Rebleeding and mortality risk are increased by ACLF but reduced by pre-emptive TIPS.

BACKGROUND & AIMS: The relationship between acute-on-chronic liver failure (ACLF) and acute variceal bleeding (AVB) is poorly understood. Specifically, the prevalence and prognosis of ACLF in the context of AVB is unclear, while the role of transjugular intrahepatic portosystemic shunt (TIPS) in the management in patients with ACLF has not been described to date. METHODS: A multicenter, international, observational study was conducted in 2,138 patients from 34 centers between 2011 and 2015. ACLF was defined and graded according to the EASL-CLIF consortium definition. Placement of pre-emptive TIPS (pTIPS) was based on individual center policy. Patients were followed-up for 1 year, until death or liver transplantation. Cox regression and competing risk models (Gray's test) were used to identify independent predictors of rebleeding or mortality. RESULTS: At admission, 380/2,138 (17.8%) patients had ACLF according to EASL-CLIF criteria (grade 1: 38.7%; grade 2: 39.2%; grade 3: 22.1%). The 42-day rebleeding (19% vs. 10%; p <0.001) and mortality (47% vs. 10%; p <0.001) rates were higher in patients with ACLF and increased with ACLF grades. Of note, the presence of ACLF was independently associated with rebleeding and mortality. pTIPS placement improved survival in patients with ACLF at 42 days and 1 year. This effect was also observed in propensity score matching analysis of 66 patients with ACLF, of whom 44 received pTIPs and 22 did not. CONCLUSIONS: This large multicenter international real-life study identified ACLF at admission as an independent predictor of rebleeding and mortality in patients with AVB. Moreover, pTIPS was associated with improved survival in patients with ACLF and AVB. LAY SUMMARY: Acute variceal bleeding is a deadly complication of liver cirrhosis that results from severe portal hypertension. This study demonstrates that the presence of acute-on-chronic liver failure (ACLF) is the strongest predictor of mortality in patients with acute variceal bleeding. Importantly, patients with ACLF and acute variceal (re)bleeding benefit from pre-emptive (early) placement of a transjugular intrahepatic portosystemic shunt.

Preemptive-TIPS Improves Outcome in High-Risk Variceal Bleeding: An Observational Study.

Patients admitted with acute variceal bleeding (AVB) and Child-Pugh C score (CP-C) or Child-Pugh B plus active bleeding at endoscopy (CP-B+AB) are at high risk for treatment failure, rebleeding, and mortality. A preemptive transjugular intrahepatic portosystemic shunt (p-TIPS) has been shown to improve survival in these patients, but its use in clinical practice has been challenged and not routinely incorporated. The present study aimed to further validate the role of preemptive TIPS in a large number of high-risk patients. This multicenter, international, observational study included 671 patients from 34 centers admitted for AVB and high risk of treatment failure. Patients were managed according to current guidelines, and use of drugs and endoscopic therapy (D+E) or p-TIPS was based on individual center policy. p-TIPS in the setting of AVB is associated with a lower mortality in CP-C patients compared with D+E (1 year mortality 22% vs. 47% in D+E group; P = 0.002). Mortality rate in CP-B+AB patients was low, and p-TIPS did not improve it. In CP-C and CP-B+AB patients, p-TIPS reduced treatment failure and rebleeding (1-year cumulative incidence function probability of remaining free of the composite endpoint: 92% vs. 74% in the D+E group; P = 0.017) and development of de novo or worsening of previous ascites without increasing rates of hepatic encephalopathy. Conclusion: p-TIPS must be the treatment of choice in CP-C patients with AVB. Because of the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients.

Identification of an immunogenic protein of Giardia lamblia using monoclonal antibodies generated from infected mice.

The humoral immune response plays an important role in the clearance of Giardia lamblia. However, our knowledge about the specific antigens of G. lamblia that induce a protective immune response is limited. The purpose of this study was to identify and characterise the immunogenic proteins of G. lamblia in a mouse model. We generated monoclonal antibodies (moAbs) specific to G. lamblia (1B10, 2C9.D11, 3C10.E5, 3D10, 5G8.B5, 5F4, 4C7, 3C5 and 3C6) by fusing splenocytes derived from infected mice. Most of these moAbs recognised a band of ± 71 kDa (5G8 protein) and this protein was also recognised by serum from the infected mice. We found that the moAbs recognised conformational epitopes of the 5G8 protein and that this antigen is expressed on the cell surface and inside trophozoites. Additionally, antibodies specific to the 5G8 protein induced strong agglutination (> 70-90%) of trophozoites. We have thus identified a highly immunogenic antigen of G. lamblia that is recognised by the immune system of infected mice. In summary, this study describes the identification and partial characterisation of an immunogenic protein of G. lamblia. Additionally, we generated a panel of moAbs specific for this protein that will be useful for the biochemical and immunological characterisation of this immunologically interesting Giardia molecule.

Estado de salud de los colombianos: una aplicación del eq-5d-3l* / State of health of colombians: an application of the eq-5d-3l

Objetivo: describir los estados de salud de la población colombiana a partir de la información de la Encuesta Nacional de Salud en términos del instrumento EQ-5D-3L. Materiales y métodos: se describen los estados de salud de la población colombiana utilizando el sistema descriptivo del Euroqol -5D-3L, a partir de la información de la Encuesta Nacional de Salud. Resultados: las personas en edades comprendidas entre los 25-29 y los 20-24 años fueron las que manifestaron en mayor medida no tener problemas de salud (11111) con una tasa de respuesta del 76,57% y 76,25% respectivamente. Por el contrario, el 44,57% de las personas perteneciente al grupo de edad comprendido entre los 65 y 69 años manifestaron tener al menos un problema en algún nivel de las dimensiones de salud del EQ-5D-3L. Conclusiones: la descripción de los estados de salud en función de las dimensiones EQ-5D-3L reviste gran importancia porque permite realizar comparaciones entre el estado de salud de la población colombiana y la población de otros países o regiones..(AU)

Objective: to describe the health status of the Colombian population based on information from the National Health Survey in terms of the EQ-5D-3L instrument.Materials and methods: the health status of the Colombian population is described using the Euroqol-5D-3L descriptive system, based on information from the National Health Survey. Results: people aged between 25-29 and 20-24 years were the ones who showed the greatest lack of health problems (11111) with a response rate of 76.57% and 76.25%, respectively. In contrast, 44.57% of the people in the age group 65-69 reported having at least one problem at some level of the health dimensions of the EQ-5D-3L. Conclusions: the description of health status according to EQ-5D-3L dimensions is very important because it allows comparisons between the health status of the Colombian population and the population of other countries or regions..(AU)

Economia laboral y discapacidad: reflexiones en torno a un asunto de salud pública / Economia do trabalho e deficiencia: reflexões a partir da saúde pública / Labor economics and disability: reflections around Public Health

La prevalencia de la discapacidad en el mundo es un fenómeno persistente. La Organización Mundial de la Salud y el Banco Mundial afirman que el 15% de la población del mundo esta afectada por algún tipo de discapacidad. La inclusión laboral es uno de los obstaculos mas grandes que enfrenta este grupo poblacional. Esta realidad se ve reflejada en aspectos como la probabilidad de tener empleo, la generación de ingresos entre otros. Estos aspectos, que son de naturaleza económica, son abordados la mayor parte de las veces desde disciplinas diferentes a la economÝa, potenciando en ocasiones un enfoque poco integral y asistencialista de este problema. Objetivo: Establecer y analizar desde el punto de vista económico cuales son los principales factores que inciden sobre las posibilidades laborales de la población en discapacidad. Conclusiones: la revisión permite identificar que las condiciones bajo las que viven las personas en discapacidad son desventajosas debido a prejuicios sociales, pero también por la ausencia de consideración expresa de los obstaculos que enfrentan para integrarse a todas las situaciones de la vida.

Disability prevalence around the world is a constant phenomenon. The World Health Organization and the World Bank state that 15% of the world population is affected by some kind of disability. Labor inclusion is one of the biggest obstacles that this population faces. This reality is clearly seen in aspects such as the possibility to have a job, and the way to make an income among others. These economic aspects are discussed most of the time by disciplines different from economics, resulting as a problem because of the poor attention given to this issue. Objective: To establish and analyze the main factors affecting employment possibilities among disable population. Conclusions: This work allows us to identify that people with disabilities face disadvantages due to social prejudices and also because of the lack of consideration they face when trying to integrate to everyday aspects.

A prevalência da deficiência em todo o mundo Ú um fenomeno persistente. A Organização Mundial de Saúde e o Banco Mundial dizem que 15% da população mundial sofre de algum tipo de deficiência. A inclusão laboral deste grupo populacional é um dos maiores obstaculos por eles enfrentados. Essa realidade é sentida por este grupo em muitos aspectos, como a probabilidade de emprego e a geração de renda, entre outros. Estes aspectos, de natureza economica, na maioria das vezes são abordados a partir de outras disciplinas diferentes da economia, caracterizando-os com um padrão assistencialista e pouco integral. Objetivo: Estabelecer e analisar, do ponto de vista economico, quais são os principais fatores que afetam o mundo laboral e a possibilidade de emprego da populção com deficiência. Conclusões: A avaliação permite reconhecer que as pessoas com deficiência estão em desvantagem por causa do preconceito social, mas também por não haver um reconhecimento explicito dos obstaculos que enfrentam para integrar-se a todos os aspectos da vida.

Identification of an immunogenic protein of Giardia lamblia using monoclonal antibodies generated from infected mice

The humoral immune response plays an important role in the clearance of Giardia lamblia. However, our knowledge about the specific antigens of G. lamblia that induce a protective immune response is limited. The purpose of this study was to identify and characterise the immunogenic proteins of G. lamblia in a mouse model. We generated monoclonal antibodies (moAbs) specific to G. lamblia (1B10, 2C9.D11, 3C10.E5, 3D10, 5G8.B5, 5F4, 4C7, 3C5 and 3C6) by fusing splenocytes derived from infected mice. Most of these moAbs recognised a band of ± 71 kDa (5G8 protein) and this protein was also recognised by serum from the infected mice. We found that the moAbs recognised conformational epitopes of the 5G8 protein and that this antigen is expressed on the cell surface and inside trophozoites. Additionally, antibodies specific to the 5G8 protein induced strong agglutination (> 70-90%) of trophozoites. We have thus identified a highly immunogenic antigen of G. lamblia that is recognised by the immune system of infected mice. In summary, this study describes the identification and partial characterisation of an immunogenic protein of G. lamblia. Additionally, we generated a panel of moAbs specific for this protein that will be useful for the biochemical and immunological characterisation of this immunologically interesting Giardia molecule.

Perfil de la demanda de servicios médicos en el Departamento de Santander, 2001-2007 / Profile of the demand for medical services in the Department of Santander, 2001-2007

En el presente documento se estudian las principales características de la demanda de servicios médicos en el Departamento de Santander. Para ello, se realiza un análisis descriptivo de las particularidades de la población del Departamento que demanda el servicio según afiliación, género, edad, ente otros. Los datos utilizados para el estudio, provienen básicamente de dos fuentes: el Registro Individual de Prestación de Servicios (RIPS) y las proyecciones de población 2005-2020, total departamentales y municipales, por sexo y grupos quinquenales de edad del Departamento Administrativo Nacional de Estadísticas - DANE. La unidad de análisis del presente estudio la constituyen los registros y no la población; la información disponible no permite centrar la atención sobre las personas atendidas. Los resultados indican que es necesario incorporar criterios que tengan en consideración aspectos como género, niñez o tercera edad, en el diseño de las políticas públicas de salud. De igual manera, es importante considerar los interrogantes de financiación de la red de salud de Santander, si se considera que en los últimos años las características de la consulta médica indican una mayor presión sobre el uso de los recursos asignados en el sector. [Viana RA, Navarro E. Perfil de la demanda de servicios médicos en el Departamento de Santander, 2001-2007. MedUNAB 2010; 13:85-94].

This paper explores the main characteristics of the demand for medical consultations in the department of Santander. To do this, performing a descriptive analysis of the characteristics of the population that demands the service department as affiliation, gender, age, body others. The data used for the study come primarily from two sources: the individual record or health services (RIPS) and population projections from 2005 to 2020, departmental and municipal total, by sex and five year age groups from the National Bureau of Statistics - DANE. The unit of analysis in this study was the records and not the population, the available information does not allow to focus on the people served. The results indicate a need to incorporate criteria regarding gender, children, and senior citizens in the design of public health policies. The results show that it is necessary to incorporate criteria regarding gender, children, and senior citizens in the design of public health policies. Similarly, it is important to consider the questions of financing of the health network of Santander, considering that in recent years, the pattern of medical consultation indicate greater pressure on the use of the resources allocated in the sector. [Viana RA, Navarro E. Health services demand profile in the department of Santander, 2001-2007. MedUNAB 2010; 13:85-94].