Análisis de la mortalidad en la unidad de cuidados intensivos del Hospital Central de Mendoza, Argentina

Objetivo: Analizar la mortalidad en la Unidad de Cuidados Intensivos (UCI) del Hospital Central de Mendoza y evaluar el valor predictivo de la escala APACHE II (Evaluación Fisiológica Aguda y de Salud Crónica). Material y Método: Se realizó un estudio retrospectivo y observacional de los pacientes ingresados a la Unidad de Cuidados Intensivos del Hospital Central de Mendoza, desde el 01/11/06 hasta el 31/03/08. Se calculó la distribución de sexos y de edades de la muestra, la estadía promedio, principales motivos de ingreso a la UCI y la puntuación APACHE II en las primeras 24 horas de internación. Se calculó la mortalidad esperada y la mortalidad obtenida global y se analizó el coeficiente entre ambas mortalidades. Resultados: Se incluyeron 904 pacientes, 61,82% masculinos y 38,18% femeninos, con una edad media 46 años (±19,36). Estadía promedio en la UCI 8,5 días promedio. El principal motivo de internación fueron los Traumatismos Encéfalocraneanos (TEC) con un 27,7% del total (86% asociados a politraumatismo grave). La mortalidad global obtenida fue del 41,48% vs. 24,08% esperable, con un coeficiente de mortalidad de 1,72 (p<0,0001). Conclusiones: La UCI estudiada presenta por las características de la población asistida un elevado índice de mortalidad global. La mortalidad obtenida fue 72% mayor a la mortalidad esperable según la puntuación APACHE II, demostrando esta Escala un bajo valor predictivo en nuestra UCI. La diferencia entre mortalidades podría parcialmente explicarse por la alta prevalencia de entidades con mortalidades subvaloradas por este modelo pronóstico, como pacientes politraumatizados y neurocríticos. En nuestro estudio, la Escala APACHE II presentó una franca subestimación de la mortalidad en ambas patologías. Sugerimos la realización de un estudio de regresión logística local para determinar un factor de corrección y/o adicionar puntos al valor APACHE II según el diagnóstico de ingreso del paciente. Asimismo, proponemos evaluar el empleo de medidas alternativas para predecir mortalidad, como sistemas de tercera generación (por ejemplo: APACHE III, MPM II y SAPS II).Objective: To analyze the mortality in the Intensive Care Unit (ICU) of Mendoza Central Hospital and evaluate the predictive value of the APACHE II score (Acute Physiology and Chronic Health Evaluation). Methodology: In a retrospective observational study the clinical records from the patients admitted into the Mendoza Central Hospital ICU, between 01/Nov/06 to 31/Mar/08, were reviewed. Sex and age distribution, average length of stay, major admissions causes and APACHE II score within 24 hours of admission were calculated. Observed and expected mortality and their ratio were analyzed. Results: 904 patients were included, 61.82% males and 38.18% females, with an average age of 46 years (±19.36). Average length of stay for patients admitted in the ICU was 8.5 days. The major cause of admission was traumatic brain injury at 27.7% (86% associated with severe polytrauma). Global mortality was 41.48% vs. an expected 24.08%, with a mortality ratio of 1.72 (p<0,0001). Conclusions: The studied ICU presented high mortality rates due specific characteristics of the attended population. The observed mortality was 72% higher than that predicted by the APACHE II score, indicating that this model has a low predictive power in our Hospital. The difference between the two mortality rates could be partially explained by a high prevalence of diseases under-predicted by this model, such as multiple trauma and neurocritically ill patients. In these patients, APACHE II score failed to predict mortality accurately. We suggest that a logistical regression study be performed to determine a correction factor and/or add points to the APACHE II score according the diagnosis at admittance. We propose to evaluate the use of third generation models to predict mortality, such as APACHE III, MPM II y SAPS II.Fil: Savastano, L.. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Benito, O.. Hospital Central de Mendoza. Unidad de Cuidados IntensivosFil: Cremaschi, Fabián. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Área de Neurología Clínica y Quirúrgic

Building on an oasis in Garamantian times: geoarchaeological investigation on mud architectural elements from the excavation of Fewet (Central Sahara, SW Libya)

The paper describes the micromorphological and mineralogical properties of earthen architectural elements from the excavation of the Garamantian compound of Fewet (Central Sahara, SW Libya), settled between the 2nd century BC and the 1st century AD, and compares this evidence with a set of samples from historical to modern context of Saharan and Sub-Saharan Africa. At Fewet, the production of mud bricks, plasters, and mortars employed in the building of the compound required raw materials available near the settlement. The earthen elements lack almost completely clay and organic temper, and their main components are quartz grains (sandy to silty) and a calcareous and slightly organic mud, available beside former springs. Only plaster and mortars show the addition (in limited quantity) of finely subdivided vegetal remains to the mixture. The technology for earthen elements used in Garamantian times resembles those today applied at many localities in Sub-Saharan Africa. Finally, our analyses showed that in the last millennia archaeological sediments underwent limited postdepositional weathering, mostly related to solute redistribution after occasional rainfalls. Today, the same process affects traditional mud brick buildings

Proyectos y concreciones : obras y políticas públicas durante el primer peronismo en Mendoza (1946-1955)

La interacción entre Estado, técnicas y política, nos demuestra Proyectos y concreciones, puede resultar un camino particularmente fecundo para abordar de manera ordenada, sistemática e interpretativa este campo. Se puede decir que proporciona un marco de temas relacionados que en este caso se aplica al estudio de la obra pública del peronismo en una provincia, pero que, en tanto problemática, puede ser utilizado para el abordaje de otros períodos y jurisdicciones. Como se explica en la introducción que incluye sus principales referencias, el trabajo de investigación realizado y presentado en este libro ha recogido sugerencias de varios sectores de la producción historiográfica nacional de las últimas décadas para construir una mirada específica sobre las obras públicas, mirada que no puede sino pensarse como un espacio de cruce. Nos referimos a los estudios del Estado, las historias provinciales y locales, los estudios sobre el primer peronismo y el análisis de las transformaciones espaciales, comprendiendo tanto sus distintas escalas como las disciplinas y técnicas que las proyectan y ejecutan. Considerando este marco, de ingresa a los contenidos del libro por el camino de los estudios sobre el primer peronismo. Como es sabido, desde hace ya varias décadas, los estudios provinciales han modificado las aproximaciones historiográficas tradicionales sobre tal movimiento político. El conocido trabajo editado por Darío Macor y César Tcach (La invención del peronismo en el interior del país, 2003) produjo en su momento una importante inflexión, cuya productividad continúa operando en el presente. Sin duda este libro es heredero de esa búsqueda de una nueva mirada sobre el peronismo producida por la elección jurisdiccional configurando nuevos objetos de estudio capaces de registrar realidades políticas y sociales diferentes de las presentadas por los estudios centrados en Buenos Aires o en la política a nivel nacional

Evaluación de las propiedades tecnológicas de sedimentos colmatantes de cuerpos lénticos ubicados al sudeste del área metropolitana de Buenos Aires. Estúdio preliminar para la formulación del Proyecto Productivo Inclusivo : Parque Ladrillero en el partido

Fil: Couyoupetrou, L.. Instituto de Recursos Minerales (INREMI). Facultad de Ciencias Naturales y Museo. Universidad Nacional de La Plata; ArgentinaFil: Rolny, D.. Laboratorio de Tecnología y Gestión Habitacional (LATEC). Facultad de Arquitectura y Urbanismo. Universidad Nacional de La Plata; ArgentinaFil: Hurtado, Martín Adolfo. Instituto de Geomorfología y Suelos (IGS). Facultad de Ciencias Naturales y Museo. Universidad Nacional de La Plata; ArgentinaFil: Etcheverry, Ricardo Oscar. Instituto de Recursos Minerales (INREMI). Facultad de Ciencias Naturales y Museo. Universidad Nacional de La Plata; ArgentinaFil: Cremaschi, G.. Laboratorio de Tecnología y Gestión Habitacional (LATEC). Facultad de Arquitectura y Urbanismo. Universidad Nacional de La Plata; ArgentinaFil: Forte, Luis M.. Instituto de Geomorfología y Suelos (IGS). Facultad de Ciencias Naturales y Museo. Universidad Nacional de La Plata; Argentin

Thyroid status modulates T lymphoma growth via cell cycle regulatory proteins and angiogenesis

We have shown in vitro that thyroid hormones (THs) regulate the balance between proliferation and apoptosis of T lymphoma cells. The effects of THs on tumor development have been studied, but the results are still controversial. Herein, we show the modulatory action of thyroid status on the in vivo growth of T lymphoma cells. For this purpose, euthyroid, hypothyroid, and hyperthyroid mice received inoculations of EL4 cells to allow the development of solid tumors. Tumors in the hyperthyroid animals exhibited a higher growth rate, as evidenced by the early appearance of palpable solid tumors and the increased tumor volume. These results are consistent with the rate of cell division determined by staining tumor cells with carboxyfluorescein succinimidyl ester. Additionally, hyperthyroid mice exhibited reduced survival. Hypothyroid mice did not differ significantly from the euthyroid controls with respect to these parameters. Additionally, only tumors from hyperthyroid animals had increased expression levels of proliferating cell nuclear antigen and active caspase 3. Differential expression of cell cycle regulatory proteins was also observed. The levels of cyclins D1 and D3 were augmented in the tumors of the hyperthyroid animals, whereas the cell cycle inhibitors p16/INK4A (CDKN2A) and p27/Kip1 (CDKN1B) and the tumor suppressor p53 (TRP53) were increased in hypothyroid mice. Intratumoral and peritumoral vasculogenesis was increased only in hyperthyroid mice. Therefore, we propose that the thyroid status modulates the in vivo growth of EL4 T lymphoma through the regulation of cyclin, cyclin-dependent kinase inhibitor, and tumor suppressor gene expression, as well as the stimulation of angiogenesis.Fil: Sterle, Helena Andrea. Pontificia Universidad Católica Argentina ; ArgentinaFil: Valli, Eduardo. Pontificia Universidad Católica Argentina ; ArgentinaFil: Cayrol, Maria Florencia. Pontificia Universidad Católica Argentina ; ArgentinaFil: Paulazo, Maria Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Martinel Lamas, Diego José. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Díaz Flaqué, María Celeste. Pontificia Universidad Católica Argentina ; ArgentinaFil: Klecha, Alicia Juana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Colombo, L.. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología ; ArgentinaFil: Medina, Vanina Araceli. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cremaschi, Graciela Alicia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Pontificia Universidad Católica Argentina ; ArgentinaFil: Barreiro Arcos, María Laura. Pontificia Universidad Católica Argentina ; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Biológica; Argentin

Crossing Borders Between Frontotemporal Dementia and Psychiatric Disorders: An Updated Overview

Frontotemporal dementia (FTD) includes a group of neurocognitive syndromes, clinically characterized by altered behaviors, impairment of language proficiency, and altered executive functioning. FTD is one of the most frequently observed forms of dementia in the elderly population and the most common in presenile age. As for other subtypes of dementia, FTD incidence is constantly on the rise due to the steadily increasing age of the population, and its recognition is now becoming a determinant for clinicians. FTD and psychiatric disorders can overlap in terms of clinical presentations by sharing a common genetic predisposition and neuropathological mechanism in some cases. Nonetheless, this association is often unclear and underestimated. Since its first reports, research into FTD has constantly grown, with the identification of recent findings related to its neuropathology, genetic, clinical, and therapeutic issues. Literature is thriving on this topic, with numerous research articles published in recent years. In the present review, we aimed to provide an updated description of the clinical manifestations that link and potentially confound the diagnosis of FTD and psychiatric disorders in order to improve their differential diagnosis and early detection. In particular, we systematically reviewed the literature, considering articles specifically focused on the behavioral variant FTD, published after 2015 on the PubMed database

Geomorphology of the Mt. Cusna Ridge (Northern Apennines, Italy) : evolution of a Holocene landscape

The Mt. Cusna ridge, located in the Northern Apennines (North Italy), is a mountain area of relevant geological interest for the interaction through time of distinct geomorphic processes, acting since the end of the Last Glacial Maximum. A geomorphological map at the 1:10,000 scale was produced to characterise the main landforms and processes identifiable on the ridge. From this, a detailed reconstruction of the Holocene landscape history of the area is drawn. After deglaciation, at the end of the Pleistocene, glacial and periglacial processes left wide deposits and barren surfaces. Slope and running water processes acted cyclically on the landscape through phases of stronger slope denudation and landslide activation followed by stability periods. These processes are related to the main climatic changes recorded for the N Apennines during the Holocene. Since the Late Holocene, the impact of human communities may have played a prominent role as an agent of landscape modification

Excursion to the valley of the Torrente Tiepido

The morphological evolution of the Torrent Tiepido (Province of Modena) is described. Following intense gravel excavation from its riverbed, this watercourse has been subject to accelerated erosion which has caused several problems to bridges and hydraulic structures. The remedial measures carried out in order to control this man-induced erosional process are discussed

Exploring characteristics associated with first benzodiazepine prescription in patients with affective disorders and related diagnoses

Objective In patients with affective disorders, benzodiazepines (BZDs) are frequently administered at the onset, sometimes inappropriately. We sought to identify clinical variables associated with first BZD prescription in a large sample of patients with affective disorders. Methods Four hundred sixty patients with mood or anxiety disorders attending different psychiatric services were assessed comparing those who received BZD as first treatment (BZD w/) and those who did not (BZD w/o). Results More than one third (35.7%) of the total sample had received BZDs as first prescription. In relation to mood disorders, BZD w/ subjects more frequently (a) had not a psychiatrist as first therapist, (b) had anxious symptoms at onset, (c) had adjustment disorder as first diagnosis, (d) were treated as outpatients. In relation to specific diagnoses, (a) personal decision of treatment for major depressive disorder, (b) outpatient status for bipolar disorder and (c) longer duration of untreated illness for adjustment disorder were more frequently associated with first BZD prescription. For anxiety disorders, the presence of stressful life events and the diagnoses of panic disorder or specific phobias were more frequently observed in BZD w/ patients. Conclusion Patients with affective disorders frequently received BZDs as first prescription with significant differences between and within mood and anxiety disorders