Análise das variáveis ​​envolvidas no tempo de resolução dos parâmetros metabólicos em adultos com cetoacidose diabética

Introduction. Diabetic ketoacidosis (DKA) is a life-threatening complication characterized by hyperglycemia, metabolic acidosis, and ketonemia. Although the time to resolution of DKA has been estimated at 12 to 18 hours, the factors that could prolong it have not been fully studied. Methods. Retrospective study of medical records of adult patients admitted to the general ward with a diagnosis of DKA. They were classified according to severity as mild, moderate and severe. The time to resolution of crisis (TRC) was defined as that necessary until normalization of metabolic parameters. A logistic regression analysis was performed to evaluate the association between TRC>12 hours and continuous variables. ROC analysis and survival analysis were performed using a Cox regression model. Results. 85 patients were studied. 48.23% presented severe DKA. The TRC was 14 hours, being higher in severe DKA. Patients with TRC>12 hours had a lower pH and HCO3-, and a higher anion gap, white blood cells, and volume of crystalloids used. Logistic regression analysis showed that pH and crystalloid volume correlated with TRC>12 hours. ROC analysis determined a pH cutoff value of 7.13 for TRC>12 hours (sensitivity 77%, specificity 88%). The Cox regression showed that a pH<7.13 on admission is associated with a higher TRC (HR 3.30). Conclusion. A pH lower than 7.13 at the time of hospital admission identifies patients with DKA who will need a longer time to resolve their metabolic parameters.Introducción. La cetoacidosis diabética (CAD) es una complicación potencialmente mortal caracterizada por hiperglucemia, acidosis metabólica y cetonemia. Aunque el tiempo para la resolución de la CAD se ha estimado en 12 a 18 horas, los factores que podrían prolongarlo no se han estudiado con exhaustividad. Métodos. Estudio retrospectivo de historias clínicas de pacientes adultos admitidos a sala general con diagnóstico de CAD. Se clasificaron según la severidad en leve, moderada y severa. El tiempo de resolución de la crisis (TRC) se definió como aquel necesario hasta normalización de parámetros metabólicos. Se realizó un análisis de regresión logística para evaluar la asociación entre TRC>12 horas y variables continuas. Se realizó un análisis ROC y un análisis de supervivencia utilizando un modelo de regresión de Cox. Resultados. Se estudiaron 85 pacientes. El 48.23% presentó CAD severa. El TRC fue de 14 horas, siendo mayor en CAD severa. Los pacientes con TRC>12 horas presentaron menor pH y HCO3, y mayor anión gap, glóbulos blancos y volumen de cristaloides utilizados. El análisis de regresión logística demostró que el pH y el volumen de cristaloides correlacionaron con TRC>12 horas. El análisis ROC determinó un valor de corte de pH de 7.13 para TRC>12 horas (sensibilidad 77%, especificidad 88%). La regresión de Cox demostró que un pH <7.13 al ingreso se asocia a mayor TRC (HR 3.30). Conclusión. Un pH menor a 7.13 al momento de admisión hospitalaria identifica a pacientes con CAD que necesitarán un mayor tiempo para resolver sus parámetros metabólicos.Introdução. A cetoacidose diabética (CAD) é uma complicação com risco de vida caracterizada por hiperglicemia, acidose metabólica e cetonemia. Embora o tempo para resolução do CAD tenha sido estimado em 12 a 18 horas, os fatores que poderiam prolongá-lo não foram totalmente estudados. Métodos. Estudo retrospectivo de prontuários de pacientes adultos internados na enfermaria geral com diagnóstico de CAD. Eles foram classificados de acordo com a gravidade em leve, moderado e grave. O tempo de resolução da crise (TRC) foi definido como o necessário até a normalização dos parâmetros metabólicos. Foi realizada análise de regressão logística para avaliar a associação entre TRC>12 horas e variáveis ​​contínuas. A análise ROC e a análise de sobrevivência foram realizadas usando um modelo de regressão de Cox. Resultados. 85 pacientes foram estudados. 48.23% apresentavam DAC grave. O TRC foi de 14 horas, sendo maior na CAD grave. Pacientes com TRC>12 horas apresentaram pH e HCO3- mais baixos, e maior gap aniônico, leucócitos e volume de cristaloides usados. A análise de regressão logística mostrou que o pH e o volume de cristalóide se correlacionaram com TRC>12 horas. A análise ROC determinou um valor de corte de pH de 7.13 para TRC>12 horas (sensibilidade 77%, especificidade 88%). A regressão de Cox mostrou que um pH <7.13 na admissão está associado a um TRC maior (HR 3.30). Conclusão. Um pH menor que 7.13 no momento da admissão hospitalar identifica os pacientes com CAD que precisarão de mais tempo para resolver seus parâmetros metabólicos

Educación Inclusiva. Un desafío y una oportunidad para la innovación educativa en la formación inicial del profesorado

This review aims to be a point of pause and calm that tries to treasure the keys of the Inclusive Education book. A challenge and an opportunity for educational innovation in the initial training of teachers, to bring potential readers and readers closer to the journey through the pages of the work of a network of teachers that has been woven with care and support; a book that tries to bring together the reflections and concerns that these teachers have about the initial training of education professionals and in relation to two current issues in education: inclusion and educational innovation.Esta reseña pretende ser un punto de pausa y sosiego que trata de atesorar las claves del libro Educación Inclusiva. Un desafío y una oportunidad para la innovación educativa en la formación inicial del profesorado, para acercar, a sus posibles lectoras y lectores, al viaje por las páginas del trabajo de una Red de docentes que ha sido tejido con mimo y sostén; un libro que trata de aunar las reflexiones y las preocupaciones que estos docentes tienen en torno a la formación inicial de las y los profesionales de la educación y  en relación a dos temas actuales en educación: la inclusión y la innovación educativa

Reducción de la cobertura social para los fármacos antiartrósicos sintomáticos de acción lenta: una iniciativa de desinversión en Argentina, 2015-2017

In April 2016, the National Institute of Social Services for Retirees and Pensioners discontinued its policy of 100% coverage for 159 drugs (the “social subsidy”), including symptomatic slow-acting drugs for osteoarthritis (SYSADOAs), due to insufficient evidence of significant clinical benefit. We evaluated the effect of this measure on the use of SYSADOAs as well as non-steroidal anti-inflammatory drugs (NSAIDs), which were unaffected by this policy change. We compared outpatient dispensations of SYSADOAs and NSAIDs from 2015 to 2017, measuring dispensed units, retail price, and out-of-pocket expenses for beneficiaries each month. After the change in coverage, there was a 61.6% total decrease in SYSADOA units dispensed, and a 63.4% decrease in the final sales price to the public, measured in constant values. Dispensation was not reoriented towards NSAIDs, which fell by 6.1%. The incidence of new treatments decreased (from 6.4 to 3.3 treatments per 1,000 beneficiaries per month), as did their continuity. Beneficiaries’ out-of-pocket spending on SYSADOAs increased by 75.8% (at constant values). Disinvestment in interventions with questionable therapeutic value is an important tool in working toward the sustainability of health systems.En abril de 2016, el Instituto Nacional de Servicios Sociales para Jubilados y Pensionados excluyó del subsidio social la cobertura al 100% de 159 fármacos, entre ellos, los antiartrósicos sintomáticos de acción lenta o symptomatic slow-acting drugs for osteoarthritis (SySADOA), por insuficiente evidencia de beneficio clínico significativo. Evaluamos el efecto de esta medida sobre la utilización de SySADOA y de los antiinflamatorios no esteroides (AINE), no afectados por la medida. Se compararon las dispensas ambulatorias de los SySADOA y los AINE de 2015 a 2017, midiendo unidades dispensadas, precio de venta al público y gasto de bolsillo del beneficiario para cada mes. Luego de la medida, descendieron un 61,6% los envases de SySADOA dispensados y un 63,4% el monto total del precio de venta al público, medido en valores constantes. La dispensa no se reorientó hacia los AINE, que descendieron un 6,1%. Disminuyó tanto la incidencia de nuevos tratamientos (de 6,4 a 3,3 tratamientos por 1.000 beneficiarios por mes) como su continuidad. El gasto de bolsillo de los beneficiarios en SySADOA aumentó un 75,8% (a valores constantes). La desinversión en intervenciones de valor terapéutico cuestionable es una herramienta valiosa para la sustentabilidad de los sistemas de salud

Propuesta desde la Gestión Asociada para la implementación de un proceso formativo en educación sexual a estudiantes de la Institución Educativa Departamental Agropecuaria Sierra Nevada de Santa Marta del Municipio de Fundación en el Departamento del Magdalena

Generar un proceso participativo desde la Gestión Asociada, específicamente desde la metodología de Prospectiva Participativa para el diseño y desarrollo de una propuesta formación en Educación Sexual a estudiantes de IEDA Sierra Nevada de Santa Marta del Municipio de Fundación en el Departamento del MagdalenaEn este documento de monografía como trabajo de grado para obtener el título de Especialistas en Gestión Asociada, las autoras realizaron un trabajo de campo en la Institución educativa Agropecuaria Sierra Nevada de Santa Marta del Municipio de Fundación del Departamento del Magdalena para recolectar información que permitiera evidenciar las necesidades de formación en educación sexual de los adolescentes del colegio quienes viven problemáticas como: la deserción escolar por embarazo precoz, maternidad y paternidad a temprana edad, violencia de género, enfermedades de transmisión sexual entre otras. Ante estas problemáticas, es una oportunidad desde la Gestión Asociada y su metodología de Prospectiva Participativa generar un escenario que permita a actores d el municipio sentirse corresponsables en la solución de estas problemáticas que viven los adolescentes y contribuir a transformar su realidad. Para ello, se ha diseñado una propuesta desde la Gestión Asociada, de abrir un escenario participativo que permita promover la articulación de diversos actores del territorio para que de manera colectiva se piensen y actúen el beneficio de los jóvenesIn this monograph document as a degree work to obtain the title of Specialists in Associated Management, the authors carried out fieldwork at the Sierra Nevada de Santa Marta Agricultural Educational Institution of the Fundación Municipality of the Department of Magdalena to collect information that would allow evidence the training needs in sexual education of adolescents at school who experience problems such as: school dropout due to early pregnancy, early maternity and paternity, gender violence, sexually transmitted diseases, among others. Faced with these problems, it is an opportunity from the Associated Management and its Participatory Prospective methodology to generate a scenario that allows the actors of the municipality to feel co-responsible in solving these problems that adolescents experience and contribute to transforming their reality. For this, a proposal has been designed from the Associated Management, to open a participatory scenario that allows promoting the articulation of various actors in the territory so that collectively they think and act for the benefit of young peopl

The influence of semantic and phonological factors on syntactic decisions: An event-related brain potential study

During language production and comprehension, information about a word's syntactic properties is sometimes needed. While the decision about the grammatical gender of a word requires access to syntactic knowledge, it has also been hypothesized that semantic (i.e., biological gender) or phonological information (i.e., sound regularities) may influence this decision. Event-related potentials (ERPs) were measured while native speakers of German processed written words that were or were not semantically and/or phonologically marked for gender. Behavioral and ERP results showed that participants were faster in making a gender decision when words were semantically and/or phonologically gender marked than when this was not the case, although the phonological effects were less clear. In conclusion, our data provide evidence that even though participants performed a grammatical gender decision, this task can be influenced by semantic and phonological factors

(188)Re radiopharmaceuticals for radiosynovectomy: evaluation and comparison of tin colloid, hydroxyapatite and tin-ferric hydroxide macroaggregates

BACKGROUND: Radiosynovectomy is a therapy used to relieve pain and inflammation from rheumatoid arthritis and related diseases. In this study three (188)Re particulate compounds were characterized according to their physico-chemical properties and their biological behavior in rabbits. The results were compared in order to establish which was the radiopharmaceutical that better fits the requirements of this kind of radiotherapy. METHODS: Three radiopharmaceutical formulations, tin colloid, hydroxyapatite particles (HA) and ferric hydroxide macroaggregates coated with tin colloid (FHMA), were physically characterized (number, volume and surface of the particles). For this purpose laser diffraction methodology was used. To evaluate cavity leakage of activity the following studies in New Zealand rabbits were performed: scintigraphic images for 48 hr after intraarticular injection of each radiopharmaceutical, biodistribution at 48 hr and urine samples collection during the first 24 hr post-radiopharmaceutical administration. RESULTS: Labeling procedures for (188)Re-HA and (188)Re-Sn-FHMA were labour intensive while (188)Re-Sn was easily prepared. Furthermore, (188)Re-Sn colloid offered the greatest surface area in the 2–10 microm range and was obtained with a radiochemical purity over 95%, while percentage of bound activity for (188)Re-HA and (188)Re-Sn-FHMA were 55% and 92% respectively. Stability was verified for the three radiopharmaceuticals for 24 hr. Scintigraphic studies and biodistribution in rabbits after intraarticular administration of the radiopharmaceuticals showed relevant activity only in the knee, this being over 90% of the residual activity in the whole body at 48 hr in every case. Renal elimination of (188)Re-Sn colloid and (188)Re-Sn-FHMA was detected by activity measurements in urine samples, during the first 12 hr post-radiopharmaceutical injection. The percentage of activity retained in the knee was 69.1% for (188)Re-Sn colloid, 55.1% for (188)Re-Sn-FHMA and 33.6% for (188)Re-HA. CONCLUSION: The (188)Re-Sn colloid was easy to prepare, minimum facilities were required, was stable for 24 hr and showed minimal leakage from the joint after intraarticular injection into the rabbit's knee. Furthermore, (188)Re-Sn colloid has greater retention in the knee when it is compared with the other radiopharmaceuticals, so it could provide the best therapeutic effect/absorbed dose ratio for the patient

Circadian Modulation of Gene Expression, but not Glutamate Uptake, in Mouse and Rat Cortical Astrocytes

Circadian clocks control daily rhythms including sleep-wake, hormone secretion, and metabolism. These clocks are based on intracellular transcription-translation feedback loops that sustain daily oscillations of gene expression in many cell types. Mammalian astrocytes display circadian rhythms in the expression of the clock genes Period1 (Per1) and Period2 (Per2). However, a functional role for circadian oscillations in astrocytes is unknown. Because uptake of extrasynaptic glutamate depends on the presence of Per2 in astrocytes, we asked whether glutamate uptake by glia is circadian.We measured glutamate uptake, transcript and protein levels of the astrocyte-specific glutamate transporter, Glast, and the expression of Per1 and Per2 from cultured cortical astrocytes and from explants of somatosensory cortex. We found that glutamate uptake and Glast mRNA and protein expression were significantly reduced in Clock/Clock, Per2- or NPAS2-deficient glia. Uptake was augmented when the medium was supplemented with dibutyryl-cAMP or B27. Critically, glutamate uptake was not circadian in cortical astrocytes cultured from rats or mice or in cortical slices from mice.We conclude that glutamate uptake levels are modulated by CLOCK, PER2, NPAS2, and the composition of the culture medium, and that uptake does not show circadian variations

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years