Factores de riesgo de mortalidad en pacientes con neumonía adquirida en la comunidad

Introduction: the acquired pneumonia in the community is defined as an inflammation of the lung parenchyma by an infectious agent. Objective: to determine the potential risk factors of mortality of different variables. Method: an analytical study was realized of such cases and controls in patients admitted in the Room of Internal Medicine at “Celestino Hernández Robau” Hospital with diagnosis of acquired pneumonia in the community in the period from January to December 2015. Results: the leukopenia and the hypotension detected at admission and ages 60 and older and prolonged bed rest behaved as the most common risk factors associated with mortality. Chronic obstructive pulmonary disease, history of cerebrovascular disease and the presence of neoplasms represent a fourfold increased risk as predictors. Conclusions: other variables such as submitting pneumonia in a shorter period of time than a year, history of ischemic heart disease, heart failure, alcoholism, chronic steroid use, diabetes mellitus, liver cirrhosis, smoking and presence of pleural effusion associated to an increased risk of mortality in relation to the control group, although to a lesser extent than before.Introducción: la neumonía adquirida en la comunidad se define como una inflamación del parénquima pulmonar por un agente infeccioso. Objetivo: determinar los posibles factores de riesgo de mortalidad de diferentes variables. Método: se realizó un estudio analítico de tipo casos y controles en pacientes ingresados en la Sala de Medicina Interna del Hospital “Celestino Hernández Robau” con diagnóstico de neumonía adquirida en la comunidad en el período de enero a diciembre de 2015. Resultados: la leucopenia y la hipotensión arterial detectadas al momento del ingreso, así como las edades de 60 años y más y el estar encamados por largo tiempo se comportaron como los factores de riesgo más frecuentes asociados a mortalidad. La enfermedad pulmonar obstructiva crónica, el antecedente de enfermedad cerebrovascular y la presencia de neoplasias suponen un riesgo cuatro veces mayor como predictores. Conclusiones: otras variables como haber presentado otra neumonía en un período de tiempo menor de un año, antecedentes de cardiopatía isquémica, insuficiencia cardíaca, alcoholismo, uso prolongado de esteroides, diabetes mellitus, cirrosis hepática, hábito de fumar y presencia de derrame pleural se asociaron a un riesgo mayor de mortalidad en relación con el grupo de controles, aunque en menor magnitud que los anteriores

Bioética, derechos humanos, marco constitucional en la gestión de la crisis sanitaria y las vacunas contra el Covid-19 en Ecuador

The measures applied by the Ecuadorian government to manage the health crisis caused by COVID-19 have been very controversial in terms of bioethical principles, Human Rights, and the constitutional framework. In this sense, the realization of a documentary-bibliographical investigation was proposed, in which laws, information and news about the coronavirus in Ecuador have been analyzed in order to know the consequences of the application of such measures. The right to health has been considered the main urgency to attend to in the country, however, the measures applied to attend to the health of Ecuadorians have undermined their fundamental rights, both in the health sector itself and in the economic, social, labor and moral. Consequently, a review of the fundamental bioethical principles should be proposed in such a way that moral and legal agreements are reached where fundamental rights are not violated.Las medidas aplicadas por el gobierno ecuatoriano para gestión de la crisis sanitaria causada por el COVID-19 han sido muy controversiales en cuanto a los principios bioéticos, Derechos Humanos, y el marco constitucional. En ese sentido se planteó la realización de una investigación de tipo documental-bibliográfico, en la que se han analizado leyes, informaciones y noticias sobre el coronavirus en el Ecuador con la finalidad de conocer las consecuencias de la aplicación de tales medidas. El derecho a la salud ha sido considerado como la principal urgencia que atender en el país, sin embargo, las medidas aplicadas para atender la salud de los ecuatorianos han socavado los derechos fundamentales de los mismos, tanto en el propio sector salud, como en el económico, social, laboral y moral. En consecuencia, se debe plantear una revisión de los principios bioéticos fundamentales de tal forma que se lleguen a acuerdos morales y legales donde los derechos fundamentales no sean violentados

Electrochemical Impedance Spectroscopy (EIS): A Review Study of Basic Aspects of the Corrosion Mechanism Applied to Steels

AC impedance measurements have been applied for over twenty years in electrochemistry and physics to investigate the electrical properties of conductive materials and their interfaces using an external electrical impulse (VOLTAGE, V or CURRENT, I) as driving force. Furthermore, its application has recently appeared to be destined in the Biotechnology field as an effective tool for rapid microbiologic diagnosis of living organism in situ. However, there is no doubt that the electrochemical impedance spectroscopy (EIS) is still one of the most useful techniques around the world for metal corrosion control and its monitoring. Corrosion has long been recognized as one of the most expensive stumbling blocks that concern many industries and government agencies, because it is a steel destructive phenomenon that occurs due to the chemical interaction with aqueous environments and takes place at the interface between metal and electrolyte producing an electrical charge transfer or ion diffusion process. Consequently, it is experimentally possible to determine through the EIS technique the mechanism and control that kinectics of corrosion reactions encounter. First, EIS data is collected through a potentiostat/ galvanostat apparatus. After, it is fitted to a mathematical model (i.e. an equivalent electrical circuit, EEC) for its interpretation and analysis, fundamentally seeking a meaningful physical interpretation. Finally, this review reports some basic aspects of the corrosion mechanism applied to steels through the experimental EIS response using Nyquist or Bode plots. Examples are given for different applied electrochemical impedance cases in which steel is under study intentionally exposed to a corrosive aqueous solution by applying a sinusoidal potential at various test conditions

Tumores pardos en paciente con hiperparatiroidismo secundario en hemodiálisis. Presentación de caso

Introducción: los tumores pardos son raras lesiones focales óseas de células gigantes que se presentan en el curso de hiperparatiroidismo primario, secundario o terciario como expresión de osteitis fibrosa quística. Los tumores pardos suelen ser confundidos con lesiones óseas malignas. Objetivo: describir el caso de una paciente bajo tratamiento de hemodiálisis, quien presenta tumores pardos en relación con hiperparatiroidismo secundario. Presentación de caso: describimos el caso de una paciente de 60 años bajo tratamiento de hemodiálisis con hiperparatiroidismo secundario, la que presenta radiológicamente lesiones osteolíticas en huesos largos, costillas y clavículas, diagnosticadas como tumores pardos. Múltiples calcificaciones vasculares fueron observadas. Conclusiones: esta manifestación de hiperparatiroidismo secundario se observa al incrementarse la longevidad de los pacientes con fallo renal. Una completa evaluación del paciente puede ayudar a un correcto diagnóstico.Palabras clave: tumores pardos, tumores de células gigantes, osteitis fibrosa quística, hiperparatiroidismo, hiperparatiroidismo secundario, hemodiálisis.ABSTRACTIntroduction: brown tumors are rare focal giant cell lesions of the bone, are expression of osteitisfibrosacystica due to primary, secondary, or tertiary hyperparathyroidism. It is well recognized that these brown tumours can be mistaken for malignancy. Objetive: to describe a case of a patient under hemodialysis treatment with Brown tumours due to secondary hyperparathyroidism. Case Presentation: we describe a 60-year-old female hemodialysis patient with secondary hyperparathyroidism in whom osteolithic lesions in long bones, ribs and clavicle were radiologically suspected to be brown tumor. Multiple vascular calcifications were also seen. Conclusions: this manifestation of secondary hyperparathyroidism can be expected to occur with increased longevity of patients with renal failure.  A complete evaluation can help to reach a correct diagnosis. Key words: Brown tumour, giant cells tumour, osteitisfibrosacystica, hyperparathyroidism, secondary hyperparathyroidism, hemodialysis. Normal 0 false false false EN-CA X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} <![endif]--

Arritmias ventriculares en pacientes con enfermedad renal crónica terminal en hemodiálisis. Monitorización Holter intradialítica

Introducción: las arritmias cardíacas son frecuentes en pacientes hemodializados y pueden contribuir a su mortalidad. Objetivo: estimar la frecuencia de aparición de arritmias ventriculares intradialíticas potencialmente fatales en pacientes con enfermedad renal crónica terminal en hemodiálisis y su asociación con variables clínicas, laboratorio, electrocardiográficas y ecocardiográficas. Material y Métodos: se investigaron 34 pacientes con enfermedad renal crónica terminal en hemodiálisis de tres hospitales de La Habana. A todos se les realizó ecocardiograma, electrocardiograma, potasio, calcio, urea en sangre. Se monitorizaron con Holter en la primera y segunda diálisis de la semana. Se obtuvieron 68 registros. Resultados: 36 registros (53%) exhibieron arritmias ventriculares y 32 (47%) no mostraron arritmias; 22 registros (32%) presentaron arritmias ventriculares potencialmente fatales. Los principales factores asociados con significación estadística a arritmias ventriculares potencialmente fatales fueron: edad &gt;45 años, tensión arterial media postdialítica &gt;105 mmHg, e infradesnivel del ST &gt;2 mm. La presencia de hipertrofia ventricular izquierda, la fracción de eyección &lt; 50 %, el tiempo en diálisis &gt;5 años, la existencia de arritmias auriculares y la tensión media arterial predialítica&gt;105 mmHg; se asociaron a arritmias complejas, pero no mostraron significación estadística. Los promedios de edad, tensión arterial media postdialítica, potasio predialítico, duración del QT, grosor del tabique y pared posterior del ventrículo izquierdo, fueron superiores en los casos que registraron arritmias ventriculares complejas o potencialmente fatales. Conclusiones: la mayoría de los registros obtenidos mediante Holter durante la diálisis exhibieron arritmias ventriculares. Existió un predominio de las arritmias ventriculares potencialmente fatales.  Palabras clave: hemodiálisis, arritmias ventriculares, Enfermedad Renal Crónica Terminal, monitorización holter, electrocardiografía. </p

El desarrollo municipal, factor estratégico en el posicionamiento de México en los escenarios políticos y sociales del siglo XXI

LA DEMOCRACIA COMO GOBERNABILIDAD IMPLICA, EN UN PRIMER MOMENTO, establecer una revisión periódica del papel interventor del Estado, por ser éste el principal factor de estabilidad y desarrollo democrático. En un segundo punto, de forma simultánea al estudio del papel del Estado en la conformación de un ambiente de estabilidad, crecimiento, desarrollo, orden y gobernabilidad, merece especial atención el papel y funciones cumplidas tradicionalmente por sus ámbitos de gobierno, como instancias que son fundamentales para la transición, democratización, liberalización y para la propia gobernabilidad

Deposition of Ibuprofen Crystals on Hydroxypropyl Cellulose/Polyacrylamide Gel: Experimental and Mathematic Modeling Releasing

The crystallization of nonsteroidal anti-inflammatory drug [2-(4-isobutyl-phenyl) propionic acid] ibuprofen (IBP) on a hydroxypropyl cellulose (HPC) and polyacrylamide (PAAm) gel was studied as well as the release kinetics of the drug. The IBP was crystallized on the gel surface of HPC/PAAm. It had a prismatic shape and the growth was made in an aqueous medium; the crystallinity grade of the gels HPC/PAAm and HPC/PAAm-IBU increased to 68% and to 58%, respectively. The release of IBP is performed by two means: by a non-Fickian diffusion process and by relaxation of the chains of the gel; without regard to temperature and the diffusion media, this correlates with the lower critical solution temperature (LCST) of the proposed gel. This polymer matrix provides an option for releasing nonsteroidal anti-inflammatory drugs in a temperature range of 35–39°C. Korsmeyer and Peppas mathematical model was simulated for data releases, statistically significant at 95% confidence level

Pharmacokinetic Comparability of a Biosimilar Trastuzumab Anticipated from Its Physicochemical and Biological Characterization

Comparability between a biosimilar and its reference product requires the evaluation of critical quality attributes that may impact on its pharmacological response. Herein we present a physicochemical characterization of a biosimilar trastuzumab focused on the attributes related to the pharmacokinetic response. Capillary isoelectrofocusing (cIEF) and cation exchange chromatography (CEX) were used to evaluate charge heterogeneity; glycosylation profiles were assessed through hydrophilic interaction liquid chromatography (HILIC); aggregates content was evaluated through size exclusion chromatography (SEC) while binding affinity to FcRn was evaluated using isothermal titration calorimetry (ITC). The biosimilar trastuzumab and its reference product exhibited a high degree of similarity for the evaluated attributes. In regard to the pharmacokinetic parameters, randomized, double blind, and two-arm parallel and prospective study was employed after the administration of a single intravenous dose in healthy volunteers. No significant differences were found between the pharmacokinetic profiles of both products. Our results confirm that similarity of the critical quality attributes between a biosimilar product, obtained from a different manufacturing process, and the reference product resulted in comparable pharmacokinetic profiles, diminishing the uncertainty related to the biosimilar&apos;s safety and efficacy

Jet energy measurement with the ATLAS detector in proton-proton collisions at root s=7 TeV

The jet energy scale and its systematic uncertainty are determined for jets measured with the ATLAS detector at the LHC in proton-proton collision data at a centre-of-mass energy of √s = 7TeV corresponding to an integrated luminosity of 38 pb-1. Jets are reconstructed with the anti-kt algorithm with distance parameters R=0. 4 or R=0. 6. Jet energy and angle corrections are determined from Monte Carlo simulations to calibrate jets with transverse momenta pT≥20 GeV and pseudorapidities {pipe}η{pipe}<4. 5. The jet energy systematic uncertainty is estimated using the single isolated hadron response measured in situ and in test-beams, exploiting the transverse momentum balance between central and forward jets in events with dijet topologies and studying systematic variations in Monte Carlo simulations. The jet energy uncertainty is less than 2. 5 % in the central calorimeter region ({pipe}η{pipe}<0. 8) for jets with 60≤pT<800 GeV, and is maximally 14 % for pT<30 GeV in the most forward region 3. 2≤{pipe}η{pipe}<4. 5. The jet energy is validated for jet transverse momenta up to 1 TeV to the level of a few percent using several in situ techniques by comparing a well-known reference such as the recoiling photon pT, the sum of the transverse momenta of tracks associated to the jet, or a system of low-pT jets recoiling against a high-pT jet. More sophisticated jet calibration schemes are presented based on calorimeter cell energy density weighting or hadronic properties of jets, aiming for an improved jet energy resolution and a reduced flavour dependence of the jet response. The systematic uncertainty of the jet energy determined from a combination of in situ techniques is consistent with the one derived from single hadron response measurements over a wide kinematic range. The nominal corrections and uncertainties are derived for isolated jets in an inclusive sample of high-pT jets. Special cases such as event topologies with close-by jets, or selections of samples with an enhanced content of jets originating from light quarks, heavy quarks or gluons are also discussed and the corresponding uncertainties are determined. © 2013 CERN for the benefit of the ATLAS collaboration