Evaluación del riesgo de diabetes mellitus tipo 2 en pacientes afectados con tuberculosis

Introduction: The diabetes mellitus and tuberculosis are emergent health problems around the world its impact has been growing and growing every year even though health professionals do their best effort to eradicate them and these diseases mutations could be a real health problem to fight against in the future. Through the years, different researches have demostrate that Diabetes mellitus increase the risk of getting sick of tuberculosis 2 and 4 times more frequently, it means it is a predisposing factor, but there are not researches that define this risk in a backward effect. Target: Establish risks of developing Diabetes Mellitus type 2 in patients affected by tuberculosis. Material and Method: A Quantitative, descriptive and transversal study was done, the statistical population was 60 users that take antifimic treatment in 4 Health Centers of District 09D04, zone 8. These users were tested through Findrisc Test. Results: Male patients have more risk of developing Diabetes Mellitus type 2 at the age below 45 years old and between 45 and 54 years old, in general form 48% of patients have a low level risk. Conclusion: The population of patients affected by tuberculosis has a low risk level and it is necessary take actions to mitigate this risk and prevent comorbidity.Introducción: La diabetes mellitus y la tuberculosis son problemas de salud emergentes a nivel mundial, su incidencia anual cada vez es mayor pese a todos los esfuerzos que se hacen por mitigarlas y su asociación podría ser un futuro problema de salud a enfrentar. A través de los años, diferentes investigaciones han demostrado que la Diabetes mellitus incrementa el riesgo de contraer tuberculosis entre 2 y 4 veces, es decir, es un factor predisponente pero no existen investigaciones que definan este riesgo de forma inversa. Objetivo: Determinar el riesgo de desarrollar DM2 en pacientes afectados con tuberculosis.Material y método: Se realizó un estudio cuantitativo, descriptivo y transversal, la población fueron 60 usuarios que asisten a tomar el tratamiento antifímico en 4 unidades operativas del Distrito de Salud 09D04, zona 8 a quienes se les aplico el test de Findrisc. Resultados: El género masculino presenta un mayor riesgo de desarrollar DM2 junto con el grupo etario de <45 años y 45 – 54 años, de forma general el 48% tienen un nivel de riesgo bajo. Conclusión: La población de pacientes afectados con tuberculosis, aunque presentan niveles de riesgo bajo, este se encuentra presente y es necesario tomar medidas para mitigar este riesgo y prevenir comorbilidades

Seasonally Forced SIR Systems Applied to Respiratory Infectious Diseases, Bifurcations, and Chaos

We investigate models to describe respiratory diseases with fast mutating virus pathogens such that after some years the aquired resistance is lost and hosts can be infected with new variants of the pathogen. Such models were initially suggested for respiartory diseases like influenza, showing complex dynamics in reasonable parameter regions when comparing to historic empirical influenza like illness data, e.g., from Ille de France. The seasonal forcing typical for respiratory diseases gives rise to the different rich dynamical scenarios with even small parameter changes. Especially the seasonality of the infection leads for small values already to period doubling bifurcations into chaos, besides additional coexisting attractors. Such models could in the future also play a role in understanding the presently experienced COVID-19 pandemic, under emerging new variants and with only limited vaccine efficacies against newly upcoming variants. From first period doubling bifurcations, we can eventually infer at which close by parameter regions complex dynamics including deterministic chaos can arise.Marie Skłodowska-Curie grant agreement No. 79249

The current state of antifungal stewardship among pediatric antimicrobial stewardship programs

OBJECTIVE: To characterize the current state of antifungal stewardship practices and perceptions of antifungal use among pediatric antimicrobial stewardship programs (ASPs). DESIGN: We developed and distributed an electronic survey, which included 17 closed-ended questions about institutional antifungal stewardship practices and perceptions, among pediatric ASPs. PARTICIPANTS: ASP physicians and pharmacists of 74 hospitals participating in the multicenter Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative. RESULTS: We sent surveys to 74 hospitals and received 68 unique responses, for a response rate of 92%. Overall, 63 of 68 the respondent ASPs (93%) reported that they conduct 1 or more antifungal stewardship activities. Of these 68 hospital ASPs, 43 (63%) perform prospective audit and feedback (PAF) of antifungals. The most common reasons reported for not performing PAF of antifungals were not enough time or resources (19 of 25, 76%) and minimal institutional antifungal use (6 of 25, 24%). Also, 52 hospitals (76%) require preauthorization for 1 or more antifungal agents. The most commonly restricted antifungals were isavuconazole (42 of 52 hospitals, 80%) and posaconazole (39 of 52 hospitals, 75%). Furthermore, 33 ASPs (48%) agreed or strongly agreed that antifungals are inappropriately used at their institution, and only 25 of 68 (37%) of ASPs felt very confident making recommendations about antifungals. CONCLUSIONS: Most pediatric ASPs steward antifungals, but the strategies employed are highly variable across surveyed institutions. Although nearly half of respondents identified inappropriate antifungal use as a problem at their institution, most ASPs do not feel confident making recommendations about antifungals. Future studies are needed to determine the rate of inappropriate antifungal use and the best antifungal stewardship strategies

Characteristics of antifungal utilization for hospitalized children in the United States

OBJECTIVE: To characterize antifungal prescribing patterns, including the indication for antifungal use, in hospitalized children across the United States. DESIGN: We analyzed antifungal prescribing data from 32 hospitals that participated in the SHARPS Antibiotic Resistance, Prescribing, and Efficacy among Children (SHARPEC) study, a cross-sectional point-prevalence survey conducted between June 2016 and December 2017. METHODS: Inpatients aged \u3c18 years with an active systemic antifungal order were included in the analysis. We classified antifungal prescribing by indication (ie, prophylaxis, empiric, targeted), and we compared the proportion of patients in each category based on patient and antifungal characteristics. RESULTS: Among 34,927 surveyed patients, 2,095 (6%) received at least 1 systemic antifungal and there were 2,207 antifungal prescriptions. Most patients had an underlying oncology or bone marrow transplant diagnosis (57%) or were premature (13%). The most prescribed antifungal was fluconazole (48%) and the most common indication for antifungal use was prophylaxis (64%). Of 2,095 patients receiving antifungals, 79 (4%) were prescribed \u3e1 antifungal, most often as targeted therapy (48%). The antifungal prescribing rate ranged from 13.6 to 131.2 antifungals per 1,000 patients across hospitals ( CONCLUSIONS: Most antifungal use in hospitalized children was for prophylaxis, and the rate of antifungal prescribing varied significantly across hospitals. Potential targets for antifungal stewardship efforts include high-risk, high-utilization populations, such as oncology and bone marrow transplant patients, and specific patterns of utilization, including prophylactic and combination antifungal therapy

A new minute Pristimantis (Amphibia: Anura: Strabomantidae) from the Andes of southern Ecuador

We describe a new rainfrog species (Pristimantis), from the wetland complex Oña, Nabón, Saraguro and Yacuambi, in the Andes of southern Ecuador, at altitudes ranging between 3000–3400 m a.s.l. Pristimantis tiktik sp. nov. is a small frog, displaying sexual dimorphism (the males with dorsum of various shades of gray, brown, orange or green and a whitish or pinkish yellow venter; females with brownish gray or gray dorsum and a reticulated white and black venter), with SVL ranging between 19.7–20.4 mm in females (n = 3) and 16.1–18.4 mm in males (n = 6). The skin on dorsum is tuberculated, that on venter is coarsely areolate, dorsolateral folds are absent, tympanic membrane is absent but the tympanic annulus is evident, cranial crests are absent, discs on fingers just slightly expanded, heel is lacking enlarged tubercles, inner edge of tarsus is bearing a long fold, Toe V is slightly longer than Toe III and the iris coloration is bronze with fine black reticulations. The males have a large subgular vocal sac that extends onto the chest and vocal slits but lack nuptial pads. The unique advertisement call consists of long duration series of periodically repeated clicks: “tik”. Molecular analyses place the new species in the recently resurrected P. orestes group, as the sister species of the assemblage that contains P. bambu, P. mazar, P. simonbolivari and an undescribed species. © 2018 Székely et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Peer reviewe

Study of the Perception of Thermal Comfort, Residential Satisfaction and Management Model, of the Residents of the Conservation and Energy Rehabilitation Area in the Pirineos Street, Santa Coloma de Gramenet, Spain

Para la rehabilitación del parque habitacional en zonas vulnerables, es necesario implementar modelos de gestión innovadores mediante la colaboración público-privada.El modelo de gestión utilizado en el Área de Conservación y Rehabilitación (ACR) en calle Pirineos, en el municipio de Santa Coloma de Gramenet es pionero en Cataluña ya que no se había logrado una rehabilitación del parque habitacional privado con recursos de los mismos particulares, en el contexto de un área con una población de renta baja. La función del gobierno municipal fue de promotor y mediador con los vecinos, proyectos técnicos y contratistas para la ejecución de la obra. Otro de los factores innovadores es que el Ayuntamiento funge como instancia crediticia, financiando el proyecto y ofreciendo facilidades de pago a los propietarios de las viviendas, por lo que asume el pago inicial a los contratistas, siendo una de las claves para lograr llevar a cabo la rehabilitación. Así, los propietarios tienen facilidades para retornar al Ayuntamiento el coste de las obras, o bien en dos pagos, o bien en pagos fraccionados durante cinco años e incluso inscribiendo la deuda en el registro de la propiedad en función de las condiciones individuales de cada titular.Considerando lo anterior, la presente investigación pretende conocer con mayor profundidad los cambios percibidos por los usuarios, después de la rehabilitación de sus viviendas, en tres áreas: (I) el confort térmico; (II) la satisfacción residencial; (III) y el modelo de gestión utilizado por el Ayuntamiento de Santa Coloma de Gramenet; para lo cual se realizó una encuesta cerrada, aplicada a las personas mayores de edad, cabezas de familia y que llevan habitando dentro del ACR Pirineos por más de un año, al ser susceptibles de haber notado los posibles cambios producidos por la intervención.De los resultados encontrados, uno de los más relevantes es la gestión del Ayuntamiento, que en términos generales se percibe como buena y en particular el sistema de pago. En relación con la satisfacción residencial, aún no se percibe ningún cambio trascendental sobre las relaciones sociales entre los vecinos del barrio y edificio, sin embargo, existe una percepción de mejora en la imagen del barrio y en la revalorización de sus viviendas. Respecto al confort térmico interior, la percepción de los usuarios ha mejorado en las viviendas que antes de la rehabilitación eran más frías, sin embargo, no en todos los casos han sentido diferencia en la temperatura de su hogar.Esta investigación se ha realizado dentro del seminario de la línea de máster en Gestión y Valoración Urbana y Arquitectónica en el marco del proyecto EnerValor (MINECO/FEDER BIA2015-63606-R)Per a la rehabilitació del parc residencial en zones vulnerables, cal implementar models de gestió innovadors mitjançant la col·laboració publico-privada.El model de gestió utilitzat en l'Àrea de Conservació i Rehabilitació (ACR) en carrer Pirineus, al municipi de Santa Coloma de Gramenet és pioner a Catalunya ja que no s'havia aconseguit una rehabilitació del parc d’habitatge privat amb recursos dels mateixos particulars, en el context d'una àrea amb una població de renda baixa. La funció del govern municipal va ser de promotor i mediador amb els veïns, projectes tècnics i contractistes per a l'execució de l'obra. Un altre dels factors innovadors és que l'Ajuntament dona com a instància creditícia, finançant el projecte i oferint facilitats de pagament als propietaris dels habitatges, de manera que assumeix el pagament inicial als contractistes, sent una de les claus per aconseguir dur a terme la rehabilitació. Així, els propietaris tenen facilitats per retornar a l'Ajuntament el cost de les obres, o bé en dos pagaments, o bé en pagaments fraccionats durant cinc anys i fins i tot inscrivint el deute en el registre de la propietat en funció de les condicions individuals de cada titular .Atès l'anterior, la present investigació pretén conèixer amb més profunditat els canvis percebuts pels usuaris, després de la rehabilitació dels seus habitatges, en tres àrees: (I) el confort tèrmic; (II) la satisfacció residencial; (III) i el model de gestió utilitzat per l'Ajuntament de Santa Coloma de Gramenet; per a això es va realitzar una enquesta tancada, aplicada a les persones majors d'edat, caps de família i que porten habitant dins el ACR Pirineus per més d'un any, en ser susceptibles d'haver notat els possibles canvis produïts per la intervenció.Dels resultats trobats, un dels més rellevants és la gestió de l'Ajuntament, que en termes generals es percep com a bona i en particular el sistema de pagament. En relació amb la satisfacció residencial, encara no es percep cap canvi transcendental sobre les relacions socials entre els veïns del barri i edifici, però, hi ha una percepció de millora en la imatge del barri i en la re valorització dels seus habitatges. Pel que fa al confort tèrmic interior, la percepció dels usuaris ha millorat en els habitatges que abans de la rehabilitació eren més fredes, però, no en tots els casos han sentit diferència en la temperatura de la seva llar.Aquesta investigació s'ha realitzat dins del seminari de la línia de màster en Gestió i Valoració Urbana i Arquitectònica en el marc del projecte EnerValor (MINECO / FEDER BIA2015-63606-R)For the rehabilitation of the housing stock in vulnerable areas, it is necessary to implement innovative management models through public-private collaboration.The management model used in the Conservation and Rehabilitation Area (ACR) on Pirineos Street, in the municipality of Santa Coloma de Gramenet, is a pioneer in Catalonia since it had not achieved a rehabilitation of the private housing stock with resources of the same individuals, in the context of an area with a low income population. The function of the municipal government was to promote and mediate with the neighbors, technical projects and contractors for the execution of the work. Another innovative factor is that the City Council acts as a credit institution, financing the project and offering payment facilities to homeowners, so it assumes the initial payment to contractors, being one of the keys to achieving rehabilitation. Thus, the owners have facilities to return to the City Council the cost of the works, either in two payments, or in installments over five years and even inscribing the debt in the property registry depending on the individual conditions of each owner.Considering the above, the present investigation intends to know in greater depth the changes perceived by users after rehabilitation in three areas: (I) thermal comfort; (II) residential satisfaction; (III) and the management model used by the City Council of Santa Coloma de Gramenet; for which a closed survey was carried out, applied to the elderly, heads of family and who have been living within the Pyrenees ACR for more than a year, being susceptible to having noticed the possible changes produced by the intervention.Of the results found, one of the most relevant is the management of the City Council, which in general terms is perceived as good and in particular the payment system. In relation to residential satisfaction, there is still no significant change in the social relations between the residents of the neighborhood and the building; however, there is a perception of improvement in the image of the neighborhood and in the revaluation of their homes. With regard to indoor thermal comfort, the perception of users has improved in homes that were colder before the rehabilitation, but not in all cases they have felt difference in the temperature of their home.This research has been carried out within the seminar of the master's degree in Management and Urban and Architectural Assessment within the framework of the EnerValor project (MINECO/FEDER BIA2015-63606-R)Peer Reviewe

Pacific island regional preparedness for El Niño

The El Niño Southern Oscillation (ENSO) cycle is often blamed for disasters in Pacific island communities. From a disaster risk reduction (DRR) perspective, the challenges with the El Niño part of the ENSO cycle, in particular, are more related to inadequate vulnerability reduction within development than to ENSO-induced hazard influences. This paper analyses this situation, filling in a conceptual and geographic gap in El Niño-related research, by reviewing El Niño-related preparedness (the conceptual gap) for Pacific islands (the geographic gap). Through exploring El Niño impacts on Pacific island communities alongside their vulnerabilities, resiliences, and preparedness with respect to El Niño, El Niño is seen as a constructed discourse rather than as a damaging phenomenon, leading to suggestions for El Niño preparedness as DRR as part of development. Yet the attention which El Niño garners might bring resources to the Pacific region and its development needs, albeit in the short term while El Niño lasts. Conversely, the attention given to El Niño could shift blame from underlying causes of vulnerability to a hazard-centric viewpoint. Instead of focusing on one hazard-influencing phenomenon, opportunities should be created for the Pacific region to tackle wider DRR and development concerns

Galapagos sperm whales (Physeter macrocephalus): waxing and waning over three decades

While population sizes and structures naturally fluctuate over time, rapid within-generation changes are usually driven by habitat quality shifts and/or abrupt mortality. We evaluate how sperm whales (Physeter macrocephalus, L. 1758 (=Physeter catodon, L. 1758)) responded to the dynamic habit off the Galápagos Islands over 30 years, relating it to variation in prey availability and whaling operations in the tropical Pacific. In the 1980’s, males and females were commonly sighted foraging and socializing in the northwest of the archipelago. Sightings decreased during the 1990’s; by the 2000’s they became very rare: occasional single foraging males were sighted and females abandoned the archipelago. In the 2010’s, whales return to the southern waters, in large groups with apparently more breeding males and calves. The waxing and waning of Galápagos sperm whales are likely caused by environmental shifts together with ripple effects of whaling. Their patchy prey are influenced by variation in sea temperature and productivity, which drives movements of whales in and out of the archipelago. Whaling may have aggravated these movements by leaving an attractive surplus of prey in coastal waters depleted of whales. These findings highlight the magnitude of spatiotemporal scales used by sperm whales and the consequent challenges of assessing population dynamics of long-lived, mobile pelagic species.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author