Insuficiência hepática aguda como apresentação de linfoma não-Hodgkin

Acute hepatic failure (AHF) consists of a sudden appearance of coagulopathy and hepatic encephalopathy in a patient with no previous hepatic disease.  Although the liver is the most affected organ in cancer dissemination, AHF is rare and appears essentially in cancer terminal stages. Even rarer is AHF as an initial finding of cancer. We present a case of a 39 year-old HIV positive patient in whom AHF was the initial manifestation of a non-Hodgkin lymphoma.A Insuficiência Hepática Aguda (IHA) consiste no aparecimento súbito de coagulopatia e encefalopatia hepática em doente sem doença hepática prévia. Embora o fígado seja afectado por metastização, a IHA costuma ser incomum e surgir apenas nos estadios terminais da doença. Apesar de a IHA ser uma forma rara de apresentação de neoplasias, tem sido observada em neoplasias hematológicas, nomeadamente na doença de Hodgkin e linfoma não-Hodgkin difuso de grandes células, B especialmente em doentes imunossuprimidos. É relatado um caso de um doente de 39 anos, vírus da imunodeficiência humana (VIH) 1 postivo, cuja manifestação inaugural de um linfoma não-Hodgkin foi IHA

El reencuentro con la naturaleza: voces femeninas en el tiempo

Este texto contribuye al análisis científico de diferentes áreas del conocimiento la filosofía social, la educación para el cuidado del medio ambiente mediante la sustentabilidad que incide en diversas unidades de aprendizaje en Educación para la Salud y de la Maestria en Sociología de la SaludEl relato de las voces femeninas que se escuchan en el tiempo, narran las luchas por defender un ideal, con frecuencia en la organización de las mujeres que pugnan por estabilizar el equilibrio de la naturaleza, por medio de tácticas educativas que van recorriendo el bachillerato, la normal y la universidad

Pluripotency factors regulate the onset of Hox cluster activation in the early embryo

Pluripotent cells are a transient population of the mammalian embryo dependent on transcription factors, such as OCT4 and NANOG, which maintain pluripotency while suppressing lineage specification. However, these factors are also expressed during early phases of differentiation, and their role in the transition from pluripotency to lineage specification is largely unknown. We found that pluripotency factors play a dual role in regulating key lineage specifiers, initially repressing their expression and later being required for their proper activation. We show that Oct4 is necessary for activation of HoxB genes during differentiation of embryonic stem cells and in the embryo. In addition, we show that the HoxB cluster is coordinately regulated by OCT4 binding sites located at the 3′ end of the cluster. Our results show that core pluripotency factors are not limited to maintaining the precommitted epiblast but are also necessary for the proper deployment of subsequent developmental programs

Realidades interculturales, miradas hacia el género y la educación

Este texto contribuye al análisis científico de varias áreas del conocimiento como la filosofía social, la patología, la educación para el cuidado del medio ambiente y la sustentabilidad que inciden en diversas unidades de aprendizaje de la Licenciatura en Educación para la Salud y de la Maestría en Sociología de la SaludLa presente obra, es la reunión de varias investigaciones que se han dado cita para construir un libro que representa el horizonte de autores y lectores en la pasión del dialogo. Se trata de experiencias de los observadores e interpretes de la realidad de los observadores e interpretes de la realidad social quienes se aventuraron a reunir las voces de los informantes que resguardan los secretos de sus comunidades acerca de su cultura, organización simbólica, y de sus practicas y rituales engarzados en la vida cotidiana

REALIDADES INTERCULTURALES

EL LIBRO FOMENTA LA LÍNEA DE INVESTIGACIÓN DEL CUERPO ACADÉMICO DE GÉNERO, SUSTENTABILIDAD, EDUCACIÓN Y SALUDSE RETOMAN EXPERIENCIAS DE LOS INTERPRETES DE LA REALIDAD SOCIAL QUIENES GUARDAN LOS SECRETOS DE SUS COMUNIDADES ACERCA DE LA CULTURA, ORGANIZACIÓN SIMBÓLICA DE LA VIDA COTIDIANANINGUNO ES PERSONA

MDM technological solution to consolidate customer registration in the banking sector

En estos días es importante que las empresas mantengan su información integra y confiable, ya que de ello depende en gran medida su éxito dentro del mercado. Si nos colocamos en la perspectiva del banco, los datos de los clientes representan un componente importante a tomar en cuenta, ya que son indispensables para generar un acercamiento más provechoso a los clientes mediante los procesos de análisis de datos por medio de campañas. Por este motivo, el proyecto involucró la implementación de una solución tecnológica llamada Master Data Management (MDM) dentro de una entidad bancaria, la cual busca centralizar todos los datos más importantes de la empresa en una sola data maestra. Se utilizó la herramienta MDM Informática, la cual fue desarrollada y adaptada a las necesidades de la empresa. Dentro del proyecto se utilizaron las tecnologías como Real Time Change Data Capture (CDC), Extract, Transform and Load (ETLs) y microservicios, estos últimos permitieron la integración y exposición de la data maestra dentro de la organización a través de las herramientas líderes en el mercado de la Gestión de los Datos. En el presente proyecto, se visualizó la mejora sobre como la implementación del MDM mejoró la eficiencia corporativa en todos los niveles al obtener los datos de cliente limpios y transparentes en tiempos promedios de consulta menores a los 5 segundos.These days it is important for companies to keep their information integrated and reliable, since their success in the market depends to a large extent on it. If we place ourselves in the bank's perspective, customer data represents an important component to take into account, since it is essential to generate a more profitable approach to customers through data analysis processes by campaigns. For this reason, the project involved the implementation of a technological solution called Master Data Management (MDM) within a bank, which seeks to centralize all the most important data of the company in a single master data. The MDM Informatica tool was used, which was developed and adapted to the needs of the company. Within the project, technologies such as Real Time Change Data Capture (CDC), Extract, Transform and Load (ETLs) and microservices were used, the latter allowed the integration and exposure of the master data within the organization through the leading tools in the Data Management market. In this project, the improvement was visualized on how the implementation of MDM improved corporate efficiency at all levels by obtaining clean and transparent customer data in average query times of less than 5 seconds.Trabajo de Suficiencia Profesiona

Blood cultures on internal medicine: utilization profile and clinical implications

Introdução: o uso excessivo de hemoculturas tem sido associado a aumento do tempo de internamento e de custos hospitalares. Adicionalmente, a literatura médica reporta taxas de positividade abaixo do esperado, levando à criação de índices de predição de positividade. Métodos: estudo prospectivo observacional conduzido numa enfermaria de Medicina Interna de um hospital terciário, com recolha de dados de todos os doentes a quem foram realizadas hemoculturas. Resultados: em 414 admissões, foram colhidas hemoculturas em 39.9%. Os doentes a quem foram colhidas hemoculturas tiveram maior tempo de internamento e mais exames laboratoriais e imagiológicos pedidos. 7,5% das hemoculturas foram positivas. Nos doentes com critérios de sepsis a taxa de positividade das hemoculturas foi 21,7% e não houve nenhuma hemocultura positiva em doente sem critérios de sépsis, nomeadamente em doentes com elevação isolada de proteína c-reactiva, leucocitose ou febre. O resultado da hemocultura não foi um determinante de de-escalação antibiótica. Conclusões: este estudo sugere que as hemoculturas devem ser colhidas essencialmente em doentes com sepsis, podendo esta prática diminuir o seu sobreuso.Introduction: recent literature suggests that excessive use of blood cultures could prolong length of stay and hospital costs. Moreover, low positive rates have been reported and positivity predictive scores have recently been proposed. Methods: we conducted an observational prospective study in an Internal Medicine department of a university reference hospital analysing data from all patients to whom BC was requested. Results: blood cultures were performed in 39.9% of 414 admissions. Patients with blood cultures had higher length of stay and underwent more laboratory and imaging diagnostic tests. Global positivity rate was of 7.5%. Patients fulfilling sepsis criteria had a higher positivity rate (21.7%) and there were no positive blood cultures in patients without sepsis, namely in cases of isolated creactive protein elevation, leucocytosis or fever. In addition, blood cultures results were not a determinant of antibiotic adjust or de-escalation. Conclusions: our data suggest that the use of BC should be done essentially in patients with sepsis criteria, reducing its unnecessary use, although more studies are required to validate such practice

Molecular Docking Studies of Spirostans as MAPK14 (P38α) Inhibitors and Their Potential use against Cancer

Spirostans (SPs) are chemical products widely distributed in the plant kingdom; currently, they are studied by their medical applications. Cancer has a high incidence in humans; it reaches second place worldwide deaths. In molecular biology, it has been accepted that Mitogen-Activated Protein p38alpha Kinase (MAPK14 (p38α)) is implicated in the regulation of cancer. This study aimed to identify SPs as potential MAPK14 (p38α) inhibitors. From a set of 133 modified SPs, SwissTargetPrediction platform, and molecular docking, it was obtained that 129 chemical structures had molecular interaction with the MAPK14 (p38α). From those molecules, 123 were bound to a specific inhibition site of MAPK14 (p38α), and 6 of the structures resulted in inhibitors similarly to minocycline and dasatinib. One SP had binding couple energy (BCE, kcal/mol) as that of fostamatinib. In addition, 115 modified SPs had better BCE than the minocycline but not as that using fostamatinib. The key amino acids (aa) for the protein kinase MAPK14 (p38α) inhibition were Arg 70, Asp 168, Lys 53, His 148, and Ile 145, at a different interaction level. The BCE was enhanced when the H atom was substituted in C-2, C-11, and C-17 SPs positions. Similarly, the αOH group at C-5 and C-6 upgraded BCE. Stereochemistry and substitution at C-3, C-12, and C-25 did not present significant differences (Kruskal-Wallis test, p <0.05). From all this ensemble of results, it is foreseeable that the SPs can be an option for MAPK14 (p38α) inhibition, a key modulator in cancer processes

Case Report Massive Bleeding as the First Clinical Manifestation of Metastatic Prostate Cancer due to Disseminated Intravascular Coagulation with Enhanced Fibrinolysis

Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder associated with metastatic prostate adenocarcinoma. However, DIC with enhanced fibrinolysis as an initial presentation of prostate cancer is extremely rare. The appropriate treatment to control bleeding in these situations is challenging, controversial, and based on isolated case reports in the literature. A 66-year-old male presented at the emergency department with acute severe spontaneous ecchymoses localized to the limbs, laterocervical hematoma, and hemothorax. Prostate specific antigen level was 385 g/L, bone scintigraphy revealed multiple bone metastases, and prostate biopsy confirmed adenocarcinoma (Gleason 9; 4 + 5). Laboratory investigation showed a pattern of enhanced fibrinolysis rather than the more common intravascular coagulation mechanism. Epsilon aminocaproic acid in monotherapy was initiated with a clear and rapid control of bleeding manifestations. This rare case of massive bleeding due to DIC with enhanced fibrinolysis as the first manifestation of prostate cancer suggests that in selected cases where the acute bleeding dyscrasia is clearly associated with a dominant fibrinolysis mechanism it is possible to use an approach of monotherapy with antifibrinolytics