Alteraciones retinianas detectadas por screening con cámara retinal no midriática y derivación a oftalmología en una población de alto riesgo cardiovascular / Retinal alterations detected by non-mydriatic retinal camera screening and referral to ophthalmology in a population with high cardiovascular risk

Objetivo Describir las principales alteraciones retinianas detectadas por screening con cámara retinal no midriática y evaluar los factores relacionados con la derivación a oftalmología en una población de alto riesgo cardiovascular en Palmira, Colombia. Materiales y métodos Estudio observacional de tipo transversal, con 11.983 registros fotográficos de pacientes con hipertensión y diabetes mellitus del programa de enfermedades crónicas de Gesencro S.A.S. entre 2018 y 2020. Se evaluaron con regresión logística los factores de riesgo relacionados con la derivación a oftalmología y se obtuvieron los odds ratios (OR) crudos y ajustados. Resultados Se analizaron 11.880 registros; la edad media fue de 67,7±12años, y el 69,5% fueron mujeres. Entre las alteraciones retinianas se encontraron pacientes con retinopatía diabética clasificada como más que leve (10%) y gradoI de retinopatía hipertensiva (54,9% ojo derecho, 51,9% ojo izquierdo). También se identificó edema macular (15%). Solo 2.069 (17,4%) pacientes requirieron derivación a oftalmología; el 81,3% requirieron control a 1año y el 1,3% a los 6meses. En el análisis multivariado los factores de riesgo que se relacionaron con la probabilidad para ser derivados fueron: el género masculino, la edad mayor o igual a 60años, la hemoglobina glucosilada (HbA1c) fuera de metas, la enfermedad renal crónica avanzada y la razón microalbúmina-creatinina moderada a severamente elevada. Conclusión Este estudio permitió determinar la importancia que tiene el screening con cámara retinal no midriática en pacientes de alto riesgo cardiovascular para detectar alteraciones retinianas y evaluar factores de riesgo asociados con derivación a oftalmología. El documentar tempranamente el compromiso ocular en estos pacientes podría prevenir y evitar la discapacidad visual y la ceguera (AU)

Objective To describe the main retinal alterations detected by non-mydriatic retinal camera screening and to evaluate factors related to referral to ophthalmology in a population at high cardiovascular risk in Palmira, Colombia. Materials and methods Cross-sectional observational study, which included 11,983 photographic imaging records of patients with hypertension and diabetes mellitus from Gesencro's S.A.S. comprehensive chronic disease care program between 2018 and 2020. Risk factors associated to referral to ophthalmology were evaluated with logistic regression, and crude and adjusted ORs (odds ratios) were obtained. Results A total of 11,880 records were analyzed; 67.7±12years old, and 69.5% were women. Among the retinal alterations were patients with diabetic retinopathy classified as more than mild in 10% and gradeI hypertensive retinopathy in 54.9% right eye, 51.9% left eye. Macular edema was also identified. Only 2069 patients (17.4%) required referral to ophthalmology, and for imaging control 82.6%. In the multivariate analysis, the risk factors associated with the probability of being referred were male gender, age 60years and older, glycosylated hemoglobin out-of-target, advanced chronic kidney disease and the microalbumin-to-creatinine ratio moderate to severely elevated. Conclusion This study makes it possible to determine the importance of screening with a non-mydriatic retinal camera in patients at high cardiovascular risk to detect retinal abnormalities and assess risk factors associated with referral to ophthalmology. Early documentation of ocular compromise in these patients could prevent and avoid visual impairment and blindness (AU)

[Retinal alterations detected by non-mydriatic retinal camera screening and referral to ophthalmology in a population with high cardiovascular risk]. / Alteraciones retinianas detectadas por screening con cámara retinal no midriática y derivación a oftalmología en una población de alto riesgo cardiovascular.

OBJECTIVE: To describe the main retinal alterations detected by non-mydriatic retinal camera screening and to evaluate factors related to referral to ophthalmology in a population at high cardiovascular risk in Palmira, Colombia. MATERIALS AND METHODS: Cross-sectional observational study, which included 11,983 photographic imaging records of patients with hypertension and diabetes mellitus from Gesencro's S.A.S. comprehensive chronic disease care program between 2018 and 2020. Risk factors associated to referral to ophthalmology were evaluated with logistic regression, and crude and adjusted ORs (odds ratios) were obtained. RESULTS: A total of 11,880 records were analyzed; 67.7±12years old, and 69.5% were women. Among the retinal alterations were patients with diabetic retinopathy classified as more than mild in 10% and gradeI hypertensive retinopathy in 54.9% right eye, 51.9% left eye. Macular edema was also identified. Only 2069 patients (17.4%) required referral to ophthalmology, and for imaging control 82.6%. In the multivariate analysis, the risk factors associated with the probability of being referred were male gender, age 60years and older, glycosylated hemoglobin out-of-target, advanced chronic kidney disease and the microalbumin-to-creatinine ratio moderate to severely elevated. CONCLUSION: This study makes it possible to determine the importance of screening with a non-mydriatic retinal camera in patients at high cardiovascular risk to detect retinal abnormalities and assess risk factors associated with referral to ophthalmology. Early documentation of ocular compromise in these patients could prevent and avoid visual impairment and blindness.

Deficiencia e insuficiencia de vitamina D en mujeres post cirugía bariátrica Roux en Y / Vitamin D deficiency and insufficiency among women with Roux-en-Y bariatric surgery / Deficiência e Insuficiência de vitamina D em mulheres post cirurgia bariátrica Roux em Y

Objetivo Determinar la relación entre la falta de seguimiento, adherencia al tratamiento con multivitamínicos y niveles séricos de 25-OH vitamina D (Vit-D) en mujeres post-cirugía BPRY, en la UNEME de la ciudad de Tijuana, Baja California, México. Métodos Estudio Transversal analítico que incluyó mujeres post-cirugía BPRY (GCa, n=13), con Obesidad Mórbida (GOM, n=13) y mujeres aparentemente sanas (GCo, n=13). Posterior a la autorización mediante consentimiento informado escrito, se realizó una historia clínica, valoración antropométrica, aplicación del instrumento de medición y en una segunda cita se tomó una muestra sanguínea para la cuantificación de Vit-D. El instrumento de medición fue validado mediante Kappa de Cohen mayor al 80% y alfa de Cronbach de 1. El análisis estadístico de los datos se realizó mediante pruebas de diferencia de medias t de Student y ANOVA donde se consideró una p < 0.05 en una prueba a dos colas. Se determinó prevalencia, significancia estadística de la falta de adherencia y seguimiento en relación a los niveles de Vit-D. Resultados La prevalencia de falta de adherencia al tratamiento multivitamínico en estas mujeres con post-cirugía BPRY fue de 85% y la falta de seguimiento post quirúrgico que incluye pruebas de laboratorio de micronutrientes fue del 100%. Se encontró una diferencia estadísticamente significativa entre las medias de los niveles de Vit-D entre las mujeres con y sin adherencia al multivitamínico p < 0.05, IC 95%. Conclusiones Se demostró que la falta de adherencia y seguimiento al tratamiento con multivitamínicos son factores de riesgo para la insuficiencia y deficiencia de Vit-D en pacientes con post-cirugía BPRY.

Objective To determine the interrelationships among lack of compliance, multi-vitamin treatment adherence, and serum levels of 25-OH vitamin D among women with Roux-en-Y bariatric surgery in the UNEME of Tijuana, Baja California, Mexico. Methods This is an analytical and transversal study on women with Roux-en-Y bariatric surgery (GCa, n=13) with morbid obesity (GOM, n=13), and apparently healthy women (GCo, n=13). After the corresponding written informed consents, in a first appointment, the medical record, the anthropometric assessment, and the administration of the instrument were performed, while in a second appointment, blood samples were taken in order to measure the vitamin D levels. The assessment instrument was validated through a Cohen Kappa greater than 80% and a Cronbach Alpha of 1. Student's t test and two-tailed, p < 0.05 ANOVAS were calculated. Results While a lack of adherence to multi-vitamin treatment was found in 85% of the women, a lack of post-surgical follow-up, including micro-nutrients lab tests, was found in 100%. A statistically significant difference between the mean vitamin D levels of women with and without multi-vitamin treatment adherence was found (p < 0.05, CI 95%). Conclusions It was demonstrated that the lack of adherence to multi-vitamin treatments is a vitamin D deficiency risk factor among patients with Roux-en-Y bariatric surgery.

Objetivo Determinar a relação entre a falta de seguimento, aderência ao tratamento com multivitamínicos e niveis séricos de 25-OH vitamina D (Vit-D) em mulheres post-cirurgia BPRY, na UNEME da cidade de Tijuana, Baja California, México. Métodos. Estudo Transversal analítico que incluiu mulheres post-cirurgia BPRY (GCa, n=13), com Obesidade Mórbida (GOM, n=13) e mulheres aparentemente saudáveis (GCo, n=13). Posterior à autorização mediante consentimento informado escrito, realizou-se uma história clínica, avaliação antropométrica, aplicação do instrumento de medição e em uma segunda consulta tomou-se uma amostra sanguínea para a quantificação de Vit-D. O instrumento de medição foi validado mediante Kappa de Cohen maior a 80% e alfa de Cronbach de 1. A análise estatística dos dados realizou-se mediante probas de diferencia de média t de Student e ANOVA onde se considerou uma p < 0.05 em um teste bilateral. Determinou-se prevalência, significância estatística da falta de aderência e seguimento em relação aos níveis de Vit-D. Resultados A falta de aderência ao tratamento multivitamínico nestas mulheres bariátricas foi de 85% e a falta de seguimento post cirúrgico que inclui testes de laboratório de micronutrientes foi de 100%. Encontrou-se uma diferença estatisticamente significativa entre a média dos níveis de Vit-D entre as mulheres com e sem aderência no multivitamínico p < 0.05, IC 95%. Conclusões . Demostrou-se que a falta de aderência e seguimento no tratamento com multivitamínicos são fatores de risco para a insuficiência e deficiência de Vit-D em pacientes bariátricos.

An innovative approach to the assessment of hydro-political risk: A spatially explicit, data driven indicator of hydro-political issues.

Competition over limited water resources is one of the main concerns for the coming decades. Although water issues alone have not been the sole trigger for warfare in the past, tensions over freshwater management and use represent one of the main concerns in political relations between riparian states and may exacerbate existing tensions, increase regional instability and social unrest. Previous studies made great efforts to understand how international water management problems were addressed by actors in a more cooperative or confrontational way. In this study, we analyze what are the pre-conditions favoring the insurgence of water management issues in shared water bodies, rather than focusing on the way water issues are then managed among actors. We do so by proposing an innovative analysis of past episodes of conflict and cooperation over transboundary water resources (jointly defined as "hydro-political interactions"). On the one hand, we aim at highlighting the factors that are more relevant in determining water interactions across political boundaries. On the other hand, our objective is to map and monitor the evolution of the likelihood of experiencing hydro-political interactions over space and time, under changing socioeconomic and biophysical scenarios, through a spatially explicit data driven index. Historical cross-border water interactions were used as indicators of the magnitude of corresponding water joint-management issues. These were correlated with information about river basin freshwater availability, climate stress, human pressure on water resources, socioeconomic conditions (including institutional development and power imbalances), and topographic characteristics. This analysis allows for identification of the main factors that determine water interactions, such as water availability, population density, power imbalances, and climatic stressors. The proposed model was used to map at high spatial resolution the probability of experiencing hydro-political interactions worldwide. This baseline outline is then compared to four distinct climate and population density projections aimed to estimate trends for hydro-political interactions under future conditions (2050 and 2100), while considering two greenhouse gases emission scenarios (moderate and extreme climate change). The combination of climate and population growth dynamics is expected to impact negatively on the overall hydro-political risk by increasing the likelihood of water interactions in the transboundary river basins, with an average increase ranging between 74.9% (2050 - population and moderate climate change) to 95% (2100 - population and extreme climate change). Future demographic and climatic conditions are expected to exert particular pressure on already water stressed basins such as the Nile, the Ganges/Brahmaputra, the Indus, the Tigris/Euphrates, and the Colorado. The results of this work allow us to identify current and future areas where water issues are more likely to arise, and where cooperation over water should be actively pursued to avoid possible tensions especially under changing environmental conditions. From a policy perspective, the index presented in this study can be used to provide a sound quantitative basis to the assessment of the Sustainable Development Goal 6, Target 6.5 "Water resources management", and in particular to indicator 6.5.2 "Transboundary cooperation".

Effects of type and particle size of dietary fiber on growth performance and digestive traits of broilers from 1 to 21 days of age.

A trial was conducted to study the effects of type and particle size of dietary fiber on growth performance and digestive traits of broilers from 1 to 21 d of age. There was a negative control diet with 1.54% crude fiber, a positive control diet that included 3% cellulose (CEL), and 4 additional diets arranged factorially that included 3% oat hulls (OH) or sugar beet pulp (SBP) ground through a 0.5- or a 2.0-mm screen. For the entire experimental period, fiber inclusion improved BW gain (P≤0.01) and feed conversion ratio (P≤0.001), but particle size of the fiber source did not affect performance. The relative weight of the gizzard was higher (P≤0.001) with OH and SBP than with CEL or the control diet. Also, gizzard weight decreased (P≤0.001) with a reduction in particle size of the fiber source. Fiber inclusion increased HCl concentration and reduced gizzard pH (P≤0.01), and the effects were more noticeable with OH and SBP than with CEL. Fiber inclusion increased total tract apparent retention of nitrogen (P≤0.001) and soluble ash (P≤0.001) as well as the AMEn of the diet (P≤0.001). All of these effects were in general more pronounced with OH than with CEL, with SBP being intermediate. A reduction in particle size of the OH and SBP improved total tract apparent retention of DM (P≤0.001), nitrogen (P≤0.05), and soluble ash (P≤0.01) as well as the AMEn of the diet (P≤0.05). It is concluded that additional OH and SBP improves gizzard weight and growth performance in young chicks fed low-fiber diets and that the effects are more pronounced with OH than with CEL. Particle size of OH and SBP does not affect broiler performance, but coarse grinding increases gizzard development and reduces nutrient digestibility in young birds.