Nivel de riesgo para presentar diabetes mellitus 2 en una comunidad rural del Estado de México

La diabetes Mellitus tipo 2 es una enfermedad crónica que se caracteriza por el aumento de la glucosa en la sangre conocido como hiperglucemia, se presenta en personas mayores, siendo algunos de los factores pre disponentes la obesidad, el sedentarismo, la alimentación y la genética por mencionar algunos ya que es una enfermedad multicasual (DOHME 2006

Technical Contributions to the Quality of Telerehabilitation Platforms: Case Study—ePHoRt Project

This chapter proposes three main technical contributions for the development of a telerehabilitation platform, named ePHoRT, for patients recovering from hip surgery. The first contribution is the application of a diffuse 3D model for the detection of rehabilitation exercises after hip surgery. The model applies fuzzy logic, which allows identifying in real time if a patient is performing a right or wrong movement, assisted by an avatar in 3D. The avatar copies the movements of the patient through a Kinect camera. The second contribution involves the proposal of an iterative method to improve the usability of telerehabilitation platforms along the development life cycle. The proposed method involves the use of an inspection method and includes protocols and instruments. This method has been validated in the ePHoRT project. Finally, the chapter describes accessibility guidelines for educational resources. It proposes accessibility standards for the content of educational resources in video and PDF formats in the telerehabilitation platform according to the Web Content Accessibility Guidelines (WCAG)

Propuesta de mejora para el funcionamiento de la planta de tratamiento de aguas residuales domésticas (PTARD) del distrito de Apata - Jauja

Esta investigación se realizó en la Planta de Tratamiento de Aguas Residuales Domésticas del Distrito de Apata (PTARD) - Jauja. El objetivo de este estudio fue plantear una propuesta de mejora para el funcionamiento de la PTARD, para ello se realizaron diferentes actividades como la inspección inicial con una ficha de observación , la medición de las diferentes unidades comparando con los planos de la PTARD, la medición del caudal, el muestreo del agua residual en los distintos puntos para realizar el análisis de los parámetros como la Demanda Bioquímica de Oxígeno (DBO), Demanda Química de Oxígeno (DQO), Coliformes Fecales, pH, Temperatura, Sólidos Totales en Suspensión, Aceites y Grasas, luego se realizó el análisis en gabinete para la selección de la mejor propuesta de acuerdo al análisis. Como resultados se obtuvo que la causa del mal funcionamiento de la PTARD es la falta de operación y mantenimiento de las unidades como el sistema de desinfección, lo cual indica que uno de los parámetros que no cumple con los Límites Máximos Permisibles (LMP) fueron los coliformes termotolerantes con 20 000 NMP/100, para ello se realizó un experimento sobre la cloración con dosis mínima de 10 g y máxima de 50 g. La dosis óptima fue 10 g, ya que tendrá menor costo y ayudará a disminuir los coliformes termotolerantes a 550 NMP/100. En conclusión, es necesaria la operación y mantenimiento en cada una de las unidades y la limpieza de las lagunas facultativas con el bote limpiador automático y uso de microorganismos eficaces (ME) para la disminución del parámetro de la DBO. Por otro lado, es indispensable la cloración con la dosis óptima en el sistema de desinfección para poder disminuir los coliformes termotolerantes

α-Hispanolol Induces Apoptosis and Suppresses Migration and Invasion of Glioblastoma Cells Likely via Downregulation of MMP-2/9 Expression and p38MAPK Attenuation

α-Hispanolol (α-H) is a labdane diterpenoid that has been shown to induce apoptosis in several human cancer cells. However, the effect of α-H in human glioblastoma cells has not been described. In the present work, we have investigated the effects of α-H on apoptosis, migration, and invasion of human glioblastoma cells with the aim of identifying the molecular targets underlying its mechanism of action. The results revealed that α-H showed significant cytotoxicity against human glioma cancer cell lines U87 and U373 in a concentration- and time-dependent manner. This effect was higher in U87 cells and linked to apoptosis, as revealed the increased percentage of sub-G1 population by cell cycle analysis and acquisition of typical features of apoptotic cell morphology. Apoptosis was also confirmed by significant presence of annexin V-positive cells and caspase activation. Pretreatment with caspase inhibitors diminishes the activities of caspase 8, 9, and 3 and maintains the percentage of viable glioblastoma cells, indicating that α-H induced cell apoptosis through both the extrinsic and the intrinsic pathways. Moreover, we also found that α-H downregulated the anti-apoptotic Bcl-2 and Bcl-xL proteins and activated the pro-apoptotic Bid and Bax proteins. On the other hand, α-H exhibited inhibitory effects on the migration and invasion of U87 cells in a concentration-dependent manner. Furthermore, additional experiments showed that α-H treatment reduced the enzymatic activities and protein levels of matrix metalloproteinase MMP-2 and MMP-9 and increased the expression of TIMP-1 inhibitor, probably via p38MAPK regulation. Finally, xenograft assays confirmed the anti-glioma efficacy of α-H. Taken together, these findings suggest that α-H may exert anti-tumoral effects in vitro and in vivo through the inhibition of cell proliferation and invasion as well as by the induction of apoptosis in human glioblastoma cells. This research describes α-H as a new drug that may improve the therapeutic efficacy against glioblastoma tumors.This study was supported by grant PI11/00036, PI14/00055, and PI17/00012 from the FIS, MPY 1410/09 from ISCIII and Spanish Ministry of Health (Instituto de Salud Carlos III; RD12/0036/0059) to SoH and by grants IERPY 1149/16 and IERPY-M 389/18 to AL. L JG was supported by FIS (FI12/00340). SaH was supported by IERPY 1149/16 from ISCIII.S

First reported double drug–drug interaction in a cancer renal patient under everolimus treatment: therapeutic drug monitoring and review of literature

Everolimus is an inhibitor of mammalian target of rapamycin (mTOR) used in both transplantation and cancer treatment (breast, renal and neuroendocrine). In transplantation, therapeutic drug monitoring (TDM) is recommended due to the potential drug-drug interactions with chronic medications, which can affect everolimus pharmacokinetics. In cancer treatment, everolimus is used at higher doses than in transplantation and without a systematic drug monitoring.We present a case report of a 72-year-old woman with epilepsy history to whom everolimus 10 mg QD was prescribed as third line of treatment for renal cell carcinoma (RCC). The potential drug interactions between everolimus and the patient's chronic medications, carbamazepine and phenytoin, are significant as both are known as strong inducers CYP3A4 metabolism, potentially leading to underexposure to everolimus.TDM of everolimus was recommended by the pharmacist. The literature suggests that a minimum plasma concentration (Cminss) of everolimus over 10 ng/ml is associated with better response to treatment and progression-free survival (PFS). The patient's everolimus dose had to be increased until 10 mg BID, and regular monitoring of everolimus levels showed an increase in Cminss from 3.7 ng/ml to 10.8 ng/ml.This case highlights the importance of checking for potential drug interactions and monitoring everolimus levels in patients on chronic medication, especially those with several inducers or inhibitors of CYP3A4 metabolism. TDM can help to ensure that patients are treated with their optimal dose, which can improve the effectiveness of the treatment or minimize the risk of toxicities

Propuesta de intervención frente a la desnutrición infantil de 0 a 5 años del municipio de Puerto Carreño - Vichada

No aplicaLa población infantil de 0 a 5 años del municipio de Puerto Carreño – Vichada, continúa afrontando el grave problema de la desnutrición a pesar de los esfuerzos que las entidades estatales vienen realizando para mejorar esta situación. Uno de los vacíos que se han presentado al evaluar el impacto de las acciones de complementariedad alimentaria ha sido la carencia de un diagnóstico del estado nutricional que permita conocer la situación inicial de la intervención y facilite la determinación de un sistema de vigilancia nutricional. Una de las problemáticas más grandes que enfrenta el municipio de Puerto Carreño es el acceso a una alimentación adecuada, lo cual se ve reflejado en el consumo y el estado nutricional de su población en especial la que se encuentra entre 0 a 5 años, según los indicadores económicos y sociales, la tasa de pobreza del municipio es de 29,3% y la de pobreza extrema de 8,4% (DNP, 2016). Esta propuesta está orientada a disminuir las tasas desnutrición de la población infantil de 0 a 5 años en el municipio de Puerto Carreño, bajo un enfoque interinstitucional e intersectorial que implique los actores responsables de brindar una respuesta integral a la problemática de desnutrición en la población de 0 a 5 años del municipio. Desde el sector salud, las acciones orientadas deben ser transversales cuya base se encuentra en una atención sanitaria que permita la identificación de un diagnóstico y tratamiento temprano además de promover estrategias de promoción y prevención.The child population from 0 to 5 years of age in the municipality of Puerto Carreño - Vichada continues to face the serious problem of malnutrition despite the efforts that state entities have been making to improve this situation. One of the gaps that have arisen when evaluating the impact of food complementarity actions has been the lack of a nutritional status diagnosis that allows knowing the initial situation of the intervention and facilitates the determination of a nutritional surveillance system. One of the biggest problems facing the municipality of Puerto Carreño is access to adequate food, which is reflected in the consumption and nutritional status of its population, especially those between 0 to 5 years of age. According to economic and social indicators, the municipality's poverty rate is 29.3% and the extreme poverty rate is 8.4% (DNP, 2016). This proposal is aimed at reducing the malnutrition rates of the child population from 0 to 5 years of age in the municipality of Puerto Carreño, under an inter-institutional and intersectoral approach that involves the actors responsible for providing a comprehensive response to the problem of malnutrition in the population of 0 to 5 years of the municipality. From the health sector, the oriented actions must be transversal, based on health care that allows the identification of early diagnosis and treatment, as well as promoting promotion and prevention strategies

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

Identification and Pathway Analysis of microRNAs with No Previous Involvement in Breast Cancer

microRNA expression signatures can differentiate normal and breast cancer tissues and can define specific clinico-pathological phenotypes in breast tumors. In order to further evaluate the microRNA expression profile in breast cancer, we analyzed the expression of 667 microRNAs in 29 tumors and 21 adjacent normal tissues using TaqMan Low-density arrays. 130 miRNAs showed significant differential expression (adjusted P value = 0.05, Fold Change = 2) in breast tumors compared to the normal adjacent tissue. Importantly, the role of 43 of these microRNAs has not been previously reported in breast cancer, including several evolutionary conserved microRNA*, showing similar expression rates to that of their corresponding leading strand. The expression of 14 microRNAs was replicated in an independent set of 55 tumors. Bioinformatic analysis of mRNA targets of the altered miRNAs, identified oncogenes like ERBB2, YY1, several MAP kinases, and known tumor-suppressors like FOXA1 and SMAD4. Pathway analysis identified that some biological process which are important in breast carcinogenesis are affected by the altered microRNA expression, including signaling through MAP kinases and TP53 pathways, as well as biological processes like cell death and communication, focal adhesion and ERBB2-ERBB3 signaling. Our data identified the altered expression of several microRNAs whose aberrant expression might have an important impact on cancer-related cellular pathways and whose role in breast cancer has not been previously described

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe