Comportamiento epidemiológico del hipotiroidismo subclínico y su asociación con factores de riesgo cardiometabólicos en individuos adultos del Municipio Maracaibo, Venezuela

Introducción: La relación entre el hipotiroidismo subclínico (HSC) y diversos factores de riesgo cardiovascular es controversial. El objetivo de este estudio es analizar el comportamiento de dichos factores en adultos con HSC del municipio Maracaibo, estado Zulia, Venezuela. Materiales y Métodos: Se seleccionaron 425 individuos de la base de datos del estudio de Prevalencia de Síndrome Metabólico de Maracaibo, en base a historia clínica y determinación de TSH, T3, T4, anticuerpos anti-tiroideos, glicemia, insulina basal y perfil lipídico. Las variables cualitativas fueron expresadas como frecuencias absolutas y relativas y las variables cuantitativas como media aritmética ± DE, se realizó un modelo de regresión logística múltiple para determinar la relación entre los factores de riesgo con respecto al diagnóstico de HSC. Resultados: La prevalencia del HSC fue 9,6% (n=41), presentando elevación de la glicemia, colesterol total, triacilglicéridos y VLDL, y disminución de T3 (p=0,017). La presencia de HSC es directamente proporcional a la edad y presenta una asociación significativa con anticuerpos anti-tiroideos positivos. El HSC mostró incrementar el riesgo para enfermedades cardio-metabólicas como Diabetes Mellitus tipo 2 y enfermedad cardiovascular. Conclusiones: La prevalencia de HSC es similar a la mostrada en reportes previos, estando asociado con la presencia de varios factores cardio-metabólicos. Es necesaria la determinación oportuna del perfil tiroideo, especialmente adultos mayores, para un diagnóstico precoz y adecuado seguimiento de este grupo de pacientes.&nbsp

Capitulo 2. Ciencias Naturales y Ciencias Básicas, Ingeniería y Tecnología

La diseminación de la Levitación Magnética, a pesar de lo antiguo de su tecnología, ha sido limitada. Debido a sus inconvenientes prácticos de implementación, su uso es bastante restringido, comparado con otras tecnologías (SCMaglev japonés, Transrapid alemán, o productos comerciales para ocio y entretenimiento). Con el boom de las tecnologías limpias y amigables con el medio ambiente y en concordancia con los objetivos del milenio, es pertinente plantearse el objetivo de optimizar el proceso de Levitación Magnética para generar un aprovechamiento de las ventajas de esta tecnología a nivel mecánico, eléctrico, y ambiental.  Actualmente la UNAD adelanta un proyecto de investigación cuyo objetivo es generar un modelo físico matemático de levitación magnética para aplicaciones en ingeniería. De este proyecto se ha derivado una primera revisión sistemática de los principios físicos y los modelos vigentes en Levitación Magnética

Individualised, perioperative open-lung ventilation strategy during one-lung ventilation (iPROVE-OLV): a multicentre, randomised, controlled clinical trial

Background: It is uncertain whether individualisation of the perioperative open-lung approach (OLA) to ventilation reduces postoperative pulmonary complications in patients undergoing lung resection. We compared a perioperative individualised OLA (iOLA) ventilation strategy with standard lung-protective ventilation in patients undergoing thoracic surgery with one-lung ventilation. Methods: This multicentre, randomised controlled trial enrolled patients scheduled for open or video-assisted thoracic surgery using one-lung ventilation in 25 participating hospitals in Spain, Italy, Turkey, Egypt, and Ecuador. Eligible adult patients (age ≥18 years) were randomly assigned to receive iOLA or standard lung-protective ventilation. Eligible patients (stratified by centre) were randomly assigned online by local principal investigators, with an allocation ratio of 1:1. Treatment with iOLA included an alveolar recruitment manoeuvre to 40 cm H2O of end-inspiratory pressure followed by individualised positive end-expiratory pressure (PEEP) titrated to best respiratory system compliance, and individualised postoperative respiratory support with high-flow oxygen therapy. Participants allocated to standard lung-protective ventilation received combined intraoperative 4 cm H2O of PEEP and postoperative conventional oxygen therapy. The primary outcome was a composite of severe postoperative pulmonary complications within the first 7 postoperative days, including atelectasis requiring bronchoscopy, severe respiratory failure, contralateral pneumothorax, early extubation failure (rescue with continuous positive airway pressure, non-invasive ventilation, invasive mechanical ventilation, or reintubation), acute respiratory distress syndrome, pulmonary infection, bronchopleural fistula, and pleural empyema. Due to trial setting, data obtained in the operating and postoperative rooms for routine monitoring were not blinded. At 24 h, data were acquired by an investigator blinded to group allocation. All analyses were performed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT03182062, and is complete. Findings: Between Sept 11, 2018, and June 14, 2022, we enrolled 1380 patients, of whom 1308 eligible patients (670 [434 male, 233 female, and three with missing data] assigned to iOLA and 638 [395 male, 237 female, and six with missing data] to standard lung-protective ventilation) were included in the final analysis. The proportion of patients with the composite outcome of severe postoperative pulmonary complications within the first 7 postoperative days was lower in the iOLA group compared with the standard lung-protective ventilation group (40 [6%] vs 97 [15%], relative risk 0·39 [95% CI 0·28 to 0·56]), with an absolute risk difference of -9·23 (95% CI -12·55 to -5·92). Recruitment manoeuvre-related adverse events were reported in five patients. Interpretation: Among patients subjected to lung resection under one-lung ventilation, iOLA was associated with a reduced risk of severe postoperative pulmonary complications when compared with conventional lung-protective ventilation. Funding: Instituto de Salud Carlos III and the European Regional Development Funds

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery

The PLATO Mission

International audiencePLATO (PLAnetary Transits and Oscillations of stars) is ESA's M3 mission designed to detect and characterise extrasolar planets and perform asteroseismic monitoring of a large number of stars. PLATO will detect small planets (down to <2 R_(Earth)) around bright stars (<11 mag), including terrestrial planets in the habitable zone of solar-like stars. With the complement of radial velocity observations from the ground, planets will be characterised for their radius, mass, and age with high accuracy (5 %, 10 %, 10 % for an Earth-Sun combination respectively). PLATO will provide us with a large-scale catalogue of well-characterised small planets up to intermediate orbital periods, relevant for a meaningful comparison to planet formation theories and to better understand planet evolution. It will make possible comparative exoplanetology to place our Solar System planets in a broader context. In parallel, PLATO will study (host) stars using asteroseismology, allowing us to determine the stellar properties with high accuracy, substantially enhancing our knowledge of stellar structure and evolution. The payload instrument consists of 26 cameras with 12cm aperture each. For at least four years, the mission will perform high-precision photometric measurements. Here we review the science objectives, present PLATO's target samples and fields, provide an overview of expected core science performance as well as a description of the instrument and the mission profile at the beginning of the serial production of the flight cameras. PLATO is scheduled for a launch date end 2026. This overview therefore provides a summary of the mission to the community in preparation of the upcoming operational phases