Relación del estado nutricional y severidad de crisis asmática en pacientes pediátricos de 5 a 14 años, Hospital Nacional Adolfo Guevara Velasco del Cusco, 2019-2020

Antecedentes: El exceso de peso (sobrepeso y obesidad), presente en el 23.9% de escolares de Cusco, provoca un estado inflamatorio que condicionaría un mayor riesgo de desarrollar crisis asmática aguda, incluso, de mayor severidad. El objetivo del presente estudio es establecer la relación entre el estado nutricional y la severidad de crisis asmática en pacientes pediátricos en un hospital en la ciudad de Cusco. Métodos: Estudio observacional, analítico, correlacional, transversal y retrospectivo, en una muestra de 67 pacientes de 5 a 14 años que acudieron al servicio de emergencia del Hospital Nacional Adolfo Guevara Velasco con el diagnóstico de crisis asmática aguda, que confrontó el estado nutricional (percentil del índice de masa corporal según edad y sexo) y el puntaje de severidad de crisis asmática (escala de Bierman y Pierson modificada por Tal); obteniéndose frecuencias, porcentajes, medidas de tendencia central y de dispersión, seguido se aplicó correlación Spearman, finalmente, se procesó regresión lineal bivariado y multivariado. Resultados: Se encontró que el estado nutricional (me 61.15 percentil RIC:34.8-90) y la severidad de crisis asmática aguda (x ̄ 3.94 puntos ± 1.71 DS) tuvieron una correlación moderada positiva (Rho=0.41, p<0.0006), asimismo, en la regresión lineal multivariada ajustada por confusores (uso de corticoides inhalados) se observó que aumenta en 0.167 por cada unidad de percentil de IMC (IC 95%: 0.041 a 0.293, p=0.01). Conclusiones: predominó la edad de 7 años, el sexo masculino y la procedencia fue de zona urbana, por otro lado, la mayor parte no era usuario de corticoides inhalados. Se concluye que hay una correlación moderada positiva entre el estado nutricional y la severidad de crisis asmática.Background: Excess of weight (overweight and obesity) is present among 23.9% of children in school age in Cusco. It causes an inflammatory state which represents a higher risk to develop an acute asthmatic crisis, and even a more severe condition. The aim of this study was to establish the relationship between the nutritional status, and the severity of an asthmatic crisis among pediatric patients in a hospital in Cusco. Methods: Observational, analytical, correlational, cross-sectional and retrospective study. The sample was of 67 patients in 5 to 14 years old who attended the emergency service of the Hospital Nacional Adolfo Guevara Velasco with the diagnosis of acute asthmatic crisis. It confronted the nutritional status (percentile of the body mass index according to age and sex) and the severity score of asthmatic attacks (Bierman and Pierson scale modified by Tal); obtaining frequencies, percentages, measures of central tendency and dispersion, followed by Spearman correlation. Finally, a bivariate and multivariate linear regression was processed. Results: It was found that the nutritional status (me 61.15 percentile IQR: 34.8-90) and the severity of acute asthmatic crisis (x ̄ 3.94 points ± 1.71 SD) had a moderate positive correlation (Rho = 0.41, p <0.0006). In addition, the multivariate linear regression adjusted for confounders (use of inhaled corticosteroids), showed that it increased by 0.167 for each BMI percentile unit (95% CI: 0.041 to 0.293, p=0.01). Conclusions: 7 years old, male sex and urban provenance were prevalent. On the other hand, most patients were not users of inhaled corticosteroids. In conclusion, there is a moderate positive correlation between nutritional status and the severity of asthmatic attacks

Quality Management System and Quality Assurance Programs in Radiotherapy in the Light of Regulations Applicable in México

Radiotherapy Quality Management Systems (qms) and Quality Assurance&nbsp;(qa) Programs have been proposed as an effective tool to ensure consistency between medical prescription and safe delivery of treatment to patients with minimal exposure to staff. In recent years in Mexico, there has been an increase in the acquisition of modern medical linear accelerators for the delivery of highly sophisticated radiotherapy treatments with specific qa requirements.This makes it necessary to review the current regulatory framework&nbsp;on Quality Management, to know if regulatory requirements are sufficient for the establishment, implementation and development of Comprehensive Quality Systems (qs) in radiotherapy centres. The&nbsp;objective of this work is to review the current national regulations in radiotherapy qms, in particular those referring to standard procedures, human and physical infrastructure, and the implementation of qs in the practice of health care institutions. Results show a first approach to the implementation of quality management systems and quality assurance programs in radiotherapy centres

Quality Management System and Quality Assurance Programs in Radiotherapy in the Light of Regulations Applicable in México

Radiotherapy Quality Management Systems (qms) and Quality Assurance&nbsp;(qa) Programs have been proposed as an effective tool to ensure consistency between medical prescription and safe delivery of treatment to patients with minimal exposure to staff. In recent years in Mexico, there has been an increase in the acquisition of modern medical linear accelerators for the delivery of highly sophisticated radiotherapy treatments with specific qa requirements.This makes it necessary to review the current regulatory framework&nbsp;on Quality Management, to know if regulatory requirements are sufficient for the establishment, implementation and development of Comprehensive Quality Systems (qs) in radiotherapy centres. The&nbsp;objective of this work is to review the current national regulations in radiotherapy qms, in particular those referring to standard procedures, human and physical infrastructure, and the implementation of qs in the practice of health care institutions. Results show a first approach to the implementation of quality management systems and quality assurance programs in radiotherapy centres

Mapeo multiespectral del impacto de piscinas camaroneras al ecosistema de manglar del Golfo de Guayaquil, Ecuador

La producción acuícola ecuatoriana ha tenido crecimiento exponencial a los mercados internacionales, causando de manera directa un incremento en la extensión de hectáreas deforestadas especialmente en las zonas costeras de manglar del país. El objetivo de este estudio fue mapear y estimar el impacto que ha producido la deforestación producto de la actividad camaronera en los manglares del Golfo de Guayaquil, Ecuador. Para ello, se realizó un análisis espacial con imágenes satelitales Landsat de 1985 y 2017, se utilizó el índice espectral NDVI para mapear la cobertura vegetal y NDWI para mapear e identificar las piscinas camaroneras. Además, se realizó un análisis bibliográfico para conocer el posible impacto negativo de la deforestación. Los resultados obtenidos nos permitieron mapear las piscinas camaroneras, convirtiéndose en una posible herramienta para monitorear nuevas actividades de deforestación ilegal. La afectación directa se da en la red trófica produciendo afectaciones en la población que se dedica a la pesca artesanal de ictiofauna, malacofauna y carcinofauna, además degrada la barrera natural contra la erosión y la asimilación de carbono en el planeta aumentando así el efecto invernadero. Ecuador ha perdido aproximadamente 27% del manglar original, especialmente por la producción acuícola, el urbanismo y extracción de recursos naturales en esta región

Dark matter effective field theory scattering in direct detection experiments

We examine the consequences of the effective field theory (EFT) of dark matter–nucleon scattering for current and proposed direct detection experiments. Exclusion limits on EFT coupling constants computed using the optimum interval method are presented for SuperCDMS Soudan, CDMS II, and LUX, and the necessity of combining results from multiple experiments in order to determine dark matter parameters is discussed. We demonstrate that spectral differences between the standard dark matter model and a general EFT interaction can produce a bias when calculating exclusion limits and when developing signal models for likelihood and machine learning techniques. We also discuss the implications of the EFT for the next-generation (G2) direct detection experiments and point out regions of complementarity in the EFT parameter space.National Science Foundation (U.S.)United States. Dept. of EnergyNatural Sciences and Engineering Research Council of CanadaSpain. Ministerio de Economia y Competitividad (MultiDark

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school&#x2;aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit