Vacunación del adulto en atención primaria: durante y después de pandemia

Immunization is one of the most important advances in medicine, achieving protection against numerous microorganisms that have put the health of the population at risk for centuries and is currently one of the main health prevention strategies; Recently, with the appearance of COVID-19, a before and after has been marked, since vaccination has regained visibility and importance after the pandemic. However, despite the available evidence, there is limited dissemination and promotion of vaccination in the adult, a situation that generates low coverage in this population. The current global context sets an urgent call to strengthen the implementation of vaccination plans and strategies not only in the pediatric population, but also in the adult population, so the objective of this narrative review is to synthesize the current recommendations for vaccination in the population. from Colombia and Latin America with a focus on primary care in the adult population. For this, a bibliographic search was carried out in the PubMed, Science direct, Redalyc, Scielo and academic Google databases; Including studies related to vaccination in adults in Colombia and Latin America, which allow to propose systematized vaccination strategies in primary care.La inmunización es uno de los avances más importantes de la medicina, logrando la protección contra numerosos microorganismos que han puesto en riesgo la salud de la población durante siglos y siendo en la actualidad una de las principales estrategias de prevención en salud; recientemente con la aparición del COVID-19 se ha marcado un antes y un después, pues a partir de la pandemia la vacunación recobró visibilidad e importancia, sin embargo, a pesar de la evidencia disponible, existe una limitada divulgación y promoción de la vacunación en el adulto, situación que genera una baja cobertura en esta población. El contexto global actual configura un llamado urgente a fortalecer la implementación de planes y estrategias de vacunación no sólo en la población pediátrica, sino también en la población adulta, por lo que el objetivo de esta revisión narrativa es sintetizar las recomendaciones actuales de vacunación en la población adulta de Colombia y América Latina con un enfoque en atención primaria en la población adulta. Para esto, se llevó a cabo una búsqueda bibliográfica en las bases de datos PubMed, Science direct, Redalyc, Scielo y Google académico; Incluyendo estudios relacionados con la vacunación en el adulto en Colombia y América Latina, los cuales permiten plantear estrategias sistematizadas de vacunación en atención primaria

Mitochondrial iron chelation ameliorates cigarette-smoke induced bronchitis and emphysema in mice

Chronic obstructive pulmonary disease (COPD) is linked to both cigarette smoking and genetic determinants. We have previously identified iron-responsive element binding protein 2 (IRP2) as an important COPD susceptibility gene, with IRP2 protein increased in the lungs of individuals with COPD. Here we demonstrate that mice deficient in Irp2 were protected from cigarette smoke (CS)-induced experimental COPD. By integrating RIP-Seq, RNA-Seq, gene expression and functional enrichment clustering analysis, we identified IRP2 as a regulator of mitochondrial function in the lung. IRP2 increased mitochondrial iron loading and cytochrome c oxidase (COX), which led to mitochondrial dysfunction and subsequent experimental COPD. Frataxin-deficient mice with higher mitochondrial iron loading had impaired airway mucociliary clearance (MCC) and higher pulmonary inflammation at baseline, whereas synthesis of cytochrome c oxidase (Sco2)-deficient mice with reduced COX were protected from CS-induced pulmonary inflammation and impairment of MCC. Mice treated with a mitochondrial iron chelator or mice fed a low-iron diet were protected from CS-induced COPD. Mitochondrial iron chelation also alleviated CS-impairment of MCC, CS-induced pulmonary inflammation and CS-associated lung injury in mice with established COPD, suggesting a critical functional role and potential therapeutic intervention for the mitochondrial-iron axis in COPD

Prevalence of antibodies against Toxoplasma gondii in roe deer from Spain

Roe deer (Capreolus capreolus) is an important game animal in Spain. Sera from 278 roe deer from eight areas in mainland Spain were assayed for antibodies to Toxoplasma gondii by modified agglutination test (MAT). Titers of 1:25 or higher were found in 109 (39.2%) of 278 deer. No significant differences in antibody prevalence were found between sex or age categories. In contrast, significant differences in seroprevalence between locations were evident. Roe deer from the Northern coastal habitats (high humidity and roe deer density) had the highest prevalence, compared with low prevalence in Central Spain (arid areas and low roe deer density). There was a positive correlation between antibody prevalence and mean annual rainfall (rs = 0.85, n = 8, P < 0.01). These findings have environmental and/or public health implications because venison can be an important meat source of T. gondii infections for humans and feral cats.This study is a contribution to GC-05-006, ICS, JCCM, and agreements between IREC and Principado de Asturias and Ministerio de Agricultura and OAPN, Spain. This study received partially support from the Spanish CICYT, grants AGL2004-06103, AGL2005-07401 and AGL2007-65521.Peer reviewe

Natriuretic peptide‐based inclusion criteria in heart failure with preserved ejection fraction clinical trials: insights from PARAGON‐HF

Aim: Natriuretic peptides (NPs) are now routinely incorporated as key inclusion criteria in clinical trials of heart failure with preserved ejection fraction (HFpEF) as objective measures of risk. An early amendment in PARAGON-HF required all participants to have elevated NP concentrations, but some were enrolled pre-amendment, providing a unique opportunity to understand the influence of enrolment pathway in HFpEF clinical trials. Methods and results: Among 4796 participants in PARAGON-HF, 193 (4.0%) did not meet the final NP-based enrolment criteria (N-terminal pro-B-type natriuretic peptide &gt;300 pg/ml for patients in sinus rhythm or &gt;900 pg/ml for patients in atrial fibrillation/flutter). These patients had lower rates of the primary endpoint of total heart failure hospitalizations and cardiovascular death as compared with patients meeting final enrolment criteria (8.6 [6.7–11.2] events per 100 patient-years vs. 14.0 [13.4–14.7] events per 100 patient-years; p = 0.01). The rate ratio for the treatment effect comparing sacubitril/valsartan with valsartan was 0.85 (95% confidence interval 0.74–0.99; p = 0.04) in those who met final criteria. Conclusions: Natriuretic peptides are an important tool in HFpEF clinical trials to objectively affirm diagnoses and enrich clinical event rates

Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit

Abstract Background The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU. Methods The Weill Cornell Medicine Registry and Biobank of Critically Ill Patients is an ongoing cohort of critically ill patients, for whom biological samples and clinical information (including vital signs before and during ICU hospitalization) are prospectively collected. Using such information, qSOFA and SIRS scores outside the ICU (specifically, within 8 hours before ICU admission) were calculated. This study population was therefore comprised of patients in the emergency department or the hospital wards who had suspected infection, were subsequently admitted to the medical ICU and were included in the Registry and Biobank. Results One hundred fifty-two patients (67% from the emergency department) were included in this study. Sixty-seven percent had positive cultures and 19% died in the hospital. Discrimination of in-hospital mortality using qSOFA [area under the receiver operating characteristic curve (AUC), 0.74; 95% confidence intervals (CI), 0.66–0.81] was significantly greater compared with SIRS criteria (AUC, 0.59; 95% CI, 0.51–0.67; p = 0.03). The qSOFA performed better than SIRS regarding discrimination for ICU-free days (p = 0.04), but not for ventilator-free days (p = 0.19), any organ dysfunction-free days (p = 0.13), or renal dysfunction-free days (p = 0.17). Conclusions In patients with suspected infection who eventually required admission to the ICU, qSOFA calculated before their ICU admission had greater accuracy than SIRS for predicting mortality and ICU-free days. However, it may be less clear whether qSOFA is also better than SIRS criteria for predicting ventilator free-days and organ dysfunction-free days. These findings may help clinicians gain further insight into the usefulness of qSOFA

Sex differences in heart failure with improved ejection fraction

No abstract available

Cardiac Abnormalities in Hispanic/Latina Women With Prior De Novo Hypertensive Disorders of Pregnancy

BACKGROUNDHypertensive disorders of pregnancy (HDP) are associated with long-term maternal risks for cardiovascular disease for reasons that remain incompletely understood.METHODSThe HCHS/SOL (Hispanic Community Health Study/Study of Latinos), a multi-center community-based cohort of Hispanic/Latino adults recruited 2008 to 2011, was used to evaluate the associations of history of de novo HDP (gestational hypertension, preeclampsia, eclampsia) with echocardiographic measures of cardiac structure and function in Hispanic/Latina women with ≥1 prior pregnancy and the proportion of association mediated by current hypertension (>140/90 mm Hg or antihypertensive therapy).RESULTS.The study cohort included 5168 Hispanic/Latina women with an average age (SD) of 58.7 (9.7) years at time of echocardiogram. Prior de novo HDP was reported by 724 (14%) of the women studied and was associated with lower left ventricle (LV) ejection fraction -0.66 (95% confidence interval [CI], -1.21 to -0.11), higher LV relative wall thickness 0.09 (95% CI, 0-0.18), and 1.39 (95% CI, 1.02-1.89) higher risk of abnormal LV geometry after adjusting for blood pressure and other confounders. The proportion of the association mediated by current hypertension between HDP and LV ejection fraction was 0.09 (95% CI, 0.03-0.45), LV relative wall thickness was 0.28 (95% CI, 0.16-0.51), abnormal LV geometry was 0.14 (95% CI, 0.12-0.48), concentric left ventricular hypertrophy was 0.31 (95% CI, 0.19-0.86), and abnormal LV diastolic dysfunction was 0.58 (95% CI, 0.26-0.79).CONCLUSIONS.In a large cohort of Hispanic/Latina women those with history of de novo HDP had detectable and measurable subclinical alterations in cardiac structure and both systolic and diastolic dysfunction that were only partially mediated by current hypertension

Oralidad y proceso. Una perspectiva desde Iberoamérica

La presente obra recopila algunas de las ponencias de los conferencistas participantes en los dos eventos académicos internacionales de Derecho Procesal, programados para el presente año por la Universidad de Medellín. El primero de ellos correspondiente a las VI Jornadas Internacionales de Derecho Procesal, organizadas por los programas de Maestría en Derecho Procesal y Doctorado en Derecho Procesal, organizado por la Universidad de Medellín en asocio con la Fundación Universitaria Tecnológico Comfenalco de Cartagena. Este libro representa la oportunidad perfecta para invitar a la reflexión y al análisis sobre los problemas del derecho procesal contemporáneo, y en el caso colombiano, que apenas comienza su recorrido por la senda de la oralidad procesal, para empezar a marcar pautas que trasciendan de los simples comentarios a las reformas realizadas o que están por realizarse