Frecuencia de positividad de la prueba de intradermorreacción a tuberculina en una cohorte de pacientes con artritis reumatoide previo al inicio o cambio de terapia biológica

Introducción. La artritis reumatoide es una enfermedad autoinmunitaria, crónica y deformante asociada con discapacidad. Quienes la padecen reciben inmunosupresores y tienen un gran riesgo de desarrollar tuberculosis. La prueba de intradermorreacción a la tuberculina se utiliza como tamización en quienes van a recibir terapia biológica. Objetivo. Evaluar la frecuencia de positividad en la prueba de intradermorreacción a la tuberculina en una cohorte de pacientes con artritis reumatoide. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal de una cohorte de pacientes con artritis reumatoide a quienes se les practicó la prueba de tuberculina antes de iniciar la terapia biológica o en el momento del cambio de tratamiento. Los pacientes presentaban enfermedad moderada o grave y eran candidatos para iniciar o cambiar de terapia biológica. Se definió el valor de ≥6 mm como punto de corte para la positividad de la prueba y se hizo un análisis descriptivo de cada una de las variables. Resultados. Se incluyeron 261 pacientes con artritis reumatoide, 92 % de ellos eran mujeres, la edad promedio fue de 55 años (desviación estándar, DE=13,92) y el tiempo desde el diagnóstico era de 12,3 años (DE=8,54). La frecuencia de positividad de la prueba fue de 15,71 % (n=41). Nueve de los 41 pacientes positivos habían recibido la prueba previamente (entre 1 y 6 años antes), todos con resultado negativo; 18 (43,9 %) de ellos venían recibiendo tratamiento con glucocorticoides y todos los 41 (100 %) recibían metotrexate. Conclusiones. La frecuencia de positividad de la prueba de tuberculina en pacientes colombianos con artritis reumatoide fue de aproximadamente 16 %. Se recomienda optimizar las estrategias para detectar esta condición y darle un tratamiento oportuno y, así, disminuir el riesgo de reactivación de la tuberculosis.Introduction: Rheumatoid arthritis is an autoimmune, chronic and deforming condition associated with disability. Rheumatoid arthritis patients are considered having immunosuppression being at high risk of developing tuberculosis. The tuberculin skin test is used as a screening test in candidates to receive biological therapy. Objective: To evaluate the frequency of positivity of the tuberculin skin test in a cohort of patients with rheumatoid arthritis. Materials and methods: Descriptive cross-sectional study including patients with rheumatoid arthritis in whom the tuberculin skin test was performed, prior to the start or at the time of the change of biological therapy. The patients were in moderate or severe disease activity and were candidates for initiation or change of biological therapy. The value of >6mm was defined as the cut-off point for a positive tuberculin skin test. A descriptive analysis for each of the variables included was performed. Results: In total, 261 patients with rheumatoid arthritis were included, 92% women, average age 55 years (SD 13.92) and diagnosis time 12.3 years (SD 8.54). The frequency of a positive tuberculin skin test was 15.71% (n = 41). From the patients having a positive test (n=41), the test had been previously performed in 9 patients (between 1-6 years before) and the result in all of them was negative. Tuberculin skin test positive patients (n=41) were receiving glucocorticoids (43.9%) and methotrexate (100%). Conclusions: The frequency of positivity of the tuberculin skin test in Colombian patients with diqgnosis of RA is reported (16%). Strategies aimed to the optimal identification of this condition and the proper initiation of treatment-initiation are recommended in order to reduce the risk of tuberculosis reactivation. © 2021. All Rights Reserved

ERF deletion rescues RAS deficiency in mouse embryonic stem cells

MEK inhibition in combination with a glycogen synthase kinase-3β (GSK3β) inhibitor, referred as the 2i condition, favors pluripotency in embryonic stem cells (ESCs). However, the mechanisms by which the 2i condition limits ESC differentiation and whether RAS proteins are involved in this phenomenon remain poorly understood. Here we show that RAS nullyzygosity reduces the growth of mouse ESCs (mESCs) and prohibits their differentiation. Upon RAS deficiency or MEK inhibition, ERF (E twenty-six 2 [Ets2]-repressive factor), a transcriptional repressor from the ETS domain family, translocates to the nucleus, where it binds to the enhancers of pluripotency factors and key RAS targets. Remarkably, deletion of Erf rescues the proliferative defects of RAS-devoid mESCs and restores their capacity to differentiate. Furthermore, we show that Erf loss enables the development of RAS nullyzygous teratomas. In summary, this work reveals an essential role for RAS proteins in pluripotency and identifies ERF as a key mediator of the response to RAS/MEK/ERK inhibition in mESCs.We thank Cian Lynch, Jorge Monsech, and Diego Megias for their help with microarray, ChIP-seq, and high-throughput microscopy analyses. We also thank Dr. Manuel Serrano and Dr. André Nussenzweig for their input on the manuscript, and Dr. Diego Sanz for his support throughout the project. C.M.-R. was funded by a PhD fellowship from La Caixa Foundation, T.O. was funded by a PhD fellowship from the Boehringer Ingelheim Fonds, and S.R. was funded by a Ramon y Cajal contract (RYC-2011-09242). Research was funded by Fundación Botín and Banco Santander through its Santander Universities Global Division; grants from the Spanish Ministry of Economy and Competitiveness (SAF2011-23753 and SAF2014- 57791-REDC; these projects were cofinanced with European Fonds Européen de Développement Économique et Régional [FEDER] funds), Fundació La Marato de TV3, Howard Hughes Medical Institute, and the European Research Council (ERC- 617840) to O.F.-C.; and grants from the Spanish Ministryof Economy and Competitiveness (SAF2013-49147-P and SAF2016-80874-P; these projects were cofinanced with European FEDER funds) to S.R. Author contributions: C.M.-R. and S.R. conducted most of the experiments; T.O. helped with the characterization of RASlox/lox mESCs and with ERF localization studies; E.L. helped with ChIP-seq experiments; M.D., S.O., and M.B. contributed to the work on RAS-deficient cells; M.V.-S. provided technical help; O.D. helped with genomics experiments and bioinformatics analysis; and S.R. and O.F.-C. coordinated the study and wrote the manuscript.S

Importancia y Efectos De La Sentencia T-194 De 1999

On the twenty-five 25 March of a thousand nine hundred and ninety-nine 1999, the Fourth Guardianship Review Chamber of the Constitutional Court, passed the judgment T-194 of 1999 on the action for review of the judgments handed down by the Superior Court of the Judicial District Monteria and the Supreme Court of Justice in the process of the proceedings filed under number T-175.217. against the Electric Corporation of the Atlantic Coast (CORELCA), and the mixed-economy, commercial and industrial society of the State Empresa Multipropósito Urrá S.A., in which the requests of Alvaro León Obando Moncayo were estimated in the name and representation of the members of the Association of Producers for Community Development of the Lorica Large Swamp (ASPROCIG) to request to order the defendant entities: (1) suspend the activities that violate them; (2) initiate the implementation of compensation and mitigation projects; (3) advance the impact studies that were omitted; (4) implement management, mitigation and compensation plans with effective community participation, and 5) suspend the filling of the dam until the necessary measures are taken to not cause further harm to the population and the environment.In general, the Court partially reversed the judgments made by the Criminal Standing Chamber of the Supreme Court of Justice on 8 September 1998 and the Criminal Chamber of the Superior Court of the Judicial District of Monteria on 3 July 1998 giving reason to the petitioners and, instead, ielo the rights of members of the Association of Producers for Community Development of the Large Ciénega de Lorica (ASPROCIG), to participation and to a healthy environment; and upheld the second-instance ruling, as soon as he denied the protection of the rights to life, health and work. In this light, this research aims to analyse the importance and effects of this failure on society, in particular because of the limits that it sets to the control bodies and the ratification of the sanctioning capacity that the administrative bodies have on the impacts of the construction of the civil works of the Urrá I hydroelectric plant, and the diversion of the Sinú river.The approach to work was done from alternative mechanisms to the principle of proportionality to justify the preference of one right over another resulting from a weighting process, and that the theory of the impact of judicial activism of McCann (1994), Feeley and Rubin (1998), Gerald Rosenberg (1991) and Cesar Rodríguez (2012) are a good example of this, in that sense, our idea is that judicial activism, can be, at least in some cases, or in relation to some aspects, highly satisfactory.El veinticinco (25) de marzo de mil novecientos noventa y nueve (1999), la Sala Cuarta de Revisiónde Tutelas de la Corte Constitucional, profirió la sentencia T 194 de 1999 sobre la acción de revisiónde las sentencias proferidas por el Tribunal Superior del Distrito Judicial de Montería y la CorteSuprema de Justicia en el trámite del proceso radicado bajo el número T 175.217. en contra de laCorporación E léctr ica de la Costa Atlántica CORELCA ––, y la sociedad de economía mixta,comercial e industrial del Estado Empresa Multipropósito Urrá S.A., en la cual se estimó laspeticiones de Álvaro León Obando Moncayo 3 en nombre y representación de los afiliados a laAs ociación de Productores para el Desarrollo Comunitario de la Cié naga Grande de LoricaASPROCIG de solicitar ordenar a las entidades demandadas: 1) suspender las actividades que losvulneran; 2) iniciar la ejecución de los proyectos de compensación y miti gación; 3) adelantar losestudios de impacto que se omitieron; 4) poner en práctica los planes de manejo, mitigación ycompensación con participación efectiva de la comunidad, y 5) suspender el llenado de la presa hastaque se adopten las medidas necesaria s para no causar más daño a la población y el medio ambiente.En general, la Corte revocó parcialmente los fallos proferidos por la Sala de Casación Penal de laCorte Suprema de Justicia el 8 de septiembre de 1998 y la Sala Penal del Tribunal Superior del DistritoJudicial de Montería el 3 de julio de 1998 dando razón a los peticionarios y, en su lugar, tutelo losderechos de los afiliados a la Asociación de Productores para el Desarrollo Comunitario de la CiénagaGrande de Lorica ASPROCIG --, a la participa ción y a un medio ambiente sano; y confirmó lasentencia de segunda instancia, en cuanto negó el amparo de los derechos a la vida, la salud y eltrabajo. Bajo esta perspectiva, esta investigación pretende analizar la importancia y efectos de estefallo en la sociedad, en especial, por lo s límites que en él se fija a los organismos de control y laratificación de la capacidad sancionadora que los órganos adm inistrativos locales tienen sobre lasafectaciones por la construcción de las obras civiles de la hidroeléctrica Urrá I, y la desviación del ríosinú. El abordaje del trabajo se hizo desde mecanismos alternativos al principio de proporcionalidad parajust ificar la preferencia de un derecho sobre otro resultante de un proceso ponderativo, y que la teoríade impacto del activismo judicial de McCann (1994), Feeley y Rubin (1998), Gerald Rosenberg(1991) y Cesar Rodríguez (2012) son un buen ejemplo de ello , en tal sentido, nuestra idea es que elactivismo judicial, puede ser, al menos en algunos casos, o en relación a algunos aspectos, altamentesatisfactorio

Description of changes in mean diffusivity in magnetic resonance of injuries of the ascending reticular system in patients with traumatic brain injury and impaired consciousness

Introducción: los pacientes con trauma craneoencefálico severo pueden tener secuelas neurológicas graves que generan discapacidad de rangos diferentes según la escala de Barthel. La alteración del estado de consciencia es la secuela más grave y es causa de dependencia completa de estos pacientes por la pérdida del autocuidado. La relación entre los hallazgos anormales en las neuroimágenes y los diferentes estados de conciencia ha sido objeto de investigación en los últimos años, con la posibilidad de que existan nuevas opciones con el posproceso de imágenes obtenidas por resonancia magnética nuclear. Este estudio pretende describir las alteraciones en la difusibilidad media haciendo posproceso en la secuencia de DWI en 4 pacientes con trauma craneoencefálico severo y alteración del estado de consciencia, quienes en la fase aguda del trauma fueron estudiados con imágenes convencionales de tomografía y resonancia. Materiales y métodos: se describe una serie de 4 casos de pacientes con trauma craneoencefálico severo y alteración del estado de consciencia a quienes se realizó resonancia cerebral simple. Las imágenes fueron sometidas a un posproceso de la secuencia de DWI analizando diferentes regiones por donde transcurren las fibras del sistema reticular activador ascendente (SRAA) (cuerpos restiformes, rafe medio del mesencéfalo, tálamo, regiones subinsulares y lóbulos frontales basales). Igualmente se tomaron valores de difusibilidad en regiones similares, en 5 sujetos sin alteración estructural cerebral tomados como controles. Resultados: se encontró disminución en la difusibilidad media en las diferentes regiones establecidas en el estudio, que tuvieron diferente localización en cada paciente. Los valores disminuyeron aproximadamente en un 50 % respecto a los del grupo control, observando lesiones en áreas que no fueron identificadas en la interpretación de la imagen cuando fue adquirida durante el trauma. Conclusiones: el posproceso de la secuencia DWI muestra disminución en los valores de difusibilidad media en regiones por donde transcurren las vías del sistema reticular activado ascendente, estos cambios que explican las diferentes alteraciones en el estado de conciencia, no fueron visualizados en las imágenes interpretadas bajo las técnicas convencionales. Se requiere nuevos estudios para establecer las características operativas de la prueba que permitan definir su potencial utilidad dentro de los algoritmos de clasificación inicial de los pacientes con trauma craneoencefálico severo.Introduction: Patients with severe traumatic brain injury may have severe neurological sequelae that generate disability of different ranges, according to the Barthel scale. The consciousness impairment is the most serious sequela and is a cause of complete dependence of these patients, due to the loss of self-care. The relationship between abnormal findings in neuroimaging and different states of consciousness has been the subject of research in recent years, with the possibility of new options with the post-processing of magnetic resonance imaging (MRI). This study aims to describe the alterations in the mean diffusivity by post-processing of the diffusion weighted imaging (DWI) sequence in 4 patients with severe traumatic brain injury and impairment of consciousness, who were studied with computed tomography (CT) and MRI in the acute phase of the trauma. Materials and methods: We describe a series of 4 cases of patients with severe traumatic brain injury and impaired consciousness in whom a non-enhanced brain MRI was performed. The DWI sequence images were post-processed, analyzing different regions through which the fibers of the Ascending Reticular Activating System (ARAS) (including restiform bodies, midbrain, thalamus, sub-insular regions and basal frontal lobes) pass. Likewise, diffusivity values were taken in similar regions, in 5 subjects without any structural brain abnormality, who were taken as controls. Results: There was a decrease in mean diffusivity in the different regions established in the study, which had different locations in each patient. Values decreased approximately 50 percent from values in normal patients. After post-processing, some lesions were observed in areas that were not identified in the initial MRI interpretation during the trauma. Conclusions: The post-processing of the DWI sequence shows a decrease in the mean diffusivity values in regions where the ARAS pathways pass through. These changes explaining the different alterations in consciousness were not visualized in the images interpreted under conventional MRI techniques. New studies are required to establish the operative characteristics of this test, that allow to define its potential utility within the algorithms of initial classification of patients with severe traumatic brain injur

Artistas sobre outras obras

Nunca como agora se conviveu com tanta invisibilidade: as imagens são hegemónicas, omnipresentes, e por isso invisíveis. Já não são dramáticas, são virais. São baratas, pervasivas, instantâneas. Aceites no seu valor micro, as imagens são monetizada, transformadas em liquidez. As imagens, cada vez mais visíveis, são por isso invisíveis. De certo modo poderemos acompanhar estas perplexidades na presente edição, onde os artistas são desafiados à visibilidade, através dos artigos aqui reunidos.info:eu-repo/semantics/publishedVersio

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier