Utilidad del dímero D en el diagnóstico de tromboembolismo pulmonar en la Fundación Santa Fé de Bogotá

INTRODUCCIÓN: El diagnóstico de Tromboembolismo Pulmonar (TEP) ha sido un reto clínico a pesar de los avances en modalidades diagnósticas y opciones terapéuticas, el TEP permanece como una entidad sub diagnosticada y letal. La medición en sangre del Dímero D, con punto de corte de 500 mcg/L, por lo tanto es una excelente prueba de tamizaje para los pacientes en el departamento de urgencias . Esta evaluación inicial debe ser complementada con la realización de angioTAC de tórax, decisión que debe ser tomada precozmente con el fin de evitar complicaciones que amenacen la vida METODOLOGIA: Se realizo un estudio de prueba diagnóstica retrospectivo donde se revisaron las historias clínicas de 109 pacientes adultos de la Fundación Santa Fe de Bogotá en quienes se realizo angioTAC de tórax con protocolo para TEP, con probabilidad diagnóstica de Tromboembolismo Pulmonar Baja o Intermedia por criterios de Wells y que además tengan Dímero D. Se calculo la sensibilidad y especificidad del Dímero D teniendo en cuenta la probabilidad clínica pre test calculada por criterios de Wells, y se calcularon likelihood ratio positivo y negativo para cada punto de corte de Dímero D. RESULTADOS: El estudio mostro una sensibilidad del 100% para valores de Dímero D menores de 1100 mcg/L, en pacientes con baja probabilidad, y sensibilidad de 100% para valores menores de 700 mcg/L en pacientes con probabilidad intermedia. DISCUSIÓN: Pacientes con baja probabilidad pre test por criterios de Wells con valores de Dímero D menores de 1100 mcg/L y de probabilidad intermedia con valores menores de 700 mcg/L no requieren estudios adicionales, lo cual disminuye de manera importante la toma de angioTAC y reduce costos de atención.INTRODUCTION: The diagnosis of pulmonary thromboembolism (PTE) has been a clinical challenge despite advances in diagnostic modalities and therapeutic options, PE remains an under-diagnosed and lethal entity. The measurement of D-dimer blood, with a cutoff of 500 mcg / L, therefore is an excellent screening test for patients in the emergency department. This initial assessment should be complemented with the performance of CT angiography of the chest, a decision that must be taken early to prevent life threatening complications METHODOLOGY: We performed a retrospective study of diagnostic tests which reviewed the medical records of 109 adult patients from the Fundación Santa Fe de Bogota in whom chest CT angiography was performed with PET protocol with diagnostic probability of pulmonary embolism by low or intermediate criteria Wells and also have dimer D. We calculated the sensitivity and specificity of D-dimer given the pretest clinical probability calculated by Wells criteria, and calculated positive and negative likelihood ratio for each dimer cutoff D. RESULTS: The study showed a sensitivity of 100% for D-dimer values ¿¿less than 1100 mcg / L, in patients with low probability and sensitivity of 100% for values ¿¿less than 700 mcg / L in patients with intermediate probability. DISCUSSION: Patients with low pretest probability for Wells criteria D-dimer values ¿¿less than 1100 mcg / L and intermediate probability values ¿¿less than 700 mcg / L do not require additional studies, which decreases significantly making CT angiography care and reduce costs

Desarrollo legal respecto a la integración laboral de personas con discapacidad en Bogotá

La integración de personas con discapacidad al mundo laboral ha tomado fuerza en Bogotá, especialmente durante el 2015 y 2016, se observó que la ciudad asumió el reto de hacer cumplir la Política Pública de inclusión de personas en esta condición, en ella se incluyeron temas de empleo, estudio e infraestructura. En el desarrollo de esta monografía, nos ocuparemos especialmente el tema laboral. Anteriormente las empresas tenían la convicción de que las personas con discapacidad no podían ser productivas y debían depender económicamente de sus familias; este concepto perdió valor en la sociedad actual. Los estudios detallados en esta monografía, muestran que se están desarrollando acciones conjuntas entre el Gobierno y los Empresarios, para el reconocimiento de los derechos de personas en condición de discapacidad; ellos no son limitados, son seres humanos con deberes y derechos como todos los bogotanos.The integration of people with disabilities into the working world has taken power in Bogotá, especially during the 2015 and 2016, it was observed that the city assumed the challenge of enforcing public policy of inclusion of persons in this condition; it included topic s of employment, study and infrastructure. In the development of this monograph, we will deal especially with the labor issue. Previously, companies were convinced that people with disabilities could not be productive and should be economically dependent on their families; this concept lost value in today's society. The studies detailed in this monograph show that joint actions between the government and the entrepreneurs are being developed for the recognition of the rights of persons in the condition of disability; They are not limited, they are human beings with duties and rights like all Bogotanos

Generalidades de la Farmacovigilancia

Se entiende que en farmacovigilancia el compromiso es de todos. De la industria farmacéutica, del distribuidor, comercializador, así como de los profesionales de salud; por lo que el rol del Regente de Farmacia es formar parte del equipo que busca que todos los objetivos de la farmacovigilancia se cumplan a cabalidad además de colaborar en la educación del uso adecuado de los medicamentos mediante la identificación y análisis de riesgos, con el fin de mitigar incidentes o eventos adversos. Del mismo modo se requiere también el apoyo de la Tecnovigilancia ya que tiene por objeto la identificación y la cualificación de los eventos adversos e incidentes serios e indeseados producidos por dispositivos médicos, así como la identificación de los factores de riesgo asociados a estos efectos o características, con base en la notificación, registro y evaluación sistemática de los problemas relacionados con los dispositivos médicos, con el fin de determinar la frecuencia, gravedad e incidencia de los mismos para prevenir su aparición.It is understood that in pharmacovigilance the commitment belongs to everyone. From the pharmaceutical industry, from the distributor, marketer, as well as from health professionals; That is why the role of the Pharmacy Regent is to be part of the team that seeks that all the objectives of pharmacovigilance are fully met in addition to collaborating in the education of the proper use of medications through the identification and analysis of risks, with the in order to mitigate incidents or adverse events. In the same way, the support of Technovigilance is also required since it aims to identify and qualify adverse events and serious and unwanted incidents produced by medical devices, as well as the identification of risk factors associated with these effects or characteristics, based on the notification, registration and systematic evaluation of problems related to medical devices, in order to determine their frequency, severity and incidence to prevent their appearance

Más allá del COVID-19. Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria.

Introducción. Las farmacias comunitarias representan un papel clave en la respuesta al COVID-19 y especialmente en el control de enfermedades crónicas más allá de la pandemia. Objetivo. Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria para prevenir la fragilidad y promover el autocuidado en personas mayores. Método. Estudio cualitativo de investigación-acción con mapeo de actores, segmentación de perfiles, grupos de discusión, entrevistas en profundidad y sesiones de diseño creativo. Las técnicas utilizadas aseguraron la participación de personas mayores y profesionales en todas las etapas de diseño. Resultados. Se generaron circuitos comunes de comunicación para los nuevos servicios y protocolos de actuación compartidos. Se propusieron nuevos roles profesionales en respuesta  a las necesidades, expectativas y preferencias de las personas mayores. Se diseñaron los servicios de detección de fragilidad, adherencia a nuevos medicamentos, toma de constantes y refuerzo terapéutico. El modelo aporta sistemas de comunicación bidireccional entre atención primaria y farmacia comunitaria y reconoce el papel de la farmacia comunitaria en la promoción del autocuidado y gestión de la patología crónica y la medicación. Conclusiones. Se evidencia la importancia de crear un ecosistema más abierto que dé lugar a innovaciones organizativas que aprovechen la proximidad y capilaridad de las oficinas de farmacia, así como la incorporación de la omnicanalidad en la atención, esencial en situaciones de crisis sanitaria como la actual. Asimismo, queda demostrado que las técnicas de diseño cooperativo favorecen la participación de los agentes involucrados, aumentando su contribución e impacto potencial sobre los resultados

COVID-19 : Age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study

Background: The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor. Results: In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course. Conclusions: Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease

Más allá del COVID-19. Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria.

Introducción. Las farmacias comunitarias representan un papel clave en la respuesta al COVID-19 y especialmente en el control de enfermedades crónicas más allá de la pandemia. Objetivo. Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria para prevenir la fragilidad y promover el autocuidado en personas mayores. Método. Estudio cualitativo de investigación-acción con mapeo de actores, segmentación de perfiles, grupos de discusión, entrevistas en profundidad y sesiones de diseño creativo. Las técnicas utilizadas aseguraron la participación de personas mayores y profesionales en todas las etapas de diseño. Resultados. Se generaron circuitos comunes de comunicación para los nuevos servicios y protocolos de actuación compartidos. Se propusieron nuevos roles profesionales en respuesta  a las necesidades, expectativas y preferencias de las personas mayores. Se diseñaron los servicios de detección de fragilidad, adherencia a nuevos medicamentos, toma de constantes y refuerzo terapéutico. El modelo aporta sistemas de comunicación bidireccional entre atención primaria y farmacia comunitaria y reconoce el papel de la farmacia comunitaria en la promoción del autocuidado y gestión de la patología crónica y la medicación. Conclusiones. Se evidencia la importancia de crear un ecosistema más abierto que dé lugar a innovaciones organizativas que aprovechen la proximidad y capilaridad de las oficinas de farmacia, así como la incorporación de la omnicanalidad en la atención, esencial en situaciones de crisis sanitaria como la actual. Asimismo, queda demostrado que las técnicas de diseño cooperativo favorecen la participación de los agentes involucrados, aumentando su contribución e impacto potencial sobre los resultados

Genotype and phenotype landscape of MEN2 in 554 medullary thyroid cancer patients: the BrasMEN study

Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant genetic disease caused by RET gene germline mutations that is characterized by medullary thyroid carcinoma (MTC) associated with other endocrine tumors. Several reports have demonstrated that the RET mutation profile may vary according to the geographical area. In this study, we collected clinical and molecular data from 554 patients with surgically confirmed MTC from 176 families with MEN2 in 18 different Brazili an centers to compare the type and prevalence of RET mutations with those from other countries. The most frequent mutations, classified by the number of families affected, occur in codon 634, exon 11 (76 families), followed by codon 918, exon 16 (34 families: 26 with M918T and 8 with M918V) and codon 804, exon 14 (22 families: 15 with V804M and 7 with V804L). When compared with other major published series from Europe, there are several similarities and some differences. While the mutations in codons C618, C620, C630, E768 and S891 present a similar prevalence, some mutations have a lower prevalence in Brazil, and others are found mainly in Brazil (G533C and M918V). These results reflect the singular proportion of European, Amerindian and African ancestries in the Brazilian mosaic genome83289298CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DO RIO GRANDE DO SUL - FAPERGSSem informaçãoSem informação2006/60402-1; 2010/51547-1; 2013/01476-9; 2014/06570-6; 2009/50575-4; 2010/51546-5; 2012/21942-116/2551-0000482-

Genotype and phenotype landscape of MEN2 in 554 medullary thyroid cancer patients: the BrasMEN study

Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant genetic disease caused by RET gene germline mutations that is characterized by medullary thyroid carcinoma (MTC) associated with other endocrine tumors. Several reports have demonstrated that the RET mutation profile may vary according to the geographical area. In this study, we collected clinical and molecular data from 554 patients with surgically confirmed MTC from 176 families with MEN2 in 18 different Brazilian centers to compare the type and prevalence of RET mutations with those from other countries. The most frequent mutations, classified by the number of families affected, occur in codon 634, exon 11 (76 families), followed by codon 918, exon 16 (34 families: 26 with M918T and 8 with M918V) and codon 804, exon 14 (22 families: 15 with V804M and 7 with V804L). When compared with other major published series from Europe, there are several similarities and some differences. While the mutations in codons C618, C620, C630, E768 and S891 present a similar prevalence, some mutations have a lower prevalence in Brazil, and others are found mainly in Brazil (G533C and M918V). These results reflect the singular proportion of European, Amerindian and African ancestries in the Brazilian mosaic genome

Estudo clínico e genético de uma família portadora de carcinoma medular de tireóide

O carcinoma medular de tireóide familiar (CMTF) é uma doença autossômica dominante relacionada a mutações do proto-oncogene RET, que ocorre principalmente nas regiões cisteínas da proteína RET dependentes dos códons 10 e 11. Responde por 5 a 15% dos casos de CMT hereditários. Para caracterizar o CMT de natureza familiar, este deve estar presente em pelo menos 4 indivíduos de uma mesma família. O presente trabalho objetivou o estudo clínico-genético de uma família portadora de carcinoma medular de tireóide. Esta família consiste de 25 indivíduos (13 homens e 2 mulheres) distribuídos em três gerações. Destes, seis apresentam a doença ativa: um homem da 1ª geração e dois homens e três mulheres da 2ª geração. Nenhum membro da 3ª geração desenvolveu a doença até agora. Foram coletadas amostras de sangue periférico de 19 desses indivíduos. Nestas amostras foram realizadas amplificações dos segmentos gênicos de interesse pela técnica da reação em cadeia da polimerase (PCR) e os respectivos seqüenciamentos. Até o momento, detectou-se em dois indivíduos, mutação no códon 10 (cys611tyr). Esta mutação tem uma incidência baixa (1-3%) nos casos de CMTF, mas, no entanto, implica em alto risco de agressividade do tumor. Além disso, detectou-se a presença de 3 polimorfismos (G691S, L769L, S904S), nos éxons 11, 13 e 15. Enquanto que a mutação cys611tyr está relacionada ao desenvolvimento do CMTF, sua relação com os polimorfismos encontrados e o papel desta relação com esses tumores não está esclarecida. A realização do rastreamento genético das mutações no RET deve ser considerada pela sua praticidade, custo-benefício e sensibilidade e especificidade do método. Além disso, a determinação de mutações nos familiares com CMT implicará em indicação cirúrgica preventiva e aconselhamento genético familiar.Familial medullary thyroid carcinoma (FMTC) is an autosomic dominant disorder related to mutations in the RET proto-oncogene. These mutation occur mostly in the extracellular rich cistein domains of the RET protein, related to the codons 10 and 11. The FMTC represents 5-15% of hereditary medullary thyroid carcinoma (MTC). To characterize MTC of familial origin, at least four members of a family must be affected. The present study focused upon clinical-genetics characteristics of a 25-member family (13 men and 12 women) distributed through three generations. Six of them had MTC: one first generation man, two men and three women from the second generation. Up until now, no member from the third generation has developed the disease. We studied 19 of these individuals for mutations in the RET protooncogene. A cys611tyr mutation was found in two of the kindreds. This mutation has a low incidence (1-3%) in FMTC, but implies in high aggressiveness risk. Moreover, we found the polymorphisms G691S, L769L, S904S in the exons 11, 13 and 15, respectively. While cys611tyr mutation is responsible for cases of FMTC, its relationship to these polymorphisms and the consequences of this interrelation to tumor development is still unknown. The screening for RET proto-oncogene mutations in relatives of MTC patients must be considered for its practicability, low cost, high specificity and sensibility. Besides, the determination of mutations in FMTC patients’ kindred will conduct them to prophylactic surgery and familial counseling.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Wellness program for teleworkers at the Universidad del Rosario

El presente proyecto tiene como objetivo principal diseñar un plan de bienestar específico para los teletrabajadores de la Universidad del Rosario, en respuesta a la creciente tendencia del teletrabajo y la importancia de garantizar el bienestar de los empleados en un entorno laboral diverso y descentralizado. A partir de un análisis exhaustivo de encuestas de percepción para evaluar las necesidades y preocupaciones de los teletrabajadores, el proyecto busca identificar áreas de mejora y desafíos en el contexto laboral actual, así como diseñar e implementar estrategias y programas de bienestar que aborden las inquietudes de los teletrabajadores. Se propone la creación de un plan de bienestar personalizado que fomente el compromiso, la participación activa y el acceso a recursos de bienestar físico y mental adaptados a las necesidades y horarios de los teletrabajadores. La implementación de este plan tiene como objetivo mejorar el compromiso, la salud y el bienestar de los teletrabajadores, contribuyendo a aumentar la productividad, la satisfacción laboral y el sentido de pertenencia de los empleados de la Universidad del Rosario.The main objective of this project is to design a specific well-being plan for teleworkers at the Universidad del Rosario, in response to the growing trend of teleworking and the importance of guaranteeing the well-being of employees in a diverse and decentralized work environment. Based on an exhaustive analysis of perception surveys to evaluate the needs and concerns of teleworkers, the project seeks to identify areas of improvement and challenges in the current work context, as well as design and implement well-being strategies and programs that address the concerns of teleworkers. The creation of a personalized well-being plan is proposed that encourages commitment, active participation and access to physical and mental well-being resources adapted to the needs and schedules of teleworkers. The implementation of this plan aims to improve the commitment, health and well-being of teleworkers, contributing to increasing productivity, job satisfaction and the sense of belonging of the employees of the Universidad del Rosario