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Phys Rev E ; 101(2-1): 022303, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32168577


Various functions of a network of excitable units can be enhanced if the network is in the "critical regime," where excitations are, on average, neither damped nor amplified. An important question is how can such networks self-organize to operate in the critical regime. Previously, it was shown that regulation via resource transport on a secondary network can robustly maintain the primary network dynamics in a balanced state where activity doesn't grow or decay. Here we show that this internetwork regulation process robustly produces a power-law distribution of activity avalanches, as observed in experiments, over ranges of model parameters spanning orders of magnitude. We also show that the resource transport over the secondary network protects the system against the destabilizing effect of local variations in parameters and heterogeneity in network structure. For homogeneous networks, we derive a reduced three-dimensional map which reproduces the behavior of the full system.

J Sports Sci ; 38(2): 214-230, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31795815


Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.

Desempenho Atlético/fisiologia , Desempenho Atlético/psicologia , Retroalimentação , Monitores de Aptidão Física , Motivação , Corrida/fisiologia , Corrida/psicologia , Traumatismos em Atletas/prevenção & controle , Fenômenos Biomecânicos , Marcha/fisiologia , Humanos , Percepção , Corrida/lesões
J Clin Exp Dent ; 11(7): e593-e600, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31516656


Background: To compare the frictional resistance between passive self-ligating brackets and conventional brackets with low-friction ligature under bracket/archwire and root/bone interface during dental alignment and leveling. Material and Methods: A tridimensional model of the maxilla and teeth of a patient treated with conventional brackets, and slide ligatures was generated employing the SolidWorks modeling software. SmartClip self-ligating brackets and Logic Line conventional brackets were assembled with slide low-friction ligatures, utilizing archwires with different diameters and alloys used for the alignment and leveling stage. Friction caused during the bracket/archwire interface and stress during the bone/root interface were compared through a finite element model. Results: SmartClip and Logic Line brackets with slide elastomeric low-friction elastomeric ligature showed similar frictional stress values of 0.50 MPa and 0.64 MPa, respectively. Passive self-ligating brackets transmitted a lower load along the periodontal ligament, compared to conventional brackets with a low-friction ligature. Conclusions: Slide low-friction elastomeric ligatures showed frictional forces during the bracket/archwire interface similar to those of the SmartClip brackets, while the distribution of stresses and deformations during the root/bone interface were lower in the passive self-ligating brackets. Key words:Orthodontic friction, finite element analysis, orthodontic brackets, orthodontic wires.

Sci Total Environ ; 683: 773-781, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31150897


Energy production based on the proper allocation of environmental liabilities is in line with the concept of sustainability. Flotation sludge (S) is a type of waste derived from the physical treatment of the wastewater generated in significant quantities during chicken slaughter in Brazil. If not treated, this wastewater may contribute to pollution, but further treatment provides clean energy and nutrient recycling. The present study aimed at evaluating the reduction of (S) organic load by means of mono and co-digestion with sweet potatoes (P) while promoting its conversion into energy (methane) and nutrients (digestate). Semi-continuous reactors (60 L capacity) were used with a hydraulic retention time of 25 days. The reactors were fed daily with 2.4 L consisting of 60% digestate recirculation, 40% non-chlorinated water and 4.5% total solids (TS). Using nine reactors and six progressive periods, eleven conditions were evaluated with three replicates each. The percentages of (P) and (S) varied from 0 to 100. The best observed condition in terms of energy recovery and TS removal was 60% of P + 40% of S (p ≤ 0.05), as it presented values of at least an increase of 92% in total biogas volume, an increase of 123% in specific methane production, an increase of 98% in specific methane yield and an increase of 44% in TS removal efficiency compared to mono-digestions. The fertilizer potential of the digestate generated in the different conditions was calculated and evaluated according to the area of (P) production. The results varied from 3.6 to 10.8 ha of (P) using 100 m3 of digestate. A multivariate analysis showed that higher amounts of (P) in substrate composition favor energy recycling while higher concentrations of (S) enhance the production of a digestate with valuable agronomic characteristics.

Criação de Animais Domésticos , Ipomoea batatas , Eliminação de Resíduos Líquidos/métodos , Anaerobiose , Animais , Galinhas , Esgotos , Águas Residuárias/química
Rev. colomb. gastroenterol ; 34(2): 117-124, abr.-jun. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1013927


Resumen Objetivo: el trasplante hepático es el tratamiento de elección para la falla hepática aguda y crónica. Los resultados en el trasplante hepático han mejorado en los últimos años, así que el objetivo de nuestro trabajo es comparar la experiencia de un centro en Colombia en dos períodos de tiempo diferentes. Pacientes y métodos: estudio descriptivo retrospectivo donde se analizaron pacientes adultos con primer trasplante hepático en dos períodos; serie 1, entre 2004-2010 (241 pacientes); y serie 2, entre 2011-2016 (142 pacientes). Resultados: la edad promedio fue de 54 años, el 57 % eran hombres y con un puntaje Model for End-stage Liver Disease (MELD) promedio de 20, sin cambios significativos en las características del donante y del receptor en los dos períodos. Las principales indicaciones de trasplante hepático fueron cirrosis por alcohol, cirrosis criptogénica y cirrosis por hepatitis autoinmune, con una disminución de los casos de hepatitis B y C en la serie 2. El 30 % de los pacientes tenía hepatocarcinoma. La supervivencia de los pacientes a 1 año fue de 81 % frente a 91 % y a 5 años fue de 71 % frente a 80 %, respectivamente. Las principales causas de muerte fueron: cáncer, enfermedad cardiovascular y sepsis. Existió un incremento significativo en las complicaciones biliares, sin diferencias en las complicaciones infecciosas, vasculares y el rechazo celular entre los dos períodos. Conclusión: el trasplante hepático en este centro en Colombia se relaciona con excelentes resultados a corto y mediano plazo, con una mejoría significativa en la supervivencia de los pacientes en los últimos años y con resultados similares a los reportados en otros centros del mundo.

Abstract Objective: Liver transplantation is the treatment of choice for acute and chronic liver failure. Liver transplantation results have improved in recent years, so the objective of our work was to compare results from two different periods of time at a center in Colombia. Patients and Methods: This is a retrospective descriptive study comparing first time adult liver transplant patients from 2004-2010 (Series 1: 241 patients) and from 2011-2016 (Series 2: 142 patients). Results: The average patient age was 54 years, 57% were men, and the average MELD score was 20. There were no significant differences between the characteristics of donors and recipients from one period to the next. The main indications for liver transplantation were alcoholic cirrhosis and cryptogenic and autoimmune hepatitis. Series 2 contained fewer hepatitis B and C cases than did Series 1. Thirty percent of the patients had hepatocellular carcinoma. The one-year survival rates were 81% in Series 1 and 91% in Series 2, whereas five-year survival rates were 71% and 80%, respectively. The main causes of death were cancer, cardiovascular disease and sepsis. From the first period to the second period, there was a significant increase in biliary complications but no differences in infectious complications, vascular complications or cellular rejection. Conclusion: Short and medium term liver transplantation results at this center in Colombia have been excellent, but there have been significant improvements in patient survival rates in recent years that are similar to those reported elsewhere in the world.

Ann Hepatol ; 18(3): 518-535, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31053546


Alcohol-related liver disease (ALD) is a major cause of advanced chronic liver disease in Latin-America, although data on prevalence is limited. Public health policies aimed at reducing the alarming prevalence of alcohol use disorder in Latin-America should be implemented. ALD comprises a clinical-pathological spectrum that ranges from steatosis, steatohepatitis to advanced forms such as alcoholic hepatitis (AH), cirrhosis and hepatocellular carcinoma. Besides genetic factors, the amount of alcohol consumption is the most important risk factor for the development of ALD. Continuous consumption of more than 3 standard drinks per day in men and more than 2 drinks per day in women increases the risk of developing liver disease. The pathogenesis of ALD is only partially understood and recent translational studies have identified novel therapeutic targets. Early forms of ALD are often missed and most clinical attention is focused on AH, which is defined as an abrupt onset of jaundice and liver-related complications. In patients with potential confounding factors, a transjugular biopsy is recommended. The standard therapy for AH (i.e. prednisolone) has not evolved in the last decades yet promising new therapies (i.e. G-CSF, N-acetylcysteine) have been recently proposed. In both patients with early and severe ALD, prolonged abstinence is the most efficient therapeutic measure to decrease long-term morbidity and mortality. A multidisciplinary team including alcohol addiction specialists is recommended to manage patients with ALD. Liver transplantation should be considered in the management of patients with end-stage ALD that do not recover despite abstinence. In selected cases, increasing number of centers are proposing early transplantation for patients with severe AH not responding to medical therapy.

J Environ Manage ; 236: 695-714, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30772727


A bay's capacity to buffer fluvial fluxes between the land and sea is sensitive to hydrological changes that can affect its water renewal rates. In Cartagena Bay, Colombia, pollution issues have been associated with freshwater fluxes which are projected to increase in future years. This has led to plans to reduce freshwater flows by constructing upstream hydraulic doors. Given the influence of freshwater discharge on coastal water renewal, it is important to assess how these upstream changes will affect the bay's hydrodynamic processes. This study calibrated the 3D MOHID Water model, configured with a high-resolution mixed vertical discretization to capture the bay's characteristic processes of vertical stratification and mixing. A Lagrangian transport model was used to analyze the flow of passive particle tracers and calculate water renewal time scales. Mean residence times of 3-6 days and flushing times of 10-20 days for canal water were found, while mean residence times of 23-33 days and flushing times of 70-99 days were calculated for the bay's complete water volume. An assessment of future scenarios showed that increases in freshwater runoff would result in faster water renewal in the bay, while plans to decrease freshwater discharge would result in slower water renewal in the bay. It is therefore imperative that any plans for reducing fluvial fluxes into the bay be accompanied by the control of local pollution sources, which are abundant and could worsen the bay's water quality issues should water renewal times become longer.

Baías , Hidrodinâmica , Colômbia , Monitoramento Ambiental , Água Doce , Água
Zebrafish ; 16(3): 223-232, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30625048


The analysis of behavior in animal models is an important objective in many research fields, including neuroscience, psychology, toxicology, and neuropsychopharmacology. Animal models have been used for many years, and several behavioral paradigms, such as locomotor activity, social interactions, and cognitive behavior, have been studied in animal models to correlate the behaviors with pharmacological or environmental interventions and with molecular, biochemical, and physiological findings. We reviewed the literature looking for open-source, freely available software to analyze animal behavior and found 12 freely available programs: ToxTrack, EthoWatcher, Mouse Behavior Tracker, Mouse Move, JAABA, wrMTrck, AnimalTracker, idTracker, Ctrax, Mousetracker, VideoHacking, and Cowlog, which were developed with different programs, work on different platforms, and have particular types of inputs and outputs and analysis capabilities. We reviewed some examples of their use, tested some of them, and provided several recommendations for the future development of programs for the automated analysis of behavior in animal models. In conclusion, we show freely available software for the automated analysis of behavior in animal models such as adult zebrafish and provide information for researchers and students looking for quick, easy-to-implement, and inexpensive behavior analysis alternatives.

Comportamento Animal , Etologia/métodos , Ciência dos Animais de Laboratório/métodos , Software , Peixe-Zebra , Animais , Etologia/instrumentação , Ciência dos Animais de Laboratório/instrumentação
Chaos ; 29(12): 121104, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31893648


We introduce and test a general machine-learning-based technique for the inference of short term causal dependence between state variables of an unknown dynamical system from time-series measurements of its state variables. Our technique leverages the results of a machine learning process for short time prediction to achieve our goal. The basic idea is to use the machine learning to estimate the elements of the Jacobian matrix of the dynamical flow along an orbit. The type of machine learning that we employ is reservoir computing. We present numerical tests on link inference of a network of interacting dynamical nodes. It is seen that dynamical noise can greatly enhance the effectiveness of our technique, while observational noise degrades the effectiveness. We believe that the competition between these two opposing types of noise will be the key factor determining the success of causal inference in many of the most important application situations.

Biomédica (Bogotá) ; 38(4): 555-568, oct.-dic. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-983966


Introducción. Uno de los principales factores de riesgo del carcinoma hepatocelular es el consumo crónico de alcohol. En estudios en diferentes poblaciones, se sugiere que las variantes genéticas de las enzimas que participan en el metabolismo del alcohol, como la alcohol deshidrogenasa (ADH) y la citocromo P450 (CYP2E1), estarían asociadas con riesgo de enfermedades hepáticas terminales. Objetivo. Identificar y caracterizar las variantes alélicas de los genes ADH1B, ADH1C y CYP2E1 en pacientes colombianos con diagnóstico de cirrosis y carcinoma hepatocelular. Materiales y métodos. Se incluyeron muestras de pacientes atendidos entre el 2005 y el 2007, y entre el 2014 y el 2016, en la unidad de hepatología de un hospital de Medellín. La genotipificación de las muestras se hizo mediante reacción en cadena de la polimerasa (Polymerase Chain Reaction, PCR) con análisis de los polimorfismos en la longitud de los fragmentos de restricción (Restriction Fragment Length Polymorphism, RFLP). Los resultados se compararon con los de dos grupos de control y con lo reportado en la base de datos del 1000 Genomes Project. Resultados. Se recolectaron 97 muestras de pacientes con diagnóstico de cirrosis y carcinoma hepatocelular. Los dos factores de riesgo más frecuentes fueron el consumo crónico de alcohol (18,6 %) y las colangiopatías (17,5 %). Los genotipos más frecuentes en la población de estudio fueron el ADH1B*1/1 (82 %), el ADH1C*1/1 (59 %) y el CYP2E1*C/C (84 %). Conclusiones. En este primer estudio de los polimorfismos en pacientes colombianos con diagnóstico de cirrosis y carcinoma hepatocelular, los genotipos más frecuentes fueron el ADH1B*1/1, el ADH1C*1/1 y el CYP2E1*C/C. No se observaron diferencias estadísticamente significativas en la frecuencia de los genotipos entre los casos y los controles. Se requieren estudios adicionales en población colombiana para evaluar el riesgo de la enfermedad hepática terminal por consumo crónico de alcohol y la asociación con los polimorfismos.

Introduction: One of the most important risk factors for hepatocellular carcinoma (HCC) is alcohol consumption: Studies in different populations suggest that the risk of liver disease could be associated with genetic variants of the enzymes involved in alcohol metabolism, such as alcohol dehydrogenase (ADH) and cytochrome P450 CYP2E1. Objective: To identify and characterize the allelic variants of ADH1B, ADH1C and CYP2E1 genes in Colombian patients with cirrhosis and/or HCC. Materials and methods: We included samples from patients attending the hepatology unit between 2005-2007 and 2014-2016 of a hospital in Medellin. Samples were genotyped using PCR-RFLP. We compared the results with two control groups and the 1000 Genomes Project database. Results: We collected 97 samples from patients with a diagnosis of cirrhosis and/or HCC. The two main risk factors were chronic alcohol consumption (18.6%) and cholangiopathies (17.5%). The most frequent genotypes in the study population were ADH1B*1/1 (82%), ADH1C*1/1 (59%), and CYP2E1*C/C (84%). Conclusions: This first study of polymorphisms in Colombian patients diagnosed with cirrhosis and/or HCC showed genotypes ADH1B*1/1, ADH1C*1/1 and CYP2E1*C/C as the most frequent. We found no significant differences in the genotype frequency between cases and controls. Further studies are necessary to explore the association between polymorphisms and the risk of end-stage liver disease from alcohol consumption.

Álcool Desidrogenase , Citocromo P-450 CYP2E1 , Carcinoma Hepatocelular/etiologia , Alelos , Genótipo , Cirrose Hepática/etiologia
Chaos ; 28(10): 103115, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30384653


It is widely appreciated that balanced excitation and inhibition are necessary for proper function in neural networks. However, in principle, balance could be achieved by many possible configurations of excitatory and inhibitory synaptic strengths and relative numbers of excitatory and inhibitory neurons. For instance, a given level of excitation could be balanced by either numerous inhibitory neurons with weak synapses or a few inhibitory neurons with strong synapses. Among the continuum of different but balanced configurations, why should any particular configuration be favored? Here, we address this question in the context of the entropy of network dynamics by studying an analytically tractable network of binary neurons. We find that entropy is highest at the boundary between excitation-dominant and inhibition-dominant regimes. Entropy also varies along this boundary with a trade-off between high and robust entropy: weak synapse strengths yield high network entropy which is fragile to parameter variations, while strong synapse strengths yield a lower, but more robust, network entropy. In the case where inhibitory and excitatory synapses are constrained to have similar strength, we find that a small, but non-zero fraction of inhibitory neurons, like that seen in mammalian cortex, results in robust and relatively high entropy.

Biomedica ; 38(3): 298-302, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30335234


The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis. A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed. A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma. Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a "watch and wait" basis. Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Histoplasmose/complicações , Leucemia Linfocítica Crônica de Células B/diagnóstico , Infecções Oportunistas/complicações , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Feminino , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Hipertensão/complicações , Itraconazol/uso terapêutico , Leucemia Linfocítica Crônica de Células B/complicações , Linfonodos/diagnóstico por imagem , Linfonodos/microbiologia , Linfonodos/patologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Conduta Expectante
Biomédica (Bogotá) ; 38(3): 298-302, jul.-set. 2018. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-973982


RESUMEN El linfoma linfocítico de células pequeñas es una neoplasia de células B maduras con un amplio espectro de presentaciones clínicas. Las infecciones por gérmenes oportunistas no asociadas con el tratamiento, incluso en estadios avanzados de la enfermedad, tienen baja incidencia. Se han reportado muy pocos casos de pacientes con linfoma linfocítico de células pequeñas asociado a histoplasmosis diseminada que no habían recibido quimioterapia en el momento del diagnóstico. Se presenta el caso de una paciente de 82 años que fue hospitalizada por presentar tos seca intermitente, astenia y adinamia de un mes de evolución. Se le practicaron múltiples estudios para detectar infecciones o compromiso inmunológico o reumático, y se diagnosticó un síndrome adenopático extenso con compromiso cervical, torácico y retroperitoneal. En la citometría de flujo y en la biopsia de ganglio linfático cervical, se reportaron los fenotipos CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg y CD10neg, con restricción de la cadena ligera kappa, lo cual confirmó un linfoma linfocítico de células pequeñas. En la histopatología del ganglio, se observaron granulomas epitelioides sin necrosis, pero las coloraciones especiales no mostraron la presencia de microorganismos, en tanto que el cultivo del ganglio fue positivo para Histoplasma capsulatum. Se inició el tratamiento antifúngico con anfotericina B e itraconazol, y la paciente tuvo una adecuada evolución. Dado que no se cumplían los criterios para el tratamiento oncológico, se continuó con su observación mediante controles periódicos. Las infecciones oportunistas pueden ser la manifestación clínica inicial en pacientes con síndromes linfoproliferativos de bajo grado. Este caso demuestra que pueden desarrollarse, incluso, en ausencia de quimioterapia.

ABSTRACT The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis. A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed. A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma. Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a "watch and wait" basis. Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Rev. colomb. gastroenterol ; 33(3): 221-227, jul.-set. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-978277


Resumen El consumo de alcohol es un conocido factor de riesgo para muerte prematura, morbilidad y discapacidad a nivel mundial. Los registros de la mortalidad que se asocian con el consumo de alcohol están fraccionados. El objetivo de este estudio fue escribir la mortalidad relacionada con la ingesta de alcohol en pacientes con cirrosis atendidos en un hospital universitario de la ciudad de Medellín. Materiales y métodos: se incluyeron 163 pacientes con diagnóstico de cirrosis, evaluados en la consulta externa de hepatología de un hospital de referencia en la ciudad de Medellín con 277 camas y seguimiento hasta el 2016. Se midieron variables sociodemográficas, paraclínicas y clínicas. Se consideró el consumo de alcohol al inicio del seguimiento. Se describió la supervivencia y las complicaciones asociadas con la cirrosis según el estado de consumidores vs. no consumidores de alcohol. Resultados: se siguieron 163 pacientes hasta diciembre del 2016, encontrando una mortalidad en el 51% en consumidores de alcohol vs. 39% en no consumidores (P = 0,19). Las complicaciones de la cirrosis en consumidores de alcohol fueron ascitis en 68% vs. 43% (P = 0,01) en el grupo sin consumo de alcohol, encefalopatía 40,6% vs. 13,5% (P = 0,00) y carcinoma hepatocelular (HCC) en 29% vs. 17% (P = 0,08). En el análisis por subgrupos, los pacientes con hepatitis C con consumo de alcohol tuvieron una mortalidad más alta comparado con los pacientes que no consumieron alcohol (OR 33, IC 95%: 1,06 a 1023). Conclusiones: a pesar que el consumo de alcohol no se relaciona con aumento de la mortalidad en pacientes con cirrosis en este estudio, sí se observa incremento de esta en ciertas poblaciones, como en el subgrupo de pacientes con hepatitis C.

Abstract Worldwide, alcohol consumption is a well-known risk factor for premature death, morbidity and disability. Records of mortality associated with alcohol consumption are not centralized. The aim of this study was to record the mortality rate associated with alcohol intake in patients with cirrhosis who were treated at a university hospital in the city of Medellin. Materials and methods: We included 163 patients who had been diagnosed with cirrhosis in the outpatient hepatology clinic of a 277 bed referral hospital in Medellín. Patients were monitored until 2016. Sociodemographic, paraclinical and clinical variables were measured. Alcohol consumption was considered at the beginning of the follow-up. Survival and complications associated with cirrhosis were described and recorded for patients who consumed alcohol as well as for those who did not, and then the two groups were compared. Results: One hundred sixty-three patients were followed until December 2016. The mortality rate among those who consumed alcohol was 51% while it was only 39% for those who did not consume alcohol (P = 0.19). Comparison of complications of cirrhosis showed that 68% of alcohol users developed ascites vs. 43% of non-consumers (P = 0.01); 40.6% of alcohol users developed encephalopathy vs. 13.5% of non-consumers (P = 0.00); and 29% of alcohol users developed hepatocellular carcinoma (HCC) vs. 17% of non-consumers (P = 0.08). In the subgroup analysis, patients with hepatitis C who consumed alcohol had a higher mortality rate than patients who did not consume alcohol (OR: 33, 95% CI: 1.06 to 1023). Conclusions: Although alcohol consumption was not related to increased mortality among patients with cirrhosis in this study, increased mortality was observed in the subgroup of patients with hepatitis C.

Mar Pollut Bull ; 131(Pt A): 441-452, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29886969


We used environmental magnetism methods to study recently deposited marine sediments from the estuarine ecosystems on the Caribbean coast of Colombia. Cartagena region has undergone an increasing sediment load during the last decades via sediment plumes from Magdalena River and its distributary man-made channel. Concentration dependent magnetic parameters show an increasing abundance of ferrimagnetic minerals on the uppermost sediments on sites located close to the continent (remanent magnetization SIRM = 5.4-9.5 × 10-3Am2 kg-1) as well as faraway sites (SIRM = 0.5-1.7 × 10-3Am2 kg-1 near Rosario Islands coral reef complex). The magnetic grain size and mineralogy along the cores are variable, showing the dominance of the magnetite-like minerals (remanent coercivity Hcr = 34.3-45.3 mT), with a minor contribution of high-coercivity minerals (Hcr = 472-588 mT). In addition, there is a moderate enrichment of elements Cu, Mo, and Zn (enrichment factor EF = 1.5-3.8) that indicates the additional land-derived contribution on sediments. The environmental magnetism approach, which shows significant signals of magnetic minerals and trace elements, is a reliable tool to prove the presence of continental sediment supply in coral reef ecosystems.

Recifes de Corais , Monitoramento Ambiental/métodos , Sedimentos Geológicos/análise , Sedimentos Geológicos/química , Baías/análise , Colômbia , Ecossistema , Meio Ambiente , Compostos Férricos/análise , Óxido Ferroso-Férrico/análise , Ilhas , Magnetismo , Minerais/análise , Rios
Int J Gynaecol Obstet ; 143(1): 19-23, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29939397


BACKGROUND: Medical management of retained placenta could be a safe alternative to manual removal. OBJECTIVE: To evaluate the efficacy of prostaglandin analogues for retained placenta. SEARCH STRATEGY: MEDLINE, EMBASE, CENTRAL, ICTRP, LILACS, and OpenSIGLE were searched without language restrictions from inception to January 31, 2017, by combining terms for retained placenta and prostaglandin analogues. SELECTION CRITERIA: Randomized controlled trials comparing prostaglandin analogues with any other intervention. DATA COLLECTION AND ANALYSIS: Trials were independently assessed for inclusion, data extraction, and risk of bias. Data were extracted for meta-analyses. GRADE was used to evaluate the quality of data. MAIN RESULTS: Seven randomized controlled trials (851 patients) were included. Prostaglandins did not increase the placenta expulsion rate (relative risk [RR] 1.40, 95% confidence interval [CI] 0.83-2.36) or decrease maternal transfusion (RR 0.72, 95% CI 0.43-1.22). In comparison with oxytocin, prostaglandins did not modify the expulsion rate (RR 1.26, 95% CI 0.90-1.78), maternal transfusion (RR 1.05, 95% CI 0.27-4.09), or time for delivery of placenta (mean difference -1.56 minutes, 95% CI, -9.25-6.13). Three trials comparing prostaglandins with oxytocin agonists, ergometrine, and manual removal reported similar results. CONCLUSIONS: Prostaglandin analogues do not offer an effective alternative for management of retained placenta.

Ocitócicos/uso terapêutico , Placenta Retida/tratamento farmacológico , Prostaglandinas Sintéticas/uso terapêutico , Ergonovina/uso terapêutico , Feminino , Humanos , Ocitocina/uso terapêutico , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
Rev. Fac. Med. (Bogotá) ; 66(2): 237-245, abr.-jun. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-956844


Abstract Introduction: Systemic sclerosis (SSc) is an autoimmune disease of the connective tissue that is clinically characterized by dermal thickening, which occurs due to the accumulation of connective tissue, and may involve other organs and the limbs. The multifactorial etiology of this disease is related to alterations in remodeling interactions of the extracellular matrix (ECM), immune function and presence of proliferative vasculopathy under genetic and environmental influence. Objective: To conduct a literature review on medical and surgical management from the point of view skin, hand and finger lesions surgery, as well as facial alterations in patients with systemic scleroderma. Materials and methods: A bibliographic search was performed in the Medline, LILACS, PubMed, EMBASE and Current Contents databases, using the keywords "systemic scleroderma", "plastic surgery", "hand" and "ulcers". Results: SSc requires a multidisciplinary management, since pharmacological therapy is indicated for some cases and complementary surgical management is better for others. Conclusion: This pathology significantly affects the skin by causing lesions ranging from digital ulcers to facial atrophy, which are susceptible to management by plastic surgery.

Resumen Introducción. La esclerosis sistémica (ES) es una enfermedad autoinmune del tejido conectivo que se caracteriza clínicamente por un engrosamiento cutáneo, el cual se da debido a la acumulación de tejido conectivo y puede afectar a otros órganos y a las extremidades. La etiología multifactorial de esta enfermedad corresponde a la interacción de alteraciones en el remodelamiento de la matriz extracelular, función inmunitaria y presencia de vasculopatía proliferativa bajo influencia genética y medioambiental. Objetivo. Realizar una revisión sobre el manejo médico y quirúrgico desde el punto de vista de la cirugía plástica de las lesiones en piel y manos y las alteraciones faciales de los pacientes con ES. Materiales y métodos. Se realizó una búsqueda bibliográfica en las bases de datos Medline, LILACS, PubMed, EMBASE y Current contents con las palabras claves esclerodermia sistémica, cirugía plástica, mano y ulceras. Resultados. La ES requiere manejo multidisciplinario; se presentan casos en los que se indica terapia farmacológica y otros en los que el manejo es quirúrgico complementario. Conclusión. Esta patología afecta de manera importante la piel al provocar lesiones que van desde ulceras digitales hasta atrofia facial, las cuales son susceptibles de manejo por el área de cirugía plástica.

Rev. colomb. reumatol ; 25(1): 59-62, Jan.-Mar. 2018. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-960249


RESUMEN La reacción a drogas con eosinofilia y síntomas sistémicos es una condición debida a una lista extensa de medicaciones, entre las que se encuentra la sulfasalazina. El compromiso es muy variado, desde rash cutáneo hasta afectación visceral acompañado de eosinofilia, que en ocasiones puede llevar a la muerte. El pilar del tratamiento es la suspensión del medicamento agresor y el uso de corticosteroides orales e intravenosos dependiendo de la severidad del cuadro.

ABSTRACT Drugs reactions with eosinophilia and systemic symptoms can be caused by an extensive list of medications, including sulphasalazine. The compromise is very varied, from skin rash to visceral involvement, accompanied by an eosinophilia that can sometimes lead to death. The cornerstone of the treatment is the suspension of the aggressive medication and the use of oral and intravenous corticosteroids, depending on the severity of the condition.

Biochim Biophys Acta Mol Basis Dis ; 1864(4 Pt B): 1461-1467, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28756216


Cholangiocarcinoma represents 10% of primary liver malignancies and accounts for less than 3% of all gastrointestinal malignant tumors, with an enormous geographical variation. This neoplasia can arise from the biliary tract epithelium or hepatic progenitor cells. Depending on the anatomic localization, it is classified into three subtypes: intrahepatic, perihilar and distal. This fact is one of the main difficulties, because there are many studies that indistinctly include the results in the management of these different types of cholangiocarcinoma, without differentiating its location and even including gallbladder cancer. There are many controversial points in epidemiology, liver transplantation as a treatment, limitations of different results by group and type of treatment, histological testing and chemotherapy. This is a narrative review about topics in cholangiocarcinoma. This article is part of a Special Issue entitled: Cholangiocytes in Health and Disease edited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/terapia , Colangiocarcinoma/terapia , Hepatectomia/métodos , Transplante de Fígado , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Neoplasias dos Ductos Biliares/epidemiologia , Neoplasias dos Ductos Biliares/etiologia , Neoplasias dos Ductos Biliares/patologia , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Colangiocarcinoma/epidemiologia , Colangiocarcinoma/etiologia , Colangiocarcinoma/patologia , Hepatectomia/normas , Humanos , Incidência , Excisão de Linfonodo/métodos , Excisão de Linfonodo/normas , Metástase Linfática , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Fatores de Risco , Resultado do Tratamento