Potential present and future distributions of the genus Atta of Mexico.

Temperature and precipitation influence insect distribution locally and drive large-scale biogeographical patterns. We used current and future climate data from the CHELSA database to create ensemble species distribution models for three Atta leaf-cutting ant species (Atta cephalotes, A. mexicana, and A. texana) found in Mexico. These models were used to estimate the potential impact of climate change on the distribution of these species in the future. Our results show that bioclimatic variables influence the distribution of each Atta species occupying a unique climatic niche: A. cephalotes is affected by temperature seasonality, A. mexicana by isothermality, and A. texana by the minimum temperature of the coldest month. Atta texana and A. mexicana are expected to decline their range by 80% and 60%, respectively, due to rising temperatures, decreased rainfall, and increased drought. Due to rising temperatures and increased humidity, Atta cephalotes is expected to expand its range by 30%. Since Atta species are important pests, our coexistence with them requires knowledge of their ecological functions and potential future distribution changes. In addition, these insects serve as bioindicators of habitat quality, and they can contribute to the local economy in rural areas since they are eaten as food for the nutritional value of the queens. In this sense, presenting a future perspective of these species' distribution is important for forest and crop management. Education programs also are necessary to raise awareness of the importance of these ants and the challenges they face because of climate change. Our results offer a perspective of climate change studies to define conservation and adaptation strategies for protecting vulnerable areas such as high-elevation remnant forests.

New patch-based strategy for COVID-19 automatic identification using chest x-ray images.

Purpose: The development of a robust model for automatic identification of COVID-19 based on chest x-rays has been a widely addressed topic over the last couple of years; however, the scarcity of good quality images sets, and their limited size, have proven to be an important obstacle to obtain reliable models. In fact, models proposed so far have suffered from over-fitting erroneous features instead of learning lung features, a phenomenon known as shortcut learning. In this research, a new image classification methodology is proposed that attempts to mitigate this problem. Methods: To this end, annotation by expert radiologists of a set of images was performed. The lung region was then segmented and a new classification strategy based on a patch partitioning that improves the resolution of the convolution neural network is proposed. In addition, a set of native images, used as an external evaluation set, is released. Results: The best results were obtained for the 6-patch splitting variant with 0.887 accuracy, 0.85 recall and 0.848 F1score on the external validation set. Conclusion: The results show that the proposed new strategy maintains similar values between internal and external validation, which gives our model generalization power, making it available for use in hospital settings. Supplementary Information: The online version contains supplementary material available at 10.1007/s12553-022-00704-4.

Pharmacokinetics and Pharmacodynamics of Cefepime in Adults with Hematological Malignancies and Febrile Neutropenia after Chemotherapy.

Patients with chemotherapy-induced febrile neutropenia (CIFN) may have changes in the pharmacokinetics (PK) compared to patients without malignancies or neutropenia. Those changes in antibiotic PK could lead to negative outcomes for patients if the therapy is not adequately adjusted to this. In this, open-label, non-randomized, prospective, observational, and descriptive study, a PK model of cefepime was developed for patients with hematological neoplasms and post-chemotherapy febrile neutropenia. This study was conducted at a cancer referral center, and study participants were receiving 2 g IV doses of cefepime every 8 h as 30-min infusions. Cefepime PK was well described by a two compartment model with a clearance dependent on a serum creatinine level. Using Monte Carlo simulations, it was shown that continuous infusions of 6g q24h could have a good achievement of PK/PD targets for MIC levels below the resistance cut-off point of Enterobacteriaceae. According to the simulations, it is unnecessary to increase the daily dose of cefepime (above 6 g daily) to increase the probability of target attainment (PTA). Cumulative fraction of response (CFR) using interment dosing was suboptimal for empirical therapy regimens against K. pneumoniae and P. aeruginosa, and continuous infusions could be used in this setting to maximize exposure. Patients with high serum creatinine levels were more likely to achieve predefined PK/PD targets than patients with low levels.

Enhanced Mathematical Model for Producing Highly Dense Metallic Components through Selective Laser Melting.

In this work, a previously developed mathematical model to predict bulk density of SLMed (produced via Selective Laser Melting) component is enhanced by taking laser power, scanning speed, hatch spacing, powder's thermal conductivity and specific heat capacity as independent variables. Experimental data and manufacturing conditions for the selective laser melting (SLM) of metallic materials (which include aluminum, steel, titanium, copper, tungsten and nickel alloys) are adapted from the literature and used to evaluate the validity of the proposed enhanced model. A strong relation between dependent and independent dimensionless products is observed throughout the studied materials. The proposed enhanced mathematical model shows to be highly accurate since the computed root-mean-square-error values (RMSE) does not exceed 5 × 10-7. Furthermore, an analytical expression for the prediction of bulk density of SLMed components was developed. From this, an expression for determining the needed scanning speed, with respect to laser power, to achieve highly dense components produced via SLM, is derived.

A Mathematical Dimensional Model for Predicting Bulk Density of Inconel 718 Parts Produced by Selective Laser Melting.

In this work, dimensional analysis is used to develop a general mathematical model to predict bulk density of SLMed components taking volumetric energy density, scanning speed, powder's thermal conductivity, specific heat capacity, and average grain diameter as independent variables. Strong relation between dependent and independent dimensionless products is observed. Inconel 718 samples were additively manufactured and a particular expression, in the form of a power-law polynomial, for its bulk density, in the working domain of the independent dimensionless product, was obtained. It is found that with longer laser exposure time, and lower scanning speed, better densification is attained. Likewise, volumetric energy density has a positive influence on bulk density. The negative effect of laser power in bulk density is attributed to improper process conditions leading to powder particle sublimation and ejection. A maximum error percentage between experimental and predicted bulk density of 3.7119% is achieved, which corroborates the accuracy of our proposed model. A general expression for determining the scanning speed, with respect to laser power, needed to achieve highly dense components, was derived. The model's applicability was further validated considering SLMed samples produced by AlSi10Mg and Ti6Al4V alloys. This article elucidates how to tune relevant manufacturing parameters to produce highly dense SLM parts using mathematical expressions derived from Buckingham's π- theorem.

The necessary gender perspective for the analysis of health problems.

This work begins with the difference between sex and gender, then show that the contrasts in the field of health between men and women can be explained: by the construction of gender of consultants and health service providers, by the structure of the services themselves of health (which also reflects gender constructions), and by the reproduction of gender patterns through education and research. The work shows the need to include a gender perspective in health research.

Este trabajo inicia con la diferencia entre sexo y género, para mostrar que los contrastes en el campo de la salud entre hombres y mujeres pueden explicarse por la construcción de género de consultantes y de proveedores de servicios de salud, por la estructura de los propios servicios de salud (que refleja también construcciones de género) y por la reproducción de patrones de género a través de la educación y la investigación. El trabajo muestra la necesidad de incluir la perspectiva de género en la investigación en salud.

Evaluación de la prescripción profiláctica de omeprazol y ranitidina mediante la identificación de factores de riesgo de sangrado gastrointestinal / Evaluation of prophylactic prescription of omeprazole and ranitidine by identifying risk factors for gastrointestinal bleeding

RESUMEN La información actual sobre el uso de inhibidores de la producción de ácido clorhídrico (inhibidores de bomba de protones y antagonistas de los receptores de histamina H2), en pacientes no críticos hospitalizados para la profilaxis de úlceras por estrés es controversial. Con el fin de evaluar la pertinencia de este grupo de medicamentos en conformidad con el riesgo de sangrado gastrointestinal medido por la escala de Herzig et al. {Risk factors for nosocomial gastrointestinal bleeding and use of acid-suppres-sive medication in non-critically ill patients, J. Gen. Intern. Med, 28(5), 683-690 (2013)}, se realizó un estudio observacional descriptivo longitudinal con recolección retrospectiva de la información, el cual incluyó todos los pacientes mayores de 18 años sin sangrado gastrointestinal y con más de tres días de hospitalización, en el servicio de medicina interna de un hospital de tercer nivel de Bogotá. Según esta escala, el 64% de los pacientes se clasificó en bajo riesgo, el 22,3% en medio-bajo, el 6,7% en medio-alto, y el 6,7% en alto. La prescripción profiláctica de inhibidores de la secreción ácida se realizó en el 67% de los pacientes de bajo riesgo, en el 57% de los de medio-bajo y en el 100% de los pacientes de riesgo medio-alto y alto. Cerca de la mitad (55,35%) de los pacientes recibieron un antiulceroso sin requerirlo; por lo tanto, se recomienda realizar actividades educativas dirigidas al personal prescriptor, con el fin de hacer un uso adecuado de este grupo de medicamentos.

SUMMARY Current information on the use of inhibitors of the production of hydrochloric acid (proton-pump inhibitor (PPI) ATC A02BC and histamine H2 receptor antagonists (Anti H2) ATC A02BC) in non-critical patients for the prophylaxis of stress ulcers is controversial. A descriptive longitudinal observational study with a retrospective collection of information, that included patients over 18 years with more than three days of hospitalization in internal medicine, without active gastrointestinal bleeding using the scale of Herzig et al. {Risk factors for nosocomial gastrointestinal bleeding and use of acid-suppressive medication in non-critically ill patients, J. Gen. Intern. Med., 28(5), 683-690 (2013)}, to assess the risk gastrointestinal bleeding was carried out. According to the risk score, patients were classified 64% as low risk, 22.3% medium-low risk, 6.7% medium-high risk and 6.7% high risk. Prophylactic prescription inhibiting acid secretion was performed in 67% of patients at low risk, 57% in medium-low risk and 100% for patients with medium-high and high risk. More than half (55.33%) of the patients received a PPI/anti H2 without requiring it. Educational activities are recommended to the prescribing staff in order to make proper use of this group of drugs.

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.

Y después del estatus convulsivo? / What about post-ictal state

El periodo posterior a un estatus epiléptico o a una crisis epiléptica ha despertado marcado interés debido a susrepercusiones funcionales y cognoscitivas. El estado post-ictal es la condición anormal que ocurre entre el fin dela crisis epiléptica o el estatus epiléptico y el retorno a la condición de base. El pronóstico de un paciente en estadopostictal depende directamente de la causa subyacente y del tiempo de duración del estado convulsivo. La utilidaddel electroencefalograma en el periodo post-ictal está dada por su capacidad, no solamente para determinar el fin dela crisis y el inicio del periodo post-ictal, sino también, en algunos casos permite determinar el área o hemisferio deinicio ictal y descartar la presencia de estatus no convulsivo. Las alteraciones en el estado de ánimo como depresióny psicosis deben ser evaluadas y tratadas de manera temprana en el estado post-ictal. Medicaciones antiepilépticascomo levetiracetam y lacosamida muestran frente al placebo una diferencia significativa en el control de eventospost-ictales con más rápida recuperación del estado de conciencia y control del comportamiento. Los efectospositivos de la estimulación del nervio vago en el fenómeno post-ictal permiten una mejor calidad de vida para lospacientes con epilepsias refractarias. El desarrollo de nuevas medicaciones o dispositivos que busquen emular losmecanismos endógenos anti-ictales desencadenados en el periodo post-ictal, serán los verdaderos medicamentosantiepileptogénicos.

Qué rumbo debe tomar el sistema de salud colombiano? la justificación de una comisión independiente para definir prioridades: [editoriales] / Where to next for Colombia’s health system?: the case for an independent priority setting agency: [editorial]

A pesar de los grandes avances realizados para lograr la cobertura de salud total a sus ciudadanos (1-3) el sistema de salud colombiano se enfrenta a una crisis. Hay preocupación respecto a la equidad del sistema y de si el POS y POSS realmente proporcionan la atención en salud esencial. Este fue el raciocinio del fallo de la Corte Suprema de Justicia (T760) que estableció que el POS y el POSS deberían ofrecer el mismo nivel de atención y que el faltante fuese aportado por el gobierno central (este fallo representa 800 mil millones de pesos). Enfrentado al hecho de tener que pagar por los servicios adicionales o reorganizar el sistema de salud, el gobierno propuso que los individuos que requirieran servicios de alto costo usaran sus ahorros pensionales y prestacionales para cubrir estos servicios. Esta propuesta fue muy impopular y finalmente fue retirada. Actualmente el gobierno estudia otra alternativa y es la de aumentar el gravamen de las bebidas alcohólicas, cigarrillos y juegos de azar...

[Direct costs and hospital morbimortality impact from preventable adverse drug events]. / Costos directos e impacto sobre la morbimortalidad hospitalaria de eventos adversos prevenibles a medicamentos en una institución de tercer nivel de Bogotá

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.

Comparative in vitro study of the antimicrobial activities of different commercial antibiotic products for intravenous administration.

BACKGROUND: The antimicrobial resistance is a global problem, probably due to the indiscriminate and irrational use of antibiotics, prescriptions for incorrect medicines or incorrect determinations of dose, route and/or duration. Another consideration is the uncertainty of patients receiving antibiotics about whether the quality of a generic medicine is equal to, greater than or less than its equivalent brand-name drug. The antibiotics behaviors must be evaluated in vitro and in vivo in order to confirm their suitability for therapeutic use. METHODS: The antimicrobial activities of Meropenem and Piperacillin/Tazobactam were studied by microbiological assays to determine their potencies (content), minimal inhibitory concentrations (MICs), critical concentrations and capacity to produce spontaneous drug-resistant mutants. RESULTS: With respect to potency (content) all the products fulfill USP requirements, so they should all be considered pharmaceutical equivalents. The MIC values of the samples evaluated (trade marks and generics) were the same for each strain tested, indicating that all products behaved similarly. The critical concentration values were very similar for all samples, and the ratios between the critical concentration of the standard and those of each sample were similar to the ratios of their specific antibiotic contents. Overall, therefore, the results showed no significant differences among samples. Finally, the production of spontaneous mutants did not differ significantly among the samples evaluated. CONCLUSIONS: All the samples are pharmaceutical equivalents and the products can be used in antimicrobial therapy.

[Models used for decision-making in health care]. / Modelos empleados para la Toma de Decisiones en el Cuidado de la Salud.

Decision analysis consists of a set of tools supporting and handling structured evaluation. Such methodology is widely used for the economic evaluation of health care planning and programmes. This article outlines some characteristics regarding complex decision-making and shows the fundamental issues and stages considered when making decisions in an uncertain scenario (problem definition, choosing an appropriate time-frame, structuring the problem, developing a model for analysing it, selecting the best alternative and analysing sensitivity). Some criticism of this decision-making method is then made.

Modelos empleados para la toma de decisiones en el cuidado de la salud / Models used for decision-making in health care

El análisis de decisiones es un grupo de herramientas que permiten apoyar y manejar un proceso de evaluación estructurado. Esta metodología se usa ampliamente en la evaluación económica para planeación o programas de salud. Este artículo delinea algunas características de las decisiones complejas y muestra los fundamentos y etapas que deben considerarse cuando se toman decisiones en un escenario de incertidumbre (definición del problema, selección de un marco temporal de análisis adecuado, estructuración del problema, desarrollo de un modelo para análisis, selección de la mejor alternativa y realización de análisis de sensibilidad). Finalmente se presentan algunas críticas que se han hecho a esta metodología.

Decision analysis consists of a set of tools supporting and handling structured evaluation. Such methodology is widely used for the economic evaluation of health care planning and programmes. This article outlines some characteristics regarding complex decision-making and shows the fundamental issues and stages considered when making decisions in an uncertain scenario (problem definition, choosing an appropriate time-frame, structuring the problem, developing a model for analysing it, selecting the best alternative and analysing sensitivity). Some criticism of this decision-making method is then made.

Evaluación económica de tecnología sanitaria / Economic evaluation of health technology

El presente ensayo revisa los conceptos básicos de la evaluación económica de la tecnología sanitaria, los tipos de información necesarios, y el estado del arte reportado en la literatura medica. La necesidad de evaluar económicamente los resultados de la investigación clínica ha llevado a desarrollar una nueva disciplina, la evaluación económica de la tecnología sanitaria (Farmacoeconomía). La metodología se ha desarrollado con rapidez en los últimos 10 años. Como se revisó en este ensayo, la información se basa tanto en modelos sofisticados de análisis de decisión como en la recolección prospectiva dentro de los estudios clínicos, que han mejorado nuestro entendimiento de los costos y beneficios clínicos de las tecnologías sanitarias. Esta información es importante para los clínicos, para las autoridades sanitarias para determinar el uso más adecuado de los limitados recursos para la salud. Los métodos de evaluación de nuevos productos farmacéuticos han incrementado su grado de sofisticación de manera muy rápida. En gran parte, este desarrollo es estimulado por los cambios analíticos hechos para la evaluación farmacoeconómica de la información obtenida de la investigación clínica. En Colombia, la investigación sobre estos temas deberá orientar los esfuerzos hacia el futuro, siendo necesaria además la consolidación en el país de una comunidad académica en el área

Estudio genético multiloci en la población colombiana. II distribución del complejo CcDdEe del grupo sanguíneo Rh / Genetic multiloci study in the Colombian population. II. Distribution of the CcDdEe complex in the Rh blood group

La población colombiana se caracterizó para el complejo CcDdEe del grupo sanguíneo Rh; se estudiaron diez regiones para dos generaciones; las regiones mostraron ser genéticamente homogéneas para el fator Rh, mientras que para el complejo CcDdEe y para los sistemas codominantes Cc y Ee fueron heterogéneas. La influencia de las diferentes razas en la población colombiana fue detectada a través de los fenotipos CCD-EE, CcD-Ee, CCddee, Ccddee, ccD-ee, ccddEe y ccddee