Un llamado ético a la inclusión de mujeres embarazadas en investigación: Reflexiones del Foro Global de Bioética en Investigación

El Foro Global de Bioética en Investigación (GFBR por sus siglas en inglés) se reunió el 3 y 4 de noviembre en Buenos Aires, Argentina, con el objetivo de discutir la ética de la investigación con mujeres embarazadas. El GFBR es una plataforma mundial que congrega a actores clave con el objetivo de promover la investigación realizada de manera ética, fortalecer la ética de la investigación en salud, particularmente en países de ingresos bajos y medios, y promover colaboración entre países del norte y del sur.a Los participantes en el GFBR provenientes de Latinoamérica incluyeron a eticistas, investigadores, miembros de comités de ética y representantes de autoridades sanitarias provenientes de Argentina, Brasil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Panamá, Perú, Nicaragua y la República Dominicana. Una legítima preocupación por la protección de las mujeres embarazadas y sus embriones o fetos ha llevado a la mayoría de los países de la Región de las Américas a limitar la realización de estudios con mujeres embarazadas exclusivamente a aquellos estudios específicos sobre el embarazo, y a requerir la exclusión sistemática de las mujeres embarazadas o de las mujeres que quedan embarazadas en el curso del estudio. Ciertamente, a lo largo de la historia de la ética de la investigación, se ha creído erróneamente que proteger a una población es sinónimo de excluirla de los estudios. Se sabe ahora que proceder así implica exponer a riesgos mucho mayores a la población que se busca proteger. El embarazo implica cambios fisiológicos sustantivos e impacta profundamente la manera como el cuerpo metaboliza los medicamentos. Sin embargo, por evitar hacer investigación con mujeres embarazadas, no se ha producido la evidencia científica necesaria para tomar decisiones sobre tratamientos e intervenciones preventivas con dosis eficaces y seguras para ellas y sus embriones o fetos. A manera de ilustración, en el 2001 había en los Estados Unidos apenas más de una docena de medicamentos aprobados para uso en el embarazo (1) y en el 2011 la Food and Drug Administration (FDA) aprobó por primera vez en 15 años un medicamento para su uso en el embarazo (2). Como consecuencia de no haber producido la evidencia necesaria, se pone en riesgo la salud de las mujeres embarazadas cada vez que se les da atención médica. Las mujeres embarazadas se enferman y las mujeres enfermas se embarazan, y no se sabe si los medicamentos que se les da son eficaces o siquiera seguros para ellas y sus embriones o fetos

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Molecular mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death 2018.

Over the past decade, the Nomenclature Committee on Cell Death (NCCD) has formulated guidelines for the definition and interpretation of cell death from morphological, biochemical, and functional perspectives. Since the field continues to expand and novel mechanisms that orchestrate multiple cell death pathways are unveiled, we propose an updated classification of cell death subroutines focusing on mechanistic and essential (as opposed to correlative and dispensable) aspects of the process. As we provide molecularly oriented definitions of terms including intrinsic apoptosis, extrinsic apoptosis, mitochondrial permeability transition (MPT)-driven necrosis, necroptosis, ferroptosis, pyroptosis, parthanatos, entotic cell death, NETotic cell death, lysosome-dependent cell death, autophagy-dependent cell death, immunogenic cell death, cellular senescence, and mitotic catastrophe, we discuss the utility of neologisms that refer to highly specialized instances of these processes. The mission of the NCCD is to provide a widely accepted nomenclature on cell death in support of the continued development of the field

Environmental awareness and eco-efficiency in the high school class at an educational institution in Peru

El objetivo fue determinar la relación entre la conciencia ambiental (CA) y ecoeficiencia (ECO) en escolares del 4° grado en las Institución Educativas Secundarias de la provincia de Andahuaylas, 2019. Presenta un diseño no experimental, tipo básico, enfoque cuantitativo y nivel correlacional, desarrolladas en las Institución Educativas Secundarias de la provincia de Andahuaylas, con una población de 280 educandos, y una muestra de 162 educandos. Se aplicaron dos instrumentos de 40 interrogantes para la V1 y de 44 ítems para la V2. De los resultados, se infiere nivel de asociatividad entre conciencia ambiental y ecoeficiencia. Con el Rho de Spearman, se obtuvo relación inversa y muy baja entre conciencia ambiental y la ecoeficiencia con (r = -0,043, p = 0.590>0,05), en escolares del cuarto grado en las I.E. Secundarias de la provincia de Andahuaylas, 2019. Palabras clave: conciencia ambiental; problemas ambientales; desarrollo sostenible; Ecoeficiencia; pensamiento global.The objective was to determine the relationship between environmental awareness (CA) and eco-efficiency (ECO) in 4th grade students in the Secondary Educational Institutions of the province of Andahuaylas, 2019. It presents a non-experimental design, basic type, quantitative approach and correlational level, developed in the Secondary Educational Institutions of the province of Andahuaylas, with a population of 280 students, and a sample of 162 students. Two instruments were applied with 40 questions for V1 and 44 items for V2. From the results, the level of associativity between environmental awareness and eco-efficiency is inferred. With Spearman's Rho, an inverse and very low relationship was obtained between environmental awareness and eco-efficiency (r = -0.043, p = 0.590>0.05), in fourth grade students in secondary schools in the province of Andahuaylas, 2019. Keywords: environmental awareness; environmental problems; sustainable development; eco-efficiency; global thinking

Capital intelectual y producción científica en la Universidad Peruana, 2018

El presente estudio el capital intelectual y la producción científica en la Universidad Peruana, tiene como objetivo: probar que los niveles de producción científica de 25 universidades del Perú se relacionan de manera directa y significativa con el capital intelectual en el año 2018, se han agrupado docentes bachilleres, magísteres, y doctores, para el capital intelectual y para la producción científica se ha coleccionado el número de tesis y documentos de investigación por universidad. Metodología es básica, no experimental y correlacional, los datos han sido extraídos de portal de universidades y la Superintendencia Nacional de Educación Superior Universitaria, los datos de producción científica se han obtenido de portal Alicia de Consejo Nacional de Ciencia, Tecnología e Innovación. Y se aplicó el cuestionario de percepción a 145 docentes de la Facultad de Ciencias Jurídicas, Empresariales y Pedagógicas de la Universidad José Carlos Mariátegui. Resultados; el capital intelectual fue evaluado en tres dimensiones de capital humano, estructural y relacional. En los datos cuantitativos de 25 universidades se demuestra que si hay relación directa entre las variables de 70.4%; y en percepción de docentes de la Universidad José Carlos Mariátegui en el año 2019, la correlación fue de 71.8%. Conclusión: Existe relación directa y significativa entre el capital intelectual y la producción científica, a mayores niveles de capital humano hay mayores niveles de producción científica y que a moderado niveles o bajos niveles de capital intelectual entonces la producción científica será en esos mismos niveles

Bioactividad de Plantas y Microorganismos de Ecosistemas de los Andes Ecuatorianos

Contiene: Evaluación de la actividad antifúngica de los aceites esenciales de Cymbopogon citratus y Eucaliptus globulus ante Colletotrichum sp. Estudio preliminar de los hongos del suelo en bosques de Polylepis y pastizales de zonas aledañas al PNC, Ecuador. Evaluación de mezclas de aceites esenciales de romero (Rosmarinus officinalis), arrayán (Myrceugenella apiculata) y menta (Mentha pulegium), como biocontroladores de Fusarium sp. Caracterización Nutricional y Actividad Antioxidante de Macleania rupestris (Joyapa) y Vaccinium floribundum Kunth (Mortiño). Actividad antimicrobiana de aceites esenciales de Menta (Mentha pulegium) y Cedrón (Alloysia tryphylla) en la germinación in vitro de la Orquídea Cattleya máxima. Actividad antibacteriana de extractos orgánicos y aceite esencial de Jungia rugosa Less.Especialista en Biotecnología Vegeta

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care