Factors Associated With Mortality During the First Year Post Infarction: Survival Analysis of Patients With Acute Myocardial Infarction in Colombia.

INTRODUCTION: Cardiovascular diseases account for over 80% of global deaths. Risk factors and social determinants influence mortality in patients post acute myocardial infarction (AMI). OBJECTIVE: To evaluate factors associated with post-AMI mortality during the one-year follow-up. MATERIALS AND METHODS: The study is a prospective cohort study of adults aged 18 years and older with type 1 AMI conducted between October 2021 and January 2024. Intrahospital and outpatient information was collected. Statistical analyses included the Kaplan-Meier survival curve and Cox regression analysis. Proportional hazards and model predictive capacity were evaluated. RESULTS: A total of 1873 patients were included, with a 9.4% mortality rate in the first year. At one year, the estimated survival probability was 88.61% (95% CI: 86.82-90.18). Cox analysis identified several factors associated with mortality, highlighting age (HR = 1.04, 95% CI: 1.02-1.06, p = 0.001), diabetes (HR = 1.77, 95% CI: 1.09-2.87, p = 0.020), renal insufficiency (HR = 2.25, 95% CI: 1.32-3.84, p = 0.003), and type of intervention. The model evaluation showed strong predictive capacity. CONCLUSIONS: It is essential to emphasize the importance of comprehensive management in AMI patients with risk factors such as diabetes and chronic kidney disease, as they are significant predictors of mortality during the first year post infarction.

Y Stent-Assisted Coiling Technique for Bifurcation Aneurysms Using Double Neuroform® Stent: a Large Restrospective Series.

BACKGROUND: Stent assisted coiling technique have shown to be an effective and safe endovascular strategy for wide neck bifurcation aneurysms in achieving greater packing, allowing the closure of the aneurysm and preserving the parent arteries, compared to simple coiling. MATERIAL AND METHODS: We conducted a retrospective analysis of 79 patients with cerebral aneurysms treated using 'Y'-configuration double Neuroform® stent-assisted coiling at our center from July 2009 to July 2022. RESULTS: Of the 79 patients, 76% (60/79) were incidental unruptured cerebral aneurysm and 24% were patients treated for aneurysm recanalization of a previous ruptured aneurysm (19/79). The most frequent locations were anterior communicating artery (AComA) 44.3% (35/79) and middle cerebral artery (MCA) 32.9% (26/79). We found a complete and almost complete aneurysm occlusion (Raymond-Roy occlusion classification (RROC) 1 and 2): in 100% (79/79) in the angiography after procedure, in 97.6% (42/43) at the first follow-up at 6-8 months and 100% (57/57) at the first 1-2 years of follow-up. No mortality related to treatment was detected. We registered 2.5% (2/79) major ipsilateral strokes, one due to acute in stent thrombosis (patient had a mRS: 0 in follow up at 90 days) and a spinal anterior artery occlusion (patient had a mRS: 3 in follow up at 90 days). CONCLUSION: The 'Y' stent-assisted coiling technique with double Neuroform® is a safe and effective technique for the treatment of wide-neck bifurcation aneurysms, with high rates of complete occlusion, preserving the permeability of the afferent and efferent arteries and low rate of complications.

Time-Dependent Risk for Recurrence in Survivors of Major Adverse Cardiovascular Events.

INTRODUCTION: The prevalence of the population with a history of an occlusive cardiovascular event has been increasing in recent years, which means that a large number of patients will have a higher risk of presenting a fatal recurrence. The aim is to determine variables associated with time-to-recurrent cardiovascular events and analyze how changes in low-density lipoprotein cholesterol (LDL-C) levels during follow-up may be associated with this time-to-event. MATERIALS AND METHODS: This is a prospective observational cohort study of 727 adults with a history of at least one occlusive cardiovascular event recruited at a referral hospital in northeastern Colombia. Data from a follow-up period of a maximum of 33 months (median 26 months) (one death) were used to define how clinical and sociodemographic variables impact the recurrence of major adverse cardiovascular events (MACE). Analyses were performed based on proportional hazard models and time-dependent hazard models. RESULTS: Upon enrollment, 215 (30%) of the participants reported experiencing their most recent cardiovascular event within the preceding year. After two years, the recurrence rate was 12.38% (90/727). The risk of recurrence before two years was 3.9% (95% CI 2.7-5.6). In the multiple models, the presence of severe depression gives a Hazard Ratio of 8.25 (95% CI 2.98-22.86) and LDL ≥120 md/dl Hazard Ratio of 2.12 (95% CI 1.2 -3.9). It was found that LDL >120 mg/dl maintained over time increases the chances of recurrence by 1.7% (Hazard Ratio: 1.017, 95% CI 0.008-0.025). CONCLUSIONS: The present study allows us to identify a profile of patients who should be treated promptly in an interdisciplinary manner to avoid recurrences of coronary events.

Adaptation and Validation of the 3 × 2 Achievement Goals Questionnaire in a Population of Athletes.

(1) Background: Sport goals, although widely recognised as crucial for motivation and performance in sport, are multifaceted and can be difficult to measure directly. The present research aims to validate the 3 × 2 achievement goals questionnaire of Mascret in Spanish in a population of athletes. (2) Method: By using a latent factor approach, it is possible to identify the underlying dimensions of these goals and to better understand how they are structured. For this purpose, this questionnaire has been translated and compared with the life satisfaction scale. An exploration of the multifaceted nature of sport goals has been carried out using structural equation modelling. A total of 580 athletes (463 males and 216 females, M = 21.5, SD = 2.36) from different sport disciplines and from 12 autonomous communities in Spain participated in the research. (3) Results: The results show that the questionnaire presents a high scale reliability and that all items contribute significantly to the internal consistency of the scale. (4) Conclusions: The adaptation of this scale to the Spanish population of athletes can be a valid and useful tool to measure and understand motivation and goals in the sport context.

SUCNR1 regulates insulin secretion and glucose elevates the succinate response in people with prediabetes.

Pancreatic ß-cell dysfunction is a key feature of type 2 diabetes, and novel regulators of insulin secretion are desirable. Here we report that the succinate receptor (SUCNR1) is expressed in ß-cells and is up-regulated in hyperglycemic states in mice and humans. We found that succinate acts as a hormone-like metabolite and stimulates insulin secretion via a SUCNR1-Gq-PKC-dependent mechanism in human ß-cells. Mice with ß-cell-specific Sucnr1 deficiency exhibit impaired glucose tolerance and insulin secretion on a high-fat diet, indicating that SUCNR1 is essential for preserving insulin secretion in diet-induced insulin resistance. Patients with impaired glucose tolerance show an enhanced nutritional-related succinate response, which correlates with the potentiation of insulin secretion during intravenous glucose administration. These data demonstrate that the succinate/SUCNR1 axis is activated by high glucose and identify a GPCR-mediated amplifying pathway for insulin secretion relevant to the hyperinsulinemia of prediabetic states.

Implementation of a retinal stroke-code protocol results in visual recovery in patients receiving reperfusion therapies.

INTRODUCTION: Reperfusion therapies represent promising treatments for patients with Central Retinal Artery Occlusion (CRAO), but access is limited due to low incidence and lack of protocols. We aimed to describe the benefit of implementing a Retinal Stroke-Code protocol regarding access to reperfusion, visual acuity and aetiological assessment. PATIENTS AND METHODS: Prospective cohort study performed at a Comprehensive Stroke Centre. Criteria for activation were sudden monocular, painless vision loss within 6 h from onset. Eligible patients received IAT when immediately available and IVT otherwise. All patients were followed by ophthalmologists to assess best-corrected visual acuity (BCVA) and visual complications, and by neurologists for aetiological workup. Visual amelioration was defined as improvement of at least one Early Treatment Diabetic Retinopathy Study (ETDRS) letter from baseline to 1 week. RESULTS: Of 49 patients with CRAO, 15 (30.6%) received reperfusion therapies (12 IVT, 3 IAT). Presentation beyond 6 h was the main contraindication. Patients receiving reperfusion therapies had better rates of visual improvement (33.3% vs 5.9%, p = 0.022). There were no complications related to reperfusion therapies. Rates of neovascular glaucoma were non-significantly lower in patients receiving reperfusion therapies (13.3% vs 20.6%, p = 0.701). Similar rates of atherosclerotic, cardioembolic and undetermined aetiologies were observed, leading to 10 new diagnosed atrial fibrillation and five carotid revascularizations. CONCLUSION: A comprehensive acute management of CRAO is feasible despite low incidence. In our study, reperfusion therapies were safe and associated with higher rates of visual recovery. A similar etiological workup than ischemic stroke led to of high proportion of underlying aetiologies.

Tasa metabólica en reposo por calorimetría indirecta y ecuaciones de predicción en deportistas con amputación: Análisis de concordancia

La Tasa Metabólica en Reposo (TMR) suele calcularse utilizando ecuaciones de predicción por su fácil acceso y bajo costo. Sin embargo, estas ecuaciones no se encuentran validadas en población deportista con amputación. Objetivo: determinar la concordancia entre la medición de la TMR realizada por Calorimetría Indirecta (CI) y la calculada por ecuaciones de predicción en deportistas con amputación de miembros inferiores en Bogotá. Sujetos y métodos: Este estudio evaluó 16 deportistas adultos masculinos, con amputación de miembro inferior. La TMR se midió con CI y se calculó con las ecuaciones de predicción de Harris-Benedict, Cunningham, Mifflin -St. Jeor, Schofield y Oxford. Se utilizaron dos variables diferentes de masa corporal: masa corporal total (MCT) y masa magra (MM) determinada por Absorciometría de doble energía de rayos X (DEXA) y por el método antropométrico de fraccionamiento de masas en cinco componentes (5C). La concordancia se determinó a través del coeficiente de correlación intraclase (CCI) y se graficó mediante el método de Bland- Altman. Resultados y conclusión: La TMR determinada por la ecuación de Cunningham a partir de MM evaluada por DEXA, mostró la mejor concordancia con la CI (CCI= 0,709), seguida por Harris-Benedict con MCT (CCI= 0,697) y Cunningham con MM calculada por 5C (CCI= 0,693). La ecuación de Cunningham y Harris Benedict parecen ser las más adecuadas para calcular la TMR, sin embargo, se requieren más estudios con muestras mayores, lo cual permitirá obtener resultados más precisos.

Prediction equations for calculating resting metabolic rate (RMR) are widely used given their accessibility and low cost. However, they have not been yet validated in the amputee athlete population. Objective: to determine the concordance between the RMR measured by Indirect Calorimetry (IC) and that calculated by prediction equations in athletes with lower limb amputation in Bogota. Subjects and methods: sixteen adult male athletes with lower limb amputation were included. The RMR was measured with IC and calculated with the Harris-Benedict, Cunningham, Mifflin-St. Jeor, Schofield, and Oxford prediction equations. Three different body mass variables were used: total body mass (TBM) and lean body mass (LBM) determined by Dual Energy X-ray Absorptiometry (DEXA) and by the anthropometric method of mass fractionation into five components (5C). The agreement was determined by intraclass correlation coefficient (ICC) and plotted using the Bland-Altman method. Results and conclusions: RMR determined by the Cunningham equation from LBM assessed by DEXA showed the best agreement with CI (ICC= 0.709), followed by Harris-Benedict with MCT (ICC= 0.697) and Cunningham with LBM calculated by 5C (ICC= 0.693). The Cunningham and Harris-Benedict equation seems to be the most suitable for calculating RMR. However, more studies with larger samples are needed to obtain more accurate results.

Sobre los nuevos retos y oportunidades derivados de la implementación de herramientas de inteligencia artificial en la docencia universitaria / On the new challenges and opportunities derived from the implementation of artificial intelligence tools in university teaching / Sobre os novos desafios e oportunidades decorrentes da aplicação de ferramentas de inteligência artificial no ensino universitário

La implementación de Chat GPT en la docencia universitaria puede mejorar significativamente la calidad de la enseñanza al permitir la personalización del aprendizaje, permitiendo a los estudiantes expresar sus dudas y preguntas de manera personalizada y obtener respuestas específicas y relevantes en tiempo real. Chat GPT puede adaptarse a las necesidades y estilos de aprendizaje individuales de los estudiantes. Entre muchas de las tareas que soporta esta herramienta se encuentran la traducción a múltiples idiomas, la capacidad de sintetizar texto, generar imágenes a partir de texto e incluso ser un excelente ayudante en tareas de programación.

The implementation of GPT Chat in university teaching can significantly improve the quality of teaching by enabling the personalization of learning, allowing students to express their doubts and questions in a personalized way and get specific and relevant answers in real time. Chat GPT can be tailored to the individual needs and learning styles of students. Among many of the tasks supported by this tool are translation into multiple languages, the ability to synthesize text, generate images from text and even be an excellent assistant in programming tasks.

A implementação do Chat GPT no ensino universitário pode melhorar significativamente a qualidade do ensino ao permitir a personalização da aprendizagem, permitindo que os alunos expressem as suas dúvidas e questões de forma personalizada e obtenham respostas específicas e relevantes em tempo real. O Chat GPT pode ser adaptado às necessidades individuais e aos estilos de aprendizagem dos alunos. Entre muitas das tarefas suportadas por esta ferramenta estão a tradução para várias línguas, a capacidade de sintetizar texto, gerar imagens a partir de texto e até ser um excelente assistente em tarefas de programação.

Educación ambiental mediada desde las ecologías sociocuturales para el abordaje del territorio en contextos escolares / Environmental education mediated from socio-cultural ecologies for the approach to territory in school contexts

RESUMEN Desde la perspectiva de las ecologías socioculturales, como campo emergente interdisciplinario, se puede enriquecer de manera alternativa y complementaria la educación ambiental, puesto que permite un acercamiento comprensivo a las dinámicas de ocupación humana y las transformaciones en un territorio concreto desde una mirada histórica, política y sociocultural. Esta investigación, se llevó a cabo en el contexto territorial de la cuenca del río Quindío, en el centro-occidente de Colombia, con la participación de 144 estudiantes y 40 docentes, de cuatro Instituciones Educativas públicas. La metodología fue de enfoque cualitativo, donde se empleó como instrumento de recolección y análisis de información, una encuesta tipo cuestionario con preguntas abiertas, para indagar aspectos socioambientales, históricos y paisajísticos del contexto territorial de dicha cuenca. Los resultados develaron que estudiantes y docentes, en general, desconocen los procesos históricos de ocupación humana de la región; con relación a los principales cambios percibidos en el paisaje, los estudiantes señalaron el incremento de las urbanizaciones, la disminución de las zonas verdes y la contaminación, mientras que los docentes manifestaron cambios en los usos del suelo, el crecimiento urbanístico y el desarrollo basado en el turismo. Sin duda, estos hallazgos son importantes, como lectura del territorio, para ser tenidos en cuenta en la praxis de la educación ambiental de las instituciones educativas.

ABSTRACT From the perspective of socio-cultural ecologies as an emerging interdisciplinary field, environmental education can be enriched in an alternative and complementary way since they allow a comprehensive approach to the dynamics of human occupation and transformations in a specific territory from a historical perspective, political and socio-cultural. This research was carried out in the territorial context of the Quindío River basin in central-western Colombia, with the participation of 144 students and 40 teachers from four public educational institutions. The methodology was a qualitative approach, where a questionnaire-type survey with open questions was used as an instrument for collecting and analyzing information to investigate socio-environmental, historical, and landscape aspects of the territorial context of said basin. The results revealed that students and teachers, in general, are unaware of the historical processes of human occupation of the region; Concerning the main changes perceived in the landscape, the students pointed out the increase in urbanizations, the decrease in green areas, and pollution; while teachers expressed changes in land use, urban growth, and development based on tourism. Undoubtedly, these findings are important as a reading of the territory to be considered in the praxis of environmental education in educational institutions.

Medicina de precisión para el diagnóstico de sepsis neonatal: revisión sistemática y metaanálisis / Precision medicine for the diagnosis of neonatal sepsis: systematic review and meta-analysis

ANTECEDENTES: Los biomarcadores actuales para el diagnóstico de sepsis neonatal tienen una exactitud limitada. El desarrollo de la medicina de precisión basada en tecnologías ómicas ofrece una oportunidad para mejorar el diagnóstico de la sepsis neonatal. OBJETIVOS: Evaluar la sensibilidad y especificidad de las pruebas basadas en tecnologías ómicas (metabolómica, proteómica y genómica/transcriptómica) para el diagnóstico de sepsis neonatal. METODOLOGÍA: Se realizó una revisión sistemática en bases de datos electrónicas. Se incluyeron estudios observacionales y ensayos clínicos que evaluaran las pruebas basadas en tecnologías ómicas en neonatos comparado con el cultivo para el diagnóstico de sepsis neonatal. Dos revisores independientes realizaron la evaluación de la calidad de los estudios y la extracción de los datos. Para el metaanálisis se realizó un modelo de efectos aleatorios y se planeó una evaluación de la heterogeneidad a través de un análisis de subgrupos por prueba ómica, edad gestacional y tiempo de establecimiento de la sepsis. RESULTADOS: Se observa expresión diferencial del genoma, proteoma y metaboloma entre los neonatos con y sin sepsis, identificando diferentes biomarcadores. El metaanálisis mostró una medida de resumen combinada para la sensibilidad de 0,88 (IC 95% 0,72-0,96), especificidad de 0,76 (IC 95% 0,62-0,85). CONCLUSIÓN: Las pruebas basadas en ómicas tienen una alta sensibilidad, siendo las de mejor rendimiento las basadas en genómica/transcriptómica. Los estudios tienen alta heterogeneidad.

BACKGROUND: Current biomarkers for the diagnosis of neonatal sepsis llave limited accuracy. The development of precision medicine based on omic's technologies offer an opportunity to improve the diagnosis of neonatal sepsis. AIM: To evalúate the sensitivity and specificity of tests based on omic technologies (metabolomics, proteomics and genomics) for the diagnosis of neonatal sepsis. METHODS: A systematic review was carried out in electronic databases. Observational studies and clinical trials evaluating tests based on omic technologies in neonates compared to culture for the diagnosis of neonatal sepsis were included. For the meta-analysis, a random effects model and an evaluation of heterogeneity were proposed through a subgroup analysis by omic test, gestational age and time of establishment of sepsis. RESULTS: Differential expression of the genome, proteome and metabolome is observed between neonates with and without sepsis, identifying different biomarkers. The meta-analysis showed a pooled summary measure for sensitivity of0.88 (95% CI 0.72, 0.96), specificity of0.76 (95% CI 0.62, 0.85). CONCLUSION: Omics-based tests have a high sensitivity, with the best performing ones being those based on genomics / transcriptomics. The studies have high heterogeneity.

Weaning rápido vs. weaning gradual de ventriculostomía externa en hidrocefalia secundaria a hemorragia subaracnoidea: Revisión sistemática de la literatura y metaanálisis / Weaning fast vs. Gradual Weaning of External Ventriculostomy in Hydrocephalus Secondary to Subarachnoid Hemorrhage: A Systematic Review of the Literature and Meta-analysis

Objetivo: Realizar una revisión sistemática comparando dos estrategias de weaning de Derivación Ventricular externa (DVE) en pacientes con hidrocefalia aguda y su asociación con la proporción de derivación definitiva, infección del sistema nervioso central y duración de la estancia hospitalaria en cada una de las estrategias. Diseño: Revisión sistemática de la literatura. Fuentes de datos: Se realizaron búsquedas en PubMed, Embase, Lilacs. Se incluyò literatura gris, realizando búsquedas en Google académico, Dialnet, Open gray, Teseo y Worldcat hasta el 10 de septiembre de 2019. Métodos: Se realizó una búsqueda exhaustiva de estudios de los últimos 20 años en inglés, español y portugués, que compararan dos estrategias de weaning de DVE: rápida (WR) vs gradual (WG) en pacientes con hidrocefalia aguda. El resultado primario para esta Revisión Sistemática fue la proporción de derivación definitiva en cada uno de los regímenes. Se evaluó además, la proporción de infección del sistema nervioso central y la duración de la estancia hospitalaria. Dos investigadores extrajeron de forma independiente la información de los estudios y los resultados en concordancia con la Guía PRISMA. Resultados: La revisión arrojó en total 3 artículos que cumplían con los criterios de inclusión y que se consideraron de calidad metodológica aceptable, con un número de 1198 participantes no superpuestos, 569 que fueron sometidos a weaning rápido (WR), 629 en el grupo de weaning gradual (WG). No se encontró asociación estadisticamente significativa entre las estrategias de weaning y DVP OR 0.78 (Intervalo de confianza del 95% 0.3 a 2.06; P= 0.001; I2=85%), ni para infección del sistema nervioso central OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) pero si se encontró diferencia estadísticamente significativa en la duración de la estancia hospitalaria a favor de la estrategia de weaning ràpido, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusión: Con la evidencia disponible actualmente no es posible concluir cuál es la mejor estrategia de weaning para DVE con respecto a la proporción de derivación definitiva o infecciones del sistema nervioso central; sin embargo, si se observa una tendencia clara frente a la duración de la estancia hospitalaria en la estrategia de WR. Se requiere establecer criterios claros en cuanto a la definición de WR o WG y a crear estándares en cuanto los tiempos y la definiciòn precisa de falla terapeutica respecto a estas pruebas, para posteriormente integrar y probar estos métodos en estudios idealmente prospectivos y aleatorizados.

Objective: To conduct a systematic review by comparing two strategies of external ventricular drain (EVD) in patients with acute hydrocephalus and its association with the proportion of definite drain, infection of the central nervous system, and duration of hospital stay in each strategy. Design: Systematic review of literature.Data sources: PubMed, Embase, Lilacs. Grey literature was included by conducting searches through Scholar Google, Dialnet, Open Gray, Teseo and Worldcat until the 10th September, 2019. Methods: An exhaustive search of studies was done of the last 20 years in English, Spanish and Portuguese, which compares two strategies of external ventricular drain weaning (EVD): Rapid (WR) Vs Gradual (WG)in patients with acute hydrocephalus. The primary result for this systematic review was the proportion of Ventriculoperitoneal (VP) shunt placement in each of the regimes. Besides, the proportion of the infection of the central nervous system and the duration of the hospital stay was evaluated. Two researchers extracted in an independent way the information of the studies and results according to the guide PRISMA. Results: The review produced 3 articles in total which followed with the criteria of inclusion and which were considered of acceptable methodological quality, with 1198 non-superimposed participants, 569 who were subjected to rapid weaning (RW), 629 in the group of Gradual Weaning (GW). There were no significant differences between the 2 weaning ́s groups and DVP OR 0.78 (IC 95% 0.3 a 2.06; P= 0.001; I2=85%), for the infection of the Central Nervous System (CNS) OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) but a significant differences was found in the duration of the hospital stay in favour of the strategy of RW, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusion: With the current available evidence is not possible to conclude which is the best strategy of weaning for EVD regarding to the proportion of definite shunt or infections of the CNS; but if there is a clear trend regarding the length of hospital stay in the WR strategy. It is necessary to establish clear criteria as to the definition of WR or WG and to create standards as to the times and the precise definition of therapeutic failure with respect to these tests, to later integrate and test these methods in ideally prospective and randomized studies.

Efecto del cambio de la terapia antirretroviral en la falla virológica en una cohorte de pacientes que conviven con el VIH en Medellín, Antioquia, Colombia / Effect of the change in antirretroviral therapy on virological failure in a cohort of patients living with HIV in Medellín, Antioquia, Colombia

Objetivo: determinar el efecto del cambio en la terapia antirretroviral sobre el control virológico en una cohorte de pacientes VIH positivos de una institución prestadora de servicios de salud en Medellín, Antioquia (Colombia) en el año 2017. Materiales y métodos: estudio observacional analítico transversal, comparativo entre pacientes que cambiaron y no cambiaron el esquema inicial de terapia antirretroviral. Se realizó en una cohorte de 1245 pacientes que conviven con el VIH. Resultados: un total de 322 pacientes fueron evaluados. El principal motivo de cambio fue la presencia de efectos adversos a la terapia antirretroviral, seguido de la falla virológica sin genotipo e intolerancia a la terapia antirretroviral. La falla virológica, RP 1,4 IC95% (1,2-1,6, p0,00), el tener genotipo, RP 1,2 IC95% (1,1-1,3, p 0,00) y el padecer una infección oportunista, RP 1,3 IC95% (1,0-1,6, p 0,03), se asociaron a mayor número de cambios a la TAR. La adherencia a la terapia antirretroviral, RP 0,18 IC95% (0,1-0,3, p 0,00) y la toma de otros medicamentos no relacionados al VIH (RP 0,6, IC95% 0,4-0,8, p 0,005) se asociaron a menor frecuencia de cambio de la terapia antirretroviral. El cambio de la terapia antirretroviral (OR ajustado 3,4, IC 95% (2,0-5,8), continúa siendo el factor pronóstico más importante para falla virológica. Conclusión: el cambio de la terapia antirretroviral, definida en este estudio como la principal variable de exposición, representa el principal factor de riesgo para falla virológica, incluso cuando fue ajustado por otras variables..Au

Objective: to determine the effect of the change in antiretroviral therapy on virological control in a cohort of HIV positive patients corresponding to a healthcare institution in Medellín, Antioquia (Colombia) in 2017. Materials and methods: cross-sectional,comparative analytical observational study. It was performed in a cohort of 1245 patients living with HIV. Results: a total of 322 patients were evaluated. The main reason for change was the presence of adverse effects to antiretroviral therapy, followed by virological failure without genotype and antiretroviral therapy intolerance. Virological failure, PR 1.4 95% CI (1.2-1.6, p 0,00), having genotype, PR 1.2 95% CI (1.1-1.3, p0,00 ) and suffering from an opportunistic infection, PR 1.3 95% CI (1.0-1.6, p 0,03),were associated with a greater number of changes to antiretroviral therapy. Adherence to antiretroviral therapy, PR 0.18 95% CI (0.1-0.3, p 0,00) and taking other non-HIVrelated medications (PR 0.6, 95% CI 0.4-0 , 8, p 0,005) were associated with a lower frequency of change of antiretroviral therapy. The change in antiretroviral therapy (adjusted OR 3.4, 95% CI (2.0-5.8)) remains the most important prognostic factor for virological failure. Conclusion: the change in antirretroviral therapy, defined in this study as the main exposure variable, represents the main risk factor for virological failure, even when was adjusted for other variables..Au

Efecto del tratamiento prenatal con espiramicina en la frecuencia de retinocoroiditis por toxoplasmosis congénita en una cohorte colombiana / Effect of antenatal spiramycin treatment on the frequency of retinochoroiditis due to congenital toxoplasmosis in a Colombian cohort

Resumen Introducción. La toxoplasmosis de la gestación es frecuente y grave. Hasta ahora no hay consenso sobre la utilidad del tratamiento para prevenir complicaciones oculares en el neonato. En la actualidad, uno de los medicamentos utilizados en las madres diagnosticadas es la espiramicina oral. Infortunadamente, en algunas mujeres gestantes no se hace el diagnóstico prenatal y, por esta u otras razones, no reciben el tratamiento. Objetivo. Describir la relación entre el tratamiento con espiramicina durante el embarazo en madres con toxoplasmosis de la gestación y la presentación de toxoplasmosis ocular en los recién nacidos. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de serie de casos. Se evaluó una serie prospectiva de pacientes con toxoplasmosis de la gestación durante tres años de seguimiento en el Servicio de Retinología de la Clínica Universitaria Bolivariana de Medellín. Resultados. Se registraron 23 madres con diagnóstico de toxoplasmosis de la gestación. Quince de ellas (65 %) recibieron durante la gestación tratamiento con espiramicina en dosis de 3 g al día; uno de los neonatos (6,6 %) presentó toxoplasmosis ocular. De las ocho (35 %) pacientes que no recibieron tratamiento, cinco (62,5 %) tuvieron hijos con compromiso ocular por toxoplasma. La razón de momios (odds ratio, OR) del efecto protector contra dicho compromiso en los pacientes cuyas madres recibieron tratamiento fue de 0,04 (IC95% 0,00-0,67), con valor de p menor de 0,01 en la prueba exacta de Fisher. Solo se evidenció compromiso del sistema nervioso central por toxoplasmosis mediante las imágenes de tomografía o ecografía cerebral en dos (14 %) pacientes de las 14 en quienes se hicieron estos estudios. Los dos pacientes presentaron, además, compromiso ocular; ambos fueron diagnosticados en el momento del nacimiento y sus madres no habían recibido tratamiento prenatal. Conclusiones. Estos resultados evidencian que el tratamiento con espiramicina durante el embarazo en la toxoplasmosis de la gestación redujo en 96 % (IC95% 33-100 %) el riesgo relativo de presentar la enfermedad en el recién nacido.

Abstrat Introduction: Gestational toxoplasmosis is frequent and severe. There is still debate about the benefits of treatment against ocular manifestations in the newborn. Spiramycin treatment is used for this purpose, unfortunately prenatal diagnosis is sometimes delayed and pregnant women are not treated. Objective: To describe the relationship between treatment with spiramycin during pregnancy in mothers with gestational toxoplasmosis and development of ocular toxoplasmosis in newborns. Materials and methods: We conducted a descriptive study of a case series. We evaluated a prospective cohort of patients diagnosed with gestational toxoplasmosis during three years at the Retinology Service at the Clínica Universitaria Bolivariana in Medellín. Results: Gestational toxoplasmosis was found in 23 mothers; 15 (65%) were treated during pregnancy with 3 g per day of spiramycin, eight (35%) patients were untreated. In the treated group just one newborn developed ocular toxoplasmosis (6.6%), in contrast with five (62.5%) of the eight patients who did not receive treatment. These results suggest that pregnancy treatment reduces the relative risk of ocular toxoplasmosis in the newborn by 96% (95% CI: 33 - 100%). Only two (14%) of the patients who were evaluated, had nervous system involvement related to toxoplasmosis in CT scan or cerebral ultrasound. These two patients also developed ocular pathology and were diagnosed at the time of birth, so they did not received antenatal treatment. Conclusions: A protective effect was found against the ocular involvement in patients whose mother received treatment with spiramycin (OR=0.04;95% CI: 0.00-0.67), p<0.01 (Fisher's Exact Test).

Consumo de linaza molida para la reducción de peso corporal en personas con exceso de peso / Consumption of ground flaxseed for overweight individuals to lose weight

Objetivo: describir los cambios en el peso, el porcentaje de grasa corporal y la ingesta de alimentos de personas con sobrepeso y obesidad, que consumieron 30 g diarios de linaza molida durante ocho semanas y reportar su tolerancia a este tratamiento. Materiales y metódos: se intervino un grupo de 10 participantes adultos con exceso de peso, voluntarios, quienes consumieron una dosis diaria de 30 g de linaza molida durante ocho semanas y a quienes se les solicitó que no modificaran su ingesta usual de alimentos y que no cambiaran su patrón de actividad física durante la intervención. Se midieron variables antropométricas, de consumo de alimentos y de actividad física en las semanas cero, cuatro y ocho, y se evaluó semanalmente la aceptación y tolerancia al tratamiento. Resultados: al finalizar la intervención los participantes no tuvieron cambios significativos en su peso (p=0,610), ni en su porcentaje de grasa corporal (p=0,866). No se presentaron efectos adversos. Conclusiones: el consumo de 30 g diarios de linaza molida durante ocho semanas, sin hacer reducciones en el consumo calórico y sin incrementos en la realización de actividad física, no permite reducciones de peso corporal en personas con exceso de peso.

Objective: To describe changes in weight, body fat mass and food intake in overweight and obese people, who consumed 30 g of ground flaxseed daily during eight weeks and to report the tolerance to this treatment. Materials and methods:It was an intervention study. A group of 10 overweight adults were selected to voluntarily consume 30 g of ground flaxseed through eight weeks. They were asked not to change their usual food intake and their physical activity routine during the intervention. , Food consumption, physical activity and anthropometric variables were measured at baseline, week four and week eight. Subject's tolerance to consumption of ground flaxseed was measured each week. Results: No significant changes in weight (p=0,610), and body fat mass (p=0,866) were observed. Participants did not report adverse effects. Conclusions: Intake of 30 g of ground flaxseed daily for eight weeks, without reductions of caloric intake and without increases in physical activity didn't show significant weight reductions in overweight individuals.

Efecto del consumo de linaza en el perfil lipídico, el control del cáncer y como terapia de reemplazo hormonal en la menopausia: una revisión sistemática de ensayos clínicos aleatorizados / Effect of flaxseed consumption on lipid profile, the control of cancer and hormone replacement therapy in menopause: a systematic review of randomized controlled trials

Objetivo: evaluar los efectos del consumo de linaza sobre el perfil lipídico, control del cáncer y como reemplazo hormonal en la menopausia y en la andropausia. Materiales y metódos: se realizó una revisión sistemática de ensayos clínicos aleatorizados que examinaron los efectos del consumo de linaza sobre el peso corporal, la concentración de lípidos sanguíneos, el control del cáncer y los síntomas menopáusicos, usando las bases de datos de PubMed, Lilacs, OPS, OMS y Cochrane, publicados entre el 1 de enero de 2000 y el 30 de junio de 2010. A los artículos que cumplieron con criterios de inclusión se les evaluó su calidad metodológica. Resultados: fueron incluidos 49 artículos. Los estudios reportan que el consumo de linaza genera pequeños cambios en la concentración de los lípidos sanguíneos, mejora la sintomatología en mujeres menopáusicas, promueve la reducción de índices de proliferación tumoral y el aumento de apoptosis en cáncer de mama y próstata. Conclusiones: los resultados aún no son suficientes para recomendar el uso de la linaza para el control de la hipercolesterolemia en pacientes dislipidémicos. La evidencia favorece la linaza como una alternativa en la terapia coadyuvante del tratamiento del cáncer de mama y de próstata, y en la reducción de síntomas durante la menopausia.

Objective:To evaluate the effects of flaxseed consumption in changing the lipid profile, cancer control and hormone replacement therapy at menopause and andropause in individuals of all ages. Materials and methods:We conducted a systematic review of randomized controlled trials that examined the effects of flaxseed consumption on body weight reduction, change in blood lipid levels, cancer control and menopausal symptoms. We used Pub-Med, Lilacs, the libraries of PAHO and WHO, and clinical trials published in Cochrane between January 1, 2000 and June 30, 2010. The articles that met the inclusion criteria were assessed for methodological quality. Results: We included 49 articles. Studies reported that flaxseed consumption generates small changes in blood lipid concentrations, improvement in menopausal symptoms, promotes the reduction of tumor proliferation rates and increased apoptosis in breast and prostate cancer. Conclusions: The results are not yet sufficient to recommend the use of flaxseed for the control of hypercholesterolemia in patients with dyslipidemia. The evidence favors flaxseed as an alternative adjuvant therapy for breast and prostate cancer treatment, and reduction of menopause symptoms.

Caracterización de accidentes de tránsito y valoración tarifaria de la atención médica en el servicio de urgencias, Caldas-Antioquia 2007-2008 / Caracterização de acidentes de trânsito e valorização tarifária do atendimento médico no pronto-socorro, Caldas-Antioquia 2007-2008 / Characterization of traffic accidents and tariff rating of the medical attention in the emergency services, Caldas-Antioquia, 2007-2008

El objetivo del estudio fue describir las características de persona, tiempo y lugar de los eventos y los lesionados en accidentes de tránsito, así como la tarifa de atención en el servicio de urgencias del Hospital San Vicente de Paúl del municipio de Caldas-Antioquia. Se analizaron 139 registros de personas ingresadas por lesiones producidas por accidentes de tránsito al servicio de urgencias entre 2007-2008. Las variables analizadas fueron tipo de usuario en la vía, sexo, edad, tipo de lesión producida y tarifa de atención. Resultados: la mayoría de las víctimas fueron hombres entre veinte y cuarenta años de edad. Los usuarios más vulnerables fueron peatones (33,1%), seguidos de pasajeros (30,9%) y motociclistas (20,9%). El trauma decabeza y el politrauma fueron los más comunes. Conclusión: generar medidas que ayuden a proteger a los usuarios más vulnerables de las vías debe considerarse como prioridad para losentes gubernamentales.

The objective of this study was to analyze the characteristics of person, time, place of events and injured people in traffic accidents and the rate of attention in the emergency departmentof San Vicente de Paul, Hospital in the municipality of Caldas. A total of 139 visits to hospital san Vicente de Paul of Caldas (Antioquia) emergency departments (ED) were analyzed in theperiod 2007-2008. The variables analyzed are presented as follows: type of road user (vehicle occupant, pedestrian, motorcyclist, and cyclist), sex, age group, and type of injury suffered. Results: The majority of victims were male people (64%) in the 20-to-29-year age group (35.0%).Vulnerable road users totaled 84.9% of all cases (20.9% were motorcyclists, 33.1% pedestrians, and 30.9% vehicle occupant). Victims - aged between 1 and 89 years- who had suffered injurieswere mostly pedestrians and vehicle occupants. Head and polytrauma were the most affected body parts. Conclusions: Measures aimed to protect vulnerable road users must be considered a top priority to reduce traffic-related injuries.

O objetivo deste estudo foi descrever as características de pessoa, tempo e lugar dos eventos e os feridos em acidentes de trânsito, bem como a tarifa de atenção no pronto-socorro do HospitalSan Vicente de Paúl do município de Caldas departamento de Antioquia. Foram analisados 139 registros de pessoas atendidas no pronto-socorro devido a lesões produzidas por acidentes de trânsito entre 2007-2008. As variáveis analisadas foram tipo de usuário, sexo, idade, tipo de lesãoproduzida e tarifa de atendimento. Resultados: a maioria das vítimas foram homens entre vinte e quarenta anos de idade. Os usuários mais vulneráveis foram os pedestres (33,1%), seguidospelos passageiros (30,9%) e motociclistas (20,9%). O traumatismo de cabeça e o politraumatismo foram os mais comuns. Conclusão: gerar medidas que ajudem a proteger os usuários maisvulneráveis deve ser considerado como prioridade pelos entes governamentais.

Biopsia cerebral a mano alzada guiada por tomografía / Cerebral biopsy by a handfree procedure

Se presenta la experiencia del Servicio de Neurocirugía del Hospital Universitario San Vicente de Paúl con un procedimiento alternativo para realizar una biopsia cerebral, el cual se lleva a cabo a mano alzada y guiado por tomografía sin utilizar un marco estereotáxico. Se resalta su utilidad en los casos de lesiones supratentoriales y con tamaño mayor de 3 centímetros, en centros donde no se disponga de los métodos estereotáxicos tradicionales.

Diseño de un instrumental para fijación de columna dorsal y lumbar / Design of an instrument for setting and lumbar spine

Se elaboró un trabajo de tipo experimental en el cual se planteó como objetivo esencial el diseño de un instrumental para fijación anterior de columna que reuniera las normas mínimas de biocompatibilidad, versatilidad en su aplicación y resistencia a las cargas mecánicas reportadas en la literatura como válidas para este tipo de elementos. Para hacer el diseño del instrumento se revisó la literatura acerca de los sistemas existentes en el mercado, tanto aquellos de uso rutinario como los de tipo experimental, y se buscó adecuar un sistema nuevo que cumpliera con especificaciones mínimas, pero que a la vez fuera de bajo costo y fácil aplicación. El proceso de investigación fue desarrollado en tres fases.

Teoría y técnicas de desarrollo organizacional. v.6

Vol. 6: Apéndice 1. Síntesis de las teorías organizacionales, Apéndice 2. Bibliografía

Teoría y técnicas de desarrollo organizacional. v.5

Vol. 5: Módulo IV. Desarrollo organizacional: Técnicas de intervención.