Amniotic Fluid Embolism

Amniotic fluid embolism (AFE) is a rare complication of pregnancy often resulting in catastrophic maternal and fetal outcomes. Given the rarity of this condition, there is a wide variation in reported incidence of amniotic fluid embolism. The pathophysiology of AFE is not completely understood. It is thought to be the result of a breach of the maternal-fetal barrier resulting in an abnormal maternal proinflammatory response. AFE presents as a sudden onset of hypoxia, hypotension, and coagulopathy during labor and delivery or in the immediate postpartum period. Abnormalities in the fetal heart tracing are almost always present. Risk factors often include advanced maternal age, induction of labor, cesarean delivery, operative vaginal delivery, placenta previa, and placental abruption. The diagnosis of amniotic fluid embolism is made based on clinical presentation. There are no laboratory tests that confirm the diagnosis of AFE; however, serum tryptase levels, complement levels, zinc coproporphyrin, and serum sialyl Tn (STn) may support the diagnosis. Management of women with AES is supportive and most often requires admission to an intensive care unit. Although maternal morbidity and mortality remain high, advances in medical technology and improvements in obstetrical critical care and early diagnosis of AFE have improved outcomes

Description of an Ultrasound-Guided Erector Spinae Plane Block and Comparison to a Blind Proximal Paravertebral Nerve Block in Cows: A Cadaveric Study

The proximal paravertebral nerve block is commonly used to provide anaesthesia to the flank during standing surgical procedures in adult cattle. It has been reported that additional anaesthetic infiltration may be necessary to provide complete anaesthesia. In humans as well as animal species, another technique—the ultrasound (US)-guided erector spinae plane block (ESPB)—has been described. The goal of the present study was to develop and investigate an US-guided ESPB in comparison to a blind proximal paravertebral nerve block (PPNB) in cow cadavers. In 10 cadaver specimens, injections of methylene blue-lidocaine (1:1) were performed at the level of T13, L1 and L2 vertebras, on one side doing an ESPB block and, on the other side, a PPNB. Five cadavers were injected with high (40 mL per injection for PPNB and 20 mL for ESPB) and five with low (20 and 15 mL, respectively) volumes of injectate. For the ESPB, the ultrasound probe was oriented craniocaudally, and the ventral-cranial aspect of the articular processes (T13, L1 and L2) was targeted for injection. The dye spreading was evaluated by dissection. The landmarks for US-guided injection were easily visualized; however, injections were accidentally performed at T12, T13 and L1. Nevertheless, L2 was stained in 60% of ESPBs. Epidural spreading was observed with both techniques and all volumes. Viscera puncture was reported in two PPNBs. The ESPB resulted in similar nerve staining compared to the PPNB while using a lower volume of injectate. Even better staining is expected with a T13-L2 instead of a T12-L1 ESPB approach. Further studies are warranted to evaluate the clinical efficacy

Artritis septica.: Revision de la artritis septica , generalidades.

Septic arthritis is defined as an infection that occurs within the joint space. Despite being a rare disease, it takes vital importance due to the severity of its sequels. It is because of this severity, the importance of reviewing this topic in this article. The main objective is to evaluate all possible causes, clinical characteristics, diagnostic methods, complementary studies, and the different therapeutic approaches of this pathology. This topic of review is of vital importance because the consequences of septic arthritis can be devastating to the joint and the patient if not treated in the proper manner and in the right time. Septic arthritis is considered a surgical emergency, and a delay in diagnosis and treatment can lead to irreversible damage to the joint.La artritis séptica se define como una infección que se da dentro del espacio articular. Está a pesar de ser una enfermedad poco frecuente toma vital importancia debido a la severidad de sus secuelas. Es por esta severidad la importancia de la revisión de este tema en este artículo. El objetivo principal es valorar todas las posibles causas, clínica característica, los métodos diagnósticos, estudios complementarios y los diferentes abordajes terapéuticos de esta patología. Este tema de revisión es de vital importancia debido a que las secuelas de esta patología pueden ser devastadoras para la articulación y el paciente sino se trata oportuna y adecuadamente. La artritis séptica se considera una emergencia quirúrgica, ya que el retraso en su diagnóstico y tratamiento pueden llevar a daño irreversible de la articulación

SGLT2i and GLP-1RA in cardiometabolic and renal diseases : from glycemic control to adipose tissue inflammation and senescence

Background. Over the last few years, the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) has increased substantially in medical practice due to their documented benefits in cardiorenal and metabolic health. In this sense, and in addition to being used for glycemic control in diabetic patients, these drugs also have other favorable effects such as weight loss and lowering blood pressure, and more recently, they have been shown to have cardio and renoprotective effects with anti-inflammatory properties. Concerning the latter, the individual or associated use of these antihyperglycemic agents has been linked with a decrease in proinflammatory cytokines and with an improvement in the inflammatory profile in chronic endocrine-metabolic diseases. Hence, these drugs have been positioned as first-line therapy in the management of diabetes and its multiple comorbidities, such as obesity, which has been associated with persistent inflammatory states that induce dysfunction of the adipose tissue. Moreover, other frequent comorbidities in long-standing diabetic patients are chronic complications such as diabetic kidney disease, whose progression can be slowed by SGLT2i and/or GLP-1RA. The neuroendocrine and immunometabolism mechanisms underlying adipose tissue inflammation in individuals with diabetes and cardiometabolic and renal diseases are complex and not fully understood. Summary. This review intends to expose the probable molecular mechanisms and compile evidence of the synergistic or additive anti-inflammatory effects of SGLT2i and GLP-1RA and their potential impact on the management of patients with obesity and cardiorenal compromise

Forçamento radiativo direto devido a propriedades de aerossóis na estação antártica peruana e na área metropolitana de Huancayo

We describe the results of the study of aerosol optical depth (AOD) and Direct Radiative Forcing (DRF) in Top Of Atmosphere (TOA), obtained from the measurement and monitoring campaign carried out during the XXI Antarctic Peruvian Expedition in the months of January and February 2013 and in the Metropolitan Huancayo Area in the months of June and July 2019. In the Scientific Peruvian Station at Antarctic “Machu Picchu” our used a SP02-L sun photometer, which is within the instrumental framework of the International Polar Year. This instrument has 4 channels: 412 nm, 500 nm, 675 nm and 862 nm, thus allowing direct radiation spectra measurements. And in the MHA we used the BF5 sensor. This instrument measured Direct, Diffuse and Global Radiation in low wavelength. The results calculated of AOD in polar latitudes varied between 0.0646 to 0.1061, in relation to AOD in MHA, presents the value maximum that is 0.58 (11 of June) and minimum that is 0.19 (12 June). The Angstrom coefficient was determined have values ranging from 0 to 0.07, these values also indicates the presence of big particles. Also to the MHA presents the mean value varied from 0 to 1.8, that indicated the presence the aerosols types biomass burning and industrial. Recorded optical properties used to estimate the direct aerosol radiative forcing (DARF) at the top of the atmosphere. The results indicates that on King George Island site the DARF is between [-2 4] W/m2; also, the direct aerosol radiative forcing in MHA is between [0 20] W/m2.Descrevemos os resultados do estudo da profundidade ótica do aerossol (POA) e do Forçamento Radiativo Direto (FRD) no topo da atmosfera (TOA), obtidos durante a campanha de medição e monitoramento, XXI Expedição Antártica do Peru, entre os meses de janeiro e fevereiro de 2013, e na área metropolitana de Huancayo (AMH) entre os meses de junho e julho de 2019. Na Estação Antártica Peruana Machu Picchu utilizou-se um fotômetro solar SP02-L. Tal instrumento possui 4 canais: 412 nm, 500 nm, 675 nm e 862 nm, permitindo realizar medições diretas do espectro de radiação visível. Na AMH usamos o sensor BF5, que mede a radiação direta, difusa e global em comprimento de onda curta. Os cálculos de AOD em latitudes polares variaram entre 0,0646 e 0,1061. Na AMH apresenta valor máximo de 0,58 (11 de junho) e mínimo de 0,19 (12 de junho). Determinou-se o coeficiente de Angstrom variando de 0 a 0,07, esses valores indicam a presença de partículas grandes. Na AMH varia de 0 a 1,8, que indica a presença de aerossóis de fonte de queima de biomassa e industrial. As propriedades óticas observadas foram usadas para estimar a forçante radiativa direta por aerossóis (FRDA) no topo da atmosfera. Os resultados indicam que no King George Island, o FRDA, está entre -2 e 4 W/m2; já para a AMH a forçante radiativa direta de aerossol está entre 0 e 20 W/m2.Revisión por paresCampus Huancay

The decline of dengue in the Americas in 2017: discussion of multiple hypotheses

OBJECTIVE: Since the 1980s, dengue incidence has increased 30-fold. However, in 2017, there was a noticeable reduction in reported dengue incidence cases within the Americas, including severe and fatal cases. Understanding the mechanism underlying dengue's incidence and decline in the Americas is vital for public health planning. We aimed to provide plausible explanations for the decline in 2017. METHODS: An expert panel of representatives from scientific and academic institutions, Ministry of Health officials from Latin America and PAHO/WHO staff met in October 2017 to propose hypotheses. The meeting employed six moderated plenary discussions in which participants reviewed epidemiological evidence, suggested explanatory hypotheses, offered their expert opinions on each and developed a consensus. RESULTS: The expert group established that in 2017, there was a generalised decreased incidence, severity and number of deaths due to dengue in the Americas, accompanied by a reduction in reported cases of both Zika and chikungunya virus infections, with no change in distribution among age groups affected. This decline was determined to be unlikely due to changes in epidemiological surveillance systems, as similar designs of surveillance systems exist across the region. Although sudden surveillance disruption is possible at a country or regional level, it is unlikely to occur in all countries simultaneously. Retrospective modelling with epidemiological, immunological and entomological information is needed. Host or immunological factors may have influenced the decline in dengue cases at the population level through immunity; however, herd protection requires additional evidence. Uncertainty remains regarding the effect on the outcome of sequential infections of different dengue virus (DENV) types and Zika virus (ZIKV), and vice versa. Future studies were recommended that examine the epidemiological effect of prior DENV infection on Zika incidence and severity, the epidemiological effect of prior Zika virus infection on dengue incidence and severity, immune correlates based on new-generation ELISA assays, and impact of prior DENV/other arbovirus infection on ZIKV immune response in relation to number of infections and the duration of antibodies in relation to interval of protection. Follow-up studies should also investigate whether increased vector control intensification activities contributed to the decline in transmission of one or more of these arboviruses. Additionally, proposed studies should focus on the potential role of vector competence when simultaneously exposed to various arboviruses, and on entomological surveillance and its impact on circulating vector species, with a goal of applying specific measures that mitigate seasonal occurrence or outbreaks. CONCLUSIONS: Multifactorial events may have accounted for the decline in dengue seen in 2017. Differing elements might explain the reduction in dengue including elements of immunity, increased vector control, and even vector and\or viruses changes or adaptations. Most of the results of this expert consensus group meeting are hypothetical and based on limited evidence. Further studies are needed

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

TORTURA Y PROTOCOLO DE ESTABMBÚL: Perspectivas, alternativas y contextos

La obra presenta el tema central de la tortura que esta presente en la sociedad mexicana. Sus perspectivas, alternativas y contextos.El libro consta de 23 capítulos en los cuales los autores presentan de forma analítica y crítica el contexto de la tortura en México; sus efectos, alcances y perspectivas

Investigación en Matemáticas, Economía, Ciencias Sociales y Agronomía

Cada trabajo del libro incluye conclusiones para los interesados en las temáticas aludidas y en ellos nos enteramos de aspectos como los siguientes: - El mayor incremento del precio de los insumos como el maíz, sorgo y en menor medida desperdicio de pan, en relación con el menor crecimiento del precio del ganado en pie, dará como consecuencia un desabasto de carne bovina. - El agua es un recurso primordial en las zonas áridas y semiáridas de México, en tanto que su aporte limita la producción de la agricultura. En este estudio se observó que el precio real del agua es muy bajo en relación a otras zonas agrícolas del mundo. - Hoy en día en el país se consumen alrededor de 718 mil barriles diarios de gasolinas, un aproximado de 113.7 millones de litros, una cantidad tan grande que nuestro país se ve en la necesidad de importar cerca del 39 % de las gasolinas que consumimos. - Los jaliscienses radicados en Estados Unidos tienen una mayor capacidad de financiamiento del bienestar en la entidad, que el propio gobierno de ese estado. - México continuará basando sus finanzas públicas y su política de desarrollo económico en la extracción de combustibles fósiles (petróleo). Este modelo acelerará el deterioro y agotamiento de los recursos naturales. -La importancia de la agricultura orgánica radica en que retoma los tres ámbitos de la sustentabilidad; el ámbito ambiental, el económico y el social. - Es fundamental motivar la organización de los productores de haba para que ellos puedan captar una mayor proporción de los altos márgenes de precios que los consumidores están dispuestos a pagar. - Las condiciones del clima afectan a la producción agraria. Debido al fenómeno de cambio climático, es necesario contar con herramientas informáticas que proporcionen información climatológica para poder tomar medidas preventivas a favor de una mayor cantidad y calidad de producción. La herramienta de software permite la consulta del clima por localidades evitando la necesidad de contar con una estación meteorológica