Correlación entre los niveles sanguíneos de lipoproteína(a) y las lipoproteínas trasportadoras de colesterol en un grupo de expedicionarios, durante la IX Expedición Antártica Ecuatoriana, 2004

Durante la permanencia en áreas polares se altera el metabolismo lipídico por la ingesta hipercalórica en compensación al ambiente frío; sin embargo, existirán otros factores lipídicos genéticamente determinados que no serían modificados por este ambiente como es el caso de la lipoproteína(a). Tipo de estudio: ensayo clínico, observacional, longitudinal, prospectivo, realizado a un grupo de expedicionarios durante el verano polar Antártico. Objetivos: demostrar si el estrés ambiental en el polo sur altera los niveles sanguíneos de la lipoproteína(a) y establecer su correlación en este ambiente con las lipoproteínas de alta(c-HDL) y baja densidad(c-LDL). Metodología: se extrajeron muestras sanguíneas semanales luego de 10 horas de ayuno, para determinar los niveles de la lipoproteína(a), y del perfil lipídico stándar a 20 expedicionarios sanos al inicio y al final de las 10 semanas de permanencia en la Antártida. Resultados: el universo estudiado fue de 20 personas con un promedio de edad de 39,5 años. Del grupo en estudio, el 25% (n=5) tuvo al comienzo elevación de la Lp(a) (62,8+/-32,3) del valor de referencia normal de 30mg/dl; de estos el 100%(n=5) tuvieron el c-LDL de 38(46,2+/-5,6); el 40%(n=2) mantuvo sus valores de Lp(a) elevados hasta el final de las 10 semanas de expedición (88,7+/-1,1), pero con una c-LDL> de 160mg/dL (190+/-7,0) y HDL de (38-39); el otro 60%(n=3) en el cual se normalizó la Lp(a) al final del estudio continuó con niveles elevados de c-LDL (190+/-21,5). Conclusiones: el metabolismo de las c-LDL se alteró elevándose en el 100% de los casos y disminuyendo las c-HDL en el 80% de los mismos. Los niveles plasmáticos de la LP(a) permanecieron estables durante todo el estudio, no fueron influenciados de manera significativa por el medio polar Antártico ni por la elevación de las c-LDL. Comportándose los niveles de Lp(a) de manera independiente a la de los otros lípidos

Outcome during and after anticoagulant therapy in cancer patients with incidentally found pulmonary embolism

Publisher Copyright: Copyright © 2016 ERS.Current guidelines suggest treating cancer patients with incidental pulmonary embolism comparably to patients with symptomatic pulmonary embolism. We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry to compare the rate of major bleeding and symptomatic pulmonary embolism during the course of anticoagulation and after its discontinuation in cancer patients with incidental pulmonary embolism. As of March 2016, 715 cancer patients with incidental pulmonary embolism had been enrolled in RIETE. During the course of anticoagulant therapy (mean 235 days), the rate of major bleeding was higher than the rate of symptomatic pulmonary embolism (10.1 (95% CI 7.48-13.4) versus 3.17 (95% CI 1.80-5.19) events per 100 patient-years, respectively), and the rate of fatal bleeding was higher than the rate of fatal pulmonary embolism (2.66 (95% CI 1.44-4.52) versus 0.66 (95% CI 0.17-1.81) deaths per 100 patient-years, respectively). After discontinuing anticoagulation (mean follow-up 117 days), the rate of major bleeding was lower than the rate of symptomatic pulmonary embolism (3.00 (95% CI 1.10-6.65) versus 8.37 (95% CI 4.76-13.7) events per 100 patient-years, respectively); however, there were no differences in the rate of fatal events at one death each. The risk/benefit ratio of anticoagulant therapy in cancer patients with incidental pulmonary embolism is uncertain and must be evaluated in further studies.publishersversionPeer reviewe

Real-Time Dissemination of Aggregate Data on Presentation and Outcomes of Patients With Venous Thromboembolism : The RIETE Infographics Project

In the current era of patient empowerment and precision medicine, access to timely information is critical to decision-making. Unfortunately, we currently lack patient-specific, real-time data about clinical presentation, risk of thrombotic or hemorrhagic events, key risk factors, and adverse outcomes in patients with venous thromboembolism (VTE). Accordingly, the egistro nformatizado nfermedad rombombólica (RIETE) investigators developed a tool to provide an open-source, real-time graphic representation of VTE-related data derived from over 90 000 patients with confirmed VTE. This information is intended to facilitate discussion in the informed decision-making process. The current article describes the aims, rationale, methods, and ongoing and future efforts of the real-time VTE infographics developed by the RIETE registry collaborators

A young patient with concurrent splanchnic dynamic vascular compression syndromes

A thirty-year-old lady presented with chronic, postprandial abdominal pain associated with decreased appetite and weight loss. She had a past medical history of ulcerative colitis and past surgical history of Nissen fundoplication, hysterectomy and bilateral oophorectomy for endometriosis. Enhanced computed tomography (CT) of the abdomen/pelvis displayed severe narrowing of the celiac artery (CA) at the level of its ostium (Panel A) with post-stenotic dilatation. In an abdominal vascular ultrasound with respiratory maneuvers we saw a peak systolic velocity (PSV) in the CA during inspiration of 295 cm/s. The PSV was 108 cm/s during expiration for the CA. Peak systolic velocity in the superior mesenteric artery (SMA) was 424 cm/s during inspiration. Magnetic resonance angiogram (MRA, Panel B) showed compression of the SMA with post-stenotic dilatation. No signs of perivascular inflammation or fat stranding were appreciated. Serology studies workup showed only weakly positive anti nuclear antibody (ANA) titer. A mesenteric angiography (Panels C and D) illustrated progression to occlusion of the CA, a dynamic compression of the SMA with kinking mainly during expiration, and post-stenotic dilatation. The pre-operative suspicion for dynamic mesenteric vascular compression syndromes was intra-operatively confirmed with associated scarring along the CA and SMA via the arcuate ligament.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Comparisons between Upper and Lower Extremity Deep Vein Thrombosis : A Review of the RIETE Registry

Publisher Copyright: © SAGE Publications.Background: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). Methods: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the outcomes during the course of anticoagulant therapy in patients with UEDVT versus outcomes in patients with LEDVT. Results: As of August 2015, 37,366 patients with acute DVT had been enrolled in RIETE: 35094 (94%) had LEDVT, 1334 (3.6%) non-catheter related UEDVT (672 unprovoked and 662 provoked) and 938 (2.5%) had catheter-related UEDVT. During the course of anticoagulation, patients with unprovoked UEDVT had a higher rate of DVT recurrences (hazard ratio [HR]: 2.22; 95% CI: 1.37-3.43) and a similar rate of PE recurrences or major bleeding than those with unprovoked LEDVT. Patients with non-catheter-related provoked UEDVT had a similar outcome than those with provoked LEDVT. Among patients with UEDVT, those with non-catheter related unprovoked UEDVT had a lower rate of PE recurrences (HR: 0.06; 95% CI: 0-0.35) and major bleeding (HR: 0.20; 95% CI: 0.08-0.46) than those with catheter-related UEDVT or those with non-catheter related provoked UEDVT (HR: 0.10; 95% CI: 0.004-0.60; and 0.22; 95% CI: 0.08-0.52, respectively). On multivariable analysis, any difference had disappeared. Conclusion: During the course of anticoagulation, patients with UEDVT had a similar outcome than those with LEDVT. Among UEDVT patients, there were some differences according to the presence of catheter or additional risk factors for DVT. These differences disappeared after adjusting for potentially confounding variables.publishersversionPeer reviewe

Trasplante de células hematopoyéticas

El trasplante de células hematopoyéticas (TCH) es la infusión de células progenitoras a fin de restablecer la función medular e inmune en pacientes con enfermedades hematológicas malignas y no malignas adquiridas y genéticas. El impacto del TCH se refleja en las alternativas de tratamiento, mayor difusión de la técnica y mejores opciones al paciente.El procedimiento consiste en la obtención de progenitores hematopoyéticos periféricos, mediante las células CD34+ (2- 2.5 x 106/Kg peso); es un excelente predictor de prendimiento del injerto. El trasplante de donante no relacionado, permite tratamiento a pacientes que carecen de donantes familiares histo-idénticos. Otra variante de TCH es el mini-trasplante, utilizando dosis bajas de quimioterapia e inmunosupresores, produciendo menos complicaciones, pero jerarquizando el efecto “injerto sobre tumor”, que permite la remisión de enfermedades neoplásicas hematológicas y no hematológicas, siendo una alternativa en países en vías de desarrollo, por la posibilidad de disminuir costos y complicaciones

MASTER PIECE Venta de repuestos de autos

El objetivo del presente trabajo de investigación es desarrollar una idea de negocio; aplicando para su desarrollo, la metodología cualitativa y cuantitativa; trabajaremos para ello aspectos generales del negocio como son: la idea clara del negocio a implementar, la descripción del producto o servicio a ofrecer y el equipo de trabajo que se encargara de la investigación. Luego se profundizará la investigación; trabajando el planeamiento estratégico, dando énfasis al análisis externo y su implicancia en la empresa, el FODA, la visión y misión de la empresa, las estrategias genéricas y los objetivos estratégicos a implementar. Una parte fundamental del presente trabajo de investigación será buscar información relevante del mercado; que permitirá validar la metodología a utilizar y la validación del mismo. Desarrollando luego a profundidad el plan de marketing; con la finalidad de mostrar a que publico objetivo estará orientado la idea de negocio. Finalmente, en el plan de operaciones; que permitirá centraremos en las políticas operacionales a trabajar, el diseño de las instalaciones y todo lo que englobe la parte operativa de organización. Una parte importante del desarrollo del trabajo de investigación sera la realización de la estructura organizacional y los recursos humanos que componen la organización. Asimismo se considera una parte vital del desarrollo de la idea de negocio el plan economico financiero y el financiamiento del mismo; finalmente plantearemos las principales conclusiones del trabajo de investigación de la idea de negocio.The objective of this research work is to develop a business idea; applying for its development, the qualitative and quantitative methodology; We will work for this on general aspects of the business such as: the clear idea of ​​the business to be implemented, the description of the product or service to be offered and the work team that will be in charge of the investigation. Then we will deepen the investigation; working on strategic planning, emphasizing external analysis and its implication in the company, the SWOT, the vision and mission of the company, the generic strategies and the strategic objectives to be implemented. A fundamental part of this research work will be to search for relevant market information; that will allow us to validate the methodology to be used and its validation. Then developing the marketing plan in depth; In order to show which target audience our business idea will be oriented. Then in the operations plan; this will allow us to focus on the operational policies to be worked on, the design of the facilities and everything that encompasses the operational part of the organization. An important part of the development of the research work will be the realization of the organizational structure and human resources that make up the organization. Likewise, the financial economic plan and its financing are considered a vital part of the development of the business idea; finally we will raise the main conclusions of the research work of the business idea.Trabajo de investigació

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up

Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, we review the current understanding of the pathogenesis, epidemiology, management and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexisting thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155446/1/Bikdeli-2020-COVID-19 and Thrombotic or Thromb.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155446/3/DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID_Barnes.docxhttps://deepblue.lib.umich.edu/bitstream/2027.42/155446/4/license_rdf.rdfDescription of Bikdeli-2020-COVID-19 and Thrombotic or Thromb.pdf : ArticleDescription of DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID_Barnes.docx : Deep Blue sharing agreemen

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

La convivencia en los centros educativos de educación básica en Iberoamérica

La presente aportación recoge la visión de 46 especialistas de quince países iberoamericanos sobre las formas de entender y promover la convivencia escolar en los centros educativos de los distintos países. Sus aportaciones son un conjunto de descripciones, experiencias y valoraciones significativas y en relación al contexto considerado. Las aportaciones no buscan tanto radiografiar la temática a nivel teórico como presentar lo más significativo de cada realidad y las propuestas que, al respecto, se realizan. La orientación es claramente organizativa, si consideramos que una parte común de todas las aportaciones tiene que ver con las políticas de convivencia escolar, programas aplicados, aspectos organizativos a nivel de institución, experiencias significativas y retos para la mejora. Se cubre así y de nuevo un propósito fundamental de la Red AGE, como es el de fomentar el intercambio de experiencias, la promoción del conocimiento sobre administración y gestión educativa y la reflexión sobre la práctica de la gestión. La finalidad última es la de mejorar el funcionamiento de los centros educativos (y, a través de ellos, de los sistemas educativos), procurando sean de calidad y un instrumento para el cambio profesional y social