Evolución en el diagnóstico de la muerte súbita cardíaca con base genética. Diagnóstico molecular

La incidencia de muerte súbita siguió una tendencia ascendente a lo largo del siglo pasado hasta que en las décadas de 1960 y 1970 inicio un continuo declinar en las sociedades industrializados. Hablar de muerte súbita es casi sinónimo de hacerlo de la muerte súbita de origen cardiovascular, aunque las causas pueden ser muy variadas, la gran mayoría se deben a problemas cardiovasculares, siendo la causa fundamental la cardiopatía isquémica, y por ello si analizamos factores de riesgo para sufrir una muerte súbita, globalmente, vemos que en muchas ocasiones son paralelos a los de la cardiopatía isquémica y a los factores de riesgo cardiovascular.Universidad de Granada. Facultad de Medicin

Estudio necrópsico de la muerte súbita cardíaca de origen isquémico, en un cuerpo en avanzado estado de descomposición

Es evidente que los cambios que se inician en un cadáver como consecuencia de la putrefacción suponen importantes trabas para la determinación de la causa de la muerte. Aunque un cadáver se encuentre en avanzado estado de descomposición, la realización de una autopsia detallada puede aportar una gran y rica información acerca de la etiología de la muerte y sobre el intervalo postmortem (IPM). En el caso que analizamos, a pesar de tener un cuerpo en fase colicuativa, podemos establecer que con bastante probabilidad el individuo estudiado falleció por una muerte súbita cardiaca (MSC) de origen isquémico. A esta conclusión se llega a través del análisis conjunto de los hallazgos en el cadáver durante la autopsia, la fisiopatología de la MSC de origen isquémico y los elementos fundamentales que caracterizan a este tipo de muerte. Se pudo establecer, además, un IPM de unas dos semanas.It´s evident that the changes that begin in the corpse as a consequence of putrefaction are important obstacles to determine the cause of death. Even in a body in an advanced stage of decomposition, a detailed autopsy can provide great information about the ethiology of death and postmortem interval (PMI). In the case under study, despite having a body in colliquative stage, we can establish that the cause of death was, with a high level of certainty, a sudden cardiac death (SCD) of ischemic origin. This conclusion was reached through analysis of the findings in the body during the autopsy, along with the pathophysiology of ischemic SCD and the key elements that characterize this type of death. Also it was determined a PMI of two weeks approximately

Procesos de indagación territorial en primer año: fortalezas y nuevos desafíos

Fil: Bermudez, Sabrina. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina.Fil: González, Natalia. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina.Fil: Herrera, Lucas. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina.Durante su historia, la Universidad Pública ha sido objeto de disputa entre sectores que reclaman por un mayor reconocimiento social como motor de una sociedad más justa e inclusiva y otros que la deslegitiman por considerar que debe ligar su organización y funcionamiento a la lógica del mercado. En este marco, nos proponemos reflexionar sobre las fortalezas y desafíos de una propuesta de indagación territorial, en vinculación con investigación y extensión, en una asignatura de primer año de la Licenciatura en Trabajo Social de la FCS-Universidad Nacional de Córdoba.Los vínculos entre territorio y prácticas formativas en Trabajo Social son constitutivos del proceso de enseñanza y aprendizaje durante la carrera, con relevancia singular durante el primer año. Allí se transita y tramita ese primer encuentro con la cultura del campo universitario y disciplinar, con compañeras/os, docentes y con la institución. Pero, es también el primer encuentro con las prácticas formativas en territorio que demanda una particular manera de apropiarse de sus códigos, lógicas, lenguajes y procesos de construcción del conocimiento en lo social. Es en el territorio donde es posible tejer una red de trayectorias y saberes entre equipo docente, estudiantes y vecinas/os, configurando nodos interconectados e interdependientes entre formación, extensión e investigación.https://revistas.unc.edu.ar/index.php/ConCienciaSocial/issue/view/2175info:eu-repo/semantics/publishedVersionFil: Bermudez, Sabrina. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina.Fil: González, Natalia. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina.Fil: Herrera, Lucas. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina.Otras Ciencias Sociale

A Legal and Forensic Medicine Approach to Police Physical Intervention Techniques in High-Risk Situations

Background: The physical intervention techniques (PITs) typically used by the police in troublesome situations are examined in terms of injuring potential depending on whether they target a body zone of high, medium or low vulnerability. Based on legal and forensic considerations, and principles of congruence, opportunity and proportionality, a need exists to favor opponent locking and arrest techniques targeting non-vulnerable zones to minimize the risk of severe damage. Methods: A search of the training manuals for the different kind of law of enforcement officers was carried out. Revision of injuries was available from electronic databases of academic o medical journals. Results: Three different locking and arrest PITs based on operational tactical procedures (OTP) that avoid zones of high or medium vulnerability are proposed. The new techniques use blocking, diverting and grabbing of the upper and lower limbs, followed by dislocation and locking of the same targets. Conclusions: The damaging potential of such PITs was assessed in terms of anatomical region and most were found to have a high risk of severe damage. The alternative PITs proposed here, which rely on OTP, improve in legal and forensic medical terms on existing choices and dramatically reduce the risk of injuring arrestees

Technical note: A mobile collaborative workspace to assist forensic experts in disaster victim identification scenarios

Integrated approaches to disaster victim identification (DVI) management have led to a need for technologies to improve interaction among parties involved in post-mortem (PM) and ante-mortem (AM) data collection through better communication and coordination. Mobile Forensic Workspace© (MFW) is a collaborative mobile system that not only facilitates the systematic collection of high-quality data, but also allows DVI professionals to coordinate activities and exchange data through secure real-time communication at major disaster scenarios in accordance with security, privacy and legal protocols. MFW is adaptable to any communication format (text, voice calls, photographs, etc.) and is dynamically self-reconfigurable when connectivity problems arise. It also allows data integration and backup through secure communication channels between local and remote servers. The feasibility of the system has been demonstrated through implementation of MFW on the iOS platform for iPhone, iPod Touch and iPad terminals. A further strength of MFW is that it provides out-of-the-box support for INTERPOL DVI forms. The application of information and communication technologies for DVI was shown to be useful in improving DVI management by enhancing the quality of data collection and enabling non-Internet dependent real-time data sharing and communication

Zoonotic Transmission of Diphtheria from Domestic Animal Reservoir, Spain

Toxigenic Corynebacterium ulcerans is as an emerging zoonotic agent of diphtheria. We describe the zoonotic transmission of diphtheria caused by toxigenic C. ulcerans from domestic animals in Spain, confirmed by core-genome multilocus sequence typing. Alongside an increasing number of recent publications, our findings highlight the public health threat posed by diphtheria reemergence.This work was partially funded by Área de Ganadería de la Dirección General de Agricultura, Ganadería y Alimentación de la Comunidad de Madrid.S

Method for the analysis of health personnel availability in a pandemic crisis scenario through Monte Carlo simulation

During pandemic times, difficulties and problems related to the health sector are evident as the number of patients coming to health centers is higher compared to normal situations. This increase in the number of patients is typical of the pandemic, due to the high level of contagion in the population. Health personnel have a higher risk of infection, due to their sharing the work of caring for positive patients, so the infection rate is much higher. Hence, it remains necessary to understand the behavior of infection of health personnel, in order to be prepared to deal with the care of patients. Accordingly, in this research, we present a method to estimate different scenarios of infection and assess the probability of occurrence, so we can estimate the infection rate of health personnel. We present a simulation of 21 possible scenarios with 100 workers and a minimum of 80% needed to guarantee patient care. The results show that it is more likely that a 50% contagion scenario will occur, with an acceptable probability of 20%.Campus Lima Su

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America : the ESTAMPA screening study protocol

Q1Q1Introduction Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. Methods and analysis Women aged 30–64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. Ethics and dissemination The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. Trial registration number NCT01881659Revista Internacional - Indexad

Identification of a novel locus on chromosome 2q13, which predisposes to clinical vertebral fractures independently of bone density.

OBJECTIVES: To identify genetic determinants of susceptibility to clinical vertebral fractures, which is an important complication of osteoporosis. METHODS: Here we conduct a genome-wide association study in 1553 postmenopausal women with clinical vertebral fractures and 4340 controls, with a two-stage replication involving 1028 cases and 3762 controls. Potentially causal variants were identified using expression quantitative trait loci (eQTL) data from transiliac bone biopsies and bioinformatic studies. RESULTS: A locus tagged by rs10190845 was identified on chromosome 2q13, which was significantly associated with clinical vertebral fracture (P=1.04×10-9) with a large effect size (OR 1.74, 95% CI 1.06 to 2.6). Bioinformatic analysis of this locus identified several potentially functional SNPs that are associated with expression of the positional candidate genes TTL (tubulin tyrosine ligase) and SLC20A1 (solute carrier family 20 member 1). Three other suggestive loci were identified on chromosomes 1p31, 11q12 and 15q11. All these loci were novel and had not previously been associated with bone mineral density or clinical fractures. CONCLUSION: We have identified a novel genetic variant that is associated with clinical vertebral fractures by mechanisms that are independent of BMD. Further studies are now in progress to validate this association and evaluate the underlying mechanism

Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study

Objective: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. Methods: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. Results: We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4–11): 2934 (34.3%) had a LOH 15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0–64.9) when LOH was 11–15 days, and by 72.0% (95%CI = 42.6–107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4–36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. Conclusions: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments