Asthma, Airway Hyperresponsiveness, and Lower Airway Obstruction in Children with Sickle Cell Disease

As a comorbid condition of sickle cell disease (SCD), asthma leads to increased complications and mortality. However, poor understanding of asthma phenotypes in SCD and the complex interaction with SCD-related airway inflammation, manifested by bronchial hyperresponsiveness or obstructive airway, pose a unique clinical challenge. The objective of this chapter is to provide a comprehensive review and discussion of epidemiology, pathophysiology, interactions, and clinical implications of airway hyperresponsiveness (AHR), obstructive airway, and asthma in SCD. Discussion will cover new understanding and limitations of asthma diagnosis and management in SCD. AHR, lower obstructive airway, and asthma are highly prevalent in SCD. Despite overlapping features, these entities are nonetheless distinct as demonstrated by basic science and clinical data. Diagnosis of asthma should be based on a physician assessment. We provide new unpublished data of a prospective study on diagnosing asthma in a small preschool population. Administered validated asthma-screening questionnaire to SCD children reveals good sensitivity and specificity as an asthma detection tool. It is unclear at this time if detection of bronchial lability or asthma early in life would result in better outcome of patients, or if improved control of SCD attenuates lower airway pathology. Being able to distinguish asthma from bronchial lability in the preschool age children would allow for appropriate intervention early in life

Guidelines for a public policy of youth entrepreneurship in the municipality of Sucre - Santander

La realización de la presente investigación tiene su justificación en que, a pesar de que las condiciones económicas, de acceso a nuevas tecnología y vías de comunicación, ha mejorado en el municipio de Sucre, el índice de desplazamiento y abandono del municipio por parte de la población joven es muy alto, limitando las posibilidades de desarrollo de nuestro Municipio. Se le da especial importancia a esta investigación, la cual no busca solamente redactar un documento investigativo que permita acceder al título de Magister en Políticas Publicas y Desarrollo, por el contrario, lo que se busca es construir una verdadera Política Publica encaminada al desarrollo del potencial de nuestros jóvenes, promoviendo su participación y proporcionando elementos que posibiliten su permanencia en el municipioIntroducción 8 1. Fundamento Teórico Metodológico 12 1.1 Marco teórico 12 1.2 Marco conceptual 15 1.2.1 Lineamientos de Políticas públicas. 15 1.2.2 Participación ciudadana en la política pública 17 1.2.3 La participación ciudadana y sus mecanismos formales 19 1.2.4 El alcance de la participación ciudadana en el diseño de políticas públicas. 22 2. Metodología 23 2.1 Revisión documental 24 2.2 Grupos focales 25 2.2.1 Grupo focales jóvenes de grado 11-B 25 2.2.2 Grupo focal con jóvenes de grado 11-B 27 2.2.3 Grupo focal con jóvenes grado 10 28 2.2.4 Grupo focal con docentes 30 2.3 Sistematización información DOFA. 32 2.3.1 Estudio de alternativas y descripción 34 2.4 Consideraciones éticas 38 3. Lineamientos para una Política Pública de Emprendimiento Juvenil del Municipio de Sucre – Santander 39 3.1 El diagnóstico 39 3.2 La problemática 41 3.3 Contexto nacional y local 45 3.4 Actores involucrados 48 3.3.1 La planeación 49 3.3.2 Planeación de nivel estratégico 49 3.3.3 Planeación de nivel táctico 50 4. Formulación de Soluciones 51 4.1 Sistema de emprendimiento e innovación municipal de Sucre 51 4.1.1 Unidad de emprendimiento 52 4.1.2 Promoción de la cultura del emprendimiento 52 4.1.3 Articulación entre educación y trabajo 52 4.1.4 Programas y metodologías para la formación de formadores 53 4.1.5 Gestión social 53 4.1.6 Gestión Tecnológica 53 4.1.7 Gestión de procesos culturales 54 4.1.8 Gestión de las relaciones con los graduados 54 4.2 Objetivos de la política 55 4.2.1 Objetivo general 55 4.2.2 Objetivos específicos de la política de emprendimiento 56 4.3 Metas en relación a los objetivos 56 4.4 Acciones a realizar para el logro de cada objetivo 62 5. Instrumentos de Evaluación 66 6. Conclusiones 68 Referencias 72 Bibliografía 82 Anexos 90 Apéndices 97MaestríaThe realization of this research has its justification in that, despite the fact that the economic conditions, access to new technology and communication routes have improved in the Municipality of Sucre, the rate of displacement and abandonment of the municipality by the Young population is very high, limiting the development possibilities of our Municipality. Special importance is given to this research, which does not only seek to write an investigative document that allows access to the title of Magister in Public Policy and Development, on the contrary, what is sought is to build a true Public Policy aimed at the development of potential of our young people, promoting their participation and providing elements that enable their permanence in the MunicipalityModalidad Presencia

Criterios de implementación ISO 14000:2015 Caso Estudio Sector Producción Derivados Lácteos.

Criterios de implementación ISO 14000:2015 Caso Estudio Sector Producción Derivados Lácteos.A partir de la Revisión Ambiental Inicial – RAI, se identifican las distintas fases del proceso productivo para determinar con exactitud en cuál de estas se desarrollan actividades susceptibles de generar impactos; la fase de análisis involucra la elaboración de la matriz de aspectos e impactos ambientales, determinar el alcance del sistema de gestión ambiental enfocado desde la perspectiva de cuestiones externas e internas, así como las necesidades y expectativas de las partes interesadas, la matriz legal permite identificar el estado de cumplimiento de la normas ambientales vigentes y aplicables a la empresa.The different phases of the productive process are identified to determine exactly which of these activities are likely to generate impacts; the analysis phase involves the elaboration of the matrix of environmental aspects and impacts, determining the scope of the environmental management system focused from the perspective of external and internal issues, as well as the needs and expectations of the interested parties, the legal matrix allows identifying the state of compliance with the environmental regulations in force and applicable to the company. Keywords: regulations, environment, dairy production, quality, management, environmental aspects, environmental impacts

Association between Lipid Profile and Apolipoproteins with Risk of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis

Background and Aims. Biomarkers are necessary to stratify the risk of diabetic foot ulcers (DFUs). This systematic review and meta-analysis aimed to evaluate the association between the lipid profile and apolipoproteins with the risk of DFU. Methods. A systematic search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science among adult patients. Cohort and case-control studies were included. Random-effects models were used for meta-analyses, and the effects were expressed as odds ratio (OR) and their 95% confidence intervals (CIs). We evaluated publication bias through Egger's test and funnel plot. Results. A total of 12 cohort studies and 26 case-control studies were included, with 17076 patients. We found that the higher values of total cholesterol (TC), low-density lipoprotein (LDL), triglycerides, and lipoprotein(a) (Lp(a)) were associated with a higher risk of developing DFU (OR: 1.47, OR: 1.47, OR: 1.5, OR: 1.85, respectively). Otherwise, the lower values of HDL were associated with a higher risk of developing DFU (OR: 0.49). Publication bias was not found for associations between TC, HDL, LDL, or TG and the risk of DFU. Conclusions. The high values of LDL, TC, TG, and Lp(a) and low values of HDL are associated with a higher risk of developing DFU. Furthermore, we did not find a significant association for VLDL, ApoA1, ApoB, and ApoB/ApoA1 ratio.Revisión por pare

Fibrinogen-to-Albumin Ratio and Blood Urea Nitrogen-to-Albumin Ratio in COVID-19 Patients: A Systematic Review and Meta-Analysis

Fibrinogen-to-albumin ratio (FAR) and blood urea nitrogen-to-albumin ratio (BAR) are inflammatory biomarkers that have been associated with clinical outcomes of multiple diseases. The objective of this study is to evaluate the association of these biomarkers with the severity and mortality of COVID-19 patients. A systematic search was performed in five databases. Observational studies that reported the association between FAR and BAR values with the severity and mortality of COVID-19 patients were included. Random-effects models were used for meta-analyses, and effects were expressed as Odds Ratio (OR) and their 95% confidence intervals (CI). Publication bias was assessed using the Begg test, while the quality assessment was assessed using the Newcastle Ottawa Scale. A total of 21 studies (n = 7949) were included. High FAR values were associated with a higher risk of severity (OR: 2.41; 95% CI 1.41–4.12; p < 0.001) and mortality (OR: 2.05; 95% CI 1.66–2.54; p < 0.001). High BAR values were associated with higher risk of mortality (OR: 4.63; 95% CI 2.11–10.15; p < 0.001). However, no statistically significant association was found between BAR values and the risk of severity (OR: 1.16; 95% CI 0.83–1.63; p = 0.38). High FAR and BAR values were associated with poor clinical outcomes.Revisión por pare

XVI International Congress of Control Electronics and Telecommunications: "Techno-scientific considerations for a post-pandemic world intensive in knowledge, innovation and sustainable local development"

Este título, sugestivo por los impactos durante la situación de la Covid 19 en el mundo, y que en Colombia lastimosamente han sido muy críticos, permiten asumir la obligada superación de tensiones sociales, políticas, y económicas; pero sobre todo científicas y tecnológicas. Inicialmente, esto supone la existencia de una capacidad de la sociedad colombiana por recuperar su estado inicial después de que haya cesado la perturbación a la que fue sometida por la catastrófica pandemia, y superar ese anterior estado de cosas ya que se encontraban -y aún se encuentran- muchos problemas locales mal resueltos, medianamente resueltos, y muchos sin resolver: es decir, habrá que rediseñar y fortalecer una probada resiliencia social existente - producto del prolongado conflicto social colombiano superado parcialmente por un proceso de paz exitoso - desde la tecnociencia local; como lo indicaba Markus Brunnermeier - economista alemán y catedrático de economía de la Universidad de Princeton- en su libro The Resilient Society…La cuestión no es preveerlo todo sino poder reaccionar…aprender a recuperarse rápido.This title, suggestive of the impacts during the Covid 19 situation in the world, and which have unfortunately been very critical in Colombia, allows us to assume the obligatory overcoming of social, political, and economic tensions; but above all scientific and technological. Initially, this supposes the existence of a capacity of Colombian society to recover its initial state after the disturbance to which it was subjected by the catastrophic pandemic has ceased, and to overcome that previous state of affairs since it was found -and still is find - many local problems poorly resolved, moderately resolved, and many unresolved: that is, an existing social resilience test will have to be redesigned and strengthened - product of the prolonged Colombian social conflict partially overcome by a successful peace process - from local technoscience; As Markus Brunnermeier - German economist and professor of economics at Princeton University - indicates in his book The Resilient Society...The question is not to foresee everything but to be able to react...learn to recover quickly.Bogot

American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus

10.1002/acr.23834ARTHRITIS CARE & RESEARCH715579-59

Primary Ciliary Dyskinesia Diagnostic Challenges: Understanding the Clinical Phenotype of the Puerto Rican RSPH4A Founder Mutation

Primary ciliary dyskinesia (PCD) is a rare, heterogeneous ciliopathy resulting in chronic oto-sino-pulmonary disease, bronchiectasis, newborn respiratory distress, and laterality defects. PCD diagnosis can be achieved by following diagnostic algorithms that include electron microscopy, genetics, and ancillary testing. Genetic mutations in more than 45 genes, including RSPH4A, can lead to PCD. RSPH4A mutations located on chromosome six, affect radial spokes and results in central complex apparatus abnormalities. The RSPH4A [c.921 + 3_6delAAGT] founder mutation was described as one cause of PCD without laterality defects in Puerto Rico. Additionally, there are further diagnostic challenges present in the Puerto Rican population to diagnose PCD. We describe the demographics, clinical features, and RSPH4A genetic variants in 13 patients with clinical PCD affecting 11 Puerto Ricans from unrelated families

Nasal Nitric Oxide Levels: Improving the Diagnosis of Primary Ciliary Dyskinesia in Puerto Rico

Primary Ciliary Dyskinesia (PCD) is a rare genetic disease characterized by motile cilia dysfunction with a prevalence of 1 in 16,309 individuals in Hispanic populations. In Puerto Rico, the prevalence of PCD is unknown. Diagnosis of PCD in Puerto Rico is challenging due to the lack of diagnostic technology. Algorithms for PCD diagnosis include clinical history, genetic testing, ciliary biopsy, and nasal Nitric Oxide (nNO) levels. For the first time, this study successfully implemented and measured the nNO levels in subjects with the RSPH4A (c.921+3_921+6del (intronic)) as a diagnostic tool to complement the current algorithm for PCD diagnosis on the island. The nNO level differentiated homozygous subjects with PCD due to the RSPH4A (c.921+3_921+6del (intronic)) founder mutation compared to healthy gender-age matched controls and subjects with VUS or negative genetic testing for PCD. The acquisition of state-of-the-art diagnostic tools such as nNO positively impacted and expanded our current PCD diagnostic capabilities in Puerto Rico for our founder genetic mutation. The addition of nNO technology promotes earlier disease screening and recognition for patients with PCD on the island. The access to nNO helped us to properly characterize the PCD diagnosis for patients with the RSPH4A (c.921+3_921+6del (intronic)). As a result, our findings will allow us to be part of the national PCD foundation registry and represent Puerto Rican Hispanics in future PCD multicentric clinical trials

The Genetics of Primary Ciliary Dyskinesia in Puerto Rico

Primary ciliary dyskinesia (PCD) has been linked to more than 50 genes that cause a spectrum of clinical symptoms, including newborn respiratory distress, sinopulmonary infections, and laterality abnormalities. Although the RSPH4A (c.921+3_6delAAGT) pathogenic variant has been related to Hispanic groups with Puerto Rican ancestry, it is uncertain how frequently other PCD-implicated genes are present on the island. A retrospective chart review of n = 127 genetic reports from Puerto Rican subjects who underwent genetic screening for PCD variants was conducted from 2018 to 2022. Of 127 subjects, 29.1% subjects presented PCD pathogenic variants, and 13.4% were homozygous for the RSPH4A (c.921+3_6delAAGT) founder mutation. The most common pathogenic variants were in RSPH4A and ZMYND10 genes. A description of the frequency and geographic distribution of implicated PCD pathogenic variants in Puerto Rico is presented. Our findings reconfirm that the presence of PCD in Puerto Rico is predominantly due to a founder pathogenic variant in the RSPH4A (c.921+3_6delAAGT) splice site. Understanding the frequency of PCD genetic variants in Puerto Rico is essential to map a future genotype-phenotype PCD spectrum in Puerto Rican Hispanics with a heterogeneous ancestry