Observer-based control for plasma glucose regulation in type 1 diabetes mellitus patients with unknown input delay.

This article introduces an observer-based control strategy tailored for regulating plasma glucose in type 1 diabetes mellitus patients, addressing challenges like unknown time-varying delays and meal disturbances. This control strategy is based on an extended Bergman minimal model, a nonlinear glucose-insulin model to encompass unknown inputs, such as unplanned meals, exercise disturbances, or delays. The primary contribution lies in the design of an observer-based state feedback control in the presence of unknown long delays, which seeks to support and enhance the performance of the traditional artificial pancreas by considering realistic scenarios. The observer and control gains for the observer-based control are computed through linear matrix inequalities formulated from Lyapunov conditions that guarantee closed-loop stability. This design deploys a soft and gentle dynamic response, similar to a natural pancreas, despite meal disturbances and input delays. Numerical tests demonstrate the scheme's effectiveness in glycemic level regulation and hypoglycemic episode avoidance.

Building a Rechargeable Voltaic Battery via Reversible Oxide Anion Insertion in Copper Electrodes.

Voltaic pile, the very first battery built by humanity in 1800, plays a seminal role in battery development history. However, the premature design leads to the inevitable copper ion dissolution issue, which dictates its primary battery nature. To address this issue, solid-state electrolytes, ion exchange membranes, and/or sophisticated electrolytes are widely utilized, leading to high costs and complicated cell configuration. Herein, we build a rechargeable zinc-copper voltaic battery from simple and cheap electrolyte/separator materials, thus eliminating the need to use the above components. Notably, our battery leverages the Zn4SO4(OH)6·xH2O precipitation in ZnSO4 electrolytes, a common side reaction in zinc batteries, to provide a "locally alkaline" environment for copper electrodes. Consequently, oxide (O2-) anion insertion takes place and readily transforms copper to copper(I) oxide (Cu2O) without any copper ion dissolution issue. Therefore, this battery realizes a high capacity of ∼370 mA h g-1 and a long cycling of ∼500 cycles. Our work provides an innovative approach to stabilize anion insertion in metal electrodes for energy storage.

Trivalent Indium Metal as a High-Capacity, High-Efficiency, Low-Polarization, and Long-Cycling Anode for Aqueous Batteries.

Aqueous batteries using multivalent metals hold great promise for energy storage due to their low cost, high energy, and high safety. Presently, divalent metals (zinc, iron, nickel, and manganese) prevail as the leading choice, which, however, suffer from low Coulombic efficiency or dendrite growth. In stark contrast, trivalent metals have received rare attention despite their capability to unlock unique redox reactions. Herein, we investigate trivalent indium as an innovative and high-performance metal anode for aqueous batteries. The three-electron In3+/In redox endows a high capacity of ∼700 mAh g-1, on par with the Zn metal. Besides, indium exhibits a suitable redox potential (-0.34 V vs standard hydrogen electrode) and dendrite-free plating process, which renders an ultrahigh Coulombic efficiency of 99.3-99.8%. More surprisingly, it features an exceedingly low polarization of 1 mV in symmetrical cells, which is 1-2 orders of magnitude lower than any reported metals. The In-MnO2 full cell also delivers impressive performance, with a cell voltage of ∼1.2 V, a high capacity of ∼330 mAh g-1, and a long cycling time of 680 cycles. Our work exemplifies the efficacy of exploiting trivalent metals as an excellent metal anode, which provides an exciting direction for building high-performance aqueous batteries.

Bimetallic Cobalt-Nickel Selenide Nanocubes Embedded in a Nitrogen-Doped Carbon Matrix as an Excellent Li-Ion Battery Anode.

Lithium-ion batteries (LIBs) have been widely used for portable electronics and electric vehicles; however, the low capacity in the graphite anode limits the improvement of energy density. Transition-metal selenides are promising anode material candidates due to their high theoretical capacity and controllable structure. In this study, we successfully synthesize a bimetallic transition-metal selenide nanocube composite, which is well embedded in a nitrogen-doped carbon matrix (denoted as CoNiSe2/NC). This material shows a high capacity and excellent cycling for Li-ion storage. Specifically, the reversible capacity approaches ∼1245 mA h g-1 at 0.1 A g-1. When cycled at 1 A g-1, the capacity still remains at 642.9 mA h g-1 even after 1000 cycles. In-operando XRD tests have been carried out to investigate the lithium storage mechanism. We discover that the outstanding performance is due to the unique CoNiSe2/NC nanocomposite characteristics, such as the synergistic effect of bimetallic selenide on lithium storage, the small particle size, and the stable and conductive carbon structure. Therefore, this morphology structure not only reduces the volume change of metal selenides but also produces more lithium storage active sites and shortens lithium diffusion paths, which results in high capacity, good rate, and long cycling.

Psoriatic arthritis in patients with psoriasis: A clinical-epidemiological study at a dermatology center in western Mexico.

BACKGROUND/OBJECTIVE: Psoriatic arthritis (PsA) is a chronic inflammatory illness. Approximately, 15% of psoriasis patients have undiagnosed PsA. In Mexico, we found no related studies. Our objective was to investigate the clinical-epidemiological characteristics of PsA in psoriasis patients in western Mexico. METHODS: A cross-sectional study including Mexican patients with clinical and histopathological diagnosis of psoriasis. Physical examination, rheumatoid factor analysis and radiographies of axial and peripheral skeleton were performed. The prevalence of PsA using the CASPAR criteria, age, sex; clinical variants of PsA, psoriasis type and the Psoriasis Area and Severity Index (PASI), were assessed. Descriptive and inferential statistics were used. RESULTS: Of 90 patients with psoriasis, 48 met the criteria for PsA, with a prevalence of 53%, and average age of 50 ± 15 years. Predominating were, the female sex in 29 (60%), the axial variant of PsA in 24 (50%), and psoriasis plaques in 40 (83%). The average PASI was 12 ± 11. All cases were rheumatoid factor negative. These variables were not significantly different when comparing subjects with and without PsA, except for the female sex (60% vs. 7%; P < 0.001). CONCLUSIONS: Patients with psoriasis should intentionally be evaluated jointly Dermatologists and Rheumatologists searching joint involvement given the high prevalence of PsA previously undiagnosed.

Utilidad de la terapia de acuaféresis / Aquapheresis: ¿works?

Resumen La terapia de acuaféresis ha sido estudiada como una herramienta terapéutica para pacientes con sobrecarga de volumen refractaria al tratamiento con diuréticos de asa. Su objetivo principal es mitigar el impacto clínico de esta sobrecarga en los pacientes con insuficiencia cardiaca descompensada y SCR, reconociendo de esta manera los balances acumulados positivos en los pacientes críticamente enfermos como un factor independiente de mortalidad. Se realizó una búsqueda en las principales bases de datos científicas sobre la terapia de acuaféresis. Se incluyeron guías de manejo, ensayos clínicos controlados, revisiones sistemáticas y metaanálisis. Las bases bibliográficas que arrojaron resultados relevantes fueron Web of Sciences, Scopus, PubMed y SciELO y en total se encontraron 47 referencias bibliográficas publicadas entre 2005 y 2017. La acuaféresis es una terapia de ultrafiltración patentada que mejora la sobrecarga refractaria en pacientes con insuficiencia cardiaca congestiva. Hay brechas en el conocimiento en relación a su costo-efectividad, a los eventos adversos graves que se le atribuyen y a los candidatos que beneficia, por tanto, se requieren más estudios de calidad para llegar a conclusiones sólidas. Hasta el momento no hay evidencia contundente que respalde el uso sistemático y rutinario de la terapia de acuaféresis en las unidades de cuidado intensivo.

Abstract The therapy of Aquapheresis has been studied as a therapeutic tool for patients with volume overload refractory to treatment with ASA diuretics, whose main objective is to mitigate the clinical impact of the same in patients with decompensated heart failure and cardiorenal syndrome, recognizing positive cumulative balances in critically ill patients as a factor regardless of mortality. A search was made in the main scientific databases for review articles, and studies that included the Acuapheresis strategy. Bibliographic references were found in databases from 2005 to 2017. Aquapheresis therapy is a patented ultrafiltration therapy aimed at improving refractory overload in patients with congestive heart failure. There are gaps in knowledge regarding cost-effectiveness therapy, real adverse adverse event relationships attributable to it and candidates will benefit, and we believe that more quality studies are required to reach solid conclusions. So far there is no compelling evidence to support Aquapheresis therapy to implement its routine and routine use of the ICU.

[Mexican consensus on the diagnosis and treatment of atopic dermatitis in adolescents and adults]. / Consenso mexicano para el diagnóstico y tratamiento de la dermatitis atópica en adolescentes y adultos.

BACKGROUND: The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions. OBJECTIVE: To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients ≥ 12 years with AD to improve their care. METHODS: Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings. RESULTS: The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively. CONCLUSION: The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence.

Antecedentes: Los abordajes diagnósticos y las estrategias terapéuticas de la dermatitis atópica generalmente son inconsistentes entre los médicos y entre las instituciones de salud. Objetivo: Consensar las opiniones de expertos para reducir las variaciones en la práctica respecto al diagnóstico y tratamiento de pacientes ≥ 12 años con dermatitis atópica para mejorar su cuidado. Métodos: Búsqueda sistemática de la literatura en PubMed y GREAT. Con apoyo metodológico y utilizando el método Delphi se desarrolló un consenso formal entre 16 expertos en dermatología y alergología, basándose en la evidencia actual y su aplicabilidad en el contexto mexicano. A parte de una comunicación electrónica intensa, se discutieron los puntos en desacuerdo en dos reuniones presenciales. Resultados: Los expertos clínicos alcanzaron consenso en 46 declaraciones relacionadas con la definición, clasificación, estrategias de diagnóstico y tratamiento de la dermatitis atópica. Para el diagnóstico sugerimos se usan los criterios de Williams y el SCORAD (por parte del médico) y POEM (por parte del paciente) para definir la gravedad. Aunado a cuidados generales y educación terapéutica, sugerimos cuatro pasos para tratamiento, según gravedad: 1. Manejo tópico con antiinflamatorio (y sistémico: antihistamínico/antileucotrieno ­evidencia reducida­) 2. Fototerapia, 3. Ciclosporina A y 4. Dupilumab, con la posibilidad de manejarlo antes si se necesita efecto rápido. En la dermatitis atópica extrínseca sugerimos agregar inmunoterapia con alérgenos o una dieta de eliminación si existe una alergia IgE-mediada, inhalatoria o alimentaria, respectivamente. Conclusión: El panel de expertos realizó consenso en aspectos relevantes de la dermatitis atópica con enfoque en la adaptación transcultural de evidencia reciente.

Síndrome metabólico y aterosclerosis carotídea subclínica en niños y adolescentes mexicanos con acantosis nigricans.

INTRODUCCIÓN: La acantosis nigricans es un marcador de resistencia a la insulina, la cual se asocia con alteraciones metabólicas y cardiovasculares. OBJETIVO: Investigar la frecuencia de síndrome metabólico y aterosclerosis carotídea subclínica en niños y adolescentes mexicanos con acantosis nigricans y comparar los resultados entre sexos. MÉTODO: Estudio transversal. Se incluyeron 30 sujetos masculinos y 30 femeninos con diagnóstico de acantosis nigricans, menores de 18 años. Se investigó síndrome metabólico (criterios de Cook), riesgo cardiovascular (proteína C reactiva ultrasensible [PCRus]) y aterosclerosis carotídea (grosor íntima-media). Para el análisis de datos se utilizó estadística descriptiva e inferencial. RESULTADOS: La frecuencia de síndrome metabólico fue de 43 % (sexo masculino 42 % versus femenino 58 %, p = 0.58). Todos presentaron niveles anormales de PCRus: 67 % fue clasificado con riesgo cardiovascular moderado y 27 % con riesgo alto. Frecuencia de aterosclerosis carotídea 98 % (masculino 49 % versus femenino 51 %, p = 0.45). La severidad de la acantosis nigricans no influyó en los resultados. CONCLUSIONES: La búsqueda intencionada de síndrome metabólico y aterosclerosis carotídea subclínica en niños y adolescentes mexicanos con acantosis nigricans, independientemente del sexo o severidad de la enfermedad, permitirá implementar medidas para disminuir la morbimortalidad en la edad adulta. INTRODUCTION: Acanthosis nigricans is a marker of insulin resistance that is associated with metabolic and cardiovascular alterations. OBJECTIVE: To investigate the frequency of metabolic syndrome and subclinical carotid atherosclerosis in children and adolescents with acanthosis nigricans, and to compare the results between genders. METHOD: Cross-sectional study, where 30 male and 30 female subjects younger than 18 years of age diagnosed with acanthosis nigricans were included. The presence of metabolic syndrome (Cook's criteria), cardiovascular risk (ultrasensitive C-reactive protein and [us-CRP]), and carotid atherosclerosis (intima-media thickness [IMT]) was investigated. Descriptive and inferential statistics was used for data analysis. RESULTS: The frequency of metabolic syndrome was 43% (males 42 % versus females 58%, p = 0.58). All patients showed us-CRP abnormal levels: 67% were classified with moderate cardiovascular risk and 27% with high risk. The prevalence of carotid atherosclerosis was 98% (males 49% versus females 51%, p = 0.45). Acanthosis nigricans severity did not influence on the results. CONCLUSIONS: Intentional search for metabolic syndrome and subclinical carotid atherosclerosis in Mexican children and adolescents with acanthosis nigricans, regardless of gender or disease severity, will enable the implementation of measures to decrease the morbidity and mortality seen in adult age.

Model-based recursive partitioning to identify risk clusters for metabolic syndrome and its components: findings from the International Mobility in Aging Study.

OBJECTIVE: Conceptual models underpinning much epidemiological research on ageing acknowledge that environmental, social and biological systems interact to influence health outcomes. Recursive partitioning is a data-driven approach that allows for concurrent exploration of distinct mixtures, or clusters, of individuals that have a particular outcome. Our aim is to use recursive partitioning to examine risk clusters for metabolic syndrome (MetS) and its components, in order to identify vulnerable populations. STUDY DESIGN: Cross-sectional analysis of baseline data from a prospective longitudinal cohort called the International Mobility in Aging Study (IMIAS). SETTING: IMIAS includes sites from three middle-income countries-Tirana (Albania), Natal (Brazil) and Manizales (Colombia)-and two from Canada-Kingston (Ontario) and Saint-Hyacinthe (Quebec). PARTICIPANTS: Community-dwelling male and female adults, aged 64-75 years (n=2002). PRIMARY AND SECONDARY OUTCOME MEASURES: We apply recursive partitioning to investigate social and behavioural risk factors for MetS and its components. Model-based recursive partitioning (MOB) was used to cluster participants into age-adjusted risk groups based on variabilities in: study site, sex, education, living arrangements, childhood adversities, adult occupation, current employment status, income, perceived income sufficiency, smoking status and weekly minutes of physical activity. RESULTS: 43% of participants had MetS. Using MOB, the primary partitioning variable was participant sex. Among women from middle-incomes sites, the predicted proportion with MetS ranged from 58% to 68%. Canadian women with limited physical activity had elevated predicted proportions of MetS (49%, 95% CI 39% to 58%). Among men, MetS ranged from 26% to 41% depending on childhood social adversity and education. Clustering for MetS components differed from the syndrome and across components. Study site was a primary partitioning variable for all components except HDL cholesterol. Sex was important for most components. CONCLUSION: MOB is a promising technique for identifying disease risk clusters (eg, vulnerable populations) in modestly sized samples.

Cortisol and physical performance in older populations: Findings from the international mobility in aging study (IMIAS).

OBJECTIVE: To compare diurnal cortisol profiles across samples of older adults from diverse populations and to examine if differences in circadian cortisol secretion are associated with poor physical performance (SPPB<9). METHODS: Data were collected during the baseline survey of the International Mobility in Aging Study conducted in 2012 in Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania) and Manizales (Colombia). Salivary cortisol was collected from a subsample of 309 participants instructed to collect saliva on two consecutive days, and 5 different intervals each day: upon awakening (M1), 30min (M2) and 60min after awakening, at 15:00h and before bedtime (E). Cortisol was analyzed using enzyme immunoassay kits. Physical performance was measured by the Short Physical Performance Battery (SPPB). Mixed linear models were fit to assess the associations between cortisol diurnal output and physical performance, adjusting for potential confounders. RESULTS: Kingston, Saint-Hyacinthe and Tirana residents had significantly higher cortisol values than their Manizales counterparts, with the population from Tirana showing the highest levels. Attenuated morning cortisol peak (M2) (p=0.025), higher cortisol bed time (E) (p=0.005), and lower M2/E ratio (p<0.001) were found among those with SPPB<9 compared with those with good physical performance (SPPB≥9). These results were not altered after adjustment by potential confounders. CONCLUSION: Cortisol profiles varied across four diverse populations of older adults. Circadian cortisol secretion is associated with physical performance as an attenuated morning response and higher bed time values were observed in older adults with SPPB<9.

Distribución altitudinal de la riqueza y composición de "ensamblajes" de aves en una zona montañosa al sur de Nayarit, México / Altitudinal distribution, richness and composition of bird "assemblages" in a mountainous region in Southern Nayarit, Mexico

Resumen:Los estudios sobre gradientes altitudinales han permitido examinar cambios en la riqueza y composición de los ensamblajes de aves, lo que hace posible obtener información sobre las variables ambientales que determinan su distribución y factores que definen la estructura. En este trabajo se describe la variación en la riqueza y composición de los ensamblajes de aves a través de un gradiente altitudinal al sur de Nayarit. Para analizar el comportamiento de la riqueza en el gradiente se obtuvo información mediante puntos de conteo en nueve intervalos altitudinales (separados cada 300 m de altitud) desde el nivel del mar hasta los 2 700 msnm. Se estandarizó el esfuerzo de muestreo y se realizaron curvas de rarefacción, y los cambios en la composición de especies se analizaron mediante análisis de clasificación jerárquica utilizando la técnica TWINSPAN. Para identificar las variables asociadas con los cambios en riqueza se analizó el efecto de la precipitación y de la estructura del hábitat mediante árboles de regresión. Para determinar si los cambios en composición responden a cambios en los tipos de vegetación se realizó un análisis de escalamiento multidimensional no métrico (NMDS). La riqueza de especies varió de forma significativa a través del gradiente: fue alta en las partes bajas del gradiente, alcanzó su valor máximo en la parte media y disminuyó monotónicamente con la elevación. Las especies respondieron a cambios en el gradiente y se agruparon en tres pisos altitudinales. Los análisis sugieren que los cambios en la riqueza y composición de las especies están influenciados por la vegetación, su estructura y precipitación, así como por diversos aspectos relacionados con características del hábitat y la perturbación. Estos aspectos deberán ser tomados en cuenta con el fin de diseñar estrategias adecuadas para la conservación de las aves de Nayarit.

Abstract:Elevation gradient studies have strengthened the evaluation of changes in richness and composition of bird assemblages. They also provide information on environmental variables that determine bird distribution, and the variables that define their population structure. Our aim was to describe their variation through an elevational cline in Southern Nayarit, Mexico. To analyze the behavior of richness across the gradient, we gathered information through point counts in nine elevational intervals (300 m from each other) from sea level to 2 700 m of elevation. With a standardized sampling effort, we produced rarefaction curves and analyzed changes in species composition by hierarchical classification using the TWINSPAN technique. In order to identify variables associated with richness changes, we examined the effect of precipitation and habitat structure via regression trees. An analysis of nonmetric multidimensional scaling (NMDS) was implemented with the purpose to determine if the changes in composition correspond to changes in vegetation types. Species richness varied significantly across the gradient: high in the lower parts of the gradient, reached its peak in the middle, and decreased monotonically with elevation. Species responded to changes in the cline and were grouped in three elevational zones. Analyses suggest that changes in richness and species composition are influenced by vegetation, its structure and precipitation regime, as well as various aspects related to habitat features and disturbance. These aspects should be taken into account in order to design appropriate strategies for the conservation of the birds of Nayarit. Rev. Biol. Trop. 64 (4): 1537-1551. Epub 2016 December 01.

[Altitudinal distribution, richness and composition of bird assemblages in a mountainous region in Southern Nayarit, Mexico]. / Distribución altitudinal de la riqueza y composición de "ensamblajes" de aves en una zona montañosa al sur de Nayarit, México.

Elevation gradient studies have strengthened the evaluation of changes in richness and composition of bird assemblages. They also provide information on environmental variables that determine bird distribution, and the variables that define their population structure. Our aim was to describe their variation through an elevational cline in Southern Nayarit, Mexico. To analyze the behavior of richness across the gradient, we gathered information through point counts in nine elevational intervals (300 m from each other) from sea level to 2 700 m of elevation. With a standardized sampling effort, we produced rarefaction curves and analyzed changes in species composition by hierarchical classification using the TWINSPAN technique. In order to identify variables associated with richness changes, we examined the effect of precipitation and habitat structure via regression trees. An analysis of nonmetric multidimensional scaling (NMDS) was implemented with the purpose to determine if the changes in composition correspond to changes in vegetation types. Species richness varied significantly across the gradient: high in the lower parts of the gradient, reached its peak in the middle, and decreased monotonically with elevation. Species responded to changes in the cline and were grouped in three elevational zones. Analyses suggest that changes in richness and species composition are influenced by vegetation, its structure and precipitation regime, as well as various aspects related to habitat features and disturbance. These aspects should be taken into account in order to design appropriate strategies for the conservation of the birds of Nayarit.

Estudio EDECO Estudio poblacional de deterioro cognitivo en población colombiana / EDECO Study Population study of cognitive impairment in a colombian community

Objetivo: se presenta un estudio poblacional de deterioro cognitivo de un grupo de ancianos valorados en la comunidad en los cuales se determinó la prevalencia de deterioro cognitivo a través de la prueba del reloj. Material y métodos: se valoraron 803 ancianos que habitaban en comunidad, durante los meses de noviembre de 2011 a agosto de 2012, de distintas regiones del país. Se aplicaron formatos de registro y se procesaron en forma descriptiva. Resultados: los relojes evaluados por medio de los criterios de Cacho para detección de deterioro cognitivo, permitieron identificar que 40% de la población de ancianos incluidos en el estudio, presentaban un resultado sugestivo de deterioro cognitivo. El rango de edad más afectado por deterioro cognitivo, en el grupo de relojes calificados, se observó entre los 70 y 79 años (46.1%), seguido por los individuos entre los 80 y los 89 años (31.8%). El rango de edad entre 60 y 69 años mostró una prevalencia de deterioro cognitivo en 19.6%. El 57.6% de los ancianos con resultados sugestivos de deterioro cognitivo presentaban antecedente de hipertensión arterial. El 14.3% de los ancianos evaluados refirieron haber sido diagnosticado con diabetes mellitus, de los cuales 48.7% presentaron hallazgos subjetivos de deterioro cognitivo (17.4% del total de población con deterioro cognitivo). El antecedente de accidente cerebrovascular se observó en el 4.9% de la población, de los cuales 56% obtuvieron puntajes sugestivos de deterioro cognitivo. Conclusiones: con respecto a nuestro estudio, 40% de la población presentaba hallazgos sugestivos de deterioro cognitivo, además se logró evidenciar una importante prevalencia de deterioro cognitivo en factores de riesgo reportados en la literatura. También se observó que en todos los grupos evaluados los errores en la localización de las manecillas predominaron como el principal error en la realización de la prueba, seguido de las alteraciones en la presencia y secuencia de los números, mientras que la realización de la esfera fue la variable menos afectada en todos los grupos poblacionales. Se observó en el estudio que los resultados sugestivos de deterioro cognitivo presentaron una relación directa con el analfabetismo, el nivel educativo y la edad. Finalmente podemos sugerir que la prueba del reloj, en el contexto del anciano colombiano que habita en comunidad, constituye una herramienta útil para el tamizaje de la demencia en atención primaria y geriatría clínica.

Objective: a population-based study of cognitive impairment in a group of elders evaluated in the community in which the prevalence of cognitive impairment was determined through the clock test, is presented. Materials and methods: 803 elderly people living in community during the months of November 2011 to August 2012 from different regions of the country were evaluated. Registration forms were applied and processed in a descriptive way. Results: clocks evaluated by Cacho criteria for detection of cognitive impairment helped to identify that 40% of the elderly population included in the study had a suggestive result of cognitive impairment. The age range most affected by cognitive decline in the group of qualified clocks was observed between 70 and 79 years (46.1%), followed by individuals between 80 and 89 years (31.8%). The age range between 60 and 69 years showed a prevalence of cognitive impairment in 19.6%. 57.6% of the elderly with results suggestive of cognitive impairment had a history of hypertension. 14.3% of the elderly evaluated reported having been diagnosed with diabetes mellitus, and of these, 48.7% had subjective findings of cognitive impairment (17.4% of total population with cognitive impairment). A history of stroke was observed in 4.9% of the population, of which 56% obtained scores suggestive of cognitive impairment. Conclusions: regarding our study, 40% of the population was suggestive of cognitive impairment and additionally a significant prevalence of cognitive impairment in risk factors reported in the literature was evidenced. It was also observed that in all groups evaluated, the errors in locating the hands predominated as the main error in performing the test, followed by alterations in the presence and sequence of numbers while making the circle was the less affected variable in all the population groups. It was observed in the study that the results suggestive of cognitive impairment had a direct relationship with illiteracy, educational level and age. Finally, we can suggest that the clock test in the context of the Colombian elderly living in community is a useful tool for the screening of dementia in primary care and clinical geriatrics.

Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes

Abstract Objectives: To assess the validity (convergent and construct) and reliability of the Short Physical Performance Battery (SPPB) among non-disabled adults between 65 to 74 years of age residing in the Andes Mountains of Colombia. Methods: Design: Validation study; Participants: 150 subjects aged 65 to 74 years recruited from elderly associations (day-centers) in Manizales, Colombia. Measurements: The SPPB tests of balance, including time to walk 4 meters and time required to stand from a chair 5 times were administered to all participants. Reliability was analyzed with a 7-day interval between assessments and use of repeated ANOVA testing. Construct validity was assessed using factor analysis and by testing the relationship between SPPB and depressive symptoms, cognitive function, and self rated health (SRH), while the concurrent validity was measured through relationships with mobility limitations and disability in Activities of Daily Living (ADL). ANOVA tests were used to establish these associations. Results: Test-retest reliability of the SPPB was high: 0.87 (CI95%: 0.77-0.96). A one factor solution was found with three SPPB tests. SPPB was related to self-rated health, limitations in walking and climbing steps and to indicators of disability, as well as to cognitive function and depression. There was a graded decrease in the mean SPPB score with increasing disability and poor health. Conclusion: The Spanish version of SPPB is reliable and valid to assess physical performance among older adults from our region. Future studies should establish their clinical applications and explore usage in population studies.

Resumen Objetivos: Evaluar la validez convergente y de constructo, y la confiabilidad de la Batería Corta de desempeño físico (Short Physical Performance Battery -SPPB-) entre ancianos no discapacitados entre 65 a 74 años, en los Andes Colombianos. Métodos: 150 ancianos entre 65-74 años reclutados de los centros-día de la ciudad de Manizales, Colombia. Las pruebas del SPPB: equilibrio, caminar 4 m. y el tiempo para incorporarse 5 veces de una silla se aplicaron a todos los participantes. La fiabilidad fue medida con un intervalo de 7 días entre las evaluaciones, y analizada con Anova de medidas repetidas. La validez de constructo fue evaluada mediante análisis factorial y relaciones entre el SPPB con la función cognoscitiva, síntomas de depresión, auto-percepción de salud, y factores sociales; y la validez convergente mediante asociaciones con las limitaciones de movilidad y discapacidad en las Actividades de la Vida Diaria (AVD), para estos últimos análisis se usaron Test de ANOVA. Resultados: La fiabilidad del SPPB test-retest fue muy buena, 0.87 (IC95%: 0.77- 0.93). Las tres pruebas del SPPB resultaron en un solo factor. El SPPB mostró una relación con limitación en la marcha y para subir escaleras, así como con los indicadores de discapacidad, función cognoscitiva y depresión. Existe una disminución gradual del puntaje de SPPB al aumentar la discapacidad y la mala auto-percepción de salud. Conclusión: La versión en español de la Batería Corta de Desempeño físico (SPPB) demostró ser válida y confiable para evaluar el desempeño físico en ancianos en los Andes Colombianos.

Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes.

OBJECTIVES: To assess the validity (convergent and construct) and reliability of the Short Physical Performance Battery (SPPB) among non-disabled adults between 65 to 74 years of age residing in the Andes Mountains of Colombia. METHODS: Design Validation study; PARTICIPANTS: 150 subjects aged 65 to 74 years recruited from elderly associations (day-centers) in Manizales, Colombia. MEASUREMENTS: The SPPB tests of balance, including time to walk 4 meters and time required to stand from a chair 5 times were administered to all participants. Reliability was analyzed with a 7-day interval between assessments and use of repeated ANOVA testing. Construct validity was assessed using factor analysis and by testing the relationship between SPPB and depressive symptoms, cognitive function, and self rated health (SRH), while the concurrent validity was measured through relationships with mobility limitations and disability in Activities of Daily Living (ADL). ANOVA tests were used to establish these associations. RESULTS: Test-retest reliability of the SPPB was high: 0.87 (CI95%: 0.77-0.96). A one factor solution was found with three SPPB tests. SPPB was related to self-rated health, limitations in walking and climbing steps and to indicators of disability, as well as to cognitive function and depression. There was a graded decrease in the mean SPPB score with increasing disability and poor health. CONCLUSION: The Spanish version of SPPB is reliable and valid to assess physical performance among older adults from our region. Future studies should establish their clinical applications and explore usage in population studies.

OBJETIVOS: Evaluar la validez convergente y de constructo, y la confiabilidad de la Batería Corta de desempeño físico (Short Physical Performance Battery -SPPB-) entre ancianos no discapacitados entre 65 a 74 años, en los Andes Colombianos. MÉTODOS: 150 ancianos entre 65-74 años reclutados de los centros-día de la ciudad de Manizales, Colombia. Las pruebas del SPPB: equilibrio, caminar 4 m. y el tiempo para incorporarse 5 veces de una silla se aplicaron a todos los participantes. La fiabilidad fue medida con un intervalo de 7 días entre las evaluaciones, y analizada con Anova de medidas repetidas. La validez de constructo fue evaluada mediante análisis factorial y relaciones entre el SPPB con la función cognoscitiva, síntomas de depresión, auto-percepción de salud, y factores sociales; y la validez convergente mediante asociaciones con las limitaciones de movilidad y discapacidad en las Actividades de la Vida Diaria (AVD), para estos últimos análisis se usaron Test de ANOVA. RESULTADOS: La fiabilidad del SPPB test-retest fue muy buena, 0.87 (IC95%: 0.77- 0.93). Las tres pruebas del SPPB resultaron en un solo factor. El SPPB mostró una relación con limitación en la marcha y para subir escaleras, así como con los indicadores de discapacidad, función cognoscitiva y depresión. Existe una disminución gradual del puntaje de SPPB al aumentar la discapacidad y la mala auto-percepción de salud. CONCLUSIÓN: La versión en español de la Batería Corta de Desempeño físico (SPPB) demostró ser válida y confiable para evaluar el desempeño físico en ancianos en los Andes Colombianos.

Protothecosis.

Protothecosis is a rare infection caused by achlorophyllic algae that are members of the genus Prototheca. They are ubiquitous in nature in organic material. The clinical manifestations can be acute or chronic and local or disseminated. The disease is classified as cutaneous, causing bursitis or disseminated/systemic, affecting both immunocompetent and immunosuppressed patients, with more severe and disseminated infections occurring in immunocompromised individuals. Prototheca wickerhamii and Prototheca zopfii are the most frequent organisms reported in humans. Diagnosis is made by observing asexual sporangia (thecas) on histopathological examination of tissue. Medical and surgical treatment should be considered. Ketoconazole, itraconazole, fluconazole, voriconazole, posaconazole, and amphotericin B are the most commonly used antifungals. Voriconazole and amphotericin B are highly effective against Prototheca spp. Treatment failure is not uncommon because of the comorbidities that limit the therapeutic outcome.

Total lower-eyelid reconstruction: modified Fricke's cheek flap.

The present work reviews a total lower-eyelid reconstruction technique that is currently not widely in use but which, in some cases, has proven to be of great utility in the field of reconstructive plastic surgery of the palpebral area. We performed an observational, longitudinal, descriptive and retrospective follow-up study. A total of 34 cases of non-melanoma skin cancer in which the lower eyelid was completely reconstructed using one flap taken from the cheek (modified Fricke's cheek flap) were reviewed. The follow-up time for the patients ranged from several months to 5 years. Analysis was performed using the Pearson's chi-square statistical test in an effort to examine the association between the technique's range of functionality and aesthetic variables. Results were considered significant with a p<0.05. The functional result was regular for 91.2%, poor for 8.8% and excellent for 0% (p<0.05). The aesthetic result was regular for 88.2%, poor for 11.8% and excellent for 0% (p<0.05). The main complications were scleral exposure and temporary ocular chemosis. Fricke's lower cheek flap is an easy-to-perform, important and often-necessary technique that, in some cases, has yielded positive functional and aesthetic results. This procedure is performed on an outpatient basis and is optimal for aged patients who present with skin cancer and who require total lower-eyelid reconstruction. The use of this technique is associated with a low complication rate and low morbidity.

Reacciones y eventos adversos por medicamentos en ancianos que consultan un servicio de urgencias / Adverse drug reactions and adverse drug events in elderly patients consulting a hospital emergency unit

Objetivo: Determinar eventos adversos y reacciones adversas medicamentosas en ancianos que consultan a un servicio de urgencias. Dise±o: Estudio observacional comparativo de corte transversal. Pacientes y métodos: Se estudiaron 400 pacientes (>60 a±os) que consultaron al servicio de urgencias del Hospital de Caldas (Manizales, Colombia) (marzo-mayo 2004). Se evaluaron variables demogrßficas, diagnóstico primario al ingreso, enfermedades asociadas, uso de medicamentos, el estado funcional (índice de Barthel) y el tipo y severidad de los eventos y reacciones adversas a medicamentos. Se realizo anßlisis bivariado y regresión logística. Resultados: El promedio de edad fue 72.8±8.2 a±os en su mayoría mujeres (52.3%). La frecuencia de eventos y reacciones adversas a medicamentos fue 6.8%. Los sistemas orgßnicos comprometidos mßs frecuentes fueron gastrointestinal (48.1%), endocrino y metabólico (37%). El 28.3% no tomaban medicamentos. El promedio de uso de medicamentos por paciente fue 2.9±1.7. Los grupos de medicamentos mßs utilizados fueron antiplaquetarios, hipoglicemiantes, diuréticos, analgésicos-AINEs y cardiovasculares. En el anßlisis bivariado el estado funcional y el número de medicamentos se asociaron con los eventos y reacciones adversas a medicamentos (OR=3.5 IC 95% 1.58-7.87, OR=3.5, IC 95% 1.6-7.82; respectivamente), sin embargo, en el anßlisis multivariado el número de enfermedades asociadas fue la única variable asociada (OR=3.2, IC 95% 1.95-5.42). Conclusiones: Los eventos y reacciones adversas a medicamentos son una causa frecuente, importante y no bien estudiada de ancianos que consultan los servicios de urgencia. El número de enfermedades fue el principal determinante de riesgo de ingreso al servicio de urgencias.

Objective: To determine adverse drug events (ADE) and adverse drug reactions (ADR) in elderly patients consulting a third level hospital emergency unit (EU). Design: Cross sectional study. Patients and methods: Four hundred patients aged sixty years or older consulting the EU (Caldas Hospital, Manizales, Colombia) (March-May 2004). Data on demographic characteristics, primary diagnosis, associated conditions and evaluation of medications intake were taken from the clinical records. Functional state was measured according with BarthelÆs index. Type and severity of ADE and ADR were categorized. Algorithms were used for ADR operational assessment. Results: The mean of age of patients was 72.8±8.2 years, and 52.3% were females. Frequency of ADE and ADR was 6.8%. Organic systems affected were 48.1% gastrointestinal, 37% endocrine and metabolic. 28.3% of the patients were not on medication. Mean use of medications per patient was 2.9±1.7. Type of medications involved, in order of frequency, was antiplatelet, hypoglicemic, diuretic, NSAIDs and cardiovascular. Intake of medication (Odds Ratio (OR)=3.52, (IC95% =1.58-7.87), and functional status (OR=3.54 (IC95% = 1.6-7.82) were associated factors for emergency unit admission for ADE or ADR. In the logistic regression the presence of an associated illness constituted the only independent associated factor for hospitalization (OR=3.2 IC 95% 1.95-5.42). Conclusions: ADE and ADR are frequent, important and not well studied causes for consultation of elderly patients at the EU. The number of associated illness was the main risk factor for hospitalization by ADE or ADR.

Valoración baciloscópica en pacientes con enfermedad de Hansen, tratados con el esquema de la OMS / Bacilloscopic study of patients with Hansen's disease, treated with the scheme of WHO

Se estudiaron 30 pacientes con enfermedad de Hansen multibacilar (BL o LL) que terminaron el tratamiento controlado según el esquema de la OMS. Se valoraron las baciloscopias de cada paciente en sus índices bacteriológico, morfológico y tintorial durante el inicio, primer año y segundo a lo del tratamiento. Al final del tratamiento 40 por ciento de los pacientes (12) negativizó su índice bacteriológico, el resto de ellos permaneció positivo, por lo que sugerimos que los pacientes con Hansen multibacilar prolonguen por más tiempo el esquema de tratamiento que ha implantado la OMS, para evitar futuras recaídas