Hallazgos histopatológicos en pacientes con síndrome de ojo seco secundario a enfermedad autoinmune tratados con suero autógeno

ResumenObjetivoDeterminar las características histopatológicas en biopsia de conjuntiva bulbar en pacientes con síndrome de ojo seco tratados con suero autógeno y carboximetilcelulosa.Materiales y métodosSe reclutaron pacientes con diagnóstico de síndrome de ojo seco. Se les sometió a toma de biopsia de conjuntiva bulbar de ambos ojos. Se indicó a cada paciente tratamiento con suero autógeno al 20% una gota 4 veces al día en ojo derecho y carboximetilcelulosa una gota 4 veces al día en ojo izquierdo durante un mes, tras lo cual se tomó una segunda biopsia de conjuntiva bulbar. Se realizó estudio histopatológico de cada biopsia, considerando grado de infiltrado inflamatorio, grado de metaplasia escamosa y número de células caliciformes, dividiendo mediante escala numérica las variables mencionadas en 4 grados y comparando resultados con prueba de Wilcoxon.ResultadosSe incluyeron dentro del protocolo 32 ojos pertenecientes a 16 pacientes, con una edad media de 51.89 años. Los hallazgos histopatológicos posteriores al tratamiento con suero autógeno fueron: en 12 de los pacientes no hubo cambios en el grado de metaplasia escamosa, y en 4 disminuyó (p=0.046); en 5 pacientes se incrementó el número de células caliciformes (p=0.049), en 10 no se modificó y en uno disminuyó; el grado de infiltrado inflamatorio aumentó en 6 (p=0.014) pacientes y no se modificó en 10. Con carboximetilcelulosa, la metaplasia disminuyó en 2 pacientes, aumentó en uno y se mantuvo igual en el resto; el número de células caliciformes aumentó en 6 pacientes, disminuyó en 6 y no se modificó en 4; el infiltrado inflamatorio aumentó en 4 pacientes, disminuyó en 2 y se mantuvo igual en el resto.ConclusionesEl tratamiento con suero autógeno ofrece una mejoría estadísticamente significativa en cuanto al aumento de células caliciformes conjuntivales y a la disminución del grado de metaplasia escamosa. En comparación, con el tratamiento con carboximetilcelulosa no se observaron cambios estadísticamente significativos después del tratamiento en ninguna de las variables.AbstractPurposeTo determine histopathological features in conjunctival biopsy of patients with dry eye syndrome treated with autologous serum and carboximethilcelulose.Materials and methodsConjunctival biopsy was taken from both eyes of patients with dry eye syndrome. Right eyes were treated with 20% autologous serum one drop qid, whereas left eyes received carboximethilcelulose one drop qid for one month, after which new biopsies were taken. Histopathological analysis was performed, taking into account the degree of inflammatory infiltrate, degree of squamous metaplasia, and the number of goblet cells, dividing those variables in a 4 degree scale and comparing results with Wilcoxon test.ResultsA total of 32 eyes of 16 patients were included (mean age 51.89 years). After treatment with autologous serum, 12 patients showed no change in the degree of squamous metaplasia and it diminished in 4 (P=.046); 5 showed an increased number of goblet cells (P=.049), in one patient the number diminished and 10 showed no change; the inflammatory infiltrate increased in 6 patients (P=.014) and showed no change in the rest. After treatment with carboximethilcelulose, squamous metaplasia diminished in 2 patients, increased in one and the rest showed no change; the number of goblet cells increased in 6, was reduced in 6 and 4 showed no change; the inflammatory infiltrate increased in 4, was reduced in 2 and the rest showed no change.ConclussionTreatment with autologous serum offers a statistically significant improvement regarding the number of goblet cells and squamous metaplasia. Treatment with carboximethilcelulose showed no significant change in any of the variables

Planeamiento estratégico del Banco Interamericano de Finanzas

La presente tesis desarrolla el planeamiento estratégico para la Banco Interamericano de Finanzas S.A., Banbif, bajo el Modelo Secuencial del Proceso Estratégico elaborado por D’Alessio (2008). El Banbif es una entidad financiera que forma parte del grupo Ignacio Fierro, cuya misión es realizar actividades de intermediación financiera, a través de la captación y colocación de fondos, así como diversos servicios a la banca múltiple. El objetivo del presente planeamiento busca asegurar la sostenibilidad y crecimiento del negocio, a través de la creación de mejores productos y servicios eficientes, innovadores y de alta calidad, orientados principalmente a la mediana empresa y a las personas de nivel socioeconómico A,B y C. Esta propuesta de planeamiento busca orientar las decisiones de los directivos del Banbif para los próximos diez años, teniendo en cuenta la disminución en el ahorro y la inversión que se ha visto en el Perú entre los años 2011 al 2015. La tesis consta de ocho capítulos que incluyen el análisis de la situación actual y entorno, la formulación y diseño de estrategias, la implementación y la evaluación y control; y un capítulo final con las conclusiones y recomendaciones para la compañía Banbif. Finalmente, la presente tesis recomienda la implementación del presente planeamiento teniendo en cuenta la situación del sector financiero y económico del Perú al 2015.This thesis develops the strategic planing for the Banco Interamericano de Finanzas S.A., Banbif, under the strategic process sequence model elaborated by D’Alessio (2008). The Banbif is a finantial institution, that is part of Ignacio Fierro group, whose mission is to carry out financial transactions through the recruitment and placement of funds and various services to multiple bank. The aim of this planning seeks to ensure the sustainability and growth of the business, through the creation of better products and efficient, innovative and high quality services, mainly oriented to medium enterprises and people of high socioeconomic status. This proposal seeks to guide planning decisions by managers BanBif for the next ten years, considering the decline in the savings and investments occurred in Peru between 2011 and 2015. The thesis has eight chapters that include the current situation analysis and environment, the design and formulation of the strategies, implementation and evaluation and control, furthermore, a chapter with recommendations and conclusions for the Banbif. Finally, this thesis recommends the implementation of this planning considering the situation in the financial and the economic sector in Peru at 2015.Tesi

Comportamiento epidemiológico de los factores de riesgo asociados a enfermedades crónicas no transmisibles en estudiantes universitarios

Describir el comportamiento epidemiológico de los factores de riesgo relacionados a enfermedades crónicas no transmisibles asociados a hipertrigliceridemia presentes en los estudiantes del primer año de la carrera de Médico y Cirujano de la Universidad de San Carlos de Guatemala. Estudio descriptivo transversal realizado en 1097 estudiantes, en los cuales se aplicó el cuestionario del método paso a paso para la vigilancia de factores de riesgo de enfermedades crónicas (STEPS) modificado. Se encontró 610 (56%) estudiantes sexo femenino, la media de edad fue de 19 años (±1.56); en relación a los factores de riesgo modificables: 219 (20%) consumen cigarrillo, 274 (25%) consumen alcohol nocivamente, 838 (76%) se alimentan de forma inadecuada, 887 (81%) no practica actividad física significativa; se identificó que 405 (37%) presentaron un índice cintura – cadera considerado de riesgo. En cuanto a los factores asociados a la presencia de hipertrigliceridemia: obesidad se identificó en 147 (13%) estudiantes (X2 de 104.98 y OR de 7), obesidad central en 204 (19%) (X2 de 55.74 y OR de 3), el sobrepeso en 330 (30%) (X2 de 53.4727 y OR de 3), presión arterial alta en 397 (36%) (X2 de 18.63 y OR de 2), y glucemia alterada en ayunas alta en 198 (18%) (X2 de 8.3 y OR de 2). La hipertrigliceridemia se presentó en 411 estudiantes (37%), siendo la edad más afectada la de 19 años. La mayoría de estudiantes estudiados es de sexo femenino. Existe una alta prevalencia de factores de riesgo modificables asociados a enfermedades crónicas no transmisibles, de estos se identificó que factores como obesidad, obesidad central, sobrepeso, presión arterial alta y glucemia alterada en ayunas alta tienen una significativa asociación al desarrollo de hipertrigliceridemia, con un aumento del riesgo de 7, 3, 3, 2 y 2, respectivamente

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

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

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Control System Applied to the Microinjection of Artificial Tears for Severe Dry Eye Treatment

This paper presents a portable automated teardrop microinjection system as a practical solution for patients suffering from severe dry eye. The electronic device for the controlled and continuous injection of artificial tears is designed, assembled, and tested for performance and stability. It is controlled via Wi-Fi from an Android programmable device. Its design is based on the physicochemical properties of artificial tears, and with both production costs and portability in mind. The system was modeled according to the V methodology of the association for professional German engineers VDI 2206 standard. The microinjector handles a wide range of internal variables such as tears flow rate (0.13 to 60 &mu;L/min), tears viscosity (up to 600 Pa&middot;s), temperature (up to 60 &deg;C), injected volume of tears, and time between consecutive injections. For evaluation purposes, a comprehensive set of experimental tests were carried out to the system, comparing the actually delivered amount of tears, flow rate, and prescribed time vs. programmed values, the error was &sim;0.2% for commercially available artificial tears