Utilidad de la radiografía de tórax en el diagnóstico de la bronquiolitis en lactantes < 24 meses, ingresados en el Hospital Escuela Carlos Roberto Huembes, Septiembre 2015 a Septiembre 2017

Con el propósito de evaluar la utilidad de la radiografía de tórax en lactantes menores de 24 meses con Bronquiolitis se llevó a cabo un estudio descriptivo de corte transversal revisando el expediente clínico de 200 pacientes ingresados en el Hospital Escuela Carlos Roberto Huembés en el periodo de septiembre 2015 – Septiembre 2017. Entre los principales resultados se encontró que la mayoría de casos era menor de un año, con predominio del sexo masculino pertenecientes a familias que proceden del área urbana. Los principales factores de riesgo a los que estuvo expuesto el paciente fueron exposición a humo de tabaco en el hogar, vacunas incompletas, no lactancia materna, desnutrición y prematurez. Con respecto a los patrones radiológicos se encontró tenían un patrón normal 12.0%, únicamente signos de hiperinsuflación 70.5%, y el restante presentaban patrón alveolar o intersticial. Al comparar el comportamiento de los patrones radiográfico no se observaron diferencias significativas según sexo ni edad. Los siguientes factores se asociaron a mayor frecuencia de patrón radiológico alterado: Exposición a tabaco en el hogar desnutrición displasia broncopulmonar, cardiopatía congénita y prematurez. Al evaluar la proporción de casos en los que se modificó la pauta terapéutica tomando en cuenta los resultados de la radiografía de tórax se observó que esto ocurrió solo en el 5%. De forma general solo en el 4% de los casos cumple el paciente con los criterios clínicos que determinan el uso de radiografía de tórax el lactante con bronquiolitis

Modelling intervals of minimum/maximum temperatures in the Iberian Peninsula

In this paper, we propose to model intervals of minimum/maximum temperatures observed at a given location by fitting unobserved component models to bivariate systems of center and log-range temperatures. In doing so, the center and logrange temperature are decomposed into potentially stochastic trends, seasonal and transitory components. We contribute to the debate on whether the trend and seasonal components are better represented by stochastic or deterministic components. The methodology is implemented to intervals of minimum/maximum temperatures observed monthly in four locations in the Iberian Peninsula, namely, Barcelona, Coruña, Madrid and Seville. We show that, at each location, the center temperature can be represented by a smooth integrated random walk with time-varying slope while the log-range seems to be better represented by a stochastic level. We also show that center and log-range temperature are unrelated. The methodology is then extended to model simultaneously minimum/maximum temperatures observed at several locations. We fit a multi-level dynamic factor model to extract potential commonalities among center (log-range) temperature while also allowing for heterogeneity in different areas. The model is fitted to intervals of minimum/maximum temperatures observed at a large number of locations in the Iberian Peninsula.Financial Supportfrom\laCaixa"Foundation,grantLCF/PR/SR20/52550012-Climate change and economic challenges for the Spanish society, is gratefully acknowledged. The third author also acknowledges financial support from the Spanish Government grant PID2019-108079GBC21/AIE/10.13039/501100011033 (MINECO/FEDER).The suppor tof Jouni Helske with some of the codes used in this paper is also gratefully acknowledged. We are also grateful to participants at the 69th International Symposium of Forecasters (July, 2022),Rome-Waseda Time Series Symposium (October, 2022) and 16th International Conference, Computational and Financial Econometrics (December, 2022).Any remaining errors are obviously our responsibility

A practical floating-gate Muller-C element using vMOS threshold gates

This paper presents the rationale for vMOS-based realizations of digital circuits when logic design techniques based on threshold logic gates are used. Some practical problems in the vMOS implementation of threshold gates have been identified and solved. The feasibility and versatility of the proposed technique as well as its potential as a low-cost design technique for CMOS technologies have been shown by experimental results from a multiple-input Muller C-element. The proposed new realization exhibits better performance related to delay and area and power consumption than the traditional logic implementation

Diagnóstico de la empresa INET en términos organizacionales y de procedimientos para el análisis de un software.

En este capítulo daremos una breve introducción de algunos conceptos que a lo largo de esta investigación se estarán mencionando, ya que al realizar el manual de procedimientos permitirá al funcionario de la empresa conocer claramente qué debe hacer, cómo, cuándo y dónde debe hacerlo, conociendo también los recursos y requisitos necesarios para complementar una determinada tarea

PARASITOSIS INTESTINALES EN ESCOLARES URBANOS, SUBURBANOS Y RURALES DEL NOROESTE DE MÉXICO

Las parasitosis intestinales son un problema de salud pública que se asocia también a la carencia de infraestructura en una comunidad. América Latina ha experimentado una migración humana acelerada del área rural a la urbana sin que ello signifi que una vida mejor, porque la infraestructura urbana no responde a las demandas de ese aumento poblacional. Esto puede infl uir en la prevalencias de parasitosis intestinal entre población rural y urbana. Este estudio comparó las prevalencias de parasitosis intestinales entre escolares rurales, suburbanos y urbanos del municipio de Hermosillo Sonora, noroeste de México. La técnica de Faust se usó para identifi car parásitos intestinales. Setecientos veintiocho escolares (54%) (6-14 años) participaron voluntariamente durante septiembre de 2010. Doscientos cincuenta y cuatro, 145 y 329 eran escolares urbanos, suburbanos y rurales respectivamente. De los 728 participantes 29% (n=211) tenían parasitosis intestinales mientras que 71% (n= 517) no mostraron tales infecciones. Se estimó una prevalencia de 28% de infecciones intestinales por protozoarios, particularmente de 18% por Giardia duodenalis, y muy baja de helmintos intestinales (2%). Los escolares suburbanos presentaron prevalencias signifi cativamente más altas de parasitosis intestinales (44,9%), protozoosis (41,4%), Entamoeba histolytica/dispar/moshkovskii (6.9%), Giardia duodenalis (39,3%), Endolimax nana (27,6%) y Entamoeba coli (17%) que los urbanos y rurales (

Tenofovir vs lamivudine plus adefovir in chronic hepatitis B: TENOSIMP-B study

AIM To demonstrate the non-inferiority (15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate (TDF) vs the combination of lamivudine (LAM) plus adefovir dipivoxil (ADV) in the maintenance of virologic response in patients with chronic hepatitis B (CHB) and prior failure with LAM. METHODS This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups (TDF and LAM+ADV) of adult patients with hepatitis B e antigen (HBeAg)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were analysed. RESULTS Forty-six patients were evaluated [median age: 55.4 years (30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA (HBV-DNA) remained undetectable, all patients remained HBeAg negative, and hepatitis B surface antigen (HBsAg) positive. Alanine aminotransferase (ALT) values at the end of the study were similar in the 2 groups (25.1 ± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects (AEs) (53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively (P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment (€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001). CONCLUSION TDF monotherapy proved to be safe and not inferior to the LAM+ADV combination therapy in maintaining virologic response in patients with CHB and previous LAM failure. In addition, the use of TDF generated a significant savings in hospital costs

Evaluation of two treatment strategies for the prevention of preterm birth in women identified as at risk by ultrasound (PESAPRO Trial): Study protocol for a randomized controlled trial

Background: Premature birth is considered one of the main problems in modern Obstetrics. It causes more than 50 % of neonatal mortality; it is responsible for a large proportion of infant morbidity and incurs very high economic costs. Cervical length, which can be accurately measured by ultrasound, has an inverse relationship with the risk of preterm birth. As a result, having an effective intervention for asymptomatic patients with short cervix could reduce the prematurity. Although recently published data demonstrates the effectiveness of vaginal progesterone and cervical pessary, these treatments have never been compared to one another. Methods/Design: The PESAPRO study is a noncommercial, multicenter, open-label, randomized clinical trial (RCT) in pregnant women with a short cervix as identified by transvaginal ultrasonography at 19 to 22 weeks of gestation. Patients are randomized (1:1) to either daily vaginal progesterone or cervical pessary until the 37th week of gestation or delivery; whichever comes first. During the trial, women visit every 4 weeks for routine questions and tests. The primary outcome is the proportion of spontaneous preterm deliveries before 34 weeks of gestation. A sample size of 254 pregnant women will be included at 29 participating hospitals in order to demonstrate noninferiority of placing a pessary versus vaginal progesterone. The first patient was randomized in August 2012, and recruitment of study subjects will continue until the end of December 2015. Discussion: This trial assesses the comparative efficacy and safety between two accepted treatments, cervical pessary versus vaginal progesterone, and it will provide evidence in order to establish clinical recommendationsThe study has been funded by two national grants from the Spanish Ministry of Health and ISCIII

Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response

Effectiveness of Thrombectomy in Stroke According to Baseline Prognostic Factors: Inverse Probability of Treatment Weighting Analysis of a Population-Based Registry

Background and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score 85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups' criteria). Results Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). Conclusions Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors