Reflexiones acerca de la eutanasia en Colombia

ResumenEste artículo de reflexión revisa el desarrollo histórico del término «eutanasia». Se postula que desnaturalizarlo ha dificultado el debate, y que debe diferenciarse de otros aspectos del final de la vida. Se hace un análisis de la problemática de los cuidados paliativos y la eutanasia en Colombia. Al respecto, se presentan algunas opiniones y propuestas.AbstractThis reflective article reviews the historical development of the term “euthanasia”. It is postulated that the distortion of the term “euthanasia” has hindered the debate around it, so it is imperative to differentiate it from other aspects of the end of life. The article ilustrates some difficulties about palliative care and euthanasia that are currently faced in Colombia. Some opinions and proposals are presented

Vascular Smooth Muscle-Specific Progerin Expression Accelerates Atherosclerosis and Death in a Mouse Model of Hutchinson-Gilford Progeria Syndrome

Background: Progerin, an aberrant protein that accumulates with age, causes the rare genetic disease Hutchinson-Gilford progeria syndrome (HGPS). Patients who have HGPS exhibit ubiquitous progerin expression, accelerated aging and atherosclerosis, and die in their early teens, mainly of myocardial infarction or stroke. The mechanisms underlying progerin-induced atherosclerosis remain unexplored, in part, because of the lack of appropriate animal models. Methods: We generated an atherosclerosis-prone model of HGPS by crossing apolipoprotein E-deficient (Apoe(-/-)) mice with Lmna(G609G/G609G) mice ubiquitously expressing progerin. To induce progerin expression specifically in macrophages or vascular smooth muscle cells (VSMCs), we crossed Apoe(-/-)Lmna(LCS/LCS) mice with LysMCre and SM22Cre mice, respectively. Progerin expression was evaluated by polymerase chain reaction and immunofluorescence. Cardiovascular alterations were determined by immunofluorescence and histology in male mice fed normal chow or a high-fat diet. In vivo low-density lipoprotein retention was assessed by intravenous injection of fluorescently labeled human low-density lipoprotein. Cardiac electric defects were evaluated by electrocardiography. Results:Apoe(-/-)Lmna(G609G/G609G) mice with ubiquitous progerin expression exhibited a premature aging phenotype that included failure to thrive and shortened survival. In addition, high-fat diet-fed Apoe(-/-)Lmna(G609G/G609G) mice developed a severe vascular pathology, including medial VSMC loss and lipid retention, adventitial fibrosis, and accelerated atherosclerosis, thus resembling most aspects of cardiovascular disease observed in patients with HGPS. The same vascular alterations were also observed in Apoe(-/-)Lmna(LCS/LCS)SM22Cre mice expressing progerin specifically in VSMCs, but not in Apoe(-/-)Lmna(LCS/LCS)LysMCre mice with macrophage-specific progerin expression. Moreover, Apoe(-/-)Lmna(LCS/LCS)SM22Cre mice had a shortened lifespan despite the lack of any overt aging phenotype. Aortas of ubiquitously and VSMC-specific progerin-expressing mice exhibited increased retention of fluorescently labeled human low-density lipoprotein, and atheromata in both models showed vulnerable plaque features. Immunohistopathological examination indicated that Apoe(-/-)Lmna(LCS/LCS)SM22Cre mice, unlike Apoe(-/-)Lmna(G609G/G609G) mice, die of atherosclerosis-related causes. Conclusions: We have generated the first mouse model of progerin-induced atherosclerosis acceleration, and demonstrate that restricting progerin expression to VSMCs is sufficient to accelerate atherosclerosis, trigger plaque vulnerability, and reduce lifespan. Our results identify progerin-induced VSMC death as a major factor triggering atherosclerosis and premature death in HGPS.Work in Dr Andres' laboratory is supported by grants from the Spanish Ministerio de Economia, Industria y Competitividad (MEIC) (SAF2016-79490-R) and the Instituto de Salud Carlos III (AC16/00091, AC17/00067) with co-funding from the Fondo Europeo de Desarrollo Regional (FEDER, ``Una manera de hacer Europa´´), the Progeria Research Foundation (Established Investigator Award 2014-52), and the Fundacio Marato TV3 (122/C/2015). The MEIC supported Dr Hamczyk (´´Formacion de Personal Investigador´´ predoctoral contract BES-2011-043938) and Dr Villa-Bellosta (´´Juan de la Cierva´´ JCI-2011-09663 postdoctoral contract). The Instituto Universitario de Oncologia is supported by Obra Social Cajastur. The Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) is supported by the MEIC and the Pro-CNIC Foundation, and is a Severo Ochoa Center of Excellence (award SEV-2015-0505).S

Engineering tissue barrier models on hydrogel microfluidic platforms

Tissue barriers play a crucial role in human physiology by establishing tissue compartmentalization and regulating organ homeostasis. At the interface between the extracellular matrix (ECM) and flowing fluids, epithelial and endothelial barriers are responsible for solute and gas exchange. In the past decade, microfluidic technologies and organ-on-chip devices became popular as in vitro models able to recapitulate these biological barriers. However, in conventional microfluidic devices, cell barriers are primarily grown on hard polymeric membranes within polydimethylsiloxane (PDMS) channels that do not mimic the cell¿ECM interactions nor allow the incorporation of other cellular compartments such as stromal tissue or vascular structures. To develop models that accurately account for the different cellular and acellular compartments of tissue barriers, researchers have integrated hydrogels into microfluidic setups for tissue barrier-on-chips, either as cell substrates inside the chip, or as self-contained devices. These biomaterials provide the soft mechanical properties of tissue barriers and allow the embedding of stromal cells. Combining hydrogels with microfluidics technology provides unique opportunities to better recreate in vitro the tissue barrier models including the cellular components and the functionality of the in vivo tissues. Such platforms have the potential of greatly improving the predictive capacities of the in vitro systems in applications such as drug development, or disease modeling. Nevertheless, their development is not without challenges in their microfabrication. In this review, we will discuss the recent advances driving the fabrication of hydrogel microfluidic platforms and their applications in multiple tissue barrier models

Una revisión sistemática de la literatura sobre los costos del tratamiento para pacientes con Infarto Agudo de Miocardio

Objective: To analyze the costs treatment for patients with Acute Myocardial Infarction (AMI) over the period from 2000 to 2016. Materials and methods: Systematic review of the literature on the costs of treatment for patients with Acute Myocardial Infarction in the period 2000-2016. We selected 30 scientific articles from the database Scielo, Medline, Redalyc, Springer Medizin and Lilacs, which met the inclusion criteria: articles published in Spanish, Portuguese or English from 2000 to 2016. To restrict the search of articles, we use the health descriptors: costs, myocardial infarction and cardiovascular, combining them with the Boolean operators ‘’AND’’, ‘’OR’’ and ‘’NOT’’. Of which, a sample of 11 articles was selected. Results: It was evidenced that a high percentage (63.6%) came from the Scielo database. According to the country of origin of the articles, it was identified that the highest percentage (36.4%) came from Colombia. Concerning the direct and indirect costs of patients with Acute Myocardial Infarction (AMI) from an international perspective, the total estimated cost for Acute Coronary Syndrome (ACS) in 2011, including direct and indirect costs, is $1.26 million (US dollars are used throughout). In Colombia, the average cost of a case of AMI during the first five years after diagnosis is USD$8,786.9. Ambulatory management costs represent 54%. Conclusion: The costs of people with Acute Myocardial Infarction in both ambits, the international and national (Colombia) are significantly attributable by surgical interventions, treatment, hospital stay and post-diagnostic outpatient management

Cardioprotective role of IGF-1 in the hypertrophied myocardium of the spontaneously hypertensive rats: A key effect on NHE-1 activity

Aim: Myocardial Na+/H+ exchanger-1 (NHE-1) hyperactivity and oxidative stress are interrelated phenomena playing pivotal roles in the development of pathological cardiac hypertrophy and heart failure. Exercise training is effective to convert pathological into physiological hypertrophy in the spontaneously hypertensive rats (SHR), and IGF-1—key humoral mediator of exercise training—inhibits myocardial NHE-1, at least in normotensive rats. Therefore, we hypothesize that IGF-1 by hampering NHE-1 hyperactivity and oxidative stress should exert a cardioprotective effect in the SHR. Methods: NHE-1 activity [proton efflux (JH+) mmol L-1 min-1], expression and phosphorylation; H2O2 production; superoxide dismutase (SOD) activity; contractility and calcium transients were measured in SHR hearts in the presence/absence of IGF-1. Results: IGF-1 significantly decreased NHE-1 activity (JH+ at pHi 6.95: 1.39 ± 0.32, n = 9 vs C 3.27 ± 0.3, n = 20, P 2O2 production accompanied by an increase in SOD activity. In addition, IGF-1 improved cardiomyocyte contractility as evidenced by an increase in sarcomere shortening and a decrease in the relaxation constant, underlined by an increase in the amplitude and rate of decay of the calcium transients. Conclusion: IGF-1 exerts a cardioprotective role on the hypertrophied hearts of the SHR, in which the inhibition of NHE-1 hyperactivity, as well as the positive inotropic and antioxidant effects, emerges as key players.Centro de Investigaciones Cardiovasculare

A systematic literature review of treatment costs for patients with Acute Myocardial Infarction

Objective: To analyze the costs treatment for patientswith Acute Myocardial Infarction (AMI) over the periodfrom 2000 to 2016.Materials and methods: Systematic review of the literatureon the costs of treatment for patients with AcuteMyocardial Infarction in the period 2000-2016. We selected30 scientific articles from the database Scielo, Medline,Redalyc, Springer Medizin and Lilacs, which met theinclusion criteria: articles published in Spanish, Portugueseor English from 2000 to 2016. To restrict the search ofarticles, we use the health descriptors: costs, myocardialinfarction and cardiovascular, combining them with theBoolean operators ‘’AND’’, ‘’OR’’ and ‘’NOT’’. Of which, asample of 11 articles was selected.Results: It was evidenced that a high percentage (63.6%)came from the Scielo database. According to the countryof origin of the articles, it was identified that the highestpercentage (36.4%) came from Colombia. Concerningthe direct and indirect costs of patients with Acute MyocardialInfarction (AMI) from an international perspective,the total estimated cost for Acute Coronary Syndrome(ACS) in 2011, including direct and indirect costs, is $1.26million (US dollars are used throughout). In Colombia, theaverage cost of a case of AMI during the first five years afterdiagnosis is USD$8,786.9. Ambulatory managementcosts represent 54%.Conclusion: The costs of people with Acute MyocardialInfarction in both ambits, the international and national(Colombia) are significantly attributable by surgical interventions,treatment, hospital stay and post-diagnosticoutpatient management

Analysis of 415 adverse events in dental practice in Spain from 2000 to 2010

Introduction: The effort to increase patient safety has become one of the main focal points of all health care profes - sions, despite the fact that, in the field of dentistry, initiatives have come late and been less ambitious. The main objective of patient safety is to avoid preventable adverse events to the greatest extent possible and to limit the negative consequences of those which are unpreventable. Therefore, it is essential to ascertain what adverse events occur in each dental care activity in order to study them in-depth and propose measures for prevention. Objectives: To ascertain the characteristics of the adverse events which originate from dental care, to classify them in accordance with type and origin, to determine their causes and consequences, and to detect the factors which facilitated their occurrence. Material and Methods: This study includes the general data from the series of adverse dental vents of the Spanish Observatory for Dental Patient Safety (OESPO) after the study and analysis of 4,149 legal claims (both in and out of court) based on dental malpractice from the years of 2000 to 2010 in Spain. Results: Implant treatments, endodontics and oral surgery display the highest frequencies of adverse events in this series (25.5%, 20.7% and 20.4% respectively). Likewise, according to the results, up to 44.3% of the adverse events which took place were due to predictable and preventable errors and complications. Conclusions: A very significant percentage were due to foreseeable and preventable errors and complications that should not have occurred

Efectividad de los medios de defensa y de los recursos establecidos en la Ley 142 de 1994, utilizados por los usuarios de Empresas Públicas de Armenia durante el año 2010

CD-T 343.092 4 B63;86 p.Esta investigación quiere determinar la situación de los usuarios de los servicios públicos de agua y alcantarillado de la ciudad de Armenia. Para ello, se analizan los factores jurídicos y las leyes que los implementan, para que a partir de éste se logre determinar la efectividad de estos medios específicos.Universidad Libre Seccional Pereir

Síndrome de Burnout y estrategias de afrontamiento en docencia de primaria y bachillerato

The objective of this research was to identify the relationship between coping strategies and burnout in primary and secondary school teachers from a school district of the city of Bogotá, D. C. For this we used a descriptive correlational design and worked with a sample of 47 elementary and high school teachers. Was used Maslash Burnout Inventory and the Coping Strategies Scale Modified. The results indicate average levels of burnout in participants, with major differences in teachers of grades six, seven and eight. Coping strategies are positively related with the syndrome are: a) wait b) emotional avoidance, and c) reflects the difficulty of coping. Those who are negatively related: a) solving problems and b) positive reappraisal.  El objetivo de esta investigación fue identificar la relación entre las estrategias de afrontamiento y el síndrome de burnout en docentes de primaria y bachillerato de un colegio distrital de la ciudad de Bogotá, D.C. Para esto se utilizó un diseño descriptivo correlacional y se trabajó con una muestra de 47 docentes de primaria y bachillerato. Se utilizó el Inventario de Burnout de Maslash y la Escala de Estrategias de Coping Modificada. Los resultados indican niveles medios del síndrome de burnout en los participantes, con diferencias mayores en los docentes de grados sexto, séptimo y octavo. Las estrategias de afrontamiento que están relacionadas positivamente con el síndrome son: a) espera; b) evitación emocional; y c) expresión de la dificultad de afrontamiento. Las que están relacionadas negativamente son: a) solución de problemas y b) reevaluación positiva