Search

Background Only two previous studies in systemic lupus erythematosus (SLE) patients have identified that the blood concentrations of uromodulin are lower in nephritis. However, none of them had evaluated whether a low serum uromodulin adjusted by the glomerular filtration rate (sUromod/eGFR index) contributed to identify patients in risk of lupus nephritis (LN) using multivariable models. Aim Therefore, this study aimed two objectives to evaluate the association between low serum uromodulin levels and low sUromod adjusted by eGFR with renal flares in SLE excluding effects of potential confounders in multivariable analyses; and to identify the value of low sUmod and low sUmod/eGFR index as a potential diagnostic marker of LN. Patients and methods Design: Cross-sectional study. SLE patients (n = 114) were investigated for lupus flare with renal SLEDAI. Two groups: a) SLE with renal flare (renal-SLEDAI≥4, n = 41) and b) SLE non-renal flare (renal SLEDAI Results Low serum uromodulin and low sUromod/eGFR index correlated to high scores of renal-SLEDAI, SLICC-renal and proteinuria. SLE patients with a renal flare had lower uromodulin levels compared to SLE patients without renal flare (p = 0.004). After adjusting by potential confounders, the low sUromod/eGFR index ( Conclusions We propose the low sUromod/eGFR index as a potential new marker of renal disease activity in SLE.

El trabajo de investigación que se desarrolló en este informe se ha llevado a cabo en el campo educativo, el cual pretende combinar la teoría con la práctica y realizar cambios en el proceso de enseñanza y aprendizaje; la metodología empleada se dividió en dos etapas, la primera de tipo cualitativo y la segunda de tipo mixto. El propósito de este estudio fue proponer posibles alternativas de solución ante las necesidades referidas como estrategias novedosas para desarrollar la comprensión lectora. En una primera etapa se realizó un diagnóstico que permitió identificar las principales necesidades, dentro del ámbito educativo, del cual se eligió la más apropiada para apoyar a la docente dándole salida a la dificultad presentada, durante la segunda etapa, se realizó un proceso de capacitación académica a fin de fortalecer las habilidades de los docentes en cuanto al uso del software educativo como herramienta didáctica en el desarrollo de la comprensión lectora en educación primaria, aprovechando los medios, recursos, herramientas tecnológicas que posee el centro educativo donde se realizó el estudio. El proceso de capacitación tuvo un impacto positivo en los docentes, puesto que, fueron motivados a dejar lo tradicional y asumieron el reto de llevar a la práctica los conocimientos adquiridos en los diferentes cursos TIC en pro de mejorar la calidad educativa. Es importante subrayar que, Software educativo fue un programa diseñado con la intensión de facilitar los procesos de enseñanza. Palabras claves: Enseñanza y Aprendizaje, Metodología, Software Educativo, Educación Virtual, Tecnologías de la información y Comunicación (TIC)

More than a billion people around the world have vision problems for different reasons, and these numbers are increasing every year. This leads us to make different innovations in the field of computer vision, with the aim of providing a better quality of life for these people. In this document we present as a resource, the development of an intelligent lens, which incorporates a Raspberry Pi ZW connected to the Google Cloud Vision API through the Wifi of the user’s mobile phone, where at the touch of a button, the Raspberry camera, captures the image, processes it in a few seconds and retrieves its main features, obtaining important information for mobilization such as: pedestrian crossings, bus stop sign, vehicles, green light, etc. 150 people from the National Union of the Blind of Peru (NUBP) were evaluated with different degrees of blindness, obtaining a 40.5% increase of independence for their mobilization.

To evaluate the utility of elevated serum P-glycoprotein (P-gp) as a risk marker of therapeutic response failure in rheumatoid arthritis (RA) patients treated with disease-modifying antirheumatic drugs (DMARDs). A cross-sectional study was conducted in 151 RA patients. Patients were classified into two groups according to the response achieved in terms of the disease activity score (DAS)28 after ≥ 6 months: (1) patients with a therapeutic response to DMARDs, with DAS28

espanolObjetivo: determinar la eficacia de la ensenanza del proceso de enfermedad en la conducta terapeutica y el nivel de conocimiento en pacientes hipertensos de pabellones de hospitalizacion de un Hospital publico de Lima. Metodologia: se empleo un estudio de diseno cuasi-experimental con metodo de intervencion (pre y post) con seguimiento de una semana. La muestra estuvo constituida por 40 pacientes entre 60 y 85 anos residentes en Lima. Resultados: se encontro cambios significativos en los grupos post intervencion, mejorando de un 3.54 a 3.72 en cuanto a la variable de conducta terapeutica en el grupo control en comparacion del grupo intervencion que tuvo un mayor aumento de 2.98 hasta 4.06, mientras que en la variable nivel de conocimiento, el grupo control presento una mejora de 3.0 a 3.02 mientras que en el grupo intervencion hubo una mejora de 2.56 a 3.56. Conclusion: la eficacia de la ensenanza influyo en el nivel de conocimiento y conducta terapeutica en los pacientes con hipertension de un hospital publico de Lima este en el Agustino, asi mismo, tuvo efecto sobre las precauciones recomendadas en cuanto a la conducta terapeutica y el nivel de conocimiento sobre el nivel del rango normal de presion sistolica y diastolica. Palabras clave: Terminologia Normalizada de Enfermeria; Conocimientos; Educacion en Enfermeria; Hipertension (Fuente: DeCS). EnglishObjective: to determine the efficacy of the teaching of the disease process in the therapeutic behavior and the level of knowledge in hypertensive patients of hospitalization wards of a public hospital in Lima. Materials and methods: a quasi-experimental design study with an intervention method (pre and post) with a one-week follow-up was used. The sample consisted of 40 patients between 60 and 85 years old living in Lima. Results: significant changes were found in the post intervention groups, improving from 3.54 to 3.72 in terms of the therapeutic behavior variable in the control group compared to the intervention group that had a greater increase from 2.98 to 4.06, while in the variable level of knowledge, the control group presented an improvement of 3.0 to 3.02 while in the intervention group there was an improvement of 2.56 to 3.56. Conclusion: the intervention influenced the increase in both the level of knowledge and therapeutic behavior. Likewise, it had a positive effect on the indicators of the main variables (recommended precautions, normal range of systolic and diastolic blood pressure). Key words: Standardized Nursing Terminology; Knowledge; Education Nursing; Hypertension (Source: DeCS).

Bone disease in rheumatoid arthritis (RA) is a complex phenomenon where genetic risk factors have been partially evaluated. The system formed by receptor activator for nuclear factor-κB (RANK), receptor activator for nuclear factor-κB ligand (RANKL), and osteoprotegerin (OPG): RANK/RANKL/OPG is a crucial molecular pathway for coupling between osteoblasts and osteoclasts, since OPG is able to inhibit osteoclast differentiation and activation. We aim to evaluate the association between SNPs C950T (rs2073617), C209T (rs3134069), T245G (rs3134070) in theTNFRSF11B(OPG) gene, and osteoporosis in RA. We included 81 women with RA and 52 healthy subjects in a cross-sectional study, genotyped them, and measured bone mineral density (BMD) at the lumbar spine and the femoral neck. Mean age in RA was50±12with disease duration of12±8years. According to BMD results, 23 (33.3%) were normal and 46 (66.7%) had osteopenia/osteoporosis. We found a higher prevalence of C allele for C950T SNP in RA. Polymorphisms C209T and T245G did not reach statistical significance in allele distribution. Further studies including patients from other regions of Latin America with a multicenter design to increase the sample size are required to confirm our findings and elucidate if C950T SNP could be associated with osteoporosis in RA.

In this cross-sectional study, we assessed the relationship between circulating TNF-alpha and E-selectin (sE-selectin) with extraarticular involvement and severity of joint disease in RA. We compared 56 patients who had RA and extraarticular involvement (ExRA) with a group of 84 patients with only articular involvement (non-ExRA). ExRA had higher circulating TNF-alpha than non-ExRA (32 +/- 9 vs. 28 +/- 6 pg/mL, P = 0.002). sE-selectin levels did not differ between both groups. sE-selectin correlated with tender joint count (rho = 0.19, P = 0.03), morning stiffness (rho = 0.19, P = 0.03), severity of pain (rho = 0.21, P = 0.02), disease activity (assessed by the patient) (rho = 0.21, P = 0.02), HAQ-DI (rho = 0.29, P = 0.004), and rheumatoid factor titers (rho = 0.31, P =0.001). Circulating TNF-alpha had no correlation with sE-selectin or disease activity. We concluded that sE-selectin correlated with severity of joint disease, further follow-up studies should evaluate if sE-selectin is useful as prognosis marker for progression of articular damage.

Objective.To compare the modifications in lipids between patients with rheumatoid arthritis (RA) receiving etanercept plus methotrexate (ETA + MTX) versus methotrexate (MTX) and their relationship with serum levels of tumor necrosis factor-alpha (TNF-α).Methods.In an observational cohort study, we compared changes in lipid levels in patients receiving ETA + MTX versus MTX in RA. These groups were assessed at baseline and at 4 and 24 weeks, measuring clinical outcomes, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and TNF-α.Results.Baseline values for lipid levels were similar in both groups. HDL-C levels increased significantly only in the ETA + MTX group (from 45.5 to 50.0 mg/dL at 4 weeks, a 10.2% increase,P<0.001, and to 56.0 mg/dL at 24 weeks, a 25.1% increase,P<0.001), while other lipids underwent no significant changes. ETA + MTX also exhibited a significant increase in TNF-α (44.8 pg/mL at baseline versus 281.4 pg/mL at 24 weeks,P<0.001). The MTX group had no significant changes in lipids or TNF-α. Significant differences in HDL-C between groups were observed at 24 weeks(P=0.04)and also in TNF-α (P=0.01).Conclusion.HDL-C levels increased significantly following treatment with ETA + MTX, without a relationship with decrease of TNF-α.

Objective.We evaluated the utility of 6 generic and 2 specific risk indices for identifying low bone mineral density (BMD) or osteoporosis in women with rheumatoid arthritis (RA); and their correlation with 10-year probability of fractures as assessed with the World Health Organization fracture risk assessment (FRAX) tool.Methods.Mexican Mestizo women with RA were evaluated in this cross-sectional study using 6 generic indices [Simple Calculated Osteoporosis Risk Estimation (SCORE); Osteoporosis Risk Assessment Instrument (ORAI); Osteoporosis Self-Assessment Tool; Age, Body Size, No Estrogen; Osteoporosis Index of Risk (OSIRIS); and Guidelines of the US National Osteoporosis Foundation], 2 specific indices (Amsterdam and modified Amsterdam), and FRAX. BMD results on dual-energy x-ray absorptiometry (DEXA) at the lumbar spine and femoral neck were considered the “gold standard.” Sensitivity, specificity, and predictive values (PV) of the indices and their correlations with FRAX results were estimated.Results.Among 191 patients, 46 had osteoporosis (24.1%) and 119 had low BMD (62.3%). For predicting osteoporosis, SCORE showed the highest sensitivity (96%), whereas OSIRIS (87%) and ORAI (82%) showed the highest specificities. OSIRIS also had the greatest positive PV (92%). The specific indices had low sensitivity and low specificity (Amsterdam, 50% and 79%, respectively; modified Amsterdam, 56% and 70%). All the indices had a low but significant correlation with FRAX.Conclusion.These findings support the use of some generic indices to identify patients with RA who should undergo DEXA testing. Currently available specific indices did not perform satisfactorily. New specific risk indices for osteoporosis in RA should be developed to increase sensitivity and specificity for predicting osteoporosis.

Objective.To evaluate the association between circulating leptin and bone mineral density (BMD) in patients with rheumatoid arthritis (RA).Methods.One-hundred thirty postmenopausal women with RA were assessed for body mass index (BMI), disease characteristics, history of drug use, rheumatoid factor, and erythrocyte sedimentation rate (ESR). BMD (g/cm2) was determined in the hip and spine by DEXA. Serum leptin concentrations were measured by ELISA. Spearman’s correlation coefficients (rho) were determined between BMD and leptin and other variables. A multiple regression analysis was used to adjust for confounders.Results.Patients’ serum leptin levels varied widely (range 2–128 ng/ml). Thirty-three patients (25%) had osteoporosis. Higher levels of leptin correlated significantly with BMD in the lumbar spine (rho = 0.17, p = 0.04) and total hip (rho = 0.21, p = 0.01). The variables that were negatively correlated with BMD were age, duration of menopause, and ESR. After adjustment for confounders, leptin was no longer associated with BMD. In the multivariate model, factors that remained associated with BMD in the total hip were age (p = 0.021) and BMI (p = 0.003); and the factors that remained associated with BMD in the lumbar spine were BMI (p = 0.03) and ESR (p = 0.01).Conclusion.No relevant association was found between circulating leptin levels and BMD in patients with RA in this cross-sectional study. Followup studies are needed to evaluate whether abnormal leptin levels confer a risk for fractures due to osteoporosis.

We evaluated the prevalence and characteristics associated with hyperhomocysteinemia in ankylosing spondylitis (AS). Ninety-seven patients with AS were compared with 97 controls. The assessment included clinical characteristics, disease activity (BASDAI), functioning (BASFI), history of drugs, and erythrocyte sedimentation rate (ESR). Total serum homocysteine (tHcy) was determined by fluorescence polarization immunoassay. A higher frequency of hyperhomocysteinemia (>15 micromol/L) was observed in AS (12 vs. 1%, P = 0.002). In the multivariate analysis the risk for hyperhomocysteinemia was increased in patients with higher score of HAQ-S (OR = 5.27, 95% CI: 1.29-21.44) and higher ESR (OR = 1.09, 95% CI: 1.02-1.18). No statistical associations was observed between hyperhomocysteinemia with other variables including methotrexate or sulfasalazine utilization. In conclusion, this study found a significant prevalence of hyperhomocysteinemia in Mexican patients with AS mainly associated to a worst functional impairment. Further follow-up studies are required to evaluate the risk of cardiovascular disease in these patients.

Tesis (Doctor en ingeniería). Universidad Nacional Autónoma de México. División de Estudios de Posgrado. Facultad de Ingeniería. Se presenta una metodología general para determinar las propiedades de propagación a problemas de valor inicial continuos y discretos, tomando en cuenta los efectos no lineales dominantes Además, mediante ejemplos aplicables, dichas propiedades se relacionan con los conceptos de consistencia, estabilidad y convergencia de aproximaciones discretas de ecuaciones de evolución.