Cardiopatía de la fibrosis quística: estudio descriptivo y de posibles factores asociados. Una forma nueva de enfermedad de Keshan

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 22 de Noviembre de 2012

Mechanical efficiency of high versus moderate intensity aerobic exercise in coronary heart disease patients: A randomized clinical trial

Background: Mechanical efficiency (ME) refers to the ability of an individual to transfer energy consumed by external work. A decreased ME, could represent an increased energy cost during exercise and may, therefore, be limited in terms of physical activity. This study aimed to compare the influence of two different exercise protocols: moderate continuous training (MCT) versus high intensity interval training (HIIT), as part of a cardiac rehabilitation program on ME values among coronary patients.  Methods: One hundred and ten coronary patients were assigned to either HIIT or MCT groups for 8 weeks. Incremental exercise tests in a cycle ergometer were performed to obtain VO2peak. Net energy expenditure (EE) and ME were obtained at intensities corresponding to the first (VT1) and second (VT2) ventilatory thresholds, and at VO2peak. Results: Both exercise programs significantly increase VO2peak with a higher increase in the HIIT group (2.96 ± 2.33 mL/kg/min vs. 3.88 ± 2.40 mL/kg/min, for patients of the MCT and HIIT groups, respectively, p < 0.001). The ME at VO2peak and VT2 only significantly increased in the HIIT group. At VT1, ME significantly increased in both groups, with a greater increase in the HIIT group (2.20 ± ± 6.25% vs. 5.52 ± 5.53%, for patients of the MCT and HIIT groups, respectively, p < 0.001).  Conclusions: The application of HIIT to patients with chronic ischemic heart disease of low risk re- sulted in a greater improvement in VO2peak and in ME at VT1, than when MCT was applied. Moreover, only the application of HIIT brought about a significant increase in ME at VT2 and at VO2peak.

Mechanical efficiency of high versus moderate intensity aerobic exercise in coronary heart disease patients: A randomized clinical trial.

Background: Mechanical efficiency (ME) refers to the ability of an individual to transfer energy consumed by external work. A decreased ME, could represent an increased energy cost during exercise and may, therefore, be limited in terms of physical activity. This study aimed to compare the influence of two different exercise protocols: moderate continuous training (MCT) versus high intensity interval training (HIIT), as part of a cardiac rehabilitation program on ME values among coronary patients. Methods: One hundred and ten coronary patients were assigned to either HIIT or MCT groups for 8 weeks. Incremental exercise tests in a cycle ergometer were performed to obtain VO2peak. Net energy expenditure (EE) and ME were obtained at intensities corresponding to the first (VT1) and second (VT2) ventilatory thresholds, and at VO2peak. Results: Both exercise programs significantly increase VO2peak with a higher increase in the HIIT group (2.96 ± 2.33 mL/kg/min vs. 3.88 ± 2.40 mL/kg/min, for patients of the MCT and HIIT groups, respectively, p < 0.001). The ME at VO2peak and VT2 only significantly increased in the HIIT group. At VT1, ME significantly increased in both groups, with a greater increase in the HIIT group (2.20 ± ± 6.25% vs. 5.52 ± 5.53%, for patients of the MCT and HIIT groups, respectively, p < 0.001). Conclusions: The application of HIIT to patients with chronic ischemic heart disease of low risk resulted in a greater improvement in VO2peak and in ME at VT1, than when MCT was applied. Moreover, only the application of HIIT brought about a significant increase in ME at VT2 and at VO2peak. (Cardiol J 2019; 26, 2: 130–137)post-print251 K

Diversidad y estructura genética de artibeus jamaicensis (chiroptera: phyllostomidae) en Chiapas, México

Deforestation causes fragmentation of habitats, which in turn affects the composition, abundance and demography of species, and therefore the population isolation of many species. The impacts of fragmentation will depend on the responsiveness of the species to disturbances in their habitat, and the configuration and structure of landscape. In some populations, habitat fragmentation can cause long-term population isolation by the reduction in population size and the weakening of relations between individuals, even in highly mobile species like bats. In Mexico, A. jamaicensis is the most studied bat; however, few studies focused on the knowledge of the impacts of habitat modification in its diversity and genetic structure. Therefore, the objective of this study was to evaluate the diversity, structure and genetic differentiation, and analyze demographic history of A. jamaicensis in two different habitats, using a 396 bp fragment of the mitochondrial Dloop region. Haplotype network revealed 34 unique haplotypes of 34 individuals analyzed. Haplotype diversity was high (h = 1) for both populations, and nucleotide diversity was relatively low (&lt; 0.03). The analysis of the distribution of pairwise differences between sequences and negative values of statistical tests based on neutrality suggest a process of recent and sudden demographic expansion of A. jamaicensis. A moderate genetic differentiation points to the existence of genetic structure of A. jamaicensis.La deforestación de las selvas provoca la fragmentación de los hábitats, lo cual interviene en la composición, abundancia y  demografía de las especies, y por lo tanto, en el aislamiento poblacional en muchas especies. Los impactos de la fragmentación dependerán de la capacidad de respuesta de las especies a los disturbios en su hábitat, y de la configuración y estructura del paisaje. En algunas poblaciones, la fragmentación del hábitat puede provocar el aislamiento poblacional a largo plazo, por la reducción del tamaño poblacional y el debilitamiento de relaciones entre individuos, aún en especies de  alta movilidad como los murciélagos. En México, A. jamaicensis es de los murciélagos más estudiados; sin embargo, son pocos los  trabajos enfocados en conocer los impactos de la modificación de su hábitat, en su diversidad y estructura genética. Por lo tanto, el objetivo de este trabajo fue evaluar la diversidad, la estructura y la diferenciación genética, así como analizar la historia demográfica de A. jamaicensis en dos hábitats diferentes, utilizando un fragmento de 396 pb de la región mitocondrial D-loop. La red de haplotipos reveló 34 haplotipos únicos de 34 individuos analizados. La diversidad haplotípica fue alta (h = 1) para ambas poblaciones, y la diversidad nucleotídica fue relativamente baja (&lt; 0.03). El análisis de la distribución de diferencias nucleotídicas pareadas (distribución mismatch), y los valores negativos de los estadísticos basados en pruebas de neutralidad, sugieren un proceso de expansión demográfica reciente y repentina de A. jamaicensis. Una moderada diferenciación genética apunta a que existe estructura genética de A. jamaicensis

Genetic variation of four tropical tree species in the Selva El Ocote Biosphere Reserve, Chiapas, Mexico

Antecedentes y Objetivos: La variación genética de especies de árboles es escasamente conocida para los bosques tropicales de México. El objetivo fue analizar la diversidad genética de Brosimum alicastrum (Moraceae) y Sapium macrocarpum (Euphorbiaceae) (especies sucesionalmente intermedias y con dispersión zoocora) y de Cecropia peltata (Cecropiaceae) y Heliocarpus appendiculatus (Malvaceae) (sucesionalmente tempranas o pioneras, con síndrome de dispersión zoocora y anemócora, respectivamente), en la selva mediana subperennifolia de la Reserva de la Biosfera Selva El Ocote (REBISO), Chiapas, México. Métodos: Se amplificaron dos regiones de ADN del gen nuclear ribosomal, ITS 1-2 e ITS 3-4, como marcadores genéticos. El ADN se extrajo de hojas o cambium de árboles de las especies elegidas en tres localidades (subpoblaciones) de la REBISO. A partir de secuencias concatenadas (578 pb), se obtuvieron los estimadores de diversidad y diferenciación genética. Resultados clave: Se registraron ocho haplotipos en B. alicastrum, 12 en S. macrocarpum, cinco en H. appendiculatus y seis en C. peltata. Los valores más altos para la mayoría de los estimadores se presentaron en S. macrocarpum (π = 0.0047, Hd = 0.79, s = 10), y también registró la menor diferenciación entre localidades (Φst = 0.22). Heliocarpus appendiculatus y C. peltata presentaron, valores más bajos de diversidad, pero una mayor diferenciación entre las localidades (Φst ~ 0.80). Conclusiones: En general, el mayor nivel de diversidad genética se registró en S. macrocarpum, especie sucesionalmente intermedia y con síndrome de dispersión zoocora. Se observó una menor variación y mayor diferenciación en las especies pioneras, H. appendiculatus y C. peltata. La variación genética observada se ajusta a un modelo evolutivo neutral, por lo que probablemente el patrón de variación observado se debe a procesos evolutivos aleatorios. No obstante, el síndrome de dispersión y su afinidad sucesional influyen en la distribución espacial de la diversidad genética.Background and Aims: Genetic variation of tree species is poorly understood for tropical forests of Mexico. The objective was to analyze the genetic diversity of Brosimum alicastrum (Moraceae) and Sapium macrocarpum (Euphorbiaceae), successionally intermediate species and dispersed by animal (zoochory), and Cecropia peltata (Cecropiaceae) and Heliocarpus appendiculatus (Malvaceae), early successional or pioneer, zoochory and anemochory dispersal syndrome, respectively, of the semi-evergreen forest of the Selva El Ocote Biosphere Reserve (REBISO), Chiapas, Mexico.Methods: Two DNA regions of the ribosomal nuclear gene, ITS 1-2 and ITS 3-4, were amplified as genetic markers. DNA was extracted from leaves or cambium of trees of the chosen species from three locations (or subpopulations) in the REBISO. From concatenated sequences (578 bp), the estimators of genetic diversity were obtained.Key results: Eight haplotypes were recorded in B. alicastrum, 12 in S. macrocarpum, five in H. appendiculatus and six in C. peltata. The highest values for most of the diversity estimators were observed in S. macrocarpum (π = 0.047, Hd = 0.79, s = 10), and the lowest differentiation between subpopulations was also recorded in this species (Φst = 0.22). In contrast, H. appendiculatus and C. peltata presented lower values but greater differentiation between the subpopulations (Φst ~ 0.80). Conclusions: Overall, the highest level of genetic diversity was recorded for S. macrocarpum, a successionally intermediate species and with zoochorous dispersal syndrome. Less variation was observed within species and greater differentiation in successionally pioneer species, H. appendiculatus and C. peltata. The genetic variation observed fits well a neutral evolutionary model; therefore, the pattern of genetic variation probably was driven by random evolutionary processes. However, the dispersal syndrome and successional affinity influence spatial distribution of genetic diversity

Effect of high-intensity interval versus continuous exercise training on functional capacity and quality of life in patients with coronary artery disease.

There is strong evidence that exercise training has beneficial health effects in patients with cardiovascular disease. Most studies have focused on moderate continuous training (MCT); however, a body of evidence has begun to emerge demonstrating that highintensity interval training (HIIT) has significantly better results in terms of morbidity and mortality. The aim of this study was to compare the effects of MCT versus HIIT on functional capacity and quality of life and to assess safety. Seventy-two patients with ischemic heart disease were assigned to either HITT or MCT for 8 weeks. We analyzed cardiopulmonary exercise stress test data, quality of life, and adverse events.High-intensity interval training resulted in a significantly greater increase in V · O 2 peak (4.5 ± 4.7 mL·kg − 1 ·min − 1 ) compared with MCT (2.5 ± 3.6 mL·kg − 1 ·min − 1 ) ( P < .05). The aerobic threshold (V T 1 ) increased by 21% in HIIT and 14% in MCT. Furthermore, there was a significant ( P < .05) increase in the distance covered in the 6-minute walk distance test in the HIIT group (49.6 ± 6.3 m) when compared with the MCT group (29.6 ± 12.0 m). Both training protocols improved quality of life. No adverse events were reported in either of the groups.On the basis of the results of this study, HIIT should be considered for use in cardiac rehabilitation as it resulted in a greater increase in functional capacity compared with MCT. We also observed greater improvement in quality of life without any increase in cardiovascular risk.post-print377 K

Sistema de seguridad y salud en el trabajo Norcol Colombia s.a.s

Elaborar el sistema de gestión de seguridad y salud en el trabajo SG-SST; donde la minería es una industria de alto riesgo en la cual el SG-SST que se trata de un proceso coherente, escalonado y lógico puede ser una herramienta eficaz para reducir los accidentes de trabajo y enfermedades profesionales. Se desarrolló en base en el Decreto 1072 de 2015 y el Decreto 0312 de 2019, realizamos la elaboración del SGSST para la empresa Norcol Colombia.Prepares the occupational health and safety management system SG-SST; where mining is a high-risk industry in which the SG-OSH is a coherent, staggered and logical process, can be an effective tool to reduce work accidents and occupational diseases.Based on Decree 1072 of 2015 and Decree 0312 of 2019, we prepared the SGSST for the company Norcol Colombia

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamentos de Bogotá D.C y Cundinamarca

En el presente trabajo se logra conocer varios relatos de hechos desafortunados que han enfrentado diferentes colombianos, además permite el aprendizaje significativo y la construcción de estrategias psicosociales mediante herramientas, metodologías y acciones que hacen que se conozca y se promuevan las redes de apoyo, la participación colectiva, la restauración y el reconocimiento de identidad, cultura disminuyendo así las consecuencias ocasionadas por la violencia. Mediante la lectura y la escucha asertiva de manera individual y seguidamente de manera colaborativa se lleva a cabo un análisis e identificación de factores relevantes de los distintos casos, como lo fue la resiliencia y las aptitudes propias de las personas para superar estas situaciones, de manera grupal se aborda el de Shimaia generando unos interrogantes de tipo circulares, reflexivos y estratégicos y luego se realiza un segundo análisis a un caso específico (masacre de El Salado) desarrollando unas estrategias que promuevan unas acciones psicosociales en pro de la reconstrucción y motivación. Con lo anterior se identifica que las víctimas afrontan la violencia mediante unas herramientas y unas redes de apoyo que les permite generar en comunidad un ambiente alentador y restaurativo. Por último, es la memorización un acto de concientización para todo el país y un homenaje para las víctimas y sus familiares en donde queda para la historia y para continuar con la lucha de una verdad y una justicia, por eso las foto-voz llevadas a cabo son realizadas mediante esa observación y esa identificación de vulneración de derechos en diferentes espacios.In this work it is possible to know several stories of unfortunate events that different Colombians have faced in their lives can be learned. It also allows for meaningful learning and the construction of psychosocial strategies through tools, methodologies and actions that make it possible to learn about and promote support networks, collective participation, restoration and recognition of identity and culture, thus reducing the consequences caused by violence. Through reading and assertive listening, individually and then collaboratively, an analysis and identification of relevant factors of the different cases is carried out, such as resilience and people's own skills to overcome these situations; the Shimaia case is approached as a group, generating circular, reflective and strategic questions, and then a second analysis is made of a specific case (El Salado massacre), developing strategies that promote psychosocial actions for reconstruction and motivation. With the above, it is identified that the victims face violence through tools and support networks that allow them to generate an encouraging and restorative environment in the community. Finally, memorialization is an act of awareness for the whole country and a tribute to the victims and their families where it remains for history and to continue with the struggle for truth and justice, that is why the photo-voices carried out are made through this observation and identification of rights violations in different spaces

The cardiomyopathy of cystic fibrosis: a modern form of Keshan disease

IntroductionWe conducted a study to determine the prevalence of structural heart disease in patients with CF, the characteristics of a cardiomyopathy not previously described in this population, and its possible relationship with nutritional deficiencies in CF.MethodsWe studied 3 CMP CF patients referred for heart-lung transplantation and a prospective series of 120 adult CF patients. All patients underwent a clinical examination, blood tests including levels of vitamins and trace elements, and echocardiography with evaluation of myocardial strain. Cardiac magnetic resonance imaging (CMR) was performed in patients with CMP and in a control group. Histopathological study was performed on hearts obtained in transplant or necropsy.ResultsWe found a prevalence of 10% (CI 4.6%–15.4%) of left ventricular (LV) dysfunction in the prospective cohort. Myocardial strain parameters were already altered in CF patients with otherwise normal hearts. Histopathological examination of 4 hearts from CF CMP patients showed a unique histological pattern of multifocal myocardial fibrosis similar to Keshan disease. Four of the five CF CMP patients undergoing CMR showed late gadolinium uptake, with a characteristic patchy pattern in 3 cases (p &lt; 0.001 vs. CF controls). Selenium deficiency (Se &lt; 60 µg/L) was associated with more severe LV dysfunction, higher prevalence of CF CMP, higher NTproBNP levels, and more severe pulmonary and digestive involvement.Conclusion10% of adults with CF showed significant cardiac involvement, with histological and imaging features resembling Keshan disease. Selenium deficiency was associated with the presence and severity of LV dysfunction in these patients

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