Solución de problemas

41. Demostrar que en el plano el lugar geométrico de los puntos, cuyas distancias a dos puntos dados A y B guardan una relación constante, es un círculo

Murciélagos y techos: Cruzando fronteras a través de la ciencia ciudadana

El Neotrópico es una de las regiones más diversas en el mundo, donde se han registrado cientos de especies de murciélagos y este número sigue ascendiendo gracias a los esfuerzos de investigación. A pesar de los distintos y valiosos servicios ecosistémicos que estas especies brindan (Boyles et al. 2011), los murciélagos enfrentan amenazas que ponen en riesgo su supervivencia, entre ellas se destacan la pérdida y fragmentación del hábitat (Frick et al. 2020). Estas amenazas han obligado a los murciélagos a buscar nuevos sitios donde habitar y, para algunas especies, principalmente insectívoras, las zonas urbanas poseen sitios con los recursos necesarios para sobrevivir, tales como alimento y refugio (Ávila-Flores y Fenton 2005; Jung y Kalko 2010; Jung y Threlfall 2016). En el momento que estas especies coexisten con los humanos, surge otra potencial amenaza que es el desconocimiento generado por la percepción errónea que existe sobre los murciélagos...Fil: Zaldaña Orantes, Karla. Programa de Conservación de Murciélagos de El Salvador ; El SalvadorFil: Rodríguez, Melissa E.. Programa de Conservación de Murciélagos de El Salvador ; El SalvadorFil: Raquel Alvarado-Larios. Programa de Conservación de Murciélagos de El Salvador ; El SalvadorFil: González Linares, Jorge. Programa de Conservación de Murciélagos de El Salvador ; El SalvadorFil: Campos Tobar, Zuleyma. Programa de Conservación de Murciélagos de El Salvador ; El SalvadorFil: Díaz, Carolina. Programa de Conservación de Murciélagos de El Salvador ; El SalvadorFil: Girón, Luis. Programa de Conservación de Murciélagos de El Salvador ; El SalvadorFil: Nuñez Rodríguez, Alvaro. Programa para la Conservación de los Murciélagos de Chile; ChileFil: Chang, Clemente Beltrán. Programa para la Conservación de los Murciélagos de Chile; ChileFil: Damino, María Verónica. Programa de Conservación de los Murciélagos de Argentina; ArgentinaFil: Di Domenica, Violeta. Programa de Conservación de los Murciélagos de Argentina; ArgentinaFil: Olmedo, María Luz. Programa de Conservación de los Murciélagos de Argentina; Argentina. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo. Programa de Investigación de Biodiversidad Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Sánchez, Tatiana. Programa de Conservación de los Murciélagos de Argentina; ArgentinaFil: Arévalo, Ana Lucía. Programa para la Conservación de los Murciélagos de Guatemala; GuatemalaFil: Nuñez, Lourdes. Programa para la Conservación de los Murciélagos de Guatemala; GuatemalaFil: Mejía, David. Programa de Conservación de Murciélagos de Honduras; HondurasFil: Aguirre, Gabriel. Programa de Conservación de Murciélagos de Nicaragua; NicaraguaFil: Saldaña, Octavio. Programa de Conservación de Murciélagos de Nicaragua; NicaraguaFil: Serrano, Alejandra. Programa de Conservación de Murciélagos de Nicaragua; NicaraguaFil: Chitaro, Santiago. Programa para la Conservación de los Murciélagos de Uruguay; UruguayFil: Martínez, Yaniré. Programa de Conservación de Murciélagos de Puerto Rico; Puerto RicoFil: Santiago, Miguel. Programa de Conservación de Murciélagos de la República Dominicana; República DominicanaFil: Mateo Jiménez, Amelia L.. Programa de Conservación de Murciélagos de la República Dominicana; República DominicanaFil: Sánchez Calderón, Ricardo. Programa para la Conservación de los Murciélagos de Costa Rica; Costa RicaFil: Oviedo Cortés, Gabriel. Programa para la Conservación de los Murciélagos de Costa Rica; Costa RicaFil: Guido Solano, Francinie. Programa para la Conservación de los Murciélagos de Costa Rica; Costa Ric

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Assessment of plasma chitotriosidase activity, CCL18/PARC concentration and NP-C suspicion index in the diagnosis of Niemann-Pick disease type C : A prospective observational study

Niemann-Pick disease type C (NP-C) is a rare, autosomal recessive neurodegenerative disease caused by mutations in either the NPC1 or NPC2 genes. The diagnosis of NP-C remains challenging due to the non-specific, heterogeneous nature of signs/symptoms. This study assessed the utility of plasma chitotriosidase (ChT) and Chemokine (C-C motif) ligand 18 (CCL18)/pulmonary and activation-regulated chemokine (PARC) in conjunction with the NP-C suspicion index (NP-C SI) for guiding confirmatory laboratory testing in patients with suspected NP-C. In a prospective observational cohort study, incorporating a retrospective determination of NP-C SI scores, two different diagnostic approaches were applied in two separate groups of unrelated patients from 51 Spanish medical centers (n = 118 in both groups). From Jan 2010 to Apr 2012 (Period 1), patients with ≥2 clinical signs/symptoms of NP-C were considered 'suspected NP-C' cases, and NPC1/NPC2 sequencing, plasma chitotriosidase (ChT), CCL18/PARC and sphingomyelinase levels were assessed. Based on findings in Period 1, plasma ChT and CCL18/PARC, and NP-C SI prediction scores were determined in a second group of patients between May 2012 and Apr 2014 (Period 2), and NPC1 and NPC2 were sequenced only in those with elevated ChT and/or elevated CCL18/PARC and/or NP-C SI ≥70. Filipin staining and 7-ketocholesterol (7-KC) measurements were performed in all patients with NP-C gene mutations, where possible. In total across Periods 1 and 2, 10/236 (4%) patients had a confirmed diagnosis o NP-C based on gene sequencing (5/118 [4.2%] in each Period): all of these patients had two causal NPC1 mutations. Single mutant NPC1 alleles were detected in 8/236 (3%) patients, overall. Positive filipin staining results comprised three classical and five variant biochemical phenotypes. No NPC2 mutations were detected. All patients with NPC1 mutations had high ChT activity, high CCL18/PARC concentrations and/or NP-C SI scores ≥70. Plasma 7-KC was higher than control cut-off values in all patients with two NPC1 mutations, and in the majority of patients with single mutations. Family studies identified three further NP-C patients. This approach may be very useful for laboratories that do not have mass spectrometry facilities and therefore, they cannot use other NP-C biomarkers for diagnosis

TX - Taller de Tesis - AR304 - 202101

Descripción: En este curso se desarrollará, mediante una propuesta arquitectónica, un proyecto escogido por el estudiante, en el que pueda acreditar que está en capacidad de hacer frente a los principales aspectos comprendidos en el desarrollo de un proyecto arquitectónico. En la primera etapa se establecen los criterios básicos de diseño de un pre-anteproyecto arquitectónico sustentado a partir de las condiciones: conceptuales, programáticas y de usuario, aspectos medio ambientales, urbano y paisajistas. En la segunda etapa se desarrolla un anteproyecto arquitectónico incluyendo además los criterios de las especialidades de estructuras, instalaciones eléctricas y sanitarias, y sistemas de evacuación. Propósito: El curso tiene como propósito la aprobación del anteproyecto con el cual el estudiante puede iniciar su Proyecto de Titulación Profesional. Busca contribuir al desarrollo de las competencias generales UPC: Comunicación Escrita, Comunicación Oral, Pensamiento Crítico, Razonamiento Cuantitativo, Manejo de la Información, Ciudadanía, Pensamiento Innovador y de las competencias específicas de la carrera: Diseño Fundamentado (que corresponde a los criterios NAAB PC2, PC3,PC5, PC8, SC5), Cultura Arquitectónica (que corresponde a los criterios NAAB1 PC4), Técnica y Construcción (que corresponde a los criterios NAAB1 SC1, SC4,SC6) y Gestión Profesional (que corresponde a los criterios NAAB1 PC6, SC2), todas en el nivel 3. Tiene como requisitos AR248 Gestión Inmobiliaria y HU61 inglés 5 y AR271 Lineamientos para el Proyecto Profesional y AR272 Seminario de Urbanismo y AR250 TIX - Taller de Ejercicio Profesional y aprobación por el director de la Carrera

TX - Taller de Tesis - AR304 - 202102

Descripción: En este curso se desarrollará, mediante una propuesta arquitectónica, un proyecto escogido por el estudiante, en el que pueda acreditar que está en capacidad de hacer frente a los principales aspectos comprendidos en el desarrollo de un proyecto arquitectónico. En la primera etapa se establecen los criterios básicos de diseño de un pre-anteproyecto arquitectónico sustentado a partir de las condiciones: conceptuales, programáticas y de usuario, aspectos medio ambientales, urbano y paisajistas. En la segunda etapa se desarrolla un anteproyecto arquitectónico incluyendo además los criterios de las especialidades de estructuras, instalaciones eléctricas y sanitarias, y sistemas de evacuación. Propósito: El curso tiene como propósito la aprobación del anteproyecto con el cual el estudiante puede iniciar su Proyecto de Titulación Profesional. Busca contribuir al desarrollo de las competencias generales UPC: Comunicación Escrita, Comunicación Oral, 3Pensamiento Crítico, Razonamiento Cuantitativo, Manejo de la Información, Ciudadanía, Pensamiento Innovador y de las competencias específicas de la carrera: Diseño Fundamentado (que corresponde a los criterios NAAB PC2, PC3,PC5, PC8, SC5), Cultura Arquitectónica (que corresponde a los criterios NAAB1 PC4), Técnica y Construcción (que corresponde a los criterios NAAB1 SC1, SC4,SC6) y Gestión Profesional (que corresponde a los criterios NAAB1 PC6, SC2), todas en el nivel 3. Tiene como requisitos AR248 Gestión Inmobiliaria y HU61 inglés 5 y AR271 Lineamientos para el Proyecto Profesional y AR272 Seminario de Urbanismo y AR250 TIX - Taller de Ejercicio Profesional y aprobación por el director de la Carrera

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

International audienceBackground: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/ hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH 2 O, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmH 2 O, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmH 2 O, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

Background: Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Methods: Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. Results: From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p &lt; 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmH2O, p &lt; 0.001), plateau (20 [15-23] vs 22 [19-26] cmH2O, p &lt; 0.001) and peak (21 [17-27] vs 26 [20-32] cmH2O, p &lt; 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p &lt; 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Conclusions: Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073