Prescription practices and medical knowledge on direct oral anticoagulants in a reference hospital

ABSTRACT: Introduction and objective: The experience and knowledge concerning the use of direct oral anticoagulants among specialists in Medellin, Colombia, are not known. Our goal was to describe the use of these drugs in patients treated at Hospital Pablo Tobón Uribe and to assess the level of knowledge regarding this issue in professionals from this institution. Materials and methods: Cross sectional study conducted between January 2012 and January 2013. Two strategies to collect information were used, namely: Analysis of relevant medical records and evaluation of knowledge about the appropriate use and prescription of direct oral anticoagulants in the group of medical specialists. Results: 114 records were included in the analysis; rivaroxaban was the most frequently prescribed drug (87%) followed by dabigatran (13%). The main indication was prophylaxis in orthopedic surgery (69%). Average of correct answers among the different specialists evaluated was 67% with no apparent difference between them. Conclusion: rivaroxaban was prescribed more often than dabigatran; however, this fact does not appear to be associated with a clear and sufficient medical knowledge about these drugs. No reports of adverse events associated with this therapy were found.RESUMEN: Se desconocen la experiencia y el conocimiento con los que cuenta el personal médico del medio en el manejo de los anticoagulantes orales directos. Se pretende describir el uso de estos medicamentos en los pacientes atendidos en el Hospital Pablo Tobón Uribe y evaluar el nivel de conocimientos al respecto en los profesionales de la misma institución. Materiales y métodos: estudio de corte transversal en el período comprendido entre enero del 2012 y enero del 2013. Para recolectar la información se utilizaron dos estrategias: el análisis de las historias clínicas pertinentes y la evaluación de conocimientos sobre la prescripción y el uso de anticoagulantes orales directos en el grupo de especialistas facultados. Resultados: en el análisis se incluyeron 114 historias; el rivaroxaban fue el medicamento prescrito con mayor frecuencia (87%) seguido del dabigatrán (13%). La principal indicación fue la profilaxis en cirugía ortopédica (69%). Entre los especialistas evaluados, el promedio de respuestas acertadas fue del 67% sin diferencias aparentes entre los mismos. Conclusión: el rivaroxaban se prescribió con mayor frecuencia que el dabigatrán; sin embargo, este hallazgo no parece asociarse con un conocimiento médico claro y suficiente acerca de estos medicamentos. No se encontraron reportes de eventos adversos asociados al uso de los mismos

Identification of IQM-266, a Novel DREAM Ligand That Modulates KV4 Currents

Downstream Regulatory Element Antagonist Modulator (DREAM)/KChIP3/calsenilin is a neuronal calcium sensor (NCS) with multiple functions, including the regulation of A-type outward potassium currents (IA). This effect is mediated by the interaction between DREAM and KV4 potassium channels and it has been shown that small molecules that bind to DREAM modify channel function. A-type outward potassium current (IA) is responsible of the fast repolarization of neuron action potentials and frequency of firing. Using surface plasmon resonance (SPR) assays and electrophysiological recordings of KV4.3/DREAM channels, we have identified IQM-266 as a DREAM ligand. IQM-266 inhibited the KV4.3/DREAM current in a concentration-, voltage-, and time-dependent-manner. By decreasing the peak current and slowing the inactivation kinetics, IQM-266 led to an increase in the transmembrane charge (QKV4.3/DREAM) at a certain range of concentrations. The slowing of the recovery process and the increase of the inactivation from the closed-state inactivation degree are consistent with a preferential binding of IQM-266 to a pre-activated closed state of KV4.3/DREAM channels. Finally, in rat dorsal root ganglion neurons, IQM-266 inhibited the peak amplitude and slowed the inactivation of IA. Overall, the results presented here identify IQM-266 as a new chemical tool that might allow a better understanding of DREAM physiological role as well as modulation of neuronal IA in pathological processes

Estado actual y propuesta de mejoramiento para los sistemas de control en el subsector del transporte público de pasajeros intermunicipal en la zona centro occidente de Colombia durante los años 2016-2017

El presente trabajo de investigación se direccionó en dos propósitos fundamentales que constituyen la naturaleza misma del fenómeno y orientan el ejercicio académico. En primer lugar, se llevó a cabo un análisis sobre el estado actual de los sistemas de control en el subsector del transporte público de pasajeros intermunicipal en la zona Centro Occidente de Colombia durante los años 2016-2017. A partir del anterior análisis, se estableció de manera general un plan de mejoramiento continuo para las organizaciones y empresas vinculadas en el estudio, a fin de posibilitar un avance en la prestación y calidad del servicio de transporte público intermunicipal entre los departamentos de Caldas, Chocó, Quindío, Valle y Risaralda, vinculados al ejercicio investigativo.The present research work was directed in two fundamental purposes that constitute the very nature of the phenomenon and guide the academic exercise. First, an analysis was carried out on the current status of control systems in the sub-sector of public intermunicipal passenger transport in the Central West of Colombia during the years 2016-2017. Based on the previous analysis, a continuous improvement plan was established in general for organizations and companies linked to the study, in order to enable progress in the provision and quality of intermunicipal public transport service between the departments of Caldas, Chocó , Quindío, Valle and Risaralda, linked to the research exercise.Universidad Libre Seccional Pereira - Facultad de Ciencias Economicas, Administrativas y Contables - Especialización en Revisoría fisca

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Fine-tuning DREAM signaling using chemical tools for neurodegenerative disease treatment

Resumen del trabajo presentado al 6th European Chemical Biology Symposium ECBS/LS-EuChemS, celebrado en Madrid (España) del 3 al 5 de abril de 2019.DREAM (Downstream Regulatory Element Antagonist Modulator), also known as KChIP-3 or calsenilin, is a multifunctional calcium binding protein that controls the expression level and/or the activity of several proteins related to calcium homeostasis, neuronal excitability and neuronal survival. As an auxiliary protein in the plasma membrane, DREAM interacts with, and regulates, the gating of KV4 potassium channels, L- and T-type voltage-dependent calcium channels, NMDA receptors and the transcriptor factor ATF6, which is involved in the unfolding protein response machinary. Considering that altered neuronal calcium homeostasis and the accumulation of poorly folded proteins are common features of many neurodegenerative pathologies, the DREAM modulation could open new avenues for the treatment of neurodegenerative diseases. We recently showed that reduced DREAM expression or blockade of DREAM activity by repaglinide is neuroprotective in Huntington's disease (HD)[1]. However, up to now, only three DREAM binding molecules have been identified. Hence, there is a clear need for the development of chemical tools to modulate and characterize DREAM activity and its interactions. In this communication we will report the identification of novel DREAM modulators by following a multidisciplinary strategy that involves structure-based design, organic chemistry, site-directed mutagenesis and in vitro and in vivo experiments. Our findings open a new avenue in the search of effective treatments of neurodegenerative diseases.Spanish Ministery of Economy, Industry and Competitivity (AEI-FEDER, EU grants): BFU2015-67284-R, SAF2017-89554-R, SAF2016-75021-R, SAF2015-66275-C2-2-R; Instituto de Salud Carlos III CIBERNED and CIBERCV programs; the Madrid regional government/Neurodegmodels; and CSIC PIE 201580E073.Peer Reviewe

Identification of IQM-266, a novel DREAM ligand that modulates Kv4 currents

Resumen del trabajo presentado al VII Congreso Red Española Canales Iónicos: Symposium 6: Drug Discovery and ion channel Pharmacology, celebrado en Cáceres del 15 al 17 de mayo de 2019.Funded by BFU2015-67284-R (to MG-R), SAF2014-53412-R and SAF2017-89554-R (to JN), SAF2013-45800-R, SAF2016-75021-R (to CV), SAF2015-66275-C2-2-R (to MM-M); UCM grant: PR75/18-21593 (to AA); and CSIC grants: PIE 201820E104 (to CV) and 201880E109 (to MG-R and MM-M).Peer Reviewe

Identification of IQM-266, a novel DREAM ligand that modulates KV4 currents

Downstream Regulatory Element Antagonist Modulator (DREAM)/KChIP3/calsenilin is a neuronal calcium sensor (NCS) with multiple functions, including the regulation of A-type outward potassium currents (I A). This effect is mediated by the interaction between DREAM and KV4 potassium channels and it has been shown that small molecules that bind to DREAM modify channel function. A-type outward potassium current (I A) is responsible of the fast repolarization of neuron action potentials and frequency of firing. Using surface plasmon resonance (SPR) assays and electrophysiological recordings of KV4.3/DREAM channels, we have identified IQM-266 as a DREAM ligand. IQM-266 inhibited the KV4.3/DREAM current in a concentration-, voltage-, and time-dependent-manner. By decreasing the peak current and slowing the inactivation kinetics, IQM-266 led to an increase in the transmembrane charge ( QKV4.3/DREAM ) at a certain range of concentrations. The slowing of the recovery process and the increase of the inactivation from the closed-state inactivation degree are consistent with a preferential binding of IQM-266 to a pre-activated closed state of KV4.3/DREAM channels. Finally, in rat dorsal root ganglion neurons, IQM-266 inhibited the peak amplitude and slowed the inactivation of I A. Overall, the results presented here identify IQM-266 as a new chemical tool that might allow a better understanding of DREAM physiological role as well as modulation of neuronal I A in pathological processes.PC was the recipient of a postgraduate FPI fellowship from the Spanish Ministry of Economy, Industry and Competitivity (MINECO). This work was funded by the Spanish Ministry of Economy, Industry and Competitivity (Ministerio de Economía y Competitividad; AEI-FEDER, EU grants): SAF2012-32209 and BFU2015-67284-R (to MG-R), SAF2014-53412-R and SAF2017- 89554-R (to JN), SAF2013-45800-R, SAF2016-75021-R (to CV) and SAF2015-66275-C2-2-R (to MM-M); Universidad Complutense de Madrid (UCM) grant: PR75/18-21593 (to AA); the Instituto de Salud Carlos III CIBERNED and CIBERCV programs (to JN and to CV, respectively) and the Madrid regional government/Neurodegmodels (to JN); Consejo Superior de Investigaciones Científicas (CSIC) grants: PIE 201820E104 (to CV) and 201880E109 (to MG-R and MM-M).We acknowledge support of the publication fee by the CSIC Open Access Publication Support Initiative through its Unit of Information Resources for Research (URICI).Peer reviewe

XV International Congress of Control Electronics and Telecommunications: "The role of technology in times of pandemic and post-pandemic: innovation and development for strategic social and productive sectors"

La anterior selección, motivados por la aseveración de Manuel Castells -hace casi 20 años ya- que la innovación y la difusión de la tecnología parecía ser la herramienta apropiada para el desarrollo en la era de la información. Este 2020, sin embargo, ante la situación disruptiva que aquejó y aqueja a la sociedad red como una estructura social emergente de la Era de la Información basada en redes de producción, energizadas por el poder y la experiencia; falló y debe reencontrar su rumbo. Es así que los problemas acuciantes, ahora, fueron: la atención sanitaria y la superación de la epidemia de Sars Cov 2; tomó forma la, hasta entonces, visión irrealista de Castells que … no podemos avanzar con nuestros modelos de desarrollo actual, destruyendo nuestro entorno y excluyendo a la mayor parte de la humanidad de los beneficios de la revolución tecnológica más extraordinaria de la historia, sin sufrir una devastadora reacción por parte de la sociedad y la naturaleza. Fue así que el Cuarto Mundo, específicamente, donde la suficiencia de recurso humano, de capital, trabajo, información y mercado -vinculados todos a través de la tecnología- supuso que atendería eficazmente a través de la población que podía por su capacidad hacer uso racional y profesional del conocimiento, las necesidades de la mayoritaria población vulnerable y vulnerada. Por lo anterior, poner en el centro a las personas, en entornos de tarea y trabajo globales hiperconectados combinando espacios físicos, corrientes de información con canales de conexión expeditos, y formando profesionales del conocimiento que asuman y afronten los retos derivados de la transformación digital de empresas, universidades, y organizaciones, pero en condiciones de equidad y sujetos de prosperidad, será el desafío en los escenarios presentes y futuros inmediatos.The previous selection, motivated by the assertion of Manuel Castells -almost 20 years ago- that innovation and diffusion of technology seemed to be the appropriate tool for development in the information age. This 2020, however, in the face of the disruptive situation that afflicted and continues to afflict the network society as an emerging social structure of the Information Age based on production networks, energized by power and experience; He failed and must find his way again. Thus, the pressing problems now were: health care and overcoming the Sars Cov 2 epidemic; Castells' until then unrealistic vision took shape that... we cannot advance with our current development models, destroying our environment and excluding the majority of humanity from the benefits of the most extraordinary technological revolution in history, without suffering a devastating reaction from society and nature. It was thus that the Fourth World, specifically, where the sufficiency of human resources, capital, work, information and market - all linked through technology - meant that it would serve effectively through the population that could, due to its capacity, make rational use. and knowledge professional, the needs of the majority vulnerable and vulnerable population. Therefore, putting people at the center, in hyperconnected global task and work environments, combining physical spaces, information flows with expedited connection channels, and training knowledge professionals who assume and face the challenges derived from the digital transformation of companies, universities, and organizations, but in conditions of equality and subject to prosperity, will be the challenge in the present and immediate future scenarios.Bogot

Biodiversidad en la cuenca del Orinoco. Bases científicas para la identificación de áreas prioritarias para la conservación y uso sostenible de la biodiversidad

Es un placer para el Instituto de Investigación de Recursos Biológicos Alexander von Humboldt presentar a la comunidad científica, conservacionista y autoridades ambientales de Colombia y Venezuela la obra Biodiversidad de la cuenca del Orinoco: bases científicas para la identificación de áreas prioritarias para la conservación y el uso sostenible de la biodiversidad. Este libro es fruto de un esfuerzo de una década de trabajo y recoge numerosos proyectos de carácter institucional que han venido desarrollándose en la Orinoquia, incluyendo el Plan de acción en biodiversidad para la cuenca del Orinoco (2005-2015), además de los resultados de reuniones técnicas de carácter binacional

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022