistencia a fármacos antituberculosos de primera línea, observándose que la mayor resistencia se presentó a isoniacida, seguido de estreptomicina, rifampicina, pirazinamida y por último a etambutol. El 49% de los pacientes con tuberculosis fármaco resistente mostraron patrón de multidrogoresistencia, el 11.6% patrón de poliresistencia y el 39.4% patrón de monoresistencia. Se concluye que hubo un número significativo de casos de tuberculosis resistente en la Región La Libertad, presentándose el patrón de multidrogoresistencia en mayor porcentaje y un número importante de casos de tuberculosis con patrón de monoresistencia a estreptomicinae isoniacida.Palabras clave: Tuberculosis multidrogoresistente, tuberculosis poliresistente

Clinical Audits in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Workflow

Objectives: Previous clinical audits for chronic obstructive pulmonary disease (COPD) have provided valuable information on the clinical care delivered to patients admitted to medical wards because of COPD exacerbations. However, clinical audits of COPD in an outpatient setting are scarce and no methodological guidelines are currently available. Based on our previous experience, herein we describe a clinical audit for COPD patients in specialized outpatient clinics with the overall goal of establishing a potential methodological workflow.Methods: A pilot clinical audit of COPD patients referred to respiratory outpatient clinics in the region of Andalusia, Spain (over 8 million inhabitants), was performed. The audit took place between October 2013 and September 2014, and 10 centers (20% of all public hospitals) were invited to participate. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The usefulness of formally scheduled regular follow-up visits was assessed. Two different databases (resources and clinical database) were constructed. Assessments were planned over a year divided by 4 three-month periods, with the goal of determining seasonal-related changes. Exacerbations and survival served as the main endpoints.Conclusions: This paper describes a methodological framework for conducting a clinical audit of COPD patients in an outpatient setting. Results from such audits can guide health information systems development and implementation in real-world settings.This study was financially supported by an unrestricted grant from Laboratorios Menarini, SA (Barcelona, Spain)

Desarrollo y aplicación de una metodología innovadora para realizar visitas técnicas virtuales a empresas y centros de investigación

El objetivo del proyecto es desarrollar una metodología innovadora para realizar visitas técnicas virtuales a plantas industriales y/o centros de investigación con alumnos que podrán utilizarse en 8 asignaturas de 4 grados y 2 másteres de la UCM.FALSEVicerrectorado de Calidad Proyectos de Innovación (2021-2022) Innova-Docenciasubmitte

The global abundance of tree palms

Aim Palms are an iconic, diverse and often abundant component of tropical ecosystems that provide many ecosystem services. Being monocots, tree palms are evolutionarily, morphologically and physiologically distinct from other trees, and these differences have important consequences for ecosystem services (e.g., carbon sequestration and storage) and in terms of responses to climate change. We quantified global patterns of tree palm relative abundance to help improve understanding of tropical forests and reduce uncertainty about these ecosystems under climate change. Location Tropical and subtropical moist forests. Time period Current. Major taxa studied Palms (Arecaceae). Methods We assembled a pantropical dataset of 2,548 forest plots (covering 1,191 ha) and quantified tree palm (i.e., ≥10 cm diameter at breast height) abundance relative to co‐occurring non‐palm trees. We compared the relative abundance of tree palms across biogeographical realms and tested for associations with palaeoclimate stability, current climate, edaphic conditions and metrics of forest structure. Results On average, the relative abundance of tree palms was more than five times larger between Neotropical locations and other biogeographical realms. Tree palms were absent in most locations outside the Neotropics but present in >80% of Neotropical locations. The relative abundance of tree palms was more strongly associated with local conditions (e.g., higher mean annual precipitation, lower soil fertility, shallower water table and lower plot mean wood density) than metrics of long‐term climate stability. Life‐form diversity also influenced the patterns; palm assemblages outside the Neotropics comprise many non‐tree (e.g., climbing) palms. Finally, we show that tree palms can influence estimates of above‐ground biomass, but the magnitude and direction of the effect require additional work. Conclusions Tree palms are not only quintessentially tropical, but they are also overwhelmingly Neotropical. Future work to understand the contributions of tree palms to biomass estimates and carbon cycling will be particularly crucial in Neotropical forests

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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&lt;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 (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;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