Experimental Determination of the Standard Enthalpy of Formation of Trimellitic Acid and Its Prediction by Supervised Learning.

The standard molar enthalpy of formation for trimellitic acid (TMAc) in the crystalline phase at 298.15 K, ΔfHm°(cr), was calculated experimentally from the enthalpy of combustion through combustion calorimetry experiments. Likewise, the standard molar enthalpy of sublimation was determined from the standard molar enthalpy of fusion and from the standard molar enthalpy of vaporization from differential scanning calorimetry and thermogravimetry, respectively. Subsequently, the standard molar enthalpies of formation in the gas-phase at 298.15 K, ΔfHm°(g), were calculated. The enthalpies of formation for TMAc, hemimellitic, and trimesic acids were predicted using multiple linear regression (MLR) with a nonreplacement evaluation technique. MLR was applied to the data set that allowed estimating these thermochemical properties with an R2 greater than 0.99. This model was used to compare the predicted and experimental results for benzene carboxylic acids.

7-Methoxy-4-methylcoumarin: Standard Molar Enthalpy of Formation Prediction in the Gas Phase Using Machine Learning and Its Comparison to the Experimental Data.

Experimentally, the standard molar enthalpy of formation in the crystalline phase at 298.15 K, ΔfHm°(cr) for 7-methoxy-4-methylcoumarin (7M4MC) was calculated by traditional linear regression, which was obtained by combustion calorimetry. Similarly, the standard molar enthalpy of sublimation was determined through the standard molar enthalpy of fusion and by the standard molar enthalpy of vaporization, from differential scanning calorimetry and thermogravimetry, respectively; lately using these results, the standard molar enthalpy of formation in the gas phase was calculated at 298.15 K, ΔfHm°(g). In addition ML was used to predict the standard molar enthalpy of formation in the gas phase for the 7M4MC, constructing an experimental data set containing three kinds of functional groups: esters, coumarins, and aromatic compounds. The procedure was performed by using multiple linear regression algorithms and stochastic gradient descent with a R2 of 0.99. The obtained models were used to compare those predicted values versus experimental for coumarins, resulting in an average error rate of 9.0%. Likewise, four homodesmic reactions were proposed and predicted with the multiple linear regression algorithm of ML obtaining good results.

Mesophotic Coral Ecosystems in the Eastern Tropical Pacific: The current state of knowledge and the spatial variability of their depth boundaries.

In the Eastern Tropical Pacific (ETP), Mesophotic Coral Ecosystems (MCEs) are limited by oceanographic conditions and are thought to be mostly absent. However, considering the currently discussed more flexible approach to define mesophotic boundaries, based on light availability, we performed a systematic search to assess their current state of knowledge. Using MODIS-Aqua satellite data (Kd490), we calculated the mesophotic boundaries in the ETP, based on optical depths, and performed a bibliographic search of studies carried out at those depths, including those present in turbid waters with KdPAR values up to 0.2 m-1. Seventy-seven papers on MCEs research were compiled in this review, recording a total of 138 species. The studies focus almost exclusively on taxonomy, ecosystem function, and reviews, indicating the need for future research regarding aspects, such as structuring environmental variables, molecular ecology, and natural resource management. Furthermore, remote sensing data show that there exists a high spatial variability of water transparency in the ETP, resulting in significant differences in KdPAR between oceanic and continental locations, mostly related to the occurrence of seasonal upwelling in the latter. Based on KdPAR, we estimated the mesophotic depth boundaries (z10%, z1%, z0.1%) for specific locations within the ETP and found that MCEs can potentially occur as shallow as 13-15 m in coastal regions. Also, we compared the calculated boundaries with the respective deepest records of light-dependent corals. With one exception, the presence of the corals was restricted to the upper mesophotic subzone (z10%-z1%), which agrees with reports for other regions, showing that light availability is one of the main drivers for the bathymetric distribution of MCEs and can be used as a first approach to identify their potential presence, though other local factors (e.g., geomorphology, temperature, internal waves) should also be considered, as they can cause shifts in depth limits.

A Novel, Reliable and Highly Versatile Method to Evaluate Different Prion Decontamination Procedures.

Transmissible spongiform encephalopathies (TSEs) are a group of invariably fatal neurodegenerative disorders. The causal agent is an aberrantly folded isoform (PrPSc or prion) of the endogenous prion protein (PrPC) which is neurotoxic and amyloidogenic and induces misfolding of its physiological counterpart. The intrinsic physical characteristics of these infectious proteinaceous pathogens makes them highly resistant to the vast majority of physicochemical decontamination procedures used typically for standard disinfection. This means prions are highly persistent in contaminated tissues, the environment (surfaces) and, of great concern, on medical and surgical instruments. Traditionally, decontamination procedures for prions are tested on natural isolates coming from the brain of infected individuals with an associated high heterogeneity resulting in highly variable results. Using our novel ability to produce highly infectious recombinant prions in vitro we adapted the system to enable recovery of infectious prions from contaminated materials. This method is easy to perform and, importantly, results in highly reproducible propagation in vitro. It exploits the adherence of infectious prion protein to beads of different materials allowing accurate and repeatable assessment of the efficacy of disinfectants of differing physicochemical natures to eliminate infectious prions. This method is technically easy, requires only a small shaker and a standard biochemical technique and could be performed in any laboratory.

Extracorporeal Membrane Oxygenation Retrieval in Coronavirus Disease 2019: A Case-Series of 19 Patients Supported at a High-Volume Extracorporeal Membrane Oxygenation Center.

OBJECTIVE: To evaluate the performance of the extracorporeal membrane oxygenation retrieval team at a high-volume extracorporeal membrane oxygenation center during the coronavirus disease 2019 pandemic. DESIGN: Observational study including all adult patients with confirmed infection due to severe acute respiratory syndrome coronavirus-2 cannulated at other centers and transported on extracorporeal membrane oxygenation to the ICU of the Vall d'Hebron University Hospital between 15 March and 10 June 2020. SETTING: The ICU (capacity expanded to 200 during the pandemic) of the Vall d'Hebron University Hospital (a 1,100-bed public university hospital in Barcelona), the referral center for extracorporeal respiratory support in Catalonia (7.5 million inhabitants). PATIENTS: Extracorporeal membrane oxygenation was considered if the Pao2/Fio2 ratio less than 80 mm Hg (refractory to prone position) and/or Paco2 greater than 80 mm Hg and pH less than 7.25 for more than 6 hours, and no contraindications for extracorporeal support were present. INTERVENTIONS: Venovenous extracorporeal membrane oxygenation was initiated in the primary center. Then, patients were transferred to the ICU of the Vall d'Hebron University Hospital where they received support until respiratory improvement. After decannulation, patients were discharged for rehabilitation at the primary center. MEASUREMENTS AND MAIN RESULTS: Nineteen patients with severe acute respiratory syndrome coronavirus-2 infection and with a mean Pao2/Fio2 ratio of 71 mm Hg (57-118 mm Hg) despite prone positioning and a mean Paco2 of 70 mm Hg (47-110 mm Hg) were transferred to our center from their primary hospital after cannulation and received venovenous extracorporeal membrane oxygenation support. Prior to cannulation, six patients (31.5%) presented vascular thrombosis, and nine (47.4%) were already receiving anticoagulant therapy. Eighteen transfers were carried out with no significant complications. While on extracorporeal membrane oxygenation, thrombotic events were recorded in nine patients (47.4%) and hemorrhagic events in 13 (68.4%). Thirteen patients (68.4%) were successfully weaned, and 12 (63.1%) were discharged home. CONCLUSIONS: Extracorporeal membrane oxygenation retrieval can rescue young, previously healthy patients with severe coronavirus disease 2019 in whom all the conventional respiratory measures have failed. Thrombotic and hemorrhagic complications are frequent in this cohort.

Determinantes del resultado a largo plazo de la estenosis de válvula pulmonar reparada / Determinants of long-term outcome of repaired pulmonary valve stenosis

INTRODUCCIÓN Y OBJETIVOS: Aunque la estenosis de la válvula pulmonar (EVP) se considera una cardiopatía congénita de bajo riesgo, se ha descrito la aparición de complicaciones y necesidad de reintervenir durante el seguimiento. Los objetivos del estudio fueron evaluar los resultados a largo plazo de la EVP reparada e identificar predictores de complicaciones cardiovasculares y reintervención. MÉTODOS: Se estudió a 158 pacientes adultos con EVP reparada (reparaciones practicadas de 1957 a 2010) con seguimiento activo en un centro terciario de referencia. RESULTADOS: Se sometió a cirugía a 95 pacientes (60%) y a valvuloplastia percutánea con balón a 63 (40%). Tras una mediana de seguimiento de 27 [20-33] años, la mayoría de los pacientes (n=134 [84,8%]) estaban en clase funcional I de la New York Heart Association, pero 61 (38.6%) requirieron reintervención, principalmente reemplazo de la valvular pulmonar (n=28 [17,7%]), y 19 (12%) presentaron al menos una complicación cardiovascular: 13 (8,2%), arritmias supraventriculares; 6 (3,8%), insuficiencia cardiaca; 5 (3,2%), accidente cerebrovascular; 1 (0,6%), muerte; 1 (0,6%) tromboembolia, y 1 (0,6%), arritmia ventricular. El análisis multivariante mostró que la edad en el momento de la reparación de la EVP (HR=1,08; IC95%, 1,04-1,12; p <0,001) y la presencia de cianosis antes de la reparación (HR=5,23; IC95%, 1,99-13,78; p = 0,001) fueron predictores independientes de complicaciones cardiovasculares. CONCLUSIONES: Se puede esperar un buen resultado a largo plazo tras de la reparación de la EVP, pero pueden aparecer complicaciones y necesidad de reintervenir. Una edad más avanzada y la presencia de cianosis en el momento de la reparación de la EVP son predictores de complicaciones cardiovasculares e identifican a una población que requiere un control más estricto

INTRODUCTION AND OBJECTIVES: Although pulmonary valve stenosis (PVS) is considered a low risk congenital heart disease, there have been reports of complications and the need for reintervention throughout follow-up. The aims of this study were to evaluate the long-term outcome of repaired PVS and to identify predictors of cardiovascular complications and reintervention. METHODS: We studied 158 adult patients with repaired PVS (repair procedures performed from 1957 to 2010) receiving active follow-up in a tertiary referral center. RESULTS: A total of 95 patients (60%) received surgical treatment, and 63 patients (40%) received percutaneous pulmonary balloon valvuloplasty. At the end of follow-up (27 years, IQR, 20-33 years), most patients (n=134, 84.8%) were in New York Heart Association functional class I, but 61 patients (38.6%) required a reintervention, mainly pulmonary valve replacement (17.7%, n=28), and 19 patients (12%) had at least one cardiovascular complication: 13 (8.2%) supraventricular arrhythmias, 6 (3.8%) heart failure, 5 (3.2%) stroke, 1 (0.6%) death, 1 (0.6%) thromboembolism, and 1 (0.6%) ventricular arrhythmia. Multivariate analysis showed that age at PVS repair (HR, 1.08; 95%CI, 1.04-1.12; P <.001) and the presence of cyanosis before PVS repair (HR, 5.23; 95%CI, 1.99-13.78; P=.001) were independent predictors for cardiovascular complications. CONCLUSIONS: Good long-term outcome can be expected after PVS repair, but complications and the need for reintervention may appear. Older age and the presence of cyanosis at PVS repair emerged as predictors of cardiovascular complications and identified a population that may merit stricter control

Determinants of long-term outcome of repaired pulmonary valve stenosis.

INTRODUCTION AND OBJECTIVES: Although pulmonary valve stenosis (PVS) is considered a low risk congenital heart disease, there have been reports of complications and the need for reintervention throughout follow-up. The aims of this study were to evaluate the long-term outcome of repaired PVS and to identify predictors of cardiovascular complications and reintervention. METHODS: We studied 158 adult patients with repaired PVS (repair procedures performed from 1957 to 2010) receiving active follow-up in a tertiary referral center. RESULTS: A total of 95 patients (60%) received surgical treatment, and 63 patients (40%) received percutaneous pulmonary balloon valvuloplasty. At the end of follow-up (27 years, IQR, 20-33 years), most patients (n=134, 84.8%) were in New York Heart Association functional class I, but 61 patients (38.6%) required a reintervention, mainly pulmonary valve replacement (17.7%, n=28), and 19 patients (12%) had at least one cardiovascular complication: 13 (8.2%) supraventricular arrhythmias, 6 (3.8%) heart failure, 5 (3.2%) stroke, 1 (0.6%) death, 1 (0.6%) thromboembolism, and 1 (0.6%) ventricular arrhythmia. Multivariate analysis showed that age at PVS repair (HR, 1.08; 95%CI, 1.04-1.12; P <.001) and the presence of cyanosis before PVS repair (HR, 5.23; 95%CI, 1.99-13.78; P=.001) were independent predictors for cardiovascular complications. CONCLUSIONS: Good long-term outcome can be expected after PVS repair, but complications and the need for reintervention may appear. Older age and the presence of cyanosis at PVS repair emerged as predictors of cardiovascular complications and identified a population that may merit stricter control.

HERC1 Ubiquitin Ligase Is Required for Normal Axonal Myelination in the Peripheral Nervous System.

A missense mutation in HERC1 provokes loss of cerebellar Purkinje cells, tremor, and unstable gait in tambaleante (tbl) mice. Recently, we have shown that before cerebellar degeneration takes place, the tbl mouse suffers from a reduction in the number of vesicles available for release at the neuromuscular junction (NMJ). The aim of the present work was to study to which extent the alteration in HERC1 may affect other cells in the nervous system and how this may influence the motor dysfunction observed in these mice. The functional analysis showed a consistent delay in the propagation of the action potential in mutant mice in comparison with control littermates. Morphological analyses of glial cells in motor axons revealed signs of compact myelin damage as tomacula and local hypermyelination foci. Moreover, we observed an alteration in non-myelinated terminal Schwann cells at the level of the NMJ. Additionally, we found a significant increment of phosphorylated Akt-2 in the sciatic nerve. Based on these findings, we propose a molecular model that could explain how mutated HERC1 in tbl mice affects the myelination process in the peripheral nervous system. Finally, since the myelin abnormalities found in tbl mice are histological hallmarks of neuropathic periphery diseases, tbl mutant mice could be considered as a new mouse model for this type of diseases.

Recombinant PrP and Its Contribution to Research on Transmissible Spongiform Encephalopathies.

The misfolding of the cellular prion protein (PrPC) into the disease-associated isoform (PrPSc) and its accumulation as amyloid fibrils in the central nervous system is one of the central events in transmissible spongiform encephalopathies (TSEs). Due to the proteinaceous nature of the causal agent the molecular mechanisms of misfolding, interspecies transmission, neurotoxicity and strain phenomenon remain mostly ill-defined or unknown. Significant advances were made using in vivo and in cellula models, but the limitations of these, primarily due to their inherent complexity and the small amounts of PrPSc that can be obtained, gave rise to the necessity of new model systems. The production of recombinant PrP using E. coli and subsequent induction of misfolding to the aberrant isoform using different techniques paved the way for the development of cell-free systems that complement the previous models. The generation of the first infectious recombinant prion proteins with identical properties of brain-derived PrPSc increased the value of cell-free systems for research on TSEs. The versatility and ease of implementation of these models have made them invaluable for the study of the molecular mechanisms of prion formation and propagation, and have enabled improvements in diagnosis, high-throughput screening of putative anti-prion compounds and the design of novel therapeutic strategies. Here, we provide an overview of the resultant advances in the prion field due to the development of recombinant PrP and its use in cell-free systems.

Absorptance determinations on multicellular tissues.

The analysis of the variation of the capacity and efficiency of photosynthetic tissues to collect solar energy is fundamental to understand the differences among species in their ability to transform this energy into organic molecules. This analysis may also help to understand natural changes in species distribution and/or abundance, and differences in species ability to colonize contrasting light environments or respond to environmental changes. Unfortunately, the challenge that optical determinations on highly dispersive samples represent has strongly limited the progression of this analysis on multicellular tissues, limiting our knowledge of the role that optical properties of photosynthetic tissues may play in the optimization of photosynthesis and growth of benthonic primary producers. The aim of this study is to stimulate the use of optical tools in marine eco-physiology, offering a succinct description of the more convenient tools and also solutions to resolve the more common technical difficulties that arise while performing optical determinations on highly dispersive samples. Our study focuses on two-dimensional (2D-) parameters: absorptance, transmittance, and reflectance, and illustrates with correct and incorrect examples, specific problems and their respective solutions. We also offer a general view of the broad variation in light absorption shown by photosynthetic structures of marine primary producers, and its low association with pigment content. The ecological and evolutionary functional implications of this variability deserve to be investigated across different taxa, populations, and marine environments.

‘Compresión extrínseca dinámica de las arterias coronarias’ en lugar de ‘fenómeno de ordeñado’ / Advisability of not using a literal translation of ‘milking phenomenon’

No disponible

"Pulmonary valve replacement diminishes the presence of restrictive physiology and reduces atrial volumes": a prospective study in Tetralogy of Fallot patients.

Pulmonary valve replacement (PVR) reduces right ventricular (RV) volumes in the setting of long-term pulmonary regurgitation after Tetralogy of Fallot (ToF) repair; however, little is known of its effect on RV diastolic function. Right atrial volumes may reflect the burden of RV diastolic dysfunction. The objective of this paper is to evaluate the clinical, echocardiographic, biochemical and cardiac magnetic resonance (CMR) variables, focusing particularly on right atrial response and right ventricular diastolic function prior to and after elective PVR in adult patients with ToF. This prospective study was conducted from January 2009 to April 2013 in consecutive patients > 18 years of age who had undergone ToF repair in childhood and were accepted for elective PVR. Twenty patients (mean age: 35 years; 70% men) agreed to enter the study. PVR was performed with a bioporcine prosthesis. Concomitant RV reduction was performed in all cases when technically possible. Pulmonary end-diastolic forward flow (EDFF) decreased significantly from 5.4 ml/m(2) to 0.3 ml/m(2) (p < 0.00001), and right atrial four-chamber echocardiographic measurements and volumes by 25% (p = 0.0024): mean indexed diastolic/systolic atrial volumes prior to surgery were 43 ml/m(2) (SD+/-4.6)/63 ml/m(2) (SD+/-5.5), and dropped to 33 ml/m(2) (SD+/-3)/46 ml/m(2) (SD+/-2.55) post-surgery. All patients presented right ventricular diastolic and systolic volume reductions, with a mean volume reduction of 35% (p < 0.00001). Right ventricular diastolic dysfunction was common in a population of severely dilated RV patients long term after ToF repair. Right ventricular diastolic parameters improved as did right atrial volumes in keeping with the known reduction in RV volumes, after PVR.

Rol de la terapia altas dosis y el trasplante de células progenitoras hematopoyéticas en pacientes con Linfoma de Hodgkin y Linfoma no Hodgkin en el Hospital Nacional Edgardo Rebagliati Martins, durante los años 1994-2005 / Role of high-dose therapy and stem cell transplantation in patients with Hodgkin's and non-Hodgkin Lymphoma in the National Hospital Edgardo Rebagliati Martins, during the years 1994-2005

Antecedentes: El uso de la terapia altas dosis (TAD) con trasplante de células progenitoras hematopoyéticas (TCPH) en el tratamiento de Linfoma Hodgkin (LH), Linfoma no Hodgkin de Bajo Grado (LNHBG) y Linfoma no Hodgkin de Alto Grado (LNHAG) recurrente o refractario ha mostrado beneficios que en nuestro país se ven limitados por la limitada accesibilidad, capacidad de aseguramiento y altos costos. La experiencia de doce años en la realización de TAD TCPH en el Hospital Nacional Edgardo Rebagliati Martins (HNERM) ha sido descrita y analizada. Material y métodos: Se colectaron datos clínicos de todos los pacientes con el diagnóstico de Linfoma Hodgkin o Linfoma No Hodgkin que fueron sometidos a TAD TCPH en la Unidad de Trasplante de Médula Ósea (UTMO) del HNERM, entre Enero 1994 a Diciembre 2005. Se incluyeron 25 casos que cumplían criterios OMS. Los regimenes de movilización incluyeron ICE (55%), Ciclofosfamida (33%) y GCSF (11%) en LH; Ciclofosfamida (100%) en LNHBG; y, Ciclofosfamida (63%), ICE (27%) y GCSF (9%) en LNH agresivo. Los regimenes de terapia altas dosis incluyeron CVD (36%), BEAM (27%) en LH; BEAC (100%) LNHBG; y, BEAC (33%) y BEAM (33%) en LNHAG. 23 (92%) recibieron TCPH autólogo, (4%) con LH, TCPH alogénico, y 1 (4%) con LNHAG, TCPH singénico, respectivamente. Resultados: Se determinaron la sobrevida global (SG) y sobrevida libre de eventos (SLE). En LH, SG 50% a 3 años y SLE 40% a 3 años. En LNHBG, SG 75% a 7,7 años y SLE 70% a 3 años. En LNHAG, SG fue 40% a 4 años y SLE 50% a los 4 años. No se detectó ninguna muerte asociada al tratamiento. Conclusión: TAD y TCPH tienen un rol preponderante en el tratamiento de LH y LNH recurrente o refractario con buena tolerancia y efectividad. Se deben propugnar medidas para su mayor cobertura y accesibilidad.

Background: High dosis therapy (HDT) and hematopoyetic progenitor cells transplant (HPCT) for the treatment of recurrent or refratory Hodgkin’s Lymphoma (HL), Low-Grade Non-Hodgkin’s Lymphoma (LGNHL) and High-Grade Non-Hodkin’s Lymphoma (HGNHL) has shown benefits which are limited for accesibility and insurance. The HNERM’s experience has been shown in this paper. Material and Methods: Clinical dates have been colected from cases of HL, LGNHL and AGNHL. 25 cases were included. Movilization regimenes included ICE (55%), Ciclofosfamid (33%) and GCSF (11%) for HL; Ciclofosfamid (100%) for LGNHL; and, Ciclofosfamid (63%), ICE (27%) and GCSF (9%) for HGNHL. High dosis therapy regimen included CVD (36%) and BEAM (27%) for HL; BEAC (100%) for LGNHL; and, BEAC (33%) and BEAM (33%) for HGNHL. 23 (92%) received autologic HPCT, (4%) of LH, allogenic HPCT, y 1 (4%) HGNHL, singenic HPCT. Results: Overal Survive (OS) and Events Free Survive (EFS) were included. For HL, OS was 50% to 3 years and EFS was 40% to 3 years. For LGNHL, OS 75% to 7,7 years and EFL 70% to 3 years. In HGNHL, OS was 40% to 4 years and EFS 50% to 4 years. There was no one case of mortality. Conclusion: HDT and HPCT have an important rol for the treatment of recurrent or refractory HL and NHL.

Multimedia de Inglés comunicativo para colaboradores de la Salud: guía de entrevista médico-paciente / A multimedia on communicative English for health care professionals abroad: a medical interview guide

Los idiomas representan una barrera para la comunicación médico-paciente. Por ello, y ante la carencia de materiales didácticos para la enseñanza del inglés médico, que contengan los pasos y requisitos fundamentales para realizar entrevista médico-paciente en la atención primaria y secundaria, elaboramos una multimedia en inglés sobre esta base, que sirva de material didáctico y guía comunicativa a los médicos que prestan su colaboración en países de habla inglesa o en los que se utilice este idioma para, de esta forma, contribuir también a la enseñanza del inglés médico en el pregrado y el posgrado. Con este objetivo, se identificaron los pasos, las preguntas, las instrucciones y recomendaciones fundamentales de la entrevista médico-paciente en la atención primaria y secundaria, para posteriormente buscar su equivalencia en el idioma inglés, mediante una amplia revisión bibliográfica de materiales dedicados a la enseñanza del inglés médico y con la ayuda de diccionarios médicos actualizados. Se identificaron, además, decenas de palabras y frases de uso coloquial que con frecuencia utilizan médicos y pacientes, así como alrededor de mil cuatrocientas palabras y ejemplos relacionados con el tema. Este material recopilado se organizó en las cuatro partes que conforman la multimedia y fue sometido a la consideración de prestigiosos especialistas de la enseñanza del inglés médico, la traducción médica y la medicina interna. Posteriormente, se procedió a la grabación del trabajo en este idioma y se confeccionó la multimedia

Casos Nuevos de Cáncer en el Instituto Nacional de Cancerología, Colombia, 2002 / New cases of Cancer at National Institute of Canceroloy

Objetivo: Describir las características sociodemográficas,clínicas e histológicas de los casos incidentes de cáncer del Instituto Nacional de Cancerología (INC)de Colombia. Materiales y Métodos: Estudio transversal descriptivo.Se incluyeron todos los casos nuevos reportados por el registro institucional en el 2002. Se realizó un análisis univariado y bivariado por variables sociodemográficas,aseguramiento,características del tumor,estado clínico y tratamiento.Se compararon proporciones con ji al cuadrado (X2) y se utilizó nivel de significancia 0,05. RESULTADOS: Hubo 4.990 casos nuevos de cáncer, 13 por ciento mas que el año anterior. De ellos,3.071 (61,5 por ciento) fueron mujeres y 359 (7,2 por ciento) menores de 17 años. El 97 por ciento tenia verificación histológica. Los tipos de cáncer más frecuentes fueron cuello uterino (14,4 por ciento),piel (13,3 por ciento) mama (12,2) por ciento, estómago (6,5por ciento)sistema hematopoyético (5,5) por ciento. El cáncer de pulmón tuvo una baja participación (2,2 por ciento) el 79,8 por ciento de los casos proviene de Bogotá y los departamentos vecinos. La proporción de pacientes tratados antes de ingresar al INC fue mayor que en los dos años anteriores (28 por ciento, 31por ciento y 34,8 por ciento, respectivamente, pmenor 0,001). Conclusiones: Los datos del registro institucional de cáncer, tanto en sus indicadores positivos como los que revelan dificultades en el proceso de atención. Deben usarse adecuadamente como una base confiable de información para la programación de acciones con base en los perfiles de los usuarios y para la búsqueda de recursos que permitan el sostenimiento de los servicios hospitalarios

Mortalidad en el Instituto Nacional de Cancerología, Colombia,2002 / Mortality at the National Cancer Institute, Colombia, 2002

Objetivos: Describir las características y las causas de uerte de pacientes del Instituto Nacional de Cancerología durante el año 2002, con base en los certificados de defunción diligenciados, e identificar os factores que se relacionan con el lugar del fallecimiento. METODOLOGIA: Estudio de corte transversal. Se realizaron análisis bivariado y multivariado, obteniendo razones de prevalencia (RP) por medio de regresi[on log-binomial. Se utilizó la prueba de Hosmer-Lemeshow par evaluar la bondad de ajuste del modeloRESULTADOS: En el año 2002 se diligenciaron 1.027 certificados de defunción, de los que 536 (52,2 por ciento) fueron de pacientes que fallecieron el el INC. De los 490 muertos en casa, 288(58,8)por ciento eran manejados por la Unidad de Cuidados Paliativos (UCP). la edad media de muerte fue 55,3 años. Las causas básicas de muerte más frecuentes fueron el cáncer de estómago (10,9)por ciento, el cáncer de cuello uterino (10,8por ciento) y el cáncer de mama (9,8 por ciento). En pacientes pediátricos lo fueron las leucemias linfoide y mieloide agudas. Los factores que aumentaron el riesgo de morir en casa en forma independiente fueron la atención por la UPC (RP:2,78: IC 95 por ciento:2,46-3,15) y un tiempo mayor a dos meses desde la primera consulta al INC. La prueba de Hosmer-Lemeshow evidenció un buen ajuste del modelo (p=0,90). CONCLUSIONES: La mortalidad en pacientes del INC justifica un esfuerzo para mejorar la calidad de los certificados de defunción, para profundizar en los factores que determinan el lugar de muerte y para desarrollar estudios que aborden diferentes aspectos de la calidad de vida de pacientes terminales.

Port-Access cardiac surgery: from a learning process to the standard.

BACKGROUND: Port-Access surgery has been one of the most innovative and controversial methods in the spectrum of minimally invasive techniques for cardiac operations and has been widely used for the treatment of several cardiac diseases. The technique was introduced in our center to evaluate its efficacy in reproducing standardized results without an additional risk. METHODS: Endovascular cardiopulmonary bypass (CPB) through femoral access and endoluminal aortic occlusion were used in 129 patients for a variety of surgical procedures, all of which were video-assisted. A minimal (4-6 cm) anterior thoracotomy through the fourth intercostal space was used in all cases as the surgical approach. RESULTS: More than 96% of the planned cases concluded as true Port-Access procedures. Mean CBP and crossclamp times were 87.2 min. +/- 51.2 (range of 10-457) and 54.9 min. +/- 30.6 (range of 10-190), respectively. Hospital mortality for the overall group was 1.5%, and mitral valve surgery had a 2.2% hospital death rate. The incidence of early neurological events was 0.7%. Mean extubation time, ICU stay, and total length of hospital stay were 5 hours +/- 6 hrs. (range of 2-32), 12 hours +/- 11.8 hrs. (range of 5-78), and 7 days +/- 7.03 days (range of 1-72), respectively. CONCLUSIONS: Our experience indicates that the Port- Access technique is safe and permits reproduction of standardized results with the use of a very limited surgical approach. We are convinced that this is a superior procedure for certain types of surgery, including isolated primary or redo mitral surgery, repair of a variety of atrial septal defects (ASDs), and atrial tumors. It is especially useful in high-risk patients, such as elderly patients or those requiring reoperation. Simplification of the procedure is nevertheless desirable in order to further reduce the time of operation and to address other drawbacks.

Guia de supervision monitoreo y evaluacion para los programas de atencion materna y perinatal:I y II niveles de atencion / x

Camino de la sobrevivencia materna y perinatal. Supervision capacitante en comunicacion interpersonal y orientacion. Estrategia de supervision en cascada. Monitoreo. Experiencia de monitoreo en los programas materno perinatales. Indicadores de monitoreo y fuentes. Instrumentos de monitoreo. Evaluacion. Instrumentos de evaluacion.

Del problema a la acción los medicamentos y acciones esenciales: manejo de complicaciones maternas y perinatales

Atensión de la madre (embarazo, parto y puerperio). Atención prenatal. Complicaciones del embarazo. Hemorragias de la 1º mitad del embarazo. Hemorragias de la 2º mitad de embarazo. Complicaciones del trabajo de parto. Atensión del parto. Atención del puerperio. Infecciones en el embarazo, post-parto o post-aborto. Atención al recien nacido. Cuidados inmediatos del recien nacido. Complicaciones respiratorias del recien nacido. Infecciones del recien nacido. Técnicas e insumos para la atención de la madre y el recien nacido. Uso de métodos natuarales y artificiales de planificación familiar temporales y definitivos. Indicadores clínicos y laboraratoriales. Piramide de atención del embarazo, parto, puerperio y el recien nacido por niveles de complejidad. Intervenciones del paquete madre-bebé (OPS/OMS)