Evaluación de la utilización de lidocaína 2% sin adrenalina en infusión endovenosa como coadyuvante de opioides para manejo del dolor oncológico no controlado con componente neuropático en cuidados paliativos

Identificar el uso de las infusiones endovenosas de lidocaína como coadyuvante de opioides para manejo de dolor neuropático en pacientes oncológicos con dolor no controlado. Metodología. Investigación observacional, analítico, retrospectivo, bietápico. Resultados. El promedio de EVA el día previo a la colocación de infusión fue de 4.4 y el promedio a las 72 horas fue de 0.6 (p=0.036). El promedio de rescates requeridos previo a la infusión fue de 3.1 y a las 72 horas el promedio fue 1.0 (p=0.004). Los valores del ESAS en los pacientes reportan un SDS promedio de 29 previo a la infusión y a las 72 horas el promedio fue de 22.7 (p=0.333). En la Escala de Karnofsky, no se observó cambios relevantes en el perfil funcional del paciente, los valores previos y posteriores fueron similares en las mediciones realizadas. Conclusiones. Se observó mejoría del dolor posterior a la administración de infusión de Lidocaína a las 72 horas, a dosis promedio de 3 mg/kg. No se observó disminución ni mejoría en la Escala de Funcionalidad de Karnofsky posterior a la infusión EV de lidocaína. La cantidad de rescates requeridos disminuyó a las 72 horas posterior a la administración de Lidocaína. Se realizó una revisión retrospectiva de expedientes como un paso preliminar para apoyar la necesidad de un estudio más profundo, interpretamos estos resultados preliminares para sugerir que la Lidocaína intravenosa puede ser un agente seguro y eficaz para el tratamiento dolor agudo con componente neuropático de difícil manejo.Tesis presentada para optar al título de Doctorado en Medicin

Describir criterios ultrasonográficos protocolizados para clasificar masas anexiales, Hospital 1º de Mayo 2019

La patología ovárica es causa frecuente de consulta ginecológica, y no existe consenso sobre su manejo óptimo. La ecografía transvaginal es la primera opción de imagen para diferenciar entre una masa anexial benigna y maligna. Este estudio es de tipo descriptivo-observacional transversal, que tiene como objetivo describir el uso de los criterios ultrasonográficos IOTA para clasificar las masas anexiales. Se realizó una revisión de expedientes clínicos, revisión del reporte de ultrasonografía y biopsia de las pacientes que consultaron por masa anexial en el Hospital Materno Infantil 1º de Mayo en el año 2019; se observa que los criterios más utilizados para describir las masas fueron el tamaño y el flujo vascular, el resto de criterios para clasificar una masa como benigna o maligna no se describieron. El uso de criterios IOTA para la descripción de masas anexiales es una herramienta que debería de usarse para describir todas las masas anexiales. La poca descripción de los criterios hace más difícil y menos útil la ultrasonografía para la toma de decisiones, además dificulta la decisión de evaluación adicional de estas masas anexiales con marcadores tumorales. Todo esto puede repercutir en el diagnóstico, manejo y pronóstico de la paciente, así como realizar intervenciones innecesarias, aumentado la morbilidad y mortalidad; y los costos institucionales

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Genetic variation in CCR2 and CXCL12 genes impacts on CD4 restoration in patients initiating cART with advanced immunesupression.

OBJECTIVE:We investigated the association of genetic polymorphisms in chemokine and chemokine receptor genes with poor immunological recovery in HIV patients starting combined antiretroviral therapy (cART) with low CD4 T-cell counts. METHODS:A case-control study was conducted in 412 HIV-infected patients starting cART with CD4 T-cell count <200 cells/μL and successful viral control for two years. CD4 count increase below 200 cells/μL after two years on cART was used to define INR (immunological non-responder) patients. Polymorphisms in CXCL12, CCL5 and CCR2 genes were genotyped using sequenom's MassARRAY platform. RESULTS:Thirty two percent (134/412) of patients were classified as INR. After adjusting by age, route of HIV infection, length of infection before cART and viral hepatitis coinfection, CCR2 rs1799864-AG genotype was significantly associated with INR status (OR [95% CI]: 1.80 [1.04-3.11]; p = 0.04), and CXCL12 rs1801157-TT genotype showed a trend (OR [95% CI]: 2.47 [0.96-6.35]; p = 0.06). CONCLUSIONS:CCR2 rs1799864-AG or CXCL12 rs1801157-TT genotypes influence on the probability of poor CD4 recovery in the population of HIV patients starting cART with low CD4 counts. Genotyping of these polymorphisms could be used to estimate the risk of poor CD4 restoration, mainly in patients who are diagnosed late in the course of infection

Quorum sensing network in clinical strains of A. baumannii : AidA is a new quorum quenching enzyme

Acinetobacter baumannii is an important pathogen that causes nosocomial infections generally associated with high mortality and morbidity in Intensive Care Units (ICUs). Currently, little is known about the Quorum Sensing (QS)/Quorum Quenching (QQ) systems of this pathogen. We analyzed these mechanisms in seven clinical isolates of A. baumannii. Microarray analysis of one of these clinical isolates, Ab1 (A. baumannii ST-2-clon-2010), previously cultured in the presence of 3-oxo-C12-HSL (a QS signalling molecule) revealed a putative QQ enzyme (α/β hydrolase gene, AidA). This QQ enzyme was present in all nonmotile clinical isolates (67% of which were isolated from the respiratory tract) cultured in nutrient depleted LB medium. Interestingly, this gene was not located in the genome of the only motile clinical strain growing in this medium (A. baumannii strain Ab421-GEIH-2010 [Ab7], isolated from a blood sample). The AidA protein expressed in E. coli showed QQ activity. Finally, we observed downregulation of the AidA protein (QQ system attenuation) in the presence of HO (ROS stress). In conclusion, most of the A. baumannii clinical strains were not surface motile (84%) and were of respiratory origin (67%). Only the pilT gene was involved in surface motility and related to the QS system. Finally, a new QQ enzyme (α/β hydrolase gene, AidA protein) was detected in these strains

Down syndrome as risk factor for respiratory syncytial virus hospitalization : A prospective multicenter epidemiological study

Respiratory syncytial virus (RSV) infection in childhood, particularly in premature infants, is associated with significant morbidity and mortality. To compare the hospitalization rates due to RSV infection and severity of disease between infants with and without Down syndrome (DS) born at term and without other associated risk factors for severe RSV infection. In a prospective multicentre epidemiological study, 93 infants were included in the DS cohort and 68 matched by sex and data of birth (±1 week) and were followed up to 1 year of age and during a complete RSV season. The hospitalization rate for all acute respiratory infection was significantly higher in the DS cohort than in the non-DS cohort (44.1% vs 7.7%, P<.0001). Hospitalizations due to RSV were significantly more frequent in the DH cohort than in the non-DS cohort (9.7% vs 1.5%, P=.03). RSV prophylaxis was recorded in 33 (35.5%) infants with DS. The rate of hospitalization according to presence or absence of RSV immunoprophylaxis was 3.0% vs 15%, respectively. Infants with DS showed a higher rate of hospitalization due to acute lower respiratory tract infection and RSV infection compared to non-DS infants. Including DS infants in recommendations for immunoprophylaxis of RSV disease should be considered

Overview of recent TJ-II stellarator results

The main results obtained in the TJ-II stellarator in the last two years are reported. The most important topics investigated have been modelling and validation of impurity transport, validation of gyrokinetic simulations, turbulence characterisation, effect of magnetic configuration on transport, fuelling with pellet injection, fast particles and liquid metal plasma facing components. As regards impurity transport research, a number of working lines exploring several recently discovered effects have been developed: the effect of tangential drifts on stellarator neoclassical transport, the impurity flux driven by electric fields tangent to magnetic surfaces and attempts of experimental validation with Doppler reflectometry of the variation of the radial electric field on the flux surface. Concerning gyrokinetic simulations, two validation activities have been performed, the comparison with measurements of zonal flow relaxation in pellet-induced fast transients and the comparison with experimental poloidal variation of fluctuations amplitude. The impact of radial electric fields on turbulence spreading in the edge and scrape-off layer has been also experimentally characterized using a 2D Langmuir probe array. Another remarkable piece of work has been the investigation of the radial propagation of small temperature perturbations using transfer entropy. Research on the physics and modelling of plasma core fuelling with pellet and tracer-encapsulated solid-pellet injection has produced also relevant results. Neutral beam injection driven Alfvénic activity and its possible control by electron cyclotron current drive has been examined as well in TJ-II. Finally, recent results on alternative plasma facing components based on liquid metals are also presented.ISSN:0029-5515ISSN:1741-432

Memorias de la semana de la Facultad de Educación / VI Semana: Investigaciones educativas y pedagógicas.

El presente libro, publicado en la Editorial de la Corporación Universitaria Minuto de Dios – UNIMINUTO, reúne las memorias de la VI Semana de la Facultad de Educación – FEDU “Investigaciones Educativas y Pedagógicas”, evento que se realiza cada año con el fin de intercambiar experiencias académicas, culturales y deportivas entre los estudiantes y profesores de la Facultad, con la participación de otras Universidades interesadas en compartir sus experiencias en el campo de la investigación, la cultura y el deporte. La temática para la VI Semana de la FEDU en 2016 estuvo relacionada con la investigación en torno a la educación y la pedagogía, de tal forma que los profesores y los estudiantes tuvieron la oportunidad de intercambiar experiencias desarrolladas en los proyectos y en los semilleros de investigación; además, los estudiantes y los egresados tuvieron la oportunidad de presentar los resultados de sus trabajos de grado y otros estudios productos de investigación

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective