Análisis multitemporal y multicriterio del fenómeno de la urbanización año 1997- 2016-2018 en la zona urbana del municipio Ricaurte – Cundinamarca

11 páginas : gráficas, mapasDebido al crecimiento urbano que se está presentando en los últimos 10 años en el municipio de Ricaurte-Cundinamarca, se manifiestan impactos en aspectos sociales, económicos y ambientales que alteran las dinámicas del entorno. En la presente investigación, analizaremos el cambio que ha tenido el municipio desde el año 1997 al 2018 y la visión actual de los habitantes. Identificando los factores que influyen, proyectándolos y dando una posible solución a este fenómeno

Uso de Dieta Cetogénica en Epilepsia Resistente a Farmacoterapia

La epilepsia es una enfermedad multifactorial ampliamente estudiada. Existen subgrupos de pacientes en quienes la clásica terapia farmacológica anticrisis no proporciona un adecuado control, aproximadamente un 30% de los portadores de la enfermedad. Algunos de estos pacientes se podrían beneficiar de una intervención quirúrgica como tratamiento curativo para su enfermedad. Cuando se encuentra con una persona resistente al control con anticrisis, se puede iniciar la dieta cetogénica como alternativa terapéutica paliativa. Esta opción consiste en una alimentación rica en grasas y en menor proporción proteínas y carbohidratos. Existen diferentes subtipos de dietas cetogénicas, con diferente nivel de restrictividad y se puede seleccionar una u otra dependiendo de los objetivos plantados y del trinomio paciente-sistema de salud-personal médico. Hasta un 50% de los sujetos afectados han experimentado una reducción significativa en las crisis. La mayoría de los efectos adversos se presentan a corto plazo y son previsibles por lo cual estos no tienen un peso significativo en abandono al tratamiento, respecto a los efectos a largo plazo, se necesita una ampliación en los estudios al respecto ya que no hay una posición completamente establecida al respecto

Epilepsia de ausencias en la niñez y adolescencia, diagnóstico, tratamiento y pronóstico

Typical absence seizures are part of a group of idiopathic generalized epileptic syndromes, including childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE). Typical absences are the main clinical feature of these syndromes whose characteristics include transient loss of consciousness of sudden onset and termination without loss of muscle tone with a variable degree of automatisms whose frequency and severity may vary according to each case. Pathophysiologically, crises are associated with overactivation of the thalamic-cortical circuit. CAE is usually associated with a good prognosis with a high percentage of remission, while JAE is usually a disorder that persists for life. Pharmacological treatment is based on the use of anticonvulsants such as ethosuximide, valproic acid and lamotrigine. Absences can also manifest atypically, which usually occur in Lennox Gastaut Syndrome, Epilepsy with myoclonic-atonic seizures, epileptic encephalopathy with spike and continuous wave during sleep (CSWS), among others. Generally, this type of crisis associates an unfavorable prognosis in which therapeutic goals are often focused on achieving a reduction in the incidence of crises and not complete remission.Las crisis de ausencias típicas forman parte de una gama de síndromes epilépticos generalizados idiopáticos dentro de los cuales se incluye la epilepsia de ausencia infantil (EAI) y la epilepsia de ausencia juvenil (EAJ). Las ausencias típicas son el signo pivote de dichos síndromes cuyas características incluyen la pérdida transitoria de consciencia, de inicio y terminación súbita, sin pérdida de tono muscular con grado variable de automatismos cuya frecuencia y severidad puede variar según cada caso. Fisiopatológicamente las crisis se asocian a una sobreactivación del circuito tálamo cortical. La EAI suele asociar buen pronóstico con alto porcentaje de remisión mientras que la EAJ suele ser un trastorno que persiste de por vida. El tratamiento se fundamenta en el uso de fármacos anticrisis tal como la etosuximida, ácido valproico y lamotrigina. Las ausencias también se pueden manifestar de manera atípica las cuales suelen presentarse en el Síndrome de Lennox Gastaut, epilepsia con crisis mioclónicas-atónicas, encefalopatía epiléptica con punta y onda continua durante el sueño (CSWS), entre otras. Generalmente dicho tipo de crisis asocia un pronóstico poco favorable en donde con frecuencia la meta terapéutica se enfoca en lograr una reducción en la incidencia de las crisis y no la remisión completa

Comorbilidad cardiaca en epilepsia: una revisión bibliográfica

Epilepsy is a disease characterized by recurrent epileptic seizures due to abnormal or excessive neuronal activity in the brain. It has been shown that these crises are associated with an increase in cardiac comorbidity. First, a relationship between epilepsy and cardiac arrhythmias has been shown, the most prevalent being sinus tachycardia. However, other entities like AV blocks or even asystole has been associated. Various mechanisms have been studied as the cause of these arrhythmias, among which, alterations at the level of ion channels stand out, which in many cases are associated with genetic alterations that cause channels that are found both in the brain and heart. Another aspect that has been evidenced is the presence of structural changes, as well as by molecular changes at the cardiac level. Regarding structural changes, echocardiographic findings of systolic and diastolic dysfunction have been evidenced, in addition to the presence in some cases of ventricular hypertrophy. Another aspect that has been found is the association of epilepsy with an increased prevalence of cardiovascular risk factors such as dyslipidemia or obesity, which is associated with the change in lifestyle that these patients have due to their diagnosis, however, despite this, it has not been possible to show a statistically significant increase in cardiovascular mortality. Finally, various medications used for epilepsy have been observed to increase cardiovascular risk; however, it has been observed that the risk due to an increase in seizures is greater than the theoretical risk that exists due to epilepsy drugs.La epilepsia es una enfermedad caracterizada por crisis epilépticas recurrentes debido a actividad neuronal anormal o excesiva a nivel cerebral. Dichas crisis están asociadas a un aumento en comorbilidad cardiaca. En primer lugar, se ha evidenciado una relación de la epilepsia con arritmias cardiacas, siendo la más prevalente la taquicardia sinusal. Además, entidades como bloqueos AV o incluso asistolia se han visto asociados. Diversos mecanismos se han estudiado como los causantes, entre los que destacan alteraciones a nivel de canales iónicos, los cuales en muchos casos están asociados con alteraciones genéticas en canales que se encuentran tanto a nivel cerebral como cardiaco. Otro aspecto importante es la presencia de cambios estructurales, así como cambios moleculares a nivel cardiaco entre lo que se ha evidenciado disfunción sistólica y diastólica, además de hipertrofia ventricular. Asimismo, se ha encontrado la asociación de epilepsia con aumento en la prevalencia de factores de riesgo cardiovasculares y la afectación directa por medicamentos. En esta revisión bibliográfica se evidencia que todos estos factores cumplen un papel en el riesgo cardiovascular, sin embargo, no en todos se ha encontrado una relación estadísticamente significativa, principalmente por problemas al diferenciar la relación directa con la mortalidad cardiovascular

Brain connectivity and cognitive functioning in individuals six months after multiorgan failure

Abstract Multiorgan failure (MOF) is a life-threating condition that affects two or more systems of organs not involved in the disorder that motivates admission to an Intensive Care Unit (ICU). Patients who survive MOF frequently present long-term functional, neurological, cognitive, and psychiatric sequelae. However, the changes to the brain that explain such symptoms remain unclear. OBJECTIVE: To determine brain connectivity and cognitive functioning differences between a group of MOF patients six months after ICU discharge and healthy controls (HC). METHODS: 22 MOF patients and 22 HC matched by age, sex, and years of education were recruited. Both groups were administered a 3T magnetic resonance imaging (MRI), including structural T1 and functional BOLD, as well as a comprehensive neuropsychological evaluation that included tests of learning and memory, speed of information processing and attention, executive function, visual constructional abilities, and language. Voxel-based morphometry was used to analyses T1 images. For the functional data at rest, functional connectivity (FC) analyses were performed. RESULTS: There were no significant differences in structural imaging and neuropsychological performance between groups, even though patients with MOF performed worse in all the cognitive tests. Functional neuroimaging in the default mode network (DMN) showed hyper-connectivity towards sensory-motor, cerebellum, and visual networks. DMN connectivity had a significant association with the severity of MOF during ICU stay and with the neuropsychological scores in tests of attention and visual constructional abilities. CONCLUSIONS: In MOF patients without structural brain injury, DMN connectivity six months after ICU discharge is associated with MOF severity and neuropsychological impairment, which supports the use of resting-state functional MRI as a potential tool to predict the onset of long-term cognitive deficits in these patients.Similar to what occurs at the onset of other pathologies, the observed hyper-connectivity might suggest network re-adaptation following MOF.This research was founded by Ministerio Economia, Industria y Competitividad, Spain and FEDER (grant no. DPI2016-79874-R) to JC and JCAL. ID's time was founded by the Department of Education of the Basque Country, postdoctoral program. JR's time was founded by the Ministry of Education, Language Policy and Culture (Basque Government). JMC's time was founded by Ikerbasque and the Department of Economic Development and Infrastructure of the Basque Country, Elkartek Program (grant no. KK-2018/00032). JCAL's time was founded by Ikerbasque and Fundacion Mutua Madrilena (grant no. AP169812018). IG's time was founded by the Instituto de Salud Carlos III for a Juan Rodes (grant no. JR15/00008) co-funded by the European Regional Development Fund/European Social Fund 'Investing in Your Future'. AJM's time was partly founded by Euskampus Fundazioa

¿Existieron vicios del razonamiento práctico en cuanto a la precipitación e inconsideración en el caso de la sentencia 01294 de 2018 del Consejo de Estado, analizado desde la prudencia política y jurídica?

13 p.A continuación, se planteará el caso de la ex representante a la cámara y senadora electa por el partido conservador colombiano Aida Merlano Rebolledo, quien perdió la investidura de su cargo en el año 2018 como consecuencia de la violación de los topes máximos de financiación de su campaña electoral, y se realizará un análisis detallado de los vicios del razonamiento prudencial de precipitación e inconsideración que se manifestaron tanto en su actuar como en el procedimiento judicial que se le realizó respectivamente. De esta manera, (y con los conceptos de los vicios del razonamiento ya entendidos) se aplicará lo establecido por prudencia jurídica y política en el caso en concreto para poder plantear una conclusión interpretativa objetiva sobre el actuar ético- moral de dicha mujer, y el por qué se expone que no fue el correcto, lo cual se espera de un jurista en el cual, los ciudadanos depositan su confianza para la buena administración de su país.Introducción Prudencia jurídica Prudencia política Resumen sentencia Vicios del razonamiento Conclusión Referencia

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

MAREJADAS RURALES Y LUCHAS POR LA VIDA, VOL. II: CONFLICTOS SOCIOTERRITORIALES Y POR RECURSOS NATURALES

Volumen 2. Conflictos socioterritoriales y por recursos naturales, coordinado por: Rosalía López Paniagua, Dante Ariel Ayala Ortiz y Armando Contreras Hernández, constituido por 19 trabajos, divididos en tres secciones. La primera titulada Tierra: tenencia y cultivos transgénicos, contiene 6 trabajos, que abordan el persistente conflicto por la tenencia de la tierra y la producción de soya y maíz transgénico y la asociada acumulación del capital por despojo que caracteriza la agricultura transgénica en México, pero también formas de resistencia como la denuncia de contaminación transgénica en la Sierra Juárez de Oaxaca y las instituciones, actores y gestión en la Reserva de la Biósfera El Triunfo en la Sierra Madre de Chiapas. La segunda sección: Territorio: Explotación y envenenamiento, está compuesta por 5 trabajos que hacen referencia a los conflictos socioambientales derivados de la minería en manos de empresas nacionales y extranjeras omisas y gobiernos cómplices de las consecuencias depredadoras que generan en territorios campesinos e indígenas, debido a su asociación con el narcotráfico y por la contaminación del agua y la tierra que provocan, además de las consecuencias perversas en la salud humana y el entorno natural en diversas regiones del país. En la tercera y última sección, Agua: contaminación y escases, los 8 trabajos que la integran, analizan los conflictos socioterritoriales y luchas por la vida, en diversos estados del país. Se trata de investigaciones que estudian movimientos y conflictos sociales actuales en el campo mexicano, como son las luchas por la defensa del territorio y la defensa de la naturaleza, trabajos que abordan especialmente las disputas por el agua, y los problemas asociados del acceso, la escasez y la contaminación, no solo internos sino con empresas y con el Estado mismo que con la aprobación y aplicación de leyes y reglamentos, el despojo a los campesinos de su territorio en el que han trabajado y vivido por generaciones.INSTITUTO DE CIENCIAS AGROPECUARIAS Y RURALES (ICAR), UNIVERSIDAD DE GUADALAJARA, EL COLEGIO DE MICHOACÁN A.C., FACULTAD DE ESTUDIOS SUPERIORES ACATLÁN-UNAM, ECOSUR, CUCOSTA SUR GRANA, ASOCIACIÓN MEXICANA DE ESTUDIOS RURALES A.C