Changes in the Seroprevalence of Tick-Borne Rickettsia and Ehrlichia Among Soldiers-Fort Liberty, North Carolina, 1991-2019.

We obtained samples from the Department of Defense Serum Repository from soldiers who were stationed at Fort Liberty, North Carolina, between 1991 and 2019 to assess temporal trends in tick-borne rickettsiosis and ehrlichiosis. Serological evidence of infection was common, with nearly 1 in 5 (18.9%) demonstrating antibodies. We observed significant decreases in Rickettsia seroprevalence (adjusted odds ratio [aOR], 0.42 [95% CI, .27-.65], P = .0001) while over the same period Ehrlichia seroprevalence, albeit less common, nearly doubled (aOR, 3.61 [95% CI, 1.10-13.99], P = .048). The increase in Ehrlichia seroprevalence likely reflects increased transmission resulting from the expanding geographic range of the lone star tick.

Precision symptom phenotyping identifies early clinical and proteomic predictors of distinct COVID-19 sequelae.

BACKGROUND: Post-COVID conditions (PCC) are difficult to characterize, diagnose, predict, and treat due to overlapping symptoms and poorly understood pathology. Identifying inflammatory profiles may improve clinical prognostication and trial endpoints. METHODS: 1,988 SARS-CoV-2 positive U.S. Military Health System beneficiaries with quantitative post-COVID symptom scores were included in this analysis. Among participants who reported moderate-to-severe symptoms on surveys collected 6-months post-SARS-CoV-2 infection, principal component analysis (PCA) followed by K-means clustering identified distinct clusters of symptoms. RESULTS: Three symptom-based clusters were identified: a sensory cluster (loss of smell and/or taste), a fatigue/difficulty thinking cluster, and a difficulty breathing/exercise intolerance cluster. Individuals within the sensory cluster were all outpatients during their initial COVID-19 presentation. The difficulty breathing cluster had a higher likelihood of obesity and COVID-19 hospitalization compared to those with no/mild symptoms at 6-months post-infection. Multinomial regression linked early post-infection D-dimer and IL-1RA elevation to fatigue/difficulty thinking, and elevated ICAM-1 concentrations to sensory symptoms. CONCLUSIONS: We identified three distinct symptom-based PCC phenotypes with specific clinical risk factors and early post-infection inflammatory predictors. With further validation and characterization, this framework may allow more precise classification of PCC cases and potentially improve the diagnosis, prognostication, and treatment of PCC.

Exposome Signatures of Gastrointestinal Disorders Among Active Duty Service Members.

INTRODUCTION: We evaluated the risk factors associated with gastrointestinal disorders (GD) among the soldiers of the Army and Marine Aviation community (AMAC) using an exposomic approach. Specifically, we aimed to determine the medical and operational factors associated with reported GD in the Military Health System. METHODS: Longitudinal data were obtained from the Medical Assessment and Readiness System (MARS) housed at Womack Army Medical Center, Fort Liberty, NC, for a retrospective cohort study that included 79,249 active duty United States AMAC active duty service members (ADSMs) from October 2015 to December 2019. Multivariable mixed-effects logistic regression was used to assess the relationship between the incidence occurrence of GD and variables including rank, service time, deployment, Armed Forces Qualification Test score, education, tobacco use, alcohol use, age, gender, race, ethnicity, body mass index (BMI), and marital status. RESULTS: The incidence of GD included 22,813 person-years of observations with a rate of 2.2 per 100 person-years and a period prevalence of 3.2%. GD was independently associated with rank, service time, and deployment (all P < 0.05). CONCLUSION: The high-risk categories associated with GD in the AMAC included age, BMI, race (not ethnicity), marital status, and service time. Our data also show that deployment time, not geographical location, was associated with a higher risk of GD. Together, these analyses suggest that White ADSMs older than 33 years of age who have experienced marriage, longer service time, and deployments appear to have a higher risk of GDs. Our assessment shows the utility of using an exposomic approach to create a member-specific, big data-informed personalized clinical algorithm of health outcomes.

SARS-CoV-2 infection is associated with self-reported post-acute neuropsychological symptoms within six months of follow-up.

BACKGROUND: Chronic neuropsychological sequelae following SARS-CoV-2 infection, including depression, anxiety, fatigue, and general cognitive difficulties, are a major public health concern. Given the potential impact of long-term neuropsychological impairment, it is important to characterize the frequency and predictors of this post-infection phenotype. METHODS: The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal study assessing the impact of SARS-CoV-2 infection in U.S. Military Healthcare System (MHS) beneficiaries, i.e. those eligible for care in the MHS including active duty servicemembers, dependents, and retirees. Four broad areas of neuropsychological symptoms were assessed cross-sectionally among subjects 1-6 months post-infection/enrollment, including: depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), fatigue (PROMIS® Fatigue 7a), and cognitive function (PROMIS® Cognitive Function 8a and PROMIS® Cognitive Function abilities 8a). Multivariable Poisson regression models compared participants with and without SARS-CoV-2 infection history on these measures, adjusting for sex, ethnicity, active-duty status, age, and months post-first positive or enrollment of questionnaire completion (MPFP/E); models for fatigue and cognitive function were also adjusted for depression and anxiety scores. RESULTS: The study population included 2383 participants who completed all five instruments within six MPFP/E, of whom 687 (28.8%) had at least one positive SARS-CoV-2 test. Compared to those who had never tested positive for SARS-CoV-2, the positive group was more likely to meet instrument-based criteria for depression (15.4% vs 10.3%, p<0.001), fatigue (20.1% vs 8.0%, p<0.001), impaired cognitive function (15.7% vs 8.6%, p<0.001), and impaired cognitive function abilities (24.3% vs 16.3%, p<0.001). In multivariable models, SARS-CoV-2 positive participants, assessed at an average of 2.7 months after infection, had increased risk of moderate to severe depression (RR: 1.44, 95% CI 1.12-1.84), fatigue (RR: 2.07, 95% CI 1.62-2.65), impaired cognitive function (RR: 1.64, 95% CI 1.27-2.11), and impaired cognitive function abilities (RR: 1.41, 95% CI 1.15-1.71); MPFP/E was not significant. CONCLUSIONS: Participants with a history of SARS-CoV-2 infection were up to twice as likely to report cognitive impairment and fatigue as the group without prior SARS-CoV-2 infection. These findings underscore the continued importance of preventing SARS-CoV-2 infection and while time since infection/enrollment was not significant through 6 months of follow-up, this highlights the need for additional research into the long-term impacts of COVID-19 to mitigate and reverse these neuropsychological outcomes.

Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study.

Background: The long-term effects of coronavirus disease 2019 (COVID-19) on physical fitness are unclear, and the impact of vaccination on that relationship is uncertain. Methods: We compared survey responses in a 1-year study of US military service members with (n = 1923) and without (n = 1591) a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We fit Poisson regression models to estimate the association between history of SARS-CoV-2 infection and fitness impairment, adjusting for time since infection, demographics, and baseline health. Results: The participants in this analysis were primarily young adults aged 18-39 years (75%), and 71.5% were male. Participants with a history of SARS-CoV-2 infection were more likely to report difficulty exercising (38.7% vs 18.4%; P < .01), difficulty performing daily activities (30.4% vs 12.7%; P < .01), and decreased fitness test (FT) scores (42.7% vs 26.2%; P < .01) than those without a history of infection. SARS-CoV-2-infected participants were at higher risk of these outcomes after adjusting for other factors (unvaccinated: exercising: adjusted risk ratio [aRR], 3.99; 95% CI, 3.36-4.73; activities: aRR, 5.02; 95% CI, 4.09-6.16; FT affected: aRR, 2.55; 95% CI, 2.19-2.98). Among SARS-CoV-2-positive participants, full vaccination before infection was associated with a lower risk of post-COVID-19 fitness impairment (fully vaccinated: exercise: aRR, 0.81; 95% CI, 0.70-0.95; activities: aRR, 0.76; 95% CI, 0.64-0.91; FT: aRR, 0.87; 95% CI, 0.76-1.00; boosted: exercise: aRR, 0.62; 95% CI, 0.51-0.74; activities: aRR, 0.52; 95% CI, 0.41-0.65; FT: aRR, 0.59; 95% CI, 0.49-0.70). Conclusions: In this study of generally young, healthy military service members, SARS-CoV-2 infection was associated with lower self-reported fitness and exercise capacity; vaccination and boosting were associated with lower risk of self-reported fitness loss.

Homicidios de niños, niñas y adolescentes en Colombia durante 2010-2020

Introducción: Los derechos de los niños, niñas y adolescentes prevalecen sobre los derechos de los demás. Sin embargo, países de ingreso medio como Colombia tienen una alta tasa de homicidios para este grupo poblacional, esto deja en evidencia que la sociedad no es capaz de proteger efectivamente su derecho fundamental a la vida. Objetivo: Describir la tendencia de los homicidios de los niños, niñas y adolescentes en Colombia para el periodo 2010-2020. Materiales y métodos: Se utilizaron los microdatos anonimizados de las defunciones no fetales de las estadísticas vitales del DANE y calcularon las tasas de homicidios para los menores de 19 años. Resultados: Durante el periodo analizado, los homicidios de los niñas, niñas y adolescentes en Colombia se redujeron, al pasar de 2485 en el año 2010 a 1360 en el 2020. Discusión: Los resultados de este trabajo muestran que los homicidios tienen diferencias significativas por grupo de edad, sexo y departamento, las cuales tienen determinantes que las explican, pero que es necesario abordar a profundidad en posteriores investigaciones. Conclusiones: Es indispensable seguir con esta tendencia decreciente para lograr garantizar el derecho a la vida de este grupo poblacional.

Introduction: The rights of children and adolescents prevail over others. However, middle-income countries such as Colombia have a high homicide rate for this population group, showing that society is not able to effectively protect their fundamental right to life. Objective: To describe the trend of homicides of children and adolescents in Colombia for the period 2010-2020. Materials and methods: We used anonymized microdata of non-fetal deaths from DANE vital statistics and calculated homicide rates for children under 19 years of age. Outcomes: During the period analyzed, homicides of children and adolescents in Colombia decreased from 2485 in 2010 to 1360 in 2020. Discussion: The results of this study show homicides have significant differences by age group, sex, and department, which have determinants that describe them but need to be addressed in depth in further research. Conclusions: It is essential to continue with this decreasing trend to guarantee the right to life for this population group.

Performance Evaluation of Biomedical Time Series Transformation Methods for Classification Tasks / Evaluación del Rendimiento de Métodos de Transformación de Series Temporales Biomédicas para Tareas de Clasificación

Abstract The extraction of time series features is essential across various fields, yet it remains a challenging endeavor. Therefore, it's crucial to identify appropriate methods capable of extracting pertinent information that can significantly enhance classification performance. Among these methods are those that translate time series into different domains. This study investigates three distinct time series transformation approaches for addressing time series classification challenges within biomedical data. The first method involves a response vector transformation, while the other two employ image transformation techniques: RandOm Convolutional KErnel Transform (ROCKET), Gramian Angular Fields, and Markov Transition Fields. These transformation methods were applied to five biomedical datasets, exploring various format configurations to ascertain the optimal representation technique and configuration for input, which in turn improves classification performance. Evaluations were conducted on the effectiveness of these methods in conjunction with two classification algorithms. The outcomes underscore the significance of these time series transformation techniques as facilitators for enhanced classification algorithms documented in current literature.

Resumen La extracción de características de series temporales es esencial en diversos campos, pero sigue siendo un desafío. Por lo tanto, es crucial identificar métodos apropiados capaces de extraer información pertinente que pueda mejorar significativamente el rendimiento de clasificación. Entre estos métodos se encuentran aquellos que traducen las series temporales a diferentes dominios. Este estudio investiga tres enfoques distintos de transformación de series temporales para abordar los desafíos de clasificación de series temporales en datos biomédicos. El primer método implica una transformación de vector de respuesta, mientras que los otros dos emplean técnicas de transformación de imagen: RandOm Convolutional KErnel Transform (ROCKET), Gramian Angular Fields y Markov Transition Fields. Estos métodos de transformación se aplicaron a cinco conjuntos de datos biomédicos, explorando diversas configuraciones de formato para determinar la técnica y configuración de representación óptima para la entrada, lo que a su vez mejora el rendimiento de clasificación. Se realizaron evaluaciones sobre la efectividad de estos métodos en conjunción con dos algoritmos de clasificación. Los resultados subrayan la importancia de estas técnicas de transformación de series temporales como facilitadoras para mejorar los algoritmos de clasificación documentados en la literatura actual.

Death and Complexity / Muerte y complejidad / Morte e complexidade

Abstract: There is no such thing as a science of death, although there is a science of life, as it happens. Death is not so much the subject matter of science but an experience, and death experiences we find abundantly in the literature. Now, experience is told not so much in a scientific tenure but as a narrative. Within the framework of bioethics, death comes closer, particularly what is usually known as end-of-life dilemmas, i.e., palliative care, a most sensitive arena, if there is any at all. This paper argues about the interplay or dialogue between death and complexity science. It claims that the knowledge of death is truly the knowledge of life and provides three arguments that lead to the central claim. The first argument is very much close to a kind of heuristic for knowing about death, while the second shows the challenge of knowing death. The third one consists of a reappraisal of death within an extensive cultural or civilizing framework. Lastly, some open-ended conclusions are drawn.

Resumen: No existe cosa tal como una ciencia de la muerte, sin embargo si existe una ciencia de la vida, por suerte. La muerte no se trata de un asunto de ciencia sino de una experiencia, y experiencias de muerte abundan en la literatura. De hecho, la experiencia se cuenta no tanto en un tono científico sino más bien como una narrativa. Dentro del marco de la bioética, la muerte se aborda de una manera más cercana, particularmente en los que se conocen como dilemas del fin de la vida, por ejemplo, el cuidado paliativo, una arena muy sensible, si es que la hay. Este artículo discute sobre la interacción o el diálogo entre la muerte y la ciencia de la complejidad. Afirma que el conocimiento de la muerte en verdad es el conocimiento de la vida y da tres argumentos que llevan a esta afirmación central. El primer argumento es muy cercano a un tipo de heurística por conocer acerca de la muerte, mientras que el segundo expone el reto de conocer la muerte. El tercero consiste en una revaluación de la muerte dentro de un amplio marco cultural o civilizador. Por último, se esbozan algunas conclusiones abiertas.

Resumo: Não existe uma ciência da morte como tal, contudo sim existe uma ciência da vida. A morte não se trata de um assunto de ciência, mas sim de uma experiência, e experiências de morte abundam na literatura. De fato, a experiência se conta não tanto em um tom científico, mas sim como uma narrativa. No âmbito da bioética, a morte é abordada de uma maneira mais íntima, particularmente no que se conhece como "dilemas do fim da vida", por exemplo, no cuidado paliativo, uma arena muito sensível, sim é que a há. Neste artigo, discute-se sobre a interação ou o diálogo entre a morte e a ciência da complexidade. Afirma-se que o conhecimento da morte em verdade é o conhecimento da vida e são apresentados três argumentos que levam a essa afirmação central. O primeiro argumento é muito próximo de um tipo de heurística por conhecer sobre a morte, enquanto o segundo expõe o desafio de conhecer a morte. O terceiro consiste em uma reavaliação da morte dentro de um amplo referencial cultural ou civilizador. Por último, são esboçadas algumas conclusões abertas.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

resumen está disponible en el texto completo

Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Presentaciones atípicas de COVID-19: Serie de casos / COVID-19 atypical presentations: Case series

Resumen El objetivo del presente trabajo fue presentar una serie de casos de COVID-19 con manifestaciones atípicas de la enfermedad. Los casos fueron atendidos por un equipo interdisciplinario de personal de la salud de una clínica de cuarto nivel en Barranquilla, Colombia, y posteriormente los investigadores tomaron los datos de las historias clínicas. Se evaluaron tres casos: el primero tuvo evolución tórpida y coinfección con virus de la influenza H1N1 y los otros dos, manifestaciones gastrointestinales como debut de la enfermedad; todos tuvieron desenlace satisfactorio. La pandemia por SARS-CoV-2 cada día cobra más vidas, por lo que para identificar oportunamente a los infectados y tomar medidas tanto terapéuticas como de prevención y así evitar la propagación de la enfermedad y lograr su control, es necesario realizar reportes de caso en donde se evidencie la diversa variedad de presentaciones de COVID-19.

Abstract The objective of this work is to present a series of cases of COVID-19 with atypical manifestations of the disease. The cases were evaluated by an interdisciplinary team of health personnel from a fourth-level clinic in Barranquilla, Colombia, and the data was subsequently taken from the clinical history of each patient. Three cases were evaluated, initially the first case with torpid evolution, coinfection with H1N1 influenza virus, however, with satisfactory outcome, and cases two and three with gastrointestinal manifestations as disease debut, with satisfactory evolution. The SARS-CoV-2 pandemic takes more lives every day, so it is necessary to describe the cases and their diverse variety of presentation, to identify the infected and take both therapeutic and preventive measures. To prevent the spread of the disease and achieve its control.

Seis tesis sobre complejidad y salud / Six thesis about complexity and health

La bibliografía sobre complejidad y medicina es amplia, sólida y creciente. Por ejemplo, cáncer y complejidad, o el funcionamiento del sistema nervioso central y complejidad, o el sistema inmunológico y complejidad. Sin embargo, en contraste, comparativamen-te, la bibliografía en el mundo sobre salud y complejidad es sumamente escasa.En este texto quisiera formular seis tesis acerca de salud, esto es, acerca de las re-laciones entre salud y vida, en fin, en otras palabras, en torno a las relaciones entre salud y complejidad. Se trata, simple y llanamente de ampliar los marcos de las puertas que conducen a pensar la salud ­ la salud, la vida, y no ya única y principalmente la enfermedad. Complejidad hace aquí referencia a las ciencias de la complejidad y no simplemente al pensamiento complejo.

Complejidad y salud pública. Marcos, problemas, referencias / Complexity and public health. Frames, problems, references / Complexidade e saúde pública, marcos, problemas, referências

Este artículo consiste en la formulación de una tesis: debemos poder pen-sar la salud, y no simplemente la enfermedad. Para ello, se presentan y discuten brevemente las diferentes revoluciones científicas habidas en la historia, conjuntamente con las revoluciones industriales. El artículo sus-tenta que es tan sólo en el marco de la tercera revolución científica en curso, que es posible y necesario pensar, por primera vez, en salud. Pues bien, la salud, se sostiene aquí, es información, de suerte que una política de salud y un manejo de la salud son manejo de información: por qué razón y cómo es lo que se estudia en el curso del texto.

This paper sets out the claim according to which it must be possible to think about health, and not any longer abut disease or sickness. In order to do so, the various scientific and industrial revolutions are briefly presented and discussed. This paper argues that it is only within the framework of the ongoing third scientific revolutions that it becomes feasible and necessary to think about health. To be sure, health is information, so much so that any policy and management of health follows thereafter. Why and how this is so will be elaborated along the following lines

Este artigo visa formular a seguinte tese: devemos poder pensar a saúde para além da doença. Visando aprofundar nesta dis-cussão são apresentadas e debatidas brevemente as diferentes revoluções industriais. O artigo afirma que é apenas na terceira revolução científica em curso, que é possível e se fez necessá-rio pensar, pela primeira vez, na saúde. Se bem que a saúde se define como informação, uma política de saúde supõe lidar com informação. O porquê e o como são objeto do presen-te texto.

Cierre de ruptura del seno de Valsalva no coronariano con dispositivo de Amplatzer asociado a implante de válvula aórtica transcateterismo / Amplatzer device closure of a ruptured sinus of Valsalva aneurysm associated with a transcatheter aortic valve implant

Resumen Objetivo: Reportar un caso de implante de cierre de ruptura del seno de Valsalva e implante de válvula aórtica transcateterismo. Material y métodos: Paciente femenina de 82 años, con diagnóstico de estenosis valvular aórtica severa asociada con ruptura del seno de Valsalva no coronariano a la aurícula derecha e hipertensión arterial pulmonar severa, en quien, por sus comorbilidades, se decidió efectuar cierre percutáneo de la ruptura del seno de Valsalva con dispositivo de Amplatzer y posterior implante de válvula aórtica por cateterismo. Resultados: Se realiza procedimiento percutáneo de implante del dispositivo de cierre Amplatzer VSD Occluder de 8 mm sellando la ruptura del seno de Valsalva no coronariano. En segundo tiempo se realiza procedimiento de Implante de válvula aórtica transcateterismo vía femoral derecha. Se corrobora su adecuada implantación mediante angiografía y ecocardiograma transesofágico. Se considera exitoso el procedimiento ya que se implantaron ambos dispositivos en forma rápida, adecuada y sin complicaciones. Conclusiones: Se reporta un caso de cierre de ruptura de seno coronario con dispositivo Amplatzer e implante de prótesis aórtica transcateterismo.

Abstract Objective: To report the case of an implant for the closure of a Valsalva sinus rupture and implantation of a transcatheter aortic valve. Material and methods: An 82 year-old female patient, with a diagnosis of severe aortic valve stenosis associated with a non-coronary rupture of the sinus of Valsalva, at the right atrium, as well as severe pulmonary arterial hypertension. Due to her comorbidities, it was decided to perform a percutaneous closure of the sinus of Valsalva rupture with an Amplatzer device, and a subsequent aortic valve implantation by catheterisation. Results: A percutaneous procedure was performed by implanting an 8 mmAmplatzer VSD Occluder device, sealing the non-coronary rupture of the sinus of Valsalva. In a second time, an aortic valve was implanted using transcatheterisation via the right femoral artery. It was checked that it was appropriately implanted using angiography and a transoesophageal echocardiogram. The procedure was considered successful, since both devices could be implanted rapidly, adequately, and with no complications. Conclusions: The case is reported of the closure of the sinus of Valsalva rupture with an Amplatzer device and the transcatheterisation implantation of an aortic valve.

Definición de nanomateriales para Colombia / Definition of Nanomateriais for Colombia / Definição de nanomateriais para a Colômbia

Debido a la creciente producción y uso de nanomateriales para actividades de investigación y desarrollo en Colombia, es necesario establecer una definición del término nanomaterial que facilite la toma de decisiones en torno a iniciativas de carácter regulatorio y de normatividad. Se presenta la definición de nanomateriales para Colombia que ha adoptado el Consejo Nacional Asesor de Nanociencia y Nanotecnología adscrito a la Red Colombiana de Nanociencia y Nanotecnología.

Due to the increasing production and use of nanomaterials in research and development activities in Colombia, it is necessary to define the nanomaterial term in order to facilitate decision-making process regarding initiatives with a regulatory or normative character. This article presents the nanomaterials definition that has been adopted by the National Advisory Council for Nanoscience and Nanotechnology, a Colombian Network of Nanoscience and Nanotechnology.

Dada a crescente produção e utilização de nanomateriais para a pesquisa e desenvolvimiento na Colombia, é urgente estabelecer uma definição do termo de nanomaterial para facilitar a tomada de decisão sobre iniciativas na regulamentação e as leis. É apresentada uma definição de nanomateriais para a Colombia que aprovou o Conselho Consultivo Nacional de Nanociência e Nanotecnologia ligado à Rede Colombiana de Nanociência e Nanotecnologia.

Caracterización clínico-radiológica y exploración de asociación entre el éxito terapéutico y edad en pacientes sometidos a pancreatocolangiografía retrógrada endoscópica en un hospital de tercer nivel de los años 2008 al 2014 en Lima-Perú / Clinical-radiological characteristics and explore the association between therapeutic success in patients undergoing ERCP and age in Cayetano Heredia Hospital, Lima, Peru

Comparar características clínico-radiológicas y explorar la asociación entre el éxito terapéutico y edad en pacientes sometidos a CPRE en el Hospital Cayetano Heredia, Lima, Perú. Materiales y métodos: Estudio retrospectivo, descriptivo basado en la revisión de registros de pacientes sometidos a CPRE durante los años 2008 al 2014. Estos se dividieron en dos grupos: mayor o igual a 60 años (grupo 1) y menores de 60 años (grupo 2). Se documentaron las indicaciones de CPRE, hallazgo radiológico, éxito terapéutico, diagnóstico posterior a la CPRE y complicaciones. Resultados: Se revisaron un total de 450 registros, el grupo 1 compuesto de 164 y el grupo 2 de 286 pacientes. La indicación de CPRE más frecuente fue certeza de colédoco-litiasis y el hallazgo radiológico más frecuente fue dilatación de la vía biliar (p=0,155). El diagnóstico más común fue colédoco-litiasis a predominio del grupo 2. Se logró una limpieza completa de la vía biliar en 185 (78,75%) pacientes con diagnóstico de coledocolitiasis, a predominio del grupo 2 (p=0,008) (OR=0,46; IC95%: 0,25-0,87). La complicación más frecuente fue pancreatitis (p=0,01). Conclusiones: Colédoco-litiasis y pancreatitis fueron el diagnóstico y la complicación más frecuente. Encontramos que el éxito terapéutico en los pacientes que presentaron coledocolitiasis está asociado a una edad menor de 60 años...

To compare the clinical-radiological characteristics and explore the association between therapeutic success in patients undergoing ERCP and age in Cayetano Heredia Hospital, Lima, Peru. Materials and methods: Retrospective, descriptive study based on the review of records of patients undergoing ERCP between the years 2008 to 2014. These were divided into two groups: greater than or equal to 60 years (group 1) and less than 60 years (group 2). Indications of ERCP, radiological finding, therapeutic success, diagnostic and complications were documented. Results: A total of 450 patients were studied, the group 1 consisting of 164 and group 2 of 286 patients. The most frequent indication for ERCP in both groups was choledocholithiasis. The most common radiological finding in both groups was bile duct dilatation (p=0.155). The most common diagnosis was choledocholithiasis in both groups, predominantly in group 2. We achieved a complete cleaning of the bile duct in 185(78.75%) patients with choledocholithiasis, finding more patients in group 2 (p=0.008) (OR=0.46; CI 95%: 0.25-0.87). The most frequent complication was pancreatitis in both groups (p=0.01). Conclusions: Choledocholithiasis and pancreatitis were the diagnosis and the most frequent complication. We found that the therapeutic success in patients who presented choledocholithiasis is associated with an age less than 60 years...

Embolectomía pulmonar y bypass cardiopulmonar durante el embarazo / Pulmonary embolectomy and cardiopulmonary bypass during pregnancy

La cirugía cardiaca con circulación extracorpórea en pacientes obstétricas representa un capítulo especial, debido a los cambios fisiológicos producidos por el embarazo y factores como el manejo anestésico, la monitorización y la perfusión durante el bypass cardiopulmonar que se producen sobre el binomio madre-feto, organismos en situaciones diferentes y con intereses opuestos. Describimos el manejo anestésico de una paciente de 26,2 semanas de embarazo con un tromboembolismo pulmonar y trombo auricular adherido a catéter central con comunicación interauricular.

Cardiac surgery with extracorporeal circulation in obstetric patients is a separate chapter because of the physiological changes brought about by pregnancy and factors such as anesthetic management, monitoring and perfusion during the cardiopulmonary bypass that affects both the mother and the child; both experience different circumstances and have dissimilar interests. The paper discusses the anesthetic management of a patient in her 26.2weeks of gestation with a pulmonary thromboembolism and atrial intracavitary thrombus attached to the central catheter with atrial septal defect.

Crisis de la bioética y bioética en medio de las crisis / Crisis of bioethics and bioethics in the midst of crises / Crise da bioética e a bioética no meio da crise

Bioethics is currently in the midst of a deep crisis. A review of the state-of-the art clealry shows that the discipline has been encountering a number of hurdels both in its social significance as well as in its scientific and epistemological concern. Simultaneously, human living and societies are living a number of intertwined crises all around. This paper argues that both phenomena are deeply related and studies the reasons and consequences...

La bioética se encuentra actualmente en medio de una profunda crisis. Una revisión del estado del arte muestra que esta disciplina ha venido encontrando una serie de obstáculos tanto con respecto a su significado social como con respecto a su propio estatuto científico y epistemológico. Al mismo tiempo, los seres humanos y las sociedades se encuentran inmersas en una serie de crisis entrelazadas entre sí. Este artículo sostiene que ambos fenómenos se hallan profundamente relacionados y estudia las razones y las consecuencias de ello...

Atualmente a Bioética se encontra dentro de uma profunda crise. Uma revisão do estado da arte mostra que esta disciplina vem encontrando uma série de obstáculos, tanto em relação ao seu significado social como em relação ao seu próprio estatuto científico e epistemológico. Ao mesmo tempo, os seres humanos e as sociedades estão imersos em uma série de crises interligadas entre si. Este artigo sustenta que ambos os fenômenos se encontram profundamente relacionados e estuda os motivos e consequências disso...

Ética sin metafísica: ¿y la bioética qué? / Ética sem metafísica: e o que acontece com a bioética? / Ethics wihout metaphysics: and what about bioethiscs?

La filosofía ha asistido a un proceso largo mediante el cual numerosas disciplinas se han independizado de ella, tales como la estética, la lógica, y la historia. Prácticamente todas las disciplinas tradicionales que alguna vez pertenecieron a la filosofía se han convertido actualmente en ciencias o disciplinas independientes. Sin embargo, el único campo que permanece al interior de la filosofía es la ética o la moral. El resultado es que la ética o la moral cumplen las veces de la metafísica. Este artículo argumenta a favor de la posibilidad de una ética sin metafísica. Al final, surge la pregunta: si ello es así, ¿qué sucede entonces con la bioética? La razón que motiva este interrogante tiene que ver con las relaciones intrínsecas entre ética y bioética...

Philosophy has been watching for a while how various disciplines have become independent from her, namely aesthetics, logics, history. Nearly all traditional disciplines that once belonged to philosophy are nowadays a sciences or a discipline on its own. Yet, the only one that still remains within philosophy is ethics, i.e. morality. The outcome is that ethics, i. e. morality is pervaded by metaphysics. This paper claims for the possibility of an ethics without metaphysics. At the end, the question is raised: if so, what about biothics? The reason that motivates the question has to do with the inner relationships between ethics and bioethics...

A filosofia tem assistido um longo processo através do qual inúmeras disciplinas dela se independizaram, tais como, a estética, a lógica, a história. Praticamente todas as disciplinas tradicionais, que alguma vez pertenceram à filosofia, são hoje ciências ou disciplinas independentes. Entretanto, o único campo que permanece dentro da filosofia é o da ética ou moral. O resultado é que a ética ou a moral cumprem as vezes da metafísica. Este artigo argumenta a favor da possibilidade de uma ética sem metafísica. No final, surge a pergunta: se é assim, o que acontece então com a bioética? A razão que motiva esta pergunta tem a ver com as relações intrínsecas entre ética e bioética...

Costos directos e impacto sobre la morbimortalidad hospitalariade eventos adversos prevenibles a medicamentosen una institución de tercer nivel de Bogotá / Direct costs and impact on hospital morbidity and mortality of preventable adverse drug events in a tertiary institution in Bogota

Introducción. La implementación de actividades de farmacovigilancia permite supervisar y evaluar aspectos relacionados con la atención médica. Es necesario que la información recolectada permita identificar oportunidades para mejorar la calidad de la atención en salud. Se propone un análisis de los eventos adversos a medicamentos desde la óptica preventiva y económica, estableciendo su impacto local.Objetivo. Determinar el porcentaje de eventos adversos prevenibles a medicamentos, reportados en una institución de tercer nivel, para establecer su impacto sobre la morbimortalidad y el económico desde la óptica del pagador y mostrando la relevancia de usar un método que permita identificarlos y evitar o disminuir su presentación. Materiales y métodos. A partir de los reportes generados durante actividades de farmacovigilancia en el año 2007 en un hospital de tercer nivel de Bogotá, se revisaron las historias clínicas de los pacientes involucrados y se evaluó la relación de causalidad, la gravedad y el carácter prevenible de los eventos adversos a medicamentos. Se calcularon los costos directos generados, agrupándolos en pruebas diagnósticas, tiempo de estancia adicional, procedimientos y medicamentos adicionales. Resultados. Se revisaron 448 reportes de eventos adversos a medicamentos en 283 pacientes y se encontró que 24,8 % de los eventos reportados eran prevenibles, con mortalidad de 1,1 % y costos totales asociados con su atención entre $ 33´620.346 (US$ 16.687) y $ 37´754.856 (US$ 18.739). Los factores más frecuentemente asociados con la prevención fueron las interacciones farmacológicas y las dosis o frecuencias inadecuadas de administración.Conclusiones. Es importante tomar medidas tendientes a disminuir la presentación de eventos adversos prevenibles a medicamentos, ya que repercuten negativamente tanto sobre la salud de los pacientes, como en el consumo de recursos.

Introduction. Implementing pharmacovigilance activities consists of monitoring and assessment of activities related to medical attention. However, additional data are necessary to identify conditions where care quality can be improved. Therefore, a focus on adverse drug events analysis from a prevention and economic perspective is needed, with emphasis on its local impact.Objective. Preventable adverse drug events were summarized to establishing their impact on morbidity and mortality, as well as to estimate the ensuing economic burden. Materials and methods. The data were gathered from a level 3 hospital (high complexity), located in Bogotá, Colombia, where specific pharmacovigilance activities were recorded in 2007. Patient charts were reviewed to characterize adverse drug events according to their causality, severity and preventability. Direct costs were estimated by grouping diagnostic tests, length of hospitalization, procedures and additional drugs required. Results. The charts of 283 patients and 448 reports were analyzed. These data indicated that 24.8% of adverse drug events were preventable and that an associated mortality of 1.1% had occurred. The associated direct costs were between USD $16,687 and $18,739. Factors more commonly associated with preventability were drug-drug interactions, as well as inappropriate doses and unsuitable frequencies at which the drugs were administrated. Conclusions. The data recommended that actions be taken to decrease preventable adverse drug events, because of negative impact on patient’s health, and unnecessary consumption of healthcare resources.

El impacto biológico de los autoinductores bacterianos / The biological impact of bacterial autoinducers

Las bacterias, a pesar de ser organismos unicelulares, presentan una gran complejidad. Durante mucho tiempo fueron consideradas como organismos asociales cuyas funciones principales eran el nutrirse y el reproducirse. Sin embargo, se ha observado que las bacterias son los microorganismos con la mayor capacidad de adaptación a ambientes diversos, además responden a múltiples estímulos, tanto nutricionales como ambientales (pH, disponibilidad de oxígeno, osmolaridad, etc.). En las últimas décadas se ha reportado que tanto las bacterias grampositivas como las gramnegativas son capaces de comunicarse entre si mediante sistemas especializados de comunicación celular. A tales sistemas se les ha denominado “sistemas de señalización” y “autoinductores” a las moléculas señal que desencadenan diferentes respuestas celulares, como la formación de biopelículas, la transformación bacteriana, la producción de bioluminiscencia, la producción de antibióticos o de factores de virulencia, entre otras. En este trabajo se presentan los aspectos más relevantes relacionados a los autoinductores de bacterias grampositivas y gramnegativas, así como su participación en diferentes procesos biológicos.

Bacteria, in spite of being unicellular organisms, present great complexity. During a long time they were considered as asocial organisms whose main functions were feeding and reproducing. Nevertheless, it has been observed that bacteria are the microorganisms with the greatest capacity for adapting to diverse environments, also responding to multiple stimuli, both nutritional and environmental (pH, oxygen availability, osmolarity, etc.). During the last decades it has been reported that bacteria, both gram negative and gram positive, are capable of communicating among them through specialized cell-communication systems. These systems have been called “signaling systems” and the signaling molecules which unchain the various cell responses such as biofilm formation, bacterial transformation, luminescence production, antibiotic production, or virulence factor production, among others, have been called “autoinducers”. This paper presents the most relevant aspects related with gram positive and gram negative bacteria autoinducers, as well as their participation in different biological processes.