Instrumentos utilizados para la evaluación psicológica forense del testimonio en el delito de abuso sexual infantil : un estado del arte

Este proyecto de investigación pretende establecer y analizar los instrumentos empleados por la psicología forense para evaluar el testimonio de niños abusados sexualmente. El abuso sexual infantil es una problemática social relevante en Colombia y la psicología forense, como disciplina encargada de evaluarlo, se encuentra en proceso de desarrollo y tiende a aplicar sus instrumentos indiscriminadamente. Para esto, se realiza un estudio cualitativo, que sigue una modalidad de investigación documental, en tanto consiste en un estado del arte de la literatura publicada en Estados Unidos, España, Inglaterra y Colombia sobre dichos instrumentos. Este análisis se realizó de acuerdo a categorías teóricas y permitió concluir que aún cuando en Colombia ninguno de los instrumentos revisados está validado, algunos sí pueden aplicase pero teniendo en cuenta tanto sus alcances y limitaciones, como la normatividad del país contenida en el Código de Procedimiento Penal y en la ley de Infancia y Adolescencia. Además, los peritos psicólogos encargados deben ceñirse a las guías de buena práctica de dichos instrumentos, para así evitar posibles distorsiones del recuerdo y de la narración infantil.Psicólogo (a)Pregrad

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Modificación de nanobarras de oro para aumentar la llegada al cerebro

Tesis para optar al grado de Doctora en Ciencias FarmacéuticasLas nanobarras de oro son nanomateriales muy interesantes para su uso en la terapia de diferentes patologías como cáncer o la enfermedad de Alzheimer, ya que poseen la capacidad de absorber gran cantidad de energía en la región del infrarrojo cercano, en la cual los tejidos biológicos son transparentes a la radiación, y disiparla en forma de calor. No obstante para una eventual terapia, estos nanomateriales deben llegar a su blanco terapéutico que en el caso de la enfermedad de Alzheimer son los agregados tóxicos de la proteína β amiloide presentes en el cerebro. Uno de los grandes desafíos de la nanomedicina para la terapia de enfermedades neurodegenerativas es el de lograr que los nanomateriales lleguen al sistema nervioso central. Para estos propósitos, en esta tesis se multifuncionalizaron las Nanobarras de oro con el péptido Angiopep-2, que se utiliza como lanzadera de fármacos para favorecer el paso a través de la barrera hematoencefálica, y además con el péptido qshyrhispaqv (D1), el cual posee una afinidad en el rango sub-micromolar in vitro por los agregados del péptido β amiloide. Asimismo, las NR se conjugaron con dos tipos de polietilenglicol: Metoxi-Polietilenglicol tiolado que evita las interacciones inespecíficas, y Carboxi-Polietilenglicol tiolado que contiene un grupo carboxílico que permite la unión con un grupo amino terminal correspondiente a los péptidos, empleando agentes acoplantes. Las nanopartículas obtenidas fueron caracterizadas por Microscopia Electrónica de Transmisión, Espectrofotometría UV-Visible, Potencial Zeta y Dispersión Dinámica de la luz. Adicionalmente fue evaluada la citotoxicidad, estabilidad y la penetración in vitro de Nanobarras modificadas en células endoteliales microvasculares de rata bEnd.3 y RBEMC, observándose la capacidad de ingresar al medio intracelular. La capacidad de las Nanobarras modificadas de reconocer fibras de péptido β amiloide fue ensayada mediante una incubación con dichas fibras, y su posterior visualización por Microscopía electrónica de Transmisión. Por otra parte, se observó en cerebro de rata ex vivo la llegada al cerebro por fluorescencia, y se comprobó mediante cuantificación de oro. Como resultado de esta tesis se puede concluir que el conjugado propuesto de Nanobarras de oro modificadas con los péptidos Angiopep-2 y D1, no presenta toxicidad celular, y además es capaz de llegar al cerebro en mayor proporción que su control, que corresponde a Nanobarras de oro no modificadas. Además, en ensayos in vitro se confirmó la capacidad de reconocer agregados de fibras de péptido β-amiloide. De esta forma se espera poder contribuir al desarrollo de una estrategia para mejorar la llegada de las nanopartículas de oro al Sistema Nervioso Central, lo que representará un gran avance para una posible terapia de la enfermedad de AlzheimerGold Nanorods are very interesting nanomaterials for use in the therapy of different pathologies such as cancer or Alzheimer's disease, since they have the capacity to absorb large amounts of energy and to dissipate it in the form of heat in the near infrared region, in which biological tissues are transparent to radiation. However for a possible therapy, these nanomaterials must reach their therapeutic target, which in the case of Alzheimer's disease are the toxic aggregates of the β amyloid protein present in the brain. One of the bigger challenges of nanomedicine for neurodegenerative disease therapy is that nanomaterials reach the central nervous system. For this purpose, Gold Nanorods were multifunctionalized with the peptide Angiopep-2, which is used as a drug shuttle to promote passage through the blood-brain barrier, and also with the peptide qshyrhispaqv (D1), which has an affinity in the sub-micromolar range in vitro by the amyloid aggregates. Also, the Gold Nanorods were conjugated to two types of polyethylene glycol: thiolated Metoxy-Polyethylene glycol avoiding non-specific interactions, and Carboxy-Polyethylene glycol containing a carboxylic group which allows attachment to a terminal amino group corresponding to the peptides using coupling agents. The nanoparticles obtained were characterized by Transmission Electron Microscopy, UV-Visible Spectrophotometry, Zeta Potential and Dynamic Light Scattering. In addition, cytotoxicity, stability and in vitro penetration in microvascular endothelial cells of rat bEnd.3 and RBMVEC were evaluated, and the capacity to enter the intracellular medium was observed. The ability of the multifunctionalized Gold Nanorods to recognize β amyloid peptide fibers were assayed by incubation with said peptide and visualization by Transmission Electron Microscopy. On the other hand, the arrival to the brain was observed ex vivo by fluorescence, and was checked by quantification of gold. As a result of this thesis it can be concluded that the proposed conjugate does not present cytotoxicity, and is also able to reach the brain in a greater proportion than its control. In addition, the ability to recognize aggregates of β amyloid peptide fibers was confirmed in in vitro assays. In this way it is hoped to contribute to the development of a strategy to improve the arrival of gold nanoparticles to the Central Nervous System, which will represent a great advance for a possible therapy of Alzheimer's diseas

Voltammetric behavior of naratriptan and its determination in tablets

The electrochemical behavior and the analytical application of the selective serotonin agonist naratriptan (N-methyl-3-(1-methyl-4-piperidyl)indole-5-ethanesulfonamide) are presented herein. Naratriptan exhibits an anodic response in aqueous media over a broad pH range (pH 2-12). as determined by differential pulse voltammetry and cyclic voltammetry using glassy carbon electrodes. This response is irreversible in nature, diffusion-controlled and probably caused by the oxidation of the naratriptan indole moiety. The differential pulse voltammetry technique was performed in 0.1 mol L-1 Britton-Robinson buffer (pH = 3), which elicited the most reproducible results. The percentage of naratriptan recovery was 102.1 +/- 1.8%, and the limits of detection and quantitation were 9.5 x 10(-6) and 2.0 x 10(-5) mol L-1, respectively. Selectivity trials revealed that the oxidation signal of the drug was not disturbed by the presence of excipients or degradation products. Thus, we conclude that the method presented herein is useful for the quantification of naratriptan in pharmaceutical drugs and that this method requires no separations or extractions. Finally, this voltammetric method was successfully applied to determine the quantity and the content uniformity of naratriptan in drug tablets. A comparison of this technique to the standard high-performance liquid chromatography technique was conducted at the end of our study