Variability of blood eosinophil count and prognosis of COPD exacerbations

MPOC; Eosinofília; ExacerbacióEPOC; Eosinofilia; ExacerbaciónCOPD; Eosinophilia; ExacerbationBackground Eosinophils in peripheral blood are one of the emerging biomarkers in chronic obstructive pulmonary disease (COPD) patients. However, when analysing the relationship between peripheral eosinophilia and COPD prognosis, highly variable results are obtained. The aim of our study is to describe the serum eosinophilia levels in COPD patients and to analyse their relationship to prognosis following hospital admission. Methods A prospective observational study was conducted from 1 October 2016 to 1 October 2018 in the following Spanish centres: Salnés County Hospital in Vilagarcía de Arousa, Arquitecto Marcide Hospital in Ferrol and the University Hospital Complex in Santiago de Compostela. The patients were classified using three cut-off points of blood eosinophil count (BEC): 150 cells/µL, 300 cells/µL, and 400 cells/µL; in addition, the peripheral BEC was analysed on admission. Results 615 patients were included in the study, 86.2% male, mean age 73.9 years, and mean FEV1 52.7%. The mean stay was 8.4 days, and 6% of all patients were readmitted early. No significant relationship was observed between the BEC, neither in the stable phase nor in the acute phase, and hospital stay, readmissions, deaths during admission, the need for intensive care, or the condition of frequent exacerbator. Conclusion The results of our study do not seem to support the usefulness of BEC as a COPD biomarker.This paper has not been funded by any project or scholarship

Volteando la tortilla. Género y maíz en la alimentación actual de México.

Ante escenarios complejos, patriarcales y desoladores que dejan ver el neoliberalismo, la globalización agroalimentaria, el calentamiento global y las contaminaciones de granos nativos por la imposición de transgénicos, nos cuestionamos si existen algunas alternativas para preservar el maíz nativo como un recurso multiestratégico (alimentario, económico, cultural, ecológico y tecnológico) tomando en cuenta las condiciones actuales de desigualdades sociales de género, etnia, clases y edad que predominan en el campo mexicano. Para responder a algunos cuestionamientos, este libro presenta algunas alternativas a través de diversas experiencias femeninas y de relaciones de género en torno al maíz y la alimentación. Todas ellas muestran que es posible construir una masa crítica para salvaguardar el maíz nativo bajo esas condiciones desoladoras, pero siempre y cuando se “voltee la tortilla”, metáfora que da pie al inicio de otra realidad humanizada y en sincronía con la naturaleza.Proyecto realizado con financiamiento Conacy

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

Compartiendo mejoramos todos Ixtapaluca Estado de México 2010

Tesis (Licenciatura en Turismo), Instituto Politécnico Nacional, EST, 2010, 1 archivo PDF, (69 pàginas). tesis.ipn.m

Conocimiento práctico y teórico de maíz y frijol en la región triqui alta, Oaxaca

The objective of the article is to contrast the practical knowledge that women and men possess about the quality and use of corn and beans, with the theoretical knowledge to evaluate the quality of these grains in the laboratory. There were 27 semi-structured interviews and two participatory workshops, in the mother tongue ‛triqui’, in Santo Domingo of the state, region triqui high, Oaxaca. The hectolitre weight (PH) and flotation index (IF) were evaluated in 20 corn collections. In beans, cooking time (TC), water absorption capacity during soaking (CAA) and percentage of solids in the cooking broth (PSC) in 15 accessions were evaluated. The results were analyzed with a completely randomizeddesign, comparison test of tukey means and correlations. The interviewees indicated preference for white corn, with hard grains (IF= 0-12) and intermediate grains (IF= 38-62), followed by blue, pinto, yellow, red was less preferred. All the pigmented maize washard grain (IF= 13-37). The pH was between 74-81 kg hl-1. In beans, the species Phaseolus vulgarisL. (common) and Phaseolus coccineusL. (ayocote) were identified, the one with the longest tradition and preference for consumption was the ‛dry bean’(ayocote) which requires 317 min for cooking. The practical knowledge of men and women of Santo Domingo del Estado on the quality of corn and beans, showed an association with the theoretical trends of quality in corn; in the bean there was an association with the cooking time. Keywords:beans, corn, genus, milpa, traditional knowledge.El objetivo del artículo es contrastar los conocimientos prácticos que poseen mujeres y hombres sobre la calidad y uso de maíz y frijol, con los conocimientos teóricos para evaluar la calidad de estos granos en laboratorio. Se efectuaron 27 entrevistas semiestructuradas y dos talleres participativos, en la lengua materna ‘triqui’, en Santo Domingo del Estado, región ‘triqui alta, Oaxaca. Se evaluó el peso hectolítrico (PH) e índice de flotación (IF) en 20 colectas de maíz. En frijol se evaluó el tiempo de cocción (TC), capacidad de absorción de agua durante el remojo(CAA)y porcentaje de sólidos en el caldo de cocción (PSC) en 15 accesiones. Los resultados se analizaron con un diseño completamente al azar, prueba de comparación de medias tukey y correlaciones. Los(as)entrevistados(as)indicaron preferencia por el maíz blanco, con granos duros (IF= 0-12) e intermedios (IF= 38-62), seguido del azul, pinto, amarillo, el rojo fue de menor preferencia. Todos los maíces pigmentados fueron de grano duro (IF= 13-37). El PH estuvo entre 74-81 kg hl-1. En frijol se identificaron las especies Phaseolusvulgaris L. (común) y Phaseolus coccineus L. (ayocote), el de mayor tradición y preferencia para el consumo fue el ‘ejote seco’ (ayocote) que requiere 317 min para su cocción. El conocimiento práctico de hombres y mujeres de Santo Domingo del Estado sobre la calidad del maíz y frijol, mostró asociación con las tendencias teóricas de calidad en maíz; en el frijol se mostró asociación con el tiempo de cocción. Palabras clave:conocimientos tradicionales,frijol, género,maíz, milp

Retrograde Accretion of a Caribbean Fringing Reef Controlled by Hurricanes and Sea-level Rise

Predicting the impact of sea-level (SL) rise on coral reefs requires reliable models of reef accretion. Most assume that accretion results from vertical growth of coralgal framework, but recent studies show that reefs exposed to hurricanes consist of layers of coral gravel rather than in-place corals. New models are therefore needed to account for hurricane impact on reef accretion over geological timescales. To investigate this geological impact, we report the configuration and development of a 4-km-long fringing reef at Punta Maroma along the northeast Yucatan Peninsula. Satellite-derived bathymetry (SDB) shows the crest is set-back a uniform distance of 315 ±15 m from a mid-shelf slope break, and the reef-front decreases 50% in width and depth along its length. A 12-core drill transect constrained by multiple 230Th ages shows the reef is composed of an ~2-m thick layer of coral clasts that has retrograded 100 m over its back-reef during the last 5.5 ka. These findings are consistent with a hurricane-control model of reef development where large waves trip and break over the mid-shelf slope break, triggering rapid energy dissipation and thus limiting how far upslope individual waves can fragment corals and transport clasts. As SL rises and water depth increases, energy dissipation during wave-breaking is reduced, extending the clast-transport limit, thus leading to reef retrogradation. This hurricane model may be applicable to a large sub-set of fringing reefs in the tropical Western-Atlantic necessitating a reappraisal of their accretion rates and response to future SL rise

Bubble trail and folia in cenote Zapote, Mexico: petrographic evidence for abiotic precipitation driven by CO\u3csub\u3e2\u3c/sub\u3e degassing below the water table

Folia are speleothems that resemble bells, inverted cups, or bracket fungi, and whose origins are still controversial. Cenote Zapote (an underwater cave) in the Yucatán Peninsula (México), is home to some of the largest folia reported to date. These speleothems are currently growing in an active underwater system, meaning this site offers an excellent opportunity to constrain the different formation models proposed for folia, which have traditionally relied on inactive examples. In Cenote Zapote, folia are closely related to bubble trails and cupolas, suggesting an underwater CO2-degassing process. In thin section, they display a succession of columnar-open and columnar-elongated endings in micrite-dendritic fabrics. Our petrographic and geochemical results demonstrate the abiotic origin of these folia and indicate carbonate precipitation from cold water by CO2 degassing below the water table that started at least 5,210 yrs BP. We conclude that these folia formed as a result of subaqueous calcite precipitation around CO2 bubbles trapped below overhanging walls of the cave. The sequential alternation of columnar and micritic fabrics can be explained by changes in the position of the halocline and H2S-rich water mass while the exceptional size is the result of carbonate precipitation from waters saturated in CaCO3 during thousans of years. Then we propose the classification of these speleothems as a subtype of folia. This subtype could be named Hells Bells, respecting its original description

. 38. Arqueología

Por razones de política editorial tratamos de equilibrar cada número en cuanto a regiones y temporalidades, pero en esta ocasión ha resultado difícil porque hay un sesgo muy fuerte hacia el periodo Posclásico en el Altiplano. Sin embargo, esta pequeña trasgresión a nuestras reglas tiene por contraparte el interés de los artículos que conjuntan especialistas en arqueología y otros ámbitos de la antropología y la historia, con temáticas que se entrecruzan, comparten y enriquecen para ofrecer la posibilidad de lecturas aleccionadoras Encabezan el número Óscar Basante y Juan Sebastián Gómez, en cuyo trabajo preliminar se describe una colección de materiales procedentes de Zacatecas y se proporciona información sobre sitios con arquitectura y pintura rupestre de Monte Escobedo, relacionados con la cultura Bolaños. En el siguiente artículo se ofrecen algunos resultados de las excavaciones en el Cerro de los Magueyes en Metepec, Estado de México, donde Carmen Carvajal y Alfonso González, a partir del análisis de un entierro en urna del Posclásico tardío, elaboran una propuesta de identificación física e interpretación simbólica. A su vez, Denisse L. Argote y colaboradores nos ofrecen los resultados iniciales de la prospección en el sitio Los Teteles de Ocotitla, Tlaxcala, ubicado temporalmente en el Clásico y donde por medio de radar de penetración detectan anomalías en las terrazas que interpretan como posibles estructuras, tumbas u otros elementos soterrados, impulsando el uso de los llamados métodos geofísicos. En una línea de descripción iconográfica, María Teresa Muñoz y José Carlos Castañeda analizan una figurilla de barro perteneciente al acervo del Museo Histórico de la Sierra Gorda de Querétaro; con ello intentan establecer la relación de esta pieza con la deidad de la fertilidad Tlazolteotl-Ixcuina, asociándola también con la diosa pame Cachum mediante un análisis comparativo e interpretación simbólica. En el trabajo de Verónica Ortega y Víctor Álvarez, dos estructuras subterráneas del Posclásico tardío, encontradas en la zona urbana de Teotihuacan, se interpretan como temascales por medio de un análisis comparativo con otras localizadas en San Francisco Mazapa. A continuación, un salvamento en la ciudad de México proporciona información sobre la traza prehispánica de Tlatelolco y el barrio de Atezcapan. Los autores, Alberto Mena, Janis Rojas y María de Jesús Sánchez Vázquez, muestran amplio conocimiento sobre la ciudad y aportan datos para la reconfiguración del límite sur y la separación de las islas. A partir de la arqueología histórica del periodo colonial, Patricia Murrieta informa sobre el proceso productivo del azúcar en la hacienda de Tecoyutla, Guerrero, y ofrece una descripción de las labores realizadas alrededor de este monumento histórico, por las que también plantea propuestas de uso del espacio. A su vez, Carmen Aguilera diserta sobre Tlaltecuhtli, una deidad poco conocida que conjuga orígenes y para ello se discute su procedencia y género, además de plantear propuestas interpretativas y rutas de investigación iconográfica. El artículo de Ángel García Cook y Yadira Martínez Calleja es de corte técnico y descriptivo, pues detalla de manera precisa las características principales de las vías de circulación interna en Cantona, y a partir de ahí se elabora una completa tipología. Además de proporcionar hipótesis y propuestas para la interpretación, se aplica un análisis comparativo entre Cantona y otras ciudades prehispánicas en las que se han identificado calles y caminos. A partir de los hallazgos en el salvamento de La Plaza Juárez, Fernando Guerrero y colaboradores dibujan rasgos del paleopaisaje en la zona de La Alameda Central. Además, el conjunto de los contextos y el análisis iconográfico les permiten proponer usos del espacio y la posible localización del barrio de Tzapotlán, componente de México-Tenochtitlan. Por último, Francisca Ramírez parte del análisis documental, la información arqueológica y etnográfica para ofrecer un panorama que asocia los cambios climáticos y las fluctuaciones demográficas en el valle de Tehuacan para el Posclásico tardío y la primera parte de la Colonia. No podemos concluir la presentación de este número sin llamar la atención del lector a nuestras ya acostumbradas secciones Archivo Técnico y Noticia, igualmente enriquecedoras y no menos importantes; en esta ocasión ofrecemos un texto de Florencia Jacobs Muller sobre Teotihuacan, y un reporte de Rodolfo Cid y Liliana Torres a propósito del deterioro de materiales óseos. Fieles al compromiso de mantener y mejorar la calidad de este espacio de difusión y comunicación académica, esperamos que este material les sea de utilidad y los estimule a enviar sus contribuciones.</p

Clinical characterization of data-driven diabetes subgroups in Mexicans using a reproducible machine learning approach

Introduction Previous reports in European populations demonstrated the existence of five data-driven adult-onset diabetes subgroups. Here, we use self-normalizing neural networks (SNNN) to improve reproducibility of these data-driven diabetes subgroups in Mexican cohorts to extend its application to more diverse settings.Research design and methods We trained SNNN and compared it with k-means clustering to classify diabetes subgroups in a multiethnic and representative population-based National Health and Nutrition Examination Survey (NHANES) datasets with all available measures (training sample: NHANES-III, n=1132; validation sample: NHANES 1999–2006, n=626). SNNN models were then applied to four Mexican cohorts (SIGMA-UIEM, n=1521; Metabolic Syndrome cohort, n=6144; ENSANUT 2016, n=614 and CAIPaDi, n=1608) to characterize diabetes subgroups in Mexicans according to treatment response, risk for chronic complications and risk factors for the incidence of each subgroup.Results SNNN yielded four reproducible clinical profiles (obesity related, insulin deficient, insulin resistant, age related) in NHANES and Mexican cohorts even without C-peptide measurements. We observed in a population-based survey a high prevalence of the insulin-deficient form (41.25%, 95% CI 41.02% to 41.48%), followed by obesity-related (33.60%, 95% CI 33.40% to 33.79%), age-related (14.72%, 95% CI 14.63% to 14.82%) and severe insulin-resistant groups. A significant association was found between the SLC16A11 diabetes risk variant and the obesity-related subgroup (OR 1.42, 95% CI 1.10 to 1.83, p=0.008). Among incident cases, we observed a greater incidence of mild obesity-related diabetes (n=149, 45.0%). In a diabetes outpatient clinic cohort, we observed increased 1-year risk (HR 1.59, 95% CI 1.01 to 2.51) and 2-year risk (HR 1.94, 95% CI 1.13 to 3.31) for incident retinopathy in the insulin-deficient group and decreased 2-year diabetic retinopathy risk for the obesity-related subgroup (HR 0.49, 95% CI 0.27 to 0.89).Conclusions Diabetes subgroup phenotypes are reproducible using SNNN; our algorithm is available as web-based tool. Application of these models allowed for better characterization of diabetes subgroups and risk factors in Mexicans that could have clinical applications