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Este artículo tiene como objetivo identificar las tendencias y principales corrientes que abordan cuestionamientos relacionados con la producción del espacio público y su incidencia sobre la inclusión o exclusión social, especialmente aquella de las personas con discapacidad. La problemática se trata desde los debates contemporáneos planteados por diferentes autores acerca de la construcción y producción social del espacio y su influencia en la realidad físico-espacial de las ciudades. Los estudios y teorizaciones de esos autores se relacionan críticamente para construir una reflexión sobre el derecho a la ciudad, la inclusión/exclusión espacial y la discapacidad en el espacio público. Para ello, se realizó una revisión sistematizada de literatura basada en la metodología SALSA (Search/búsqueda, AppraisaL/evaluación, Synthesis/síntesis and Analysis/análisis). Como resultado de esta revisión, se evidenció que existe una sistemática separación entre la producción del espacio físico y la producción del espacio social, resultante de los actos del poder dominante mediados por los tecnócratas expertos que conciben, proyectan y materializan el espacio físico y su diferencia con las prácticas, percepciones y vivencias de quienes lo usan.

La enfermedad injerto vs huésped (EICH) aguda severa tiene un alto impacto en morbilidad y costo efectividad en el trasplante alogénico de médula ósea en nuestro país. Presentamos el primer caso reportado en Colombia de recolección de médula ósea directa por punción múltiple en adultos, como estrategia costoefectiva para disminuir la incidencia de EICH aguda severa. Se trata de una paciente con diagnóstico de aplasia medular severa con fracaso a terapia inmunosupresora previa. Se evidencia notable diferencia en el conteo de linfocitos T (LT CD3) en recolección periférica, mucho más que en recolección directa.

Introduction: Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) infection is characterised by a viral phase and a severe pro-inflammatory phase. The inhibition of the JAK/STAT pathway limits the pro-inflammatory state in moderate to severe COVID-19. Methodology: We analysed the data obtained by an observational cohort of patients with SARS-CoV-2 pneumonia treated with ruxolitinib in 22 hospitals of Mexico. The applied dose was determined based on physician’s criteria. The benefit of ruxolitinib was evaluated using the 8-points ordinal scale developed by the NIH in the ACTT1 trial. Duration of hospital stay, changes in pro-inflammatory laboratory values, mortality, and toxicity were also measured. Results: A total of 287 patients were reported at 22 sites in Mexico from March to June 2020; 80.8% received ruxolitinib 5 mg BID and 19.16% received ruxolitinib 10 mg BID plus standard of care. At beginning of treatment, 223 patients were on oxygen support and 59 on invasive ventilation. The percentage of patients on invasive ventilation was 53% in the 10 mg and 13% in the 5 mg cohort. A statistically significant improvement measured as a reduction by 2 points on the 8-point ordinal scale was described (baseline 5.39 ± 0.93, final 3.67± 2.98, p = 0.0001). There were 74 deaths. Serious adverse events were presented in 6.9% of the patients. Conclusions: Ruxolitinib appears to be safe in COVID-19 patients, with clinical benefits observed in terms of decrease in the 8-point ordinal scale and pro-inflammatory state. Further studies must be done to ensure efficacy against mortality.

Circulating cell-free mitochondrial DNA (ccf-mtDNA) may induce systemic inflammation, a common condition in chronic kidney disease (CKD), by acting as a damage-associated molecular pattern. We hypothesized that in patients with moderate to severe CKD, aerobic exercise would reduce ccf-mtDNA levels. We performed a post hoc analysis of a multicenter randomized trial (NCT01150851) measuring plasma concentrations of ccf-mtDNA at baseline and 2 and 4 mo after aerobic exercise and caloric restriction. A total of 99 participants had baseline ccf-mtDNA, and 92 participants completed the study. The median age of the participants was 57 yr, 44% were female and 55% were male, 23% had diabetes, and 92% had hypertension. After adjusting for demographics, blood pressure, body mass index, diabetes, and estimated glomerular filtration rate, median ccf-mtDNA concentrations at baseline, 2 mo, and 4 mo were 3.62, 3.08, and 2.78 pM for the usual activity group and 2.01, 2.20, and 2.67 pM for the aerobic exercise group, respectively. A 16.1% greater increase per month in ccf-mtDNA was seen in aerobic exercise versus usual activity (P = 0.024), which was more pronounced with the combination of aerobic exercise and caloric restriction (29.5% greater increase per month). After 4 mo of intervention, ccf-mtDNA increased in the aerobic exercise group by 81.6% (95% confidence interval: 8.2−204.8, P = 0.024) compared with the usual activity group and was more marked in the aerobic exercise and caloric restriction group (181.7% increase, 95% confidence interval: 41.1−462.2, P = 0.003). There was no statistically significant correlation between markers of oxidative stress and inflammation with ccf-mtDNA. Our data indicate that aerobic exercise increased ccf-mtDNA levels in patients with moderate to severe CKD. NEW & NOTEWORTHY The effects of prolonged exercise on circulating cell-free mitochondrial DNA (ccf-mtDNA) have not been explored in patients with chronic kidney disease (CKD). We showed that 4-mo aerobic exercise is associated with an increase in plasma ccf-mtDNA levels in patients with stages 3 or 4 CKD. These changes were not associated with markers of systemic inflammation. Future studies should determine the mechanisms by which healthy lifestyle interventions influence biomarkers of inflammation and oxidative stress in patients with CKD.

Objective To establish the prevalence of potentially inappropriate prescription (PIP) in older people with advanced dementia, monitored by a Geriatric Home Care Unit (GHC), as well as the associated risk factors and costs. Methods Community-dwelling patients ≥65 years with an advanced dementia diagnosis (GDS-FAST ≥ 7a) and poor 1-year vital prognosis (Frail-VIG ≥ 0.6) were included. Pharmacotherapy history was reviewed retrospectively, collecting functional and cognitive status, on the first GHC visit, of patients assessed January 2016–January 2019. Potentially inappropriate medication was defined following STOPP-Frail criteria. Results 100 patients included (76% women, 89.15 ± 5.8 years). Total medications prescribed 760 (7.63 ± 3.4 drugs per patient). 85% patients were given at least one drug considered to be PIP. 26% (196) of the total drugs registered were PIPs. Patients who were prescribed an inappropriate drug showed a higher number of total prescribed drugs (7.92 ± 3.42 vs 6.00 ± 2.24; p 0.04) and a higher frequency of polypharmacy (84.7% vs 60%; p 0.025). Risk of receiving inappropriate medication increased by 24% for each additional drug prescribed (OR 1.24; 95% CI 1.01–1.52; p 0.04). The costs associated with PIP were 113.99 euros per 100 patients/day; 41,606.35 euros per 100 patients/year. Conclusions Prescription of PIP to community-dwelling patients with severe dementia and poor vital prognosis is common and is associated with high economic impact in this population group.

Key summary points Aim The objective of this study is to describe the baseline characteristics of oldest-old patients admitted with COVID-19 to an acute geriatric unit and to determine the factors associated with in-hospital mortality. Findings Dementia, incident delirium, and the CURB-65 score ≥ 3 are independent mortality risk factors. The concurrent use of angiotensin-converting enzyme inhibitors is a protective factor. Message Recognition of geriatric syndromes may be useful to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19., Purpose To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients. Design Single-center observational study. Setting and participants Patients ≥ 75 years admitted to an Acute Geriatric Unit with COVID-19. Methods Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality. Results Three hundred patients were consecutively included (62.7% females, mean age of 86.3 ± 6.6 years). Barthel Index (BI) was

Background: Dilated Cardiomyopathy (DCM) is characterized by dilation of the left ventricle (LV) and, by consequence contractile dysfunction. DCM is caused by multiple etiologies, often the result of myocarditis, alcohol consumption, drugs and metabolic or endocrine alterations. Case: We report the case of a 36-year-old patient with a 27.6-week pregnancy with a pathological history of Heart Failure (HF) of 4 years, alcoholism of more than 15 years, methamphetamine use of more than 3 years. She presented agitation and class III dyspnea, the fatigue progressed until she presented respiratory distress accompanied by edema of the lower limbs, an echocardiogram was performed, Dilated Cardiomyopathy was diagnosed and therefore primary management was made with levosimendan and diuretic then cesarean surgery was performed. Conclusion: for this patient the use of levosimendan was beneficial, improving the symptomatology, increasing the cardiac function and making possible the performance of the cesarean delivery. There was no harm for the patient or the baby.

There is increased interest in studying ATTR-CA, a pathology that primarily affects patients of geriatric age and is frequently underdiagnosed. We aim to establish the prevalence of ATTR-CA in a cohort of patients with a history of HFpEF and to describe its characteristics.We conducted a prospective observational study. Patients ≥75 years, clinical history of HFpEF, atrial dilation ≥34ml/m50 patients were recruited, mean age 86±6 years, 54% women. Age and functional class (I-II vs. III-IV) were factors associated with presenting with ATTR-CA. Patients with positive scintigraphy had a median time to admission of 5.2 months (confidence interval [CI] 95% 0-10.9), while in those with negative scintigraphy, it was 12.2 months (95% CI 11.7-12.8); log-rank: p=0.064. Patients with positive scintigraphy had a median time to the combined endpoint (death and readmission) of 1.9 months (95% CI 0-6.1), and patients with negative scintigraphy of 11.9 months (95% CI 11.7-12); log-rank: p=0.027.ATTR-CA appears to be a prevalent etiology in elderly patients within the spectrum of HFpEF. Patients with a diagnosis of ATTR-CA had a shorter time to admission for HF and the combined event of death and admission than patients with a negative result on scintigraphy.

Background Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. Methods Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P Conclusions CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.

Resumen Introduccion y objetivos El pronostico de la estenosis aortica (EAo) grave asintomatica en la poblacion anciana, que a menudo asocia fragilidad y comorbilidades no ha sido estudiado. Se propuso analizar que factores podrian influir en la mortalidad precoz esta poblacion. Metodos Estudio ambispectivo de cohortes en 104 pacientes con edad ≥ 70 anos y EAo grave asintomatica. Se recogieron variables epidemiologicas, geriatricas, clinicas y ecocardiograficas y se compararon entre pacientes fragiles y no fragiles. Durante el seguimiento se recogio el tiempo desde el diagnostico hasta la mortalidad. Resultados El 59,6% de los pacientes eran fragiles. El 69,4% de los pacientes fragiles fallecieron, con una mediana de supervivencia de 2,52 anos (IC95%, 1,36-3,69). La tasa de supervivencia global al ano en estos sujetos fue del 76%. En el analisis multivariante la edad (HR = 2,47; IC95%, 1,00-6,12), el indice de Charlson ≥ 5 (HR = 3,75; IC95%, 1,47-9,52) y la fragilidad (HR = 6,67; IC95%, 1,43-9,52) se asociaron independientemente a la mortalidad. Un 8,7% de los pacientes presentaron un indice de Charlson ≥ 5 y tuvieron una mediana de supervivencia de 1,01 anos (IC95%, 0,36-1,67). El area bajo la curva receiver operating characteristic del indice de Charlson fue 0,739 (IC95%, 0,646-0,832). Los valores ≥ 5 mostraron una elevada especificidad (100%) pero baja sensibilidad. Conclusiones Existe una elevada prevalencia de fragilidad en pacientes ancianos con EAo grave asintomaticos. La edad, un indice de Charlson ≥ 5 y la fragilidad son marcadores independientes de mortalidad, asociando un pronostico desfavorable a corto plazo.

Introduction:Pulmonary tuberculosis has been of great interest for us given the high number of cases in our community at the Mexican-American border, however, this abundance of patients allows us to observe whether there is an association between the previously described development of hyponatremia and mortality in these patients. Objective:To determine the association between mortality and hyponatremia in patients with pulmonary tuberculosis. Material and Methods:We analyzed the electronic health record of patients with a pulmonary tuberculosis diagnosis from a 4-year period in the General Hospital of Mexicali, in México. Inclusion criteria were patients over the age of 18, a pulmonary tuberculosis diagnosis, and complete laboratory tests. The collected data was then analyzed through descriptive statistics. Results:116 patients with pulmonary tuberculosis were included, of which 91 (78.4%) were male. A history of past Infection with the Human immunodeficiency virus and previous tuberculosis infection were shown to correlate with higher mortality and requirement of intensive care. The logistic regression analysis showed that hyponatremia had no association with mortality or the need for intensive care. Complications such as Acute respiratory distress syndrome and Acute kidney injury were related to higher mortality and need for critical care. Conclusions:The incidence of hyponatremia was higher than previously described, but there was no statistical association between hyponatremia and mortality in comparison to patients with normal sodium. Among this study’s weaknesses, most patients were hospitalized at the time of diagnosis, implying they could already have had a complication, thus increasing the incidence.

Rocky mountain spotted fever is a systemic inflammatory disease that occurs from April through September, even do, it may occur during other months like this case. In addition, it is presented in a rare context with cardiomyopathy and COVID-19.

Introduction: Heat stroke is a well-known condition among people who live in high climate temperatures. In the city of Mexicali, temperatures above 40° C (104° F) are common during summer time, with constant admissions to the emergency room due to classic heat stroke. Hypotension, polypnea, anuria, coma, respiratory failure and kidney failure, were related to a higher mortality rate.Methods: This is a prospective observational cohort study of patients during the period of June to August 2018, with heat stroke defined asa central body temperature of 40°c or higher, cognitive impairmentand recent exposure to high temperatures,admitted to the Emergency Room of the General Hospital of Mexicali. At arrival, a full medical history was taken and laboratory tests were obtained.Results: twenty-eight patients were admitted with the confirmed diagnosis of classical heat stroke, with a rectal temperature between 40 to 42.2°C. Of these patients, 13 developed rhabdomyolysis, with CPK levels ranging from 1030 U/l to 18977 U/l. From these 13 patients with rhabdomyolysis, 12 developed AKI (p=0.003). Mortality in the group of patients who developed rhabdomyolysis was greater than those who did not develop rhabdomyolysis.Conclusion: The development ofRhabdomyolysis is a high-riskfactor for acute kidney injury and death

Background: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients infected with SARS-CoV-2. Methods: An ambispective, observational cohort study. A total of 305 patients >= 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden's index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. Results: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. Conclusions: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels., This work was partially supported by grants (to M.Q.-F., J.G.-P.) from the "New announcement for extraordinary initiative fund UAX-Santander COVID-19," Alfonso X el Sabio University.

Background:Computed Tomography chest scan can be a tool for classification of COVID 19 disease. We propose there is a relation between computed tomography severity index and inflammation biomarkers.Methods:Weperformed a retrospective analysis of hospitalized COVID 19 patients in Mexicali ́s General Hospital, during the period of March 2020 to December 2020. The inclusion criteria wasover 18 years old, confirmatory RT-PCR nasal swab and available CT chest scan. We extracteddata ofmedical records;variables studied were age, sex, date of symptom onset, date of admission, chest computed tomography score, RT-PCR result, laboratory values (D-dimer, fibrinogen, ferritin, procalcitonin, C-reactive protein, total leukocytes, lymphocytes), and outcome. Results:From March 2020 to December 2020, 397 patients were recruited that fulfilled the inclusion criteria from a 700 patient database. Statistically significant differences after ttests between survivors and non-survivors were found for C-reactive protein (means 47.1 ± 36 vs. 80.1 ± 54;p = 0.0009), procalcitonin (means 961 ± 279 vs. 1,032 ± 283; p = 0.023), white blood cells (means 10.57 ± 4.46 vs. 12.33 ± 6.22; p = 0.0026) and lymphocytes (means 0.79 ± 0.50 vs. 0.68 ± 0.40; p value= 0.026).Conclusions:Laboratory and imaging studies are fundamental for stratification and outcome prediction in COVID-19 patients. With these findings we can determine the prognosis of a patient, have a better approach, and search specifically for the relevant severity markers such as fibrinogen, white blood cells, lymphocytes, and C-reactive protein in hospitals with limited resources.

The results of research work are presented, which was carried out under a non-experimental, cross-sectional and descriptive design. The objective was to diagnose the presence of risk factors in the habitat of Hawksbill turtles, in the Machalilla National Park. Observation methods, document analysis, induction - deduction and interview techniques were applied to officials of the referred institution. Biotic and abiotic factors were evaluated and the results were subjected to the corresponding statistical processing. It is identified that although in the environmental order the studied habitat collects ideal conditions, factors of biotic origin that threaten the balance of that environment subsists.

Resumen Introducción: En pacientes con leucemia mieloide aguda (LMA) el trasplante de progenitores hematopoyético (TPH) es el único tratamientoz curativo. El objetivo de este estudio es presentar la experiencia y resultados del trasplante haploidéntico en pacientes adultos con LMA en la Fundación Valle del Lili, Cali - Colombia. Materiales y métodos: Estudio de cohorte retrospectivo de pacientes que recibieron trasplante haploidéntico entre 2013 y 2017, con acondicionamiento mieloablativo y ciclofosfamida postrasplante, en Fundación Valle del Lili, Cali (Colombia). Resultados: Se realizaron 47 trasplantes en pacientes con leucemia mieloide aguda en la fecha de estudio, se incluyeron en el análisis 21 pacientes con donante haploidéntico, a 3 años tanto la supervivencia global y libre de eventos fue del 38%. La incidencia acumulada de mortalidad relacionada al trasplante fue del 26% a 100 días y del 38,3%, a 38 meses de seguimiento. La incidencia acumulada de recaída a 38 meses fue del 19%. Con respecto a la enfermedad injerto versus huésped (EICH) se encontró que la incidencia acumulada de EICH aguda grado II-IV, grado III-IV y EICH crónico fue del 19%, 5% y 19% respectivamente. Conclusión: Los resultados de este estudio sugieren que el trasplante haploidéntico es una alternativa factible como tratamiento para pacientes con diagnóstico de LMA en nuestro medio. Abstract Introduction: In patients with acute myeloid leukemia (AML), hematopoietic progenitor transplantation (PHT) is the only curative treatment. The objective of this study is to present the experience and results of haploidentical transplantation in adult patients with AML at the Valle del Lili Foundation, Cali - Colombia. Materials and methods: Retrospective cohort study of patients who received haploidentical transplantation between 2013 and 2017, with myeloablative conditioning and post-transplant cyclophosphamide, in Fundación Valle del Lili, Cali (Colombia). Results: 47 transplants were performed in patients with acute myeloid leukemia on the study date, 21 patients with haploidentical donors were included in the analysis, at 3 years both overall and event-free survival was 38%. The cumulative incidence of transplant-related mortality was 26% at 100 days and 38.3% at 38 months of follow-up. The cumulative incidence of relapse at 38 months was 19%. Regarding graft versus host disease (GVHD), it was found that the cumulative incidence of acute GVHD grade II-IV, grade III-IV and chronic GVHD was 19%, 5% and 19% respectively. Conclusion: The results of this study suggest that haploidentical transplantation is a feasible alternative as a treatment for patients diagnosed with AML in our environment.

Introduction: We aimed to perform a review of SRs of non-pharmacological interventions in older patients with well-defined malnutrition using relevant outcomes agreed by a broad panel of experts. Methods: PubMed, Cochrane, EMBASE, and CINHAL databases were searched for SRs. Primary studies from those SRs were included. Quality assessment was undertaken using Cochrane and GRADE criteria. Results: Eighteen primary studies from seventeen SRs were included. Eleven RCTs compared oral nutritional supplementation (ONS) with usual care. No beneficial effects of ONS treatment, after performing two meta-analysis in body weight changes (six studies), mean difference: 0.59 (95%CI -0.08, 1.96) kg, and in body mass index changes (two studies), mean difference: 0.31 (95%CI -0.17, 0.79) kg/m2 were found. Neither in MNA scores, muscle strength, activities of daily living, timed Up&Go, quality of life and mortality. Results of other intervention studies (dietary counselling and ONS, ONS combined with exercise, nutrition delivery systems) were inconsistent. The overall quality of the evidence was very low due to risk of bias and small sample size. Conclusions: This review has highlighted the lack of high quality evidence to indicate which interventions are effective in treating malnutrition in older people. High quality research studies are urgently needed in this area.

Although circular helicates can be assembled with a range of labile transition-metal centers, solely "chiral-at-metal" examples (i.e., systems without chiral ligands) and heterometallic (i.e., mixed metal systems, racemic or chiral) circular helicates both remain unexplored. Here, we report on the enantioselective synthesis of a heterometallic (Ir2Zn4) hexameric circular helicate and its elaboration into the corresponding triply interlocked Star of David [2]catenane. The relative inertness of Ir(III) enables enantiospecific synthesis of the hexameric circular helicate using chiral-at-metal building blocks. The resulting Star of David [2]catenane, which is a chiral 6-2-1 link, is formed as a single topological enantiomer. The X-ray crystal structure of the (Ir2Zn4)-catenane shows each of the two 95-atom-long macrocycles entwined around the six metal octahedral metal ions and each other, forming a triply interlocked circular double helix. Two PF6- anions reside above and below the central cavity. The Star of David [2]catenane, both with and without coordinated Zn(II) ions, retains the photophysical properties characteristic of cyclometalated Ir(III) complexes. The synthetic strategy opens up new research directions and opportunities for the assembly of other chiral knots, links, and heterometallic circular helicates.

El incorrecto manejo térmico del paciente canino sometido a anestesia general puede generar complicaciones en la recuperación e inclusive presentar el riesgo de muerte. El objetivo fue evaluar un protocolo de prevención de la hipotermia en pacientes caninos sanos sometidos a anestesia general para la realización de un procedimiento de profilaxis dental. Para el método investigativo se reclutaron 10 pacientes para un ensayo clínico controlado de tipo cruzado por intención de tratamiento, a los pacientes se les sometió a dos procedimientos anestésicos, el primero sin ningún medio de mantenimiento de la normotermia, y el segundo procedimiento acompañado de un protocolo compuesto por precalentamiento durante 30 minutos a 28°C, manta reflectante Survival Blanket ® + luz radiante (foco infrarrojo de 250W) para minimizar la perdida de temperatura de los pacientes. Se evaluaron las temperaturas rectales (temperatura periférica) durante todo el perioperatorio (60 minutos) obtenidas en los 10 pacientes en ambas intervenciones, siendo estos datos analizados mediante una prueba estadística (T-Test) Como Resultados se encontró diferencias significativas entre aplicar y no aplicar dicho protocolo. Las diferencias estadísticamente significativas que se encontraron fueron: al final de la premedicación (p valor= 0.039), al inicio de la inducción (p valor = 0.041), y durante todo el mantenimiento (p valor= 0.008 – 0.013 – 0.012 – 0.005 – 0.008 – 0.005 – 0.005). Conclusiones. - se observó y demostró que combinar métodos activos y pasivos ayudan a minimizar la perdida de temperatura del paciente.

espanolEl objetivo de este articulo es analizar el efecto de oxidacion termica en la resistencia a la corrosion y las propiedades de dureza de nanoestructuras de TiO2 obtenidas por procesos de anodizado en solucion de HF/ H3PO4. Las nanoestructuras de TiO2 sobre Ti6Al4V por procesos de anodizado fueron sometidas a tratamiento de oxidacion termica (OT)en un rango de 500 °C a 620 °Cpor dos (2) horas. La morfologia superficial fue evaluada mediante microscopia electronica de barrido; las propiedades de dureza de nanoestructuras de TiO2 fueron obtenidas por medidas de nanoindentacion usando una probeta Berkovich de radio 150 mm. El comportamiento a la corrosion de las muestras fue estudiado usando polarizacion potenciodinamica y espectroscopia de impedancia electroquimica (EIS). Los resultados mostraron que la nanoestructuras de TiO2, modificadas por oxidacion termica, incrementaron las propiedades superficiales de dureza y resistencia a la corrosion, comparadas a las del substrato, manteniendo su estructura mixta o tubular. Ademas, se evidencio una transformacion de nanotubos a nanoporos despues de 600 °C generando cambios significativos en las propiedades mecanicas de estas estructuras. EnglishThis article aimed to analyze the effect of the thermal oxidation in the corrosion resistance and the hardness properties of TiO2 nanostructures obtained by the anodizing process in the HF/H3PO4 solution TiO2 nanostructures on Ti6Al4V obtained by anodizing processes were subjected to thermal oxidation (TO) treatments over a temperature range from 500 °C to 620 °C for 2 hours. Surface morphology was evaluated by using scanning electron microscopy; the hardness properties of TiO2 nanostructures were obtained by Nanoindentation measurements using a Berkovich probe with a tip radius of 150 mm. The corrosion behavior of the samples was studied using potentiodynamic polarization and electrochemical impedance spectroscopy (EIS). The results showed that TiO2 nanostructures, modified by thermal oxidation, increased the surface properties of hardness and corrosion resistance, compared to the substrate, maintaining its mixed or tubular structure. On the other hand, a transformation of nanotubes to nanopores after 600°C was evidenced, generating significant changes in the mechanical properties of these structures.

Objective: Cytomegalovirus infection and disease are significant causes of morbidity and mortality among patients with hematopoietic stem cell transplantation. The aim of this study was to assess the frequency of cytomegalovirus infection and characterize the patients who developed the disease. Methods: A retrospective cohort study was performed among adult patients, recipients of allogeneic HSTC between 2008 and 2015. Taking into account the institutional protocol of prophylaxis infections in hematopoietic stem cell transplantation, patients received either preemptive therapy or prophylaxis with valganciclovir. Infection was defined as a positive pp65 antigenemia assay or PCR higher than 500 copies/mL. Disease was defined as viremia with evidence of end organ damage. Results: Seventy patients were included, the median age was 36 years old (IQR 17–62). A total of 93% of the recipients had a positive serology. The Cytomegalovirus infection occurred in 59% of the patients. Eleven patients developed disease (16%), the most frequent manifestation being colitis, followed by pneumonitis and a single case of retinitis. There were no differences between the preemptive therapy or prophylaxis groups. The mean time of onset of the disease was day 94 post-transplant. Three patients developed disease with a viral load lower than 1000 copies/mL. Conclusion: The incidence of cytomegalovirus infection after transplantation at our institution is high. It was found that the disease can occur with any level of viral load and is associated with high mortality. Keywords: Cytomegalovirus infection, Hematopoietic stem cell transplantation, Viral load

The nesting environment is known to significantly affect the breeding success of sea turtles. Sandy beach habitats, where sea turtles nest, are frequently affected by high tides and waves on Ecuadorian beaches during windy events. The objectives of this study were: i) to determine the variables that affect nest site selection by two sea turtle species, Eretmochelys imbricata and Chelonia mydas in Ecuador, ii) to compare features of the nesting places of successful vs. failed clutches and iii) to quantify the changes in the intensity and frequency of the tide and its relation to the loss of eggs for the last 10 years. We monitored 15 hawksbill and 26 green turtle nests for two years on five beaches on the mainland coast of Ecuador. The results show that the presence of a dune scarps negatively affected successful nesting, while the proportion of eggs lost was positively associated with road distance, sea distance and nest depth. In addition, the results showed that the loss of eggs was greater for the green turtle, the presence of dune scarps and tides. Finally, using the data available on hatching success over the last 10 years we found a significant relationship between the intensity of the tides and the loss of eggs during this period. We conclude that nest site selection and hatching success vary with beach microhabitats and therefore local information is needed to protect suitable habitats., This work received financial support from the research project PROG-015-DIP-PROYE-001-2019.

Bone loss and vitamin D deficiency are common in HIV patients. However, bone health status in newly diagnosed HIV patients has not been thoroughly described. Our aim was to assess the bone mineral density (BMD), bone resorption and vitamin D status in newly diagnosed HIV patients. A prospective observational study in HIV newly diagnosed therapy-naive persons. Patients with secondary causes of osteoporosis were excluded. Bone densitometry (DXA), a bone resorption marker (CTx), 25-hydroxyvitamin D (25OHD), CD4 count and HIV viral load (VL) were done in 70 patients. Vitamin D results were compared with a group of healthy volunteers. All patients were men, mean age 31 years (19–50). Low BMD (Z score ≤ 2.0) was found in 13%, all of them in lumbar spine, and in only one patient also in femoral neck. Bone resorption was high in 16%. One out of four participants had low BMD or high bone resorption. Vitamin D deficiency (25OHD

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.

Esta investigación titulada: “Factores ecológicos y su incidencia en los ecosistemas del chame (Dormitator latifrons) en la Segua de Canuto cantón Chone – Ecuador” se realizó durante el periodo 2017. En Ecuador, uno de los más importantes es el Humedal la Segua, ubicado en el cantón Chone de la provincia de Manabí, el mismo que constituye una fuente importante de recursos que genera beneficios sociales y económicos para los habitantes de la zona por ser propicio para la reproducción del Chame (Dormitator latifrons); actividades que generan afectaciones en este ecosistema. La metodología empleada para su desarrollo se basó en la aplicación de técnicas e instrumentos como la observación, las encuestas y las pruebas de campo, para la realización de la investigación se tomaron muestras de temperatura y pH en el centro de la Segua de Canuto del cantón Chone los días a realizar la toma de muestras fueron los lunes y jueves por un lapso de 2 meses: octubre y noviembre, los horarios que se establecieron para la toma de muestras fueron de 7:30 a 8:00, de 12:30 a 13:00 y de 17:00 a 17:30, con intervalos de 3 minutos cada uno para la medición de la temperatura y pH, con los valores encontrados se realizó un promedio general para cada día la cual se utilizó para demostración del estudio, los análisis de las muestras tomadas en el humedal durante 28 días demostraron que el nivel de pH se encontró dentro del rango promedio óptimo; mientras que la temperatura se encontró en niveles ideales antes mencionados únicamente en tres días. Cabe recalcar que en el resto de los días en el que se realizaron los análisis, para la temperatura los resultados sobrepasaron el rango promedio óptimo para el ecosistema del chame, lo cual demuestra que tanto el desarrollo de las actividades económicas como los cambios climáticos que se generan en la zona tienen un impacto negativo en el ecosistema del chame.

The ‘off’ state for aminocatalysis by a switchable [2]rotaxane is shown to correspond to an ‘on’ state for anion-binding catalysis. Conversely, the aminocatalysis ‘on’ state of the dual-function rotaxane is inactive in anion-binding catalysis. Switching between the different states is achieved through the stimuli-induced change of position of the macrocycle on the rotaxane thread. The anion-binding catalysis results from a pair of triazolium groups that act together to CH-hydrogen bond to halide anions when the macrocycle is located on an alternative (ammonium) binding site, stabilizing the in situ generation of benzhydril cation and oxonium ion intermediates from activated alkyl halides. The aminocatalysis and anion-binding catalysis sites of the dual-function rotaxane catalyst can be sequentially concealed or revealed, enabling catalysis of both steps of a tandem reaction process.

Resumen El meloncillo es una especie en expansion en el centro y norte de la Peninsula Iberica. Ningun trabajo, hasta la fecha, habia confirmado este proceso dispersivo en su borde de distribucion suroriental, situado en trabajos previos entre las provincias de Malaga y Granada. Por medio de un muestreo sistematico e intensivo focalizado en la especie (con trampas de pelo, rastreo de indicios, recoleccion de citas y encuestas), se muestrearon 49 cuadriculas UTM (10x10 km) en aproximadamente la mitad occidental de la provincia de Granada, entre noviembre de 2014 y enero de 2015. Se detecto la presencia segura de la especie en 16 cuadriculas (bibliografia cientifica, trampas de pelo, atropello, entrada en centro de recuperacion, capturas en coto de caza, fototrampeo y taxidermia) y seis con presencia probable (avistamientos sin foto, huellas y encuestas). Nuestros resultados muestran que el meloncillo esta experimentando una expansion hacia el extremo suroriental de la Peninsula. Este estudio pone de relieve que las trampas de pelo constituyen un metodo no invasivo de gran eficacia para el seguimiento de la distribucion de la especie. Los resultados obtenidos tienen gran utilidad como herramienta de gestion en proyectos de conservacion e investigacion sobre dicha especie. Palabras clave: Granada, meloncillo, presencia, rastreo de indicios, trampa de pelo. Abstract The Egyptian mongoose is expanding in the center and north of the Iberian Peninsula. So far no studies confirm the dispersal process in the most southeastern distribution, which was previously located between the provinces of Malaga and Granada. Through a systematic and intensive methodology focused on detecting mongoose (hair-traps, sign surveys and questionnaires), 49 UTM-grids (10x10 km) were sampled in approximately the western region of the province of Granada, between November 2014 and January 2015. The presence of the species has been confirmed in 16 grids (scientific literature, hair-traps, roadkills, records from wildlife recovery centers, kills in hunting grounds, reliable quotes from camera traps and/or taxidermy) and in other 6 grids the presence was considered probable (sightings without photo, fingerprints and surveys). Our results show that the mongoose is undergoing an expansion to the southeastern part of the Peninsula. This study also shows that hair-traps are a non-invasive method highly effective for monitoring the distribution of this species. These results could be a useful management tool in conservation projects and research on this species. Keywords: Granada, Egyptian mongoose, presence, indirect sampling, hair trap. DOI: 10.7325/Galemys.2016.A5