Short-Term Cardiac and Noncardiac Mortality Following Liver Transplantation

Objectives. To determine the importance of acute cardiac events as a cause of mortality compared to non-cardiac events in the four month period following liver transplantation (LT) using current preoperative cardiac screening strategies. Patients and Methods. We retrospectively reviewed timing, type, and outcome of adverse cardiac events, and all cause mortality in the 4 month postoperative period in 393 consecutive LT patients from October 1999 to February 2008. Results. Of 30 total deaths (7.6% overall mortality rate), 27 (90%) were due to surgical or medical complications and 3 (10%) were primary cardiac deaths (0.8% cardiac mortality rate). Acute cardiac events occurred in 26 patients (6.6%), including 13 arrhythmias (50%), 7 new onset heart failures (27%), and 6 myocardial infarctions (23%). Twelve of 13 intraoperative events were arrhythmias (92%) including two of three cardiac deaths. Conclusions. Using current preoperative screening recommendations, deaths from primary cardiac events within four months of LT are very uncommon (0.8%), especially compared with deaths related to medical and surgical complications (6.9%)

Mercadeo

Se describen conceptos asociados al mercadeo y se presenta el material de referencia que corresponde al área de mercadeo de la empresa asociativa en todas sus facetas y durante todas sus fases de desarrollo.Concepts associated with marketing are described and the reference material corresponding to the marketing area of the associative company in all its facets and during all its development phases is presented.El concepto de mercadeo -- Definición del mercado para la empresa asociativa -- Estrategia del mercado para la empresa asociativa -- El producto -- El precio -- La distribución -- La promociónnaDocumento producto del convenio de cooperación técnica SENA - Holanda.Series de la colección PMUR: 1. Guía Metodológica; 2. Material Didáctico; 3. Lecturas de Referencia; 4. Estudios.Publicaciones de la serie “Lecturas de referencia” : 1. Características de las Empresas Asociativas; 2. Mercadeo; 3. Producción; 4. Tecnología; 5. Financiación; 6. Contabilidad; 7. Marco Legal; 8. Formación Socioempresarial.92 página

Producción

Fascículo que describe el concepto de producción, se exponen las características y objetivos específicos de la producción en la pequeña empresa asociativa, sistemas para preparación, programación y organización de la producción y métodos para el cálculo de costos de producción.Fascicle describing the concept of production, the specific characteristics and objectives of production in the small associative enterprise, systems for preparation, programming and organization of production and methods for calculating production costs are set out.Características y objetivos de la pequeña empresa -- Preparación, programación y organización de la producción en empresas urbanas -- Preparacion programacion y organizacion de la producción en empresas agropecuarias -- Calculo de costos de producción en empresas urbanas -- Cálculo de costos de producción en empresas ruralesna75 página

Financiación

Fascículo de la serie “Lecturas de referencia” que describe cómo tratar los problemas financieros en las empresas asociativas, sistema financiero adecuado en la empresa asociativa y principios para el manejo del área financiera.Fascicle of the series “Reference readings” that describes how to deal with financial problems in associative companies, adequate financial system in the associative company and principles for managing the financial area.La problemática de la financiación de empresas asociativas en los niveles informales -- una visión estructural del problema -- sistema financiero adecuado - el fondo de apoyo de empresas asociativas -- el manejo del área financiera al interior de las empresasnaDocumento producto del convenio de cooperación técnica SENA - Holanda.Series de la colección PMUR: 1. Guía Metodológica; 2. Material Didáctico; 3. Lecturas de Referencia; 4. Estudios.Publicaciones de la serie “Lecturas de referencia” : 1. Características de las Empresas Asociativas; 2. Mercadeo; 3. Producción; 4. Tecnología; 5. Financiación; 6. Contabilidad; 7. Marco Legal; 8. Formación Socioempresarial.40 página

Flatband slows down polariton dynamics in strongly coupled cavities

Flatbands in condensed-matter, atomic physics, and quantum optics stand as the basis for several strongly correlated quantum many-body phenomena such as Wigner crystallization, the fractional quantum Hall effect and Moir\'e-related physics. Besides inspiring analogies among diverse physical fields, flatbands are highly sought-after in photonics because they allow unconventional light flows such as slow-light. Here, we realize room-temperature slow-light with Frenkel polaritons excited across two strongly coupled cavities. We demonstrate the formation of a tuneable flatband appearing in absence of a periodic in-plane potential. Our simple photonic architecture enables the unique spatial segregation of photons and excitons in different cavities and maintains a balanced degree of mixing between them. This unveils a dynamical competition between many-body scattering processes and the underlying polariton nature which leads to an increased fluorescence lifetime. The polariton features are further revealed under appropriate resonant pumping, where we observe suppression of the flatband polariton fluorescence intensity.Comment: 8+ 4 page

Pretransplant Fasting Glucose Predicts New-Onset Diabetes after Liver Transplantation

New-onset diabetes after transplantation (NODAT) is common after liver transplant and associated with poorer outcomes. The aim of this study was to identify risk factors for NODAT in liver transplant recipients off corticosteroids. In 225 adult nondiabetic liver transplant recipients, the mean age was 51.7 years, the majority were men (71%), and half had HCV (49%). The mean calculated MELD score at transplantation was 18.7, and 19% underwent living-donor transplant (LDLT). One year after transplantation, 17% developed NODAT, and an additional 16% had impaired fasting glucose. The incidence of NODAT in patients with HCV was 26%. In multivariate analysis, HCV, pretransplant FPG, and LDLT were significant. Each 10 mg/dL increase in pretransplant FPG was associated with a twofold increase in future development of NODAT. The incidence of NODAT after liver transplant in patients off corticosteroids is 17%. Risk factors for developing NODAT include HCV and pretransplant FPG; LDLT is protective

Acute-on-Chronic Liver Failure: Getting ready for prime-time

Acute on chronic liver failure (ACLF) is a culmination of chronic liver disease and extra-hepatic organ failures, which is associated with a high short-term mortality and immense healthcare expenditure. There are varying definitions for organ failures and ACLF in Europe, North America and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multi-factorial and related to interactions between the immuno-inflammatory system, microbiota and the precipitating factors. Individual organ failures related to the kidney, brain, lungs and circulation have cumulative adverse effects on mortality and are often complicated or precipitated by infections. Strategies to prevent and rapidly treat these organ failures are paramount in improving survival. With the aging population and paucity of organs for liver transplant, the prognosis of ACLF patients is poor, highlighting the need for novel therapeutic strategies. The role of liver transplant in ACLF is evolving and needs further investigation across large consortia. A role for early palliative care and management of frailty as approaches to alleviate disease burden and improve patient-reported outcomes is being increasingly recognized. CONCLUSION: ACLF is a clinically relevant syndrome that is epidemic worldwide and which requires a dedicated multi-national approach focused on prognostication and management. Investigations are underway worldwide to get ACLF ready for prime time. Compensated cirrhosis with \u3e 90% 1-year survival can transition into the decompensated stage with the onset of jaundice, ascites, variceal bleeding and hepatic encephalopathy (HE) (1)Acute on chronic liver failure (ACLF) is associated with rapid deterioration of liver function leading to liver failure, multiple extra-hepatic organ failures and high short-term mortality (2). Even if patients survive the acute insult, they may never return to their pre-episode functional state (3). The term acute decompensation has been used to characterize ascites, gastrointestinal bleeding, hepatic encephalopathy or infections without organ failure(4). There are several gaps in knowledge surrounding ACLF, which will be highlighted in this review. The prevalence of ACLF is difficult to assess due to varying regional definitions (5). ACLF, once thought to occur only in decompensated cirrhosis, has been recognized even in chronic liver disease without cirrhosis (5). ACLF occurs in approximately 10-30% of hospitalized cirrhotic patients (6-8). Because of its acuity, patients are frequently admitted into the intensive care unit (ICU), and every effort is made to stabilize these patients for liver transplantation (LT). This drives healthcare costs(9). Despite this intensive management, ACLF is associated with substantial morbidity and mortality. Because curative LT is only available to \u3c 10% of cirrhotic patients each year and ACLF patients are often delisted, the morbidity and mortality rates remain high, especially with an increasing number of organ failures (10)

Actitudes sexuales y uso del condón en estudiantes universitarios de Ciudad Juárez, México

Objetivo: Describir actitudes, conductas sexuales y prevalencia de uso del condón entre los estudiantes de una universidad mexicana en la frontera de México con Estados Unidos. Material y métodos: Estudio descriptivo con una muestra de 561 estudiantes universitarios quienes dieron su consentimiento informado previo a la aplicación de un cuestionario que se depositó en una urna cerrada y sellada para garantizar confidencialidad. Se realizó análisis univariado para describir las características generales de la muestra y se compararon grupos con respecto a conductas sexuales de riesgo mediante el cálculo de la razón de momios con intervalos de confianza al 95 % y prueba de ji cuadrada de Pearson. El análisis estadístico fue realizado con el programa SPSS versión 15 para Windows. Resultados: El 69.2 % (n=379) refieren antecedentes de actividad sexual coital. En promedio el inicio de la vida sexual para los hombres fue de 16.9 años y de 18.3 años para las mujeres; el 35.9 % no utilizaron condón en su primera relación. El 76.8 % reportaron vida sexual activa en los últimos 6 meses, y solo un tercera parte de ellos (33.9 %) reportó siempre usar condón para relaciones coitales. Una proporción baja (35.3 %) reportó antecedentes de exámenes de detección de ITS, pero la mayoría (90.7 %) estaba dispuesto a practicárselos. A pesar de que la mayoría (92 %) ha recibido información sobre uso de condón y de conductas de riesgo para transmisión de VIH/SIDA e ITS, más de la mitad (55.1 %) mostraron disposición para participar en talleres educativos sobre este tema. En este artículo además se reportan los resultados de otras características, actitudes y conductas sexuales y prevalencia de comportamientos de alto riesgo para contraer VIH/SIDA e ITS de estos estudiantes. Conclusiones: Los universitarios estudiados en esta ciudad fronteriza de México forman un grupo sexualmente activo con riesgo alto para adquirir ITS por sus actitudes y características de comportamiento sexual. Es necesario desarrollar e implementar campañas de promoción de uso del condón y para detección oportuna y tratamiento de ITS en este grupo. Abstract Objective: Describe sexual attitudes and behaviors, and prevalence of condom use among students in a mexican university on the Mexico-United States border Material and methods: A descriptive study with a sample of 561 university students who gave informed consent prior to the application of a questionnaire that they deposited in a closed and sealed box to guarantee confidentiality. Univariable analysis was done to describe general characteristics of the sample, and risk sexual behaviors were compared between groups using odds ratio with confidence intervals and Pearson ́s chi square test. The statistical analysis was performed with SPSS version 15 for Windows. Results: 69.2 % (n=379) reported history of prior sexual activity. The mean age for start of sexual activity was 16.9 years for men and 18.3 years for women; 35.9 % (n=136) did not use a condom for their first life-time sexual relation. 76.8 % (n=289) had an active sex life in the past six-months, with only a third of them (n=98) reporting to always use a condom for sexual relations. A low proportion (35.3 %) reported ever having had a laboratory test to detect an STD, but most (90.7 %) stated that they would be willing to undergo a test. Although most (92 %) had received information about condom use and high-risk behaviors for HIV/AIDS and STD transmission in the past, more than half (55.1 %) showed interest to participate in educational workshops. Other results about characteristics and attitudes of sexual behaviors and prevalence of high-risk behaviors for contracting HIV/AIDS and STD’s of these students are discussed in this report. Conclusions: The University students studied in this Mexican border city represent a sexually active group at high risk for contracting HIV/AIDS or STDs given their attitudes and characteristics of sexual behaviors. It is necessary to develop and implement condom promotion campaigns and early detection and treatment of HIV/AIDS and STDs in this group. Keywords: Condom use, sexual behavior, STD’s, sexually active, university students, Mexico

Implications of Edentulism on Quality of Life among Elderly

This study aimed was to test the association between quality of life and edentulism among elderly individuals in a city in southeastern Brazil. This cross-sectional study was carried out with 163 individuals aged 60 years or older, functionally independent and non-institutionalized. Data were collected with a questionnaire and oral examination. The edentulism was the dependent variable. The independent variables were sex, age, household income and quality of life (WHOQOL-Old) and their scores. To assess the association between the dependent variable and independent variables was used bivariate analysis (p < 0.10). Poisson regression model was performed, adjusting for age and sex. The average age of participants was 69 years (± 6.1), 68.7% were female and 52.8% were diagnosed as completely edentulous (90% CI: 0.33–1.24). When the independent variables were associated to the prevalence of edentulism, statistically significant associations were found for age (p = 0.03) and social participation dimension of the WHOQOL-Old (p = 0.08). In the Poisson regression, social participation remained statistically associated to edentulism {RP = 2.12 [90% CI (1.10–4.00)]}. The social participation proved to have a significant association to edentulism, thereby attesting to the negative effect of this condition on social aspects

Childhood leukemias in Mexico: towards implementing CAR-T cell therapy programs

Leukemias are the most common type of pediatric cancer around the world. Prognosis has improved during the last decades, and many patients are cured with conventional treatment as chemotherapy; however, many patients still present with a refractory disease requiring additional treatments, including hematopoietic stem cell transplantation. Immunotherapy with monoclonal antibodies or cellular therapy is a promising strategy for treating refractory or relapsed hematological malignancies. Particularly, CAR-T cells have shown clinical efficacy in clinical trials, and different products are now commercially approved by regulatory agencies in the USA and Europe. Many challenges still need to be solved to improve and optimize the potential of these therapies worldwide. Global access to cell therapy is a significant concern, and different strategies are being explored in the middle- and low-income countries. In Mexico, leukemias represent around 50% of total cancer diagnosed in pediatric patients, and the rate of relapsed or refractory disease is higher than reported in other countries, a multi-factorial problem. Although significant progress has been made during the last decades in leukemia diagnosis and treatment, making new therapies available to Mexican patients is a priority, and cell and gene therapies are on the horizon. Efforts are ongoing to make CAR-T cell therapy accessible for patients in Mexico. This article summarizes a general landscape of childhood leukemias in Mexico, and we give a perspective about the current strategies, advances, and challenges ahead to make gene and cell therapies for leukemia clinically available