Protocolo de teleorientación para los pacientes del programa de atención domiciliaria del Hospital Santa Rosa de Tenjo, Cundinamarca con hipertensión arterial

69 páginasUbicado en el departamento de Cundinamarca, Tenjo es un municipio localizado en la Provincia de Sabana Centro, que se encuentra a 37 kilómetros de Bogotá, cuenta con una población aproximada de 24.096 habitantes y según el censo nacional de la población el 12% de la población total del municipio tiene más de 60 años y el 59% de la población se encuentra ubicada en la zona rural (1). El municipio cuenta con el Hospital Municipal Santa Rosa de Tenjo, el cual brinda servicios como consulta externa, urgencias y hospitalización, comprende además un programa de atención domiciliaria en convenio con la especialidad de Medicina Familiar y Comunitaria de la Universidad de la Sabana, el cual incluye pacientes con enfermedades crónicas que presentan alguna limitación para el acceso al centro de salud. Se ha demostrado que la atención medica de estas poblaciones vulnerables con patologías crónicas y con pobre acceso a los servicios de salud se ha obstaculizado y limitado aún más con la pandemia por COVID-19 (2,3) ; adicionalmente, por el confinamiento secundario a la pandemia los pacientes con enfermedades crónicas experimentaron repercusiones negativas en su estado emocional y dificultades en su autocuidado y control de la enfermedad (3), situación que se agrava todavía más con el hecho de que la mortalidad por COVID-19 se concentra fundamentalmente en mayores de 60 años y con enfermedades crónicas no transmisibles asociadas (4). No obstante, las enfermedades crónicas por sí mismas ya representan una de las principales causas de morbimortalidad en el mundo, con lo cual, según datos de la Organización Mundial de la Salud (OMS) las enfermedades cardiovasculares y la Diabetes Mellitus se sitúan dentro de las cinco primeras causas de muerte en adultos de ambos sexos (5).Especialización en Medicina Familiar y ComunitariaEspecialista en Medicina Familiar y Comunitari

TURISMO CINEGÉTICO: ¿UNA ALTERNATIVA DE DESARROLLO SUSTENTABLE?

Many people distort hunting tourism. This activity is taken as a murder at will and for no other reason. There is the general public about huge disinformation. In Mexico, there are no quantitative or qualitative data on the economic, social and environmental benefits generated by this type of tourism in the country. This activity can be done legally in the management of Units for the Conservation of Wildlife (UCW). Integrated management is essential to carry out successful hunting. The aim is to link economic, social and environmental benefits generated by hunting tourism, with a focus on sustainable development. This approach improves the quality of life of farmers and creates an alternative to long-term diversified production. As a result, sustainable development is evident in the dependent rural areas and lack of satisfaction of their needs

Intervenciones para promover la dignificación del fin de vida por estudiantes y profesionales de enfermería

Introducción: el cuidado es el eje de la enfermería y adquiere especial relevancia en el proceso del fin de vida y muerte, donde deben garantizarse cuidados que dignifiquen a la persona y su entorno. Los profesionales y estudiantes de enfermería deben estar capacitados para ello. Objetivo: identificar intervenciones para promover la dignificación de la persona en el fin de la vida y la muerte, entre estudiantes y profesionales de enfermería. Metodología: revisión integrativa de la literatura. Se realizaron búsquedas en bases de datos: PubMed, CUIDEN Plus, Ovid, Biblioteca Virtual en Salud y ProQuest y se incluyeron artículos derivados de investigación y revisión publicados entre 2016 y 2021. Se efectuó lectura crítica utilizando la herramienta Joanna Briggs Institute (JBI). Estudio sin riesgo ético, según la resolución 8430 de 1993. Resultados: se incluyeron 34 artículos y se construyeron cinco temáticas: dignidad humana, muerte digna en la atención de enfermería, factores que impiden la dignificación del fin de vida, beneficios para estudiantes, profesionales de enfermería, paciente y familia, y estrategias que promueven la dignidad en el fin de vida y muerte. Conclusiones: el fin de la vida y la muerte son procesos complejos a los que deben enfrentarse estudiantes y profesionales de enfermería, ante los cuales puede ser de ayuda implementar intervenciones como las identificadas, dado que contribuyen en el conocimiento, compromiso, trato humanizado y compasión; es necesaria mayor docencia e investigación al respecto

A molecular map of murine lymph node blood vascular endothelium at single cell resolution

Blood vascular endothelial cells (BECs) control the immune response by regulating blood flow and immune cell recruitment in lymphoid tissues. However, the diversity of BEC and their origins during immune angiogenesis remain unclear. Here we profile transcriptomes of BEC from peripheral lymph nodes and map phenotypes to the vasculature. We identify multiple subsets, including a medullary venous population whose gene signature predicts a selective role in myeloid cell (vs lymphocyte) recruitment to the medulla, confirmed by videomicroscopy. We define five capillary subsets, including a capillary resident precursor (CRP) that displays stem cell and migratory gene signatures, and contributes to homeostatic BEC turnover and to neogenesis of high endothelium after immunization. Cell alignments show retention of developmental programs along trajectories from CRP to mature venous and arterial populations. Our single cell atlas provides a molecular roadmap of the lymph node blood vasculature and defines subset specialization for leukocyte recruitment and vascular homeostasis

PROPUESTA DE EVALUACIÓN DE LA EQUIDAD DE GÉNERO: UN INSTRUMENTO DE MEJORA DE LA CALIDAD EN EDUCACIÓN INFANTIL

The present work is justified by our experience as college trainers in teaching, and as advisors in preschools. Likewise, our experience in applied research leads us to make approaches that are operational and realistic. Therefore the interrelationship between research and professional intervention is a constant factor in this work, which identifies us with the Action Research methodology (IA). We present a protocol to be implemented in schools which allows for the assessment of management and of pedagogical approaches, as well as the personal attitudes of adults. The results obtained so far indicate the importance of frequent evaluations of gender equity to the teaching teams in order to promote positive change in this area. We know that the models offered by adults, are of great value to children's development. Therefore instead of monitoring verbal discourse, we must control our behaviour in order to provide models that favour education in values, particularly in gender equity.http://dx.doi.org/10.14572/nuances.v20i21.1101Nuestra experiencia como formadores universitarios en el Magisterio, y como asesores en los centros de educación infantil, justifica en gran medida los objetivos y el planteamiento del trabajo que presentamos. Así mismo nuestra trayectoria en investigación aplicada nos empuja a realizar planteamientos que sean operativos y realistas. Así pues la interrelación entre investigación y la intervención profesional es un factor que contemplamos en este trabajo de forma continuada hecho que nos identifica con la metodología de Investigación-Acción (I-A). Presentamos un protocolo de aplicación en los centros educativos que posibilita tanto la evaluación de la gestión, como de los planteamientos pedagógicos del mismo como también las actitudes personales de los adultos. Los resultados obtenidos hasta el momento indican la importancia de que se realice una evaluación de la equidad de género de forma frecuente en los equipos docentes a fin de favorecer cambios positivos al respecto. Sabemos que los modelos ofrecidos por los adultos a lo largo del desarrollo de los niños tienen un gran valor. Por lo tanto más que vigilar los discursos verbales debemos controlar nuestra conducta a fin de poder ofrecer modelos que favorezcan la educación en valores, concretamente en la equidad de género.http://dx.doi.org/10.14572/nuances.v20i21.1101Nuestra experiencia como formadores universitarios en el Magisterio, y como asesores en los centros de educación infantil, justifica en gran medida los objetivos y el planteamiento del trabajo que presentamos. Así mismo nuestra trayectoria en investigación aplicada nos empuja a realizar planteamientos que sean operativos y realistas. Así pues la interrelación entre investigación y la intervención profesional es un factor que contemplamos en este trabajo de forma continuada hecho que nos identifica con la metodología de Investigación-Acción (I-A). Presentamos un protocolo de aplicación en los centros educativos que posibilita tanto la evaluación de la gestión, como de los planteamientos pedagógicos del mismo como también las actitudes personales de los adultos. Los resultados obtenidos hasta el momento indican la importancia de que se realice una evaluación de la equidad de género de forma frecuente en los equipos docentes a fin de favorecer cambios positivos al respecto. Sabemos que los modelos ofrecidos por los adultos a lo largo del desarrollo de los niños tienen un gran valor. Por lo tanto más que vigilar los discursos verbales debemos controlar nuestra conducta a fin de poder ofrecer modelos que favorezcan la educación en valores, concretamente en la equidad de género.http://dx.doi.org/10.14572/nuances.v20i21.110

Coma in adult cerebral venous thrombosis:The BEAST study

Background and purpose: Coma is an independent predictor of poor clinical outcomes in cerebral venous thrombosis (CVT). We aimed to describe the association of age, sex, and radiological characteristics of adult coma patients with CVT. Methods: We used data from the international, multicentre prospective observational BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study. Only positively associated variables with coma with <10% missing data in univariate analysis were considered for the multivariate logistic regression model. Results: Of the 596 adult patients with CVT (75.7% women), 53 (8.9%) patients suffered coma. Despite being a female-predominant disease, the prevalence of coma was higher among men than women (13.1% vs. 7.5%, p = 0.04). Transverse sinus thrombosis was least likely to be associated with coma (23.9% vs. 73.3%, p < 0.001). The prevalence of superior sagittal sinus thrombosis was higher among men than women in the coma sample (73.6% vs. 37.5%, p = 0.01). Men were significantly older than women, with a median (interquartile range) age of 51 (38.5–60) versus 40 (33–47) years in the coma (p = 0.04) and 44.5 (34–58) versus 37 (29–48) years in the non-coma sample (p < 0.001), respectively. Furthermore, an age-and superior sagittal sinus-adjusted multivariate logistic regression model found male sex (odds ratio = 1.8, 95% confidence interval [CI] = 1.0–3.4, p = 0.04 to be an independent predictor of coma in CVT, with an area under the receiver operating characteristic curve of 0.61 (95% CI = 0.52–0.68, p = 0.01). Conclusions: Although CVT is a female-predominant disease, men were older and nearly twice as likely to suffer from coma than women

Genome-Wide Association Study Identifies First Locus Associated with Susceptibility to Cerebral Venous Thrombosis

Objective Cerebral venous thrombosis (CVT) is an uncommon form of stroke affecting mostly young individuals. Although genetic factors are thought to play a role in this cerebrovascular condition, its genetic etiology is not well understood. Methods A genome-wide association study was performed to identify genetic variants influencing susceptibility to CVT. A 2-stage genome-wide study was undertaken in 882 Europeans diagnosed with CVT and 1,205 ethnicity-matched control subjects divided into discovery and independent replication datasets. Results In the overall case-control cohort, we identified highly significant associations with 37 single nucleotide polymorphisms (SNPs) within the 9q34.2 region. The strongest association was with rs8176645 (combined p = 9.15 x 10(-24); odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.76-2.31). The discovery set findings were validated across an independent European cohort. Genetic risk score for this 9q34.2 region increases CVT risk by a pooled estimate OR = 2.65 (95% CI = 2.21-3.20, p = 2.00 x 10(-16)). SNPs within this region were in strong linkage disequilibrium (LD) with coding regions of the ABO gene. The ABO blood group was determined using allele combination of SNPs rs8176746 and rs8176645. Blood groups A, B, or AB, were at 2.85 times (95% CI = 2.32-3.52, p = 2.00 x 10(-16)) increased risk of CVT compared with individuals with blood group O. Interpretation We present the first chromosomal region to robustly associate with a genetic susceptibility to CVT. This region more than doubles the likelihood of CVT, a risk greater than any previously identified thrombophilia genetic risk marker. That the identified variant is in strong LD with the coding region of the ABO gene with differences in blood group prevalence provides important new insights into the pathophysiology of CVT. ANN NEUROL 2021Peer reviewe

PEDIA: prioritization of exome data by image analysis.

PURPOSE: Phenotype information is crucial for the interpretation of genomic variants. So far it has only been accessible for bioinformatics workflows after encoding into clinical terms by expert dysmorphologists. METHODS: Here, we introduce an approach driven by artificial intelligence that uses portrait photographs for the interpretation of clinical exome data. We measured the value added by computer-assisted image analysis to the diagnostic yield on a cohort consisting of 679 individuals with 105 different monogenic disorders. For each case in the cohort we compiled frontal photos, clinical features, and the disease-causing variants, and simulated multiple exomes of different ethnic backgrounds. RESULTS: The additional use of similarity scores from computer-assisted analysis of frontal photos improved the top 1 accuracy rate by more than 20-89% and the top 10 accuracy rate by more than 5-99% for the disease-causing gene. CONCLUSION: Image analysis by deep-learning algorithms can be used to quantify the phenotypic similarity (PP4 criterion of the American College of Medical Genetics and Genomics guidelines) and to advance the performance of bioinformatics pipelines for exome analysis

Identification of a novel susceptibility locus at 13q34 and refinement of the 20p12.2 region as a multi-signal locus associated with bladder cancer risk in individuals of european ancestry

Candidate gene and genome-wide association studies (GWAS) have identified 15 independent genomic regions associated with bladder cancer risk. In search for additional susceptibility variants, we followed up on four promising single-nucleotide polymorphisms (SNPs) that had not achieved genome-wide significance in 6911 cases and 11 814 controls (rs6104690, rs4510656, rs5003154 and rs4907479, P < 1 7 10(-6)), using additional data from existing GWAS datasets and targeted genotyping for studies that did not have GWAS data. In a combined analysis, which included data on up to 15 058 cases and 286 270 controls, two SNPs achieved genome-wide statistical significance: rs6104690 in a gene desert at 20p12.2 (P = 2.19 7 10(-11)) and rs4907479 within the MCF2L gene at 13q34 (P = 3.3 7 10(-10)). Imputation and fine-mapping analyses were performed in these two regions for a subset of 5551 bladder cancer cases and 10 242 controls. Analyses at the 13q34 region suggest a single signal marked by rs4907479. In contrast, we detected two signals in the 20p12.2 region-the first signal is marked by rs6104690, and the second signal is marked by two moderately correlated SNPs (r(2) = 0.53), rs6108803 and the previously reported rs62185668. The second 20p12.2 signal is more strongly associated with the risk of muscle-invasive (T2-T4 stage) compared with non-muscle-invasive (Ta, T1 stage) bladder cancer (case-case P 64 0.02 for both rs62185668 and rs6108803). Functional analyses are needed to explore the biological mechanisms underlying these novel genetic associations with risk for bladder cancer

In-situ estimation of ice crystal properties at the South Pole using LED calibration data from the IceCube Neutrino Observatory

The IceCube Neutrino Observatory instruments about 1 km3 of deep, glacial ice at the geographic South Pole using 5160 photomultipliers to detect Cherenkov light emitted by charged relativistic particles. A unexpected light propagation effect observed by the experiment is an anisotropic attenuation, which is aligned with the local flow direction of the ice. Birefringent light propagation has been examined as a possible explanation for this effect. The predictions of a first-principles birefringence model developed for this purpose, in particular curved light trajectories resulting from asymmetric diffusion, provide a qualitatively good match to the main features of the data. This in turn allows us to deduce ice crystal properties. Since the wavelength of the detected light is short compared to the crystal size, these crystal properties do not only include the crystal orientation fabric, but also the average crystal size and shape, as a function of depth. By adding small empirical corrections to this first-principles model, a quantitatively accurate description of the optical properties of the IceCube glacial ice is obtained. In this paper, we present the experimental signature of ice optical anisotropy observed in IceCube LED calibration data, the theory and parametrization of the birefringence effect, the fitting procedures of these parameterizations to experimental data as well as the inferred crystal properties.</p