Acidente Vascular Cerebral Isquêmico em paciente jovem devido à deficiência de proteína S no contexto da distrofia muscular - relato de caso

A 19-year-old woman with a 6-year history, consisting of frequent falls and weakness due to loss of strength in the lower extremities. During the last 10 hours, she presented a sudden episode of left hemiplegia, deviation of the labial commissure to the right, dysarthria and four emetic episodes. She was diagnosed with an ischemic stroke caused by a deficiency of the S-protein and, in addition, a muscular dystrophy. This case report may indicate a relationship between muscular dystrophy and ischemic stroke caused by a protein S deficiencyMujer de 19 años con historia de 6 años de evolución consistente en caídas frecuentes y debilidad debido a la pérdida de fuerza en los miembros inferiores. Durante las últimas 10 horas, presentó un episodio repentino de hemiplejia izquierda, desviación de la comisura labial a la derecha, disartria y cuatro episodios eméticos. Ella fue diagnosticada con accidente cerebrovascular isquémico causado por una deficiencia de la proteína S y además con distrofia muscular. Este reporte de caso puede indicar una relación entre la distrofia muscular y el accidente cerebrovascular isquémico causado por una deficiencia de proteína S.Mulher de 19 anos com história de 6 anos, consistindo de quedas frequentes e fraqueza devido à perda de força nas extremidades inferiores. Durante as últimas 10 horas, apresentou episódio súbito de hemiplegia esquerda, desvio da comissura labial à direita, disartria e quatro episódios eméticos. Ela foi diagnosticada com um acidente vascular cerebral isquêmico causado por uma deficiência da proteína S e, além disso, uma distrofia muscular. Este relato de caso pode indicar uma relação entre distrofia muscular e acidente vascular cerebral isquêmico causado por deficiência de proteína

Caracterização clínica, risco de pé diabético e sua associação com o nível de autocuidado em pacientes com diabetes mellitus tipo 2

Introduction: Diabetic foot disease is a complication of diabetes mellitus that significantly affects the quality of life. It can be prevented through concrete and straightforward actions of routine foot care. Objective: To describe the clinical characteristics, the risk of diabetic foot disease, and its association with the level of self-care in patients with type 2 diabetes mellitus in the city of Tunja. Methods: Quantitative cross-sectional study with a sample of 79 participants selected by convenience. Measurements included a sociodemographic and clinical description, risk stratification, and level of self-care. Univariate and bivariate data analysis was performed using SPSS (version 27). Results: The mean age of the participants was 61.8 years, and most were women (62.0 %) with a history of neuropathy (73.4 %), bony prominences and deformities (21.5 %), inadequate footwear (26.6 %), poor preventive education (31.6 %), and previous ulcers (26.6 %). About half of them ranked high in the risk stratification categories for diabetic foot disease (46.0 %) and reported middle levels of self-care (57.1; SD = 13.9). The level of self-care was related to the risk stratification category for diabetic foot disease (p = 0.010). Conclusions: Self-care for preventing diabetic foot disease is essential to reduce risk factors and timely detect lesions. It needs to be promoted through health education.Introducción: el pie diabético es una complicación de la diabetes mellitus que causa importantes afectaciones en la calidad de vida. Este puede prevenirse mediante acciones concretas y simples de cuidado rutinario pedio. Objetivo: describir las características clínicas, el riesgo de pie diabético y su asociación con el nivel de autocuidado en pacientes con diabetes mellitus tipo 2 de la ciudad de Tunja. Metodología: estudio cuantitativo de corte transversal, con muestra de 79 participantes seleccionados por conveniencia; las mediciones incluyeron la caracterización sociodemográfica y clínica, así como la clasificación en categoría de riesgo y nivel de autocuidado. El análisis de datos univariado y bivariado se realizó mediante el programa SPSS (versión 27). Resultados: los participantes tenían una edad promedio de 61,8 años, la mayoría eran mujeres (62,0 %), con antecedentes representativos como neuropatía (73,4 %), deformidades en las prominencias óseas (21,5 %), uso de calzado inadecuado (26,6 %), escasa educación preventiva (31,6 %), úlceras previas (26,6 %); cerca de la mitad estaban ubicados en categorías altas de riesgo para pie diabético (46,0 %) y el autocuidado fue reportado en niveles medios (57,1; DE = 13,9). El nivel de autocuidado se relacionó con las categorías de riesgo de pie diabético (p = 0,010). Conclusiones: el autocuidado en la prevención del pie diabético es fundamental en la mitigación de los factores de riesgo y en la detección oportuna de lesiones. Este requiere ser fomentado desde la educación en salud.Introdução: o pé diabético é uma complicação do diabetes mellitus que causa importantes efeitos na qualidade de vida. Isso pode ser prevenido por meio de ações concretas e simples de cuidados de rotina. Objetivo: descrever as características clínicas, o risco de pé diabético e sua associação com o nível de autocuidado em pacientes com diabetes mellitus tipo 2 na cidade de Tunja. Objetivo: descrever as características clínicas, o risco de pé diabético e sua associação com o nível de autocuidado em pacientes com diabetes mellitus tipo 2 na cidade de Tunja. Metodologia: estudo quantitativo transversal, com amostra de 79 participantes selecionados por conveniência; As medidas incluíram caracterização sociodemográfica e clínica, bem como classificação em categoria de risco e nível de autocuidado. A análise dos dados univariados e bivariados foi realizada por meio do programa SPSS (versão 27). Resultados: os participantes tinham média de idade de 61,8 anos, a maioria eram mulheres (62,0%), com histórico representativo como neuropatia (73,4%), deformidades em proeminências ósseas (21,5%), uso de calçados inadequados (26,6%), pouca educação preventiva (31,6%), úlceras prévias (26,6%); quase a metade estava localizada em categorias de alto risco para pé diabético (46,0%) e o autocuidado foi relatado em níveis médios (57,1; DP = 13,9). O nível de autocuidado foi relacionado às categorias de risco do pé diabético (p = 0,010). Conclusões: o autocuidado na prevenção do pé diabético é essencial na mitigação dos fatores de risco e na detecção atempada de lesões. Isso precisa ser promovido a partir da educação em saúde

Fatores de risco e classificação de risco para doença tromboembólica em mulheres no pós-parto

 Introduction. Women in the postpartum period have a higher risk of morbidity and mortality, with an increase of up to 10 times the risk of thromboembolic disease compared to non-pregnant women of childbearing age. Objective. To describe the sociodemographic characteristics, risk factors, and risk classification for thromboembolic events of postpartum women in a reference hospital in the department of Boyacá during 2018. Methodology. Observational, descriptive, cross-sectional study, carried out in 398 postpartum women, who were surveyed and assessed by the Gynecology and Obstetrics Service of the Sogamoso Regional Hospital during 2018, the factors and risk classification for thromboembolic events were identified. Results and conclusions. Postpartum women have a median age of 26 years [RIQ; 10 years], from the urban area in 62.6% and mostly from the socioeconomic stratum one with 69.6%. The most frequent risk factors found were caesarean section with 33.2%, overweight with 31.4%, obesity grade I and II with 11.3% and preterm delivery with 7.5%. The risk classification for thromboembolic events in the total population was classified as: 6% low risk, 89.5% moderate risk and 4.5% high risk. Identification of the level of risk for thromboembolic events in postpartum women is necessary in the gynecology and obstetrics services in a standardized and systematic way, as well as mitigating these risks and thus guaranteeing the prevention of this type of complications.Introducción. Las mujeres en el periodo posparto presentan un mayor riesgo de morbilidad y mortalidad, con un incremento de hasta 10 veces el riesgo de enfermedad tromboembólica, en comparación con mujeres no embarazadas en edad fértil. Objetivo. Describir las características sociodemográficas, factores de riesgo y clasificación de riesgo para eventos tromboembólicos de las mujeres posparto en un hospital de referencia del departamento de Boyacá durante el año 2018. Metodología. Estudio observacional, descriptivo, de corte transversal, realizado en 398 mujeres posparto, quienes fueron encuestadas y valoradas por el servicio de ginecobstetricia del Hospital Regional de Sogamoso, durante el año 2018; se identificaron los factores y se hizo clasificación de riesgo para eventos tromboembólicos. Resultados y conclusiones. Las mujeres posparto cuentan con una mediana de edad de 26 años [RIQ; 10 años], procedentes del área urbana en el 62,6% y en su mayoría (69,6%) del estrato socioeconómico uno. Los factores de riesgo más frecuentes encontrados fueron la cesárea (33,2%), el sobrepeso (31,4%), la obesidad grado I y II (11,3%) y el parto pretérmino (7,5%). La clasificación de riesgo para eventos tromboembólicos en el total de la población se clasificó como: 6% riesgo bajo, 89,5% riesgo moderado y 4,5% riesgo alto. Es necesario contar en los servicios de ginecobstetricia con la identificación del nivel de riesgo para eventos tromboembólicos de las mujeres posparto, de forma estandarizada y sistemática; igualmente, mitigar estos riesgos y así garantizar la prevención de este tipo de complicaciones.Introdução: Mulheres no período pós-parto apresentam maior risco de morbilidade e mortalidade,com aumento de até 10 vezes o risco de doenças tromboembólicas, em comparação com mulheresnão grávidas em idade reprodutiva. Objetivo: Descrever as características sociodemográficas, fatores de risco e classificação de risco para eventos tromboembólicos em mulheres pós-parto no hospital de referência no departamento de Boyacá durante o ano 2018. Metodologia: Estudo observacional, des-critivo, transversal, realizado em 398 mulheres pós-parto, que foram inquiridas e avaliadas pelo servi-ço de ginecologia e obstetrícia do Hospital Regional de Sogamoso, durante o ano de 2018; Identifica-ram-se fatores e classificação de risco para eventos tromboembólicos. Resultados e conclusões: as mulheres no pós-parto têm uma idade mediana de 26 anos [RIQ; 10 anos], 62,6% da zona urbana e a maioria (69,6%) do estrato socioeconômico um. Os fatores de risco mais frequentes encontrados fo-ram cesárea (33,2%), sobrepeso (31,4%), obesidade graus I e II (11,3%) e parto prematuro (7,5%). A classificação de risco para eventos tromboembólicos na população total foi classificada em: 6% de baixo risco, 89,5% de risco moderado e 4,5% de alto risco. É necessário contar com os serviços de ginecoobstetrícia com a identificação do grau de risco para eventos tromboembólicos em mulheres pós-parto, de forma padronizada e sistematizada; da mesma forma, mitigar esses riscos e, assim, ga-rantir a prevenção deste tipo de complicações

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

5to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

El V Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2019, realizado del 6 al 8 de febrero de 2019 y organizado por la Universidad Politécnica Salesiana, ofreció a la comunidad académica nacional e internacional una plataforma de comunicación unificada, dirigida a cubrir los problemas teóricos y prácticos de mayor impacto en la sociedad moderna desde la ingeniería. En esta edición, dedicada a los 25 años de vida de la UPS, los ejes temáticos estuvieron relacionados con la aplicación de la ciencia, el desarrollo tecnológico y la innovación en cinco pilares fundamentales de nuestra sociedad: la industria, la movilidad, la sostenibilidad ambiental, la información y las telecomunicaciones. El comité científico estuvo conformado formado por 48 investigadores procedentes de diez países: España, Reino Unido, Italia, Bélgica, México, Venezuela, Colombia, Brasil, Estados Unidos y Ecuador. Fueron recibidas un centenar de contribuciones, de las cuales 39 fueron aprobadas en forma de ponencias y 15 en formato poster. Estas contribuciones fueron presentadas de forma oral ante toda la comunidad académica que se dio cita en el Congreso, quienes desde el aula magna, el auditorio y la sala de usos múltiples de la Universidad Politécnica Salesiana, cumplieron respetuosamente la responsabilidad de representar a toda la sociedad en la revisión, aceptación y validación del conocimiento nuevo que fue presentado en cada exposición por los investigadores. Paralelo a las sesiones técnicas, el Congreso contó con espacios de presentación de posters científicos y cinco workshops en temáticas de vanguardia que cautivaron la atención de nuestros docentes y estudiantes. También en el marco del evento se impartieron un total de ocho conferencias magistrales en temas tan actuales como la gestión del conocimiento en la universidad-ecosistema, los retos y oportunidades de la industria 4.0, los avances de la investigación básica y aplicada en mecatrónica para el estudio de robots de nueva generación, la optimización en ingeniería con técnicas multi-objetivo, el desarrollo de las redes avanzadas en Latinoamérica y los mundos, la contaminación del aire debido al tránsito vehicular, el radón y los riesgos que representa este gas radiactivo para la salud humana, entre otros

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 9

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, volumen 9, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

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

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 <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (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 obesit