Histoplasmosis progresiva diseminada en un paciente sin VIH

Objective. To report a case of progressive disseminated histoplasmosis in a patient without immunodeficiency, HIV Elisa negative and discussion regarding the clinical presentation and diagnosis. Study design: Clinical case report and literature review. Methods. Medical history, histopathology, paraclinics' report, review of articles published in indexed journals. Results. The patient has 1-month length symptoms: weight loss, hemoptysis, progressive dysphagia, skin lesions and ulcerated mucosa. In biopsies taken, intracellular blastoconidias and yeast were identified in lymph tissues, gastric mucosa and bone marrow. Conclusions: It is a case of progressive histoplamasmosis in HIV-free patients with lung, gastric and lymphatic tissue involvement.Objetivo: reportar un caso de histoplasmosis progresiva diseminada en un paciente sin inmunodeficiencia, con Elisa para VIH negativo y discusión con respecto a la presentación clínica y diagnóstico. Diseño del estudio: reporte de un caso clínico y revisión de la literatura. Métodos: historia clínica, histopatología, reporte de paraclínicos, revisión de artículos publicados en revistas indexadas. Resultados: el paciente presenta síntomas de 1 mes de duración con pérdida de peso, hemoptisis, disfagia progresiva, lesiones en piel y mucosas ulceradas. En las biopsias tomadas se identificaron blastoconidias intracelulares y levaduras en los tejidos de ganglio, mucosa gástrica y médula ósea. Conclusiones: es un caso de histoplamasmosis progresiva en paciente sin VIH con compromiso pulmonar, gástrico y tejido linfático

Resistencia a medicamentos Anti-rretrovirales (ARV) en pacientes con segundo fracaso terapéutico en un programa de VIH, Colombia

Objective. To make a description of ARV drugs in patients with second therapeutic failure in an HIV Program between January and December, 2011. Materials and methods. Adescriptive, retrospective case series study was conducted. It was made a description of HIV mutations, clinical characteristics and laboratory findings of patients with resistance in second therapeutic failure. Results. 30 patients with second therapeutic failure were identified in the study period. The average time of use of ARV therapy per patient was 77.2 (SD = 56). 12 patients underwent three changes of ARV months shema per therapeutic failure and 2 other patients up to four changes of schema. Most frequent mutations were the primary to Protease inhibitors (M46I, I54V, L101) and to inhibitors of Reverse analog Transcriptase of Nucleoside. (Abacavir, Didanosine and Zidovudine, Stavudine). Objetivo. Describir la resistencia a los medicamentos antirretrovirales en pacientes con segundo fracaso terapéutico en un Programa de VIH entre enero de 2011 a Diciembre de 2011. Material y métodos. Se realizó un estudio descriptivo, retrospectivo de serie de casos. Donde se describieron las mutaciones del VIH, características clínicas y hallazgos de laboratorio de los pacientes con resistencia en segundo fracaso terapéutico. Resultados. Se identificaron 30 pacientes con segundo fracaso terapéutico en el periodo de estudio. El tiempo promedio de uso de Terapia Anti-rretroviral por paciente fue de 77,2 meses (DS= 56). A 12 pacientes se les realizaron tres cambios de esquema anti-rretroviral por fracaso terapéutico y otros 2 pacientes hasta cuatro cambios de esquema. Las mutaciones más frecuentes fueron las primarias a Inhibidores de Proteasa (M46I, I54V, L10I) y a Inhibidores de Transcriptasa Inversa Análogos de Nucleósidos (Abacavir, Didanosina y Zidovudina, Estavudina)

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Anales del III Congreso Internacional de Vivienda y Ciudad "Debate en torno a la nueva agenda urbana"

Acta de congresoEl III Congreso Internacional de Vivienda y Ciudad “Debates en torno a la NUEVa Agenda Urbana”, ha sido una apuesta de alto compromiso por acercar los debates centrales y urgentes que tensionan el pleno ejercicio del derecho a la ciudad. Para ello las instituciones organizadoras (INVIHAB –Instituto de Investigación de Vivienda y Hábitat y MGyDH-Maestría en Gestión y Desarrollo Habitacional-1), hemos convidado un espacio que se concretó con potencia en un debate transdisciplinario. Convocó a intelectuales de prestigio internacional, investigadores, académicos y gestores estatales, y en una metodología de innovación articuló las voces académicas con las de las organizaciones sociales y/o barriales en el Foro de las Organizaciones Sociales que tuvo su espacio propio para dar voz a quienes están trabajando en los desafíos para garantizar los derechos a la vivienda y los bienes urbanos en nuestras ciudades del Siglo XXI

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Evaluación de la médula ósea en pacientes citopénicos infectados con el virus de la inmunodeficiencia humana tipo 1 en hospital colombiano del tercer nivel

Objective: To describe the findings in the study of bone marrow of patients with human immunodeficiency virus (HIV) infection who present some type of cytopenia in a highly complex hospital in southern Colombia. Materials and methods: Retrospective descriptive study of case series. All adult patients with confirmed HIV infection who presented some type of cytopenia during January 2011 to December 2014 at the University Hospital Hernando Moncaleano Perdomo de Neiva, were included. A total of 37 patients com-pleted the inclusion criteria. Results: the median age was 35 years, 59 % men; in 48.6 % of the individuals, the time of diagnosis by HIV was less than one year and 59 % did not receive antiretroviral therapy at the time of admission. A median was found in a leukocyte count of 2400 cells / mm3, neutrophils of 1400 cells / mm3, CD4 lymphocytes of 43 cells / mm3. The bone marrow study was positive in 27 % of the cases (10 patients), finding disseminated opportunistic infection in six patients; two neoplasms, plus a medullar hypoplasia and a case of megaloblastic anemia. Conclusion: The study of bone marrow in patients with HIV infection is a useful tool and should be performed in all patients with HIV infection with advanced disease in the study of cytopenia associated or not with fever.Objetivo: describir los hallazgos en el estudio de medula ósea de los pacientes con infección por virus de inmunodeficiencia humana que presentaron algún tipo de citopenia. Materiales y métodos: estudio descriptivo retrospectivo con 37 pacientes adultos con infección confirmada por el virus de inmunodeficiencia humana que presentaron algún tipo de citopenia, durante enero 2011 a diciembre de 2014 en el Hospital Universitario Hernando Moncaleano Perdomo de Neiva. Resultados: la mediana de edad fue 35 años, el 59 % fueron hombres; en el 48,6 % el tiempo de diagnóstico de la infección fue inferior a un año y el 59 % no recibían terapia antiretroviral al momento de ingreso. La mediana de recuento leucocitario de 2 400 células/mm3 , neutrófilos de 1 400 células/mm3 y de linfocitos CD4 de 43 células/mm3 . El estudio de medula ósea fue positivo en el 27 %, encontrando infección oportunista diseminada en seis pacientes; dos con neoplasias, además de uno con hipoplasia medular y otro con anemia megaloblástica. Conclusión: el estudio de medula ósea en los pacientes con infección por virus de inmunodeficiencia humana es una herramienta útil y se debe realizar a todos los pacientes con enfermedad avanzada en el estudio de citopenia asociada o no a fiebre

La subcontratación laboral en América Latina: miradas multidimensionales

La subcontratación laboral, la flexibilidad laboral externa, la terciarización laboral, la deslaboralización de las relaciones de trabajo y el trabajo no registrado, son distintas términos para nombrar la exteriorización de los riesgos que los empresarios descargan sobre los trabajadores y las trabajadoras, quienes, sin el apoyo de las garantías del derecho laboral, quedan sometidos a las presiones de los contratos del derecho civil. Este libro aborda esta problemática que afecta a todos los trabajadores del Continente

Resultados Semilleros de investigación 2011

Aproximaciones al sector minero no energético en colombia (2009-2010) / Discursos y contradiscursos en la construcción e inter-vención de las sujetas desplazadas desde una perspectiva interseccional de género / El rol de los actores en el entramado institucional de los partidos políticos y sistemas electorales en colombia en el final de la primera década del Siglo XXI / Administración de justicia en los pueblos indígenas de Arauca. Pueblos Sikuani (165), Uwa (222), Hitnu (266), Inga (291), Caño Mochuelo (317), Pueblo Betoye (343) / De la violencia a la democracia: hacia la construcción de un modelo justicia comunitaria en tres corregimientos de Simití, sur de Bolívar / Ética, política y mundo común / Multiculturalismo y plurinacionalidad. Análisis comparado de las Constituciones Boliviana y Colombiana en perspectiva intercultural / La reconstitución del patrimonio del deudor / Consecuencias políticas, económicas, y sociales de la implementación de programas hacia la juventud y contribuciones analíticas para el logro de buenos resul-tados desde la administración distrital en políticas para jóvenes de Bogotá / El “allemansrätten” o el derecho público de acceso al pai-saje en la planeación urbana y ambiental de la ciudad de Bogotá D.C. / Penas alternativas a la prisión en Colombia / Políticas públicas en seguridad desde un nuevo paradigma socia