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This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated.A cross-sectional study enrolling women aged 18-25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%-49.3%), and 17.4% (95%CI: 13.1%- 21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81-3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14-3.30) after controlling for confounders.There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed.

Different studies have reported the association between perceived stress and unhealthy diet choices. We aimed to determine whether there is a relationship between perceived stress and fat intake among undergraduate medical students.A cross-sectional study was performed including first-year medical students. The outcome of interest was the self-report of fat intake assessed using the Block Screening Questionnaire for Fat Intake (high vs. low intake), whereas the exposure was perceived stress (low/normal vs. high levels). The prevalence of high fat intake was estimated and the association of interest was determined using prevalence ratios (PR) and 95% confidence intervals (95%CI). Models were created utilizing Poisson regression with robust standard errors. Data from 523 students were analyzed, 52.0% female, mean age 19.0 (SD 1.7) years. The prevalence of high fat intake was 42.4% (CI: 38.2%-46.7%). In multivariate model and compared with those with lowest levels of stress, those in the middle (PR = 1.59; 95%CI: 1.20-2.12) and highest (PR = 1.92; 95%CI: 1.46-2.53) categories of perceived stress had greater prevalence of fat intake. Gender was an effect modifier of this association (p = 0.008).Greater levels of perceived stress were associated with higher fat intake, and this association was stronger among males. More than 40% of students reported having high fat consumption. Our results suggest the need to implement strategies that promote decreased fat intake.

BackgroundDisability rates increase with age. In 2012, Peruvian older adults (≥ 65 years) represented 9% of the population. Additionally, older population reported disabilities at about 5 times the rate of Peruvians between 36 and 64 years old, and 30% of older population lived in poverty. Peruvian seniors living in extreme poverty experience disabilities and the extent of their access to healthcare is unknown.ObjectiveThis study assesses associations between disability and access to healthcare among Peruvians older individuals living in extreme poverty.MethodsSecondary analysis of a national representative population based survey that utilizes information from Peru's 2012 survey Health and Wellbeing in Older Adults (ESBAM), which includes older adults living in extreme poverty. We define disability in terms of the Activities of Daily Living (ADL disability) framework. Healthcare access was assessed as having any of Peru's available health insurance schemes combined with preventive health services (vision assessment, influenza vaccination, blood pressure assessment, diabetes screening, and cholesterol assessment). Poisson robust regression models were used to evaluate the associations among relevant variables. Prevalence Ratios and 95% confidence intervals (95%CI) were reported.ResultsData from 3869 individuals (65 to 80 years old), of whom 1760 (45.5%) were females, were analyzed. The prevalence of ADL disability was 17.3% (95%CI: 16.0%-18.4%). In addition, more than 60% had never received any of the preventive measures evaluated, except for the blood pressure assessment. In the adjusted model, people with ADL disability had 63% less probability of having extensive insurance, compared to those without disability (pConclusionsThis study shows that this Peruvian older population living in extreme poverty has limited access to healthcare services. Although there was no consistent association between ADL disability and the healthcare access, there is an urgent need to reduce the inequitable access to healthcare of this poor Peruvian older population.

BACKGROUND:Human adult adipose-derived stem cells (hADSCs) have become the most promising cell source for regenerative medicine. However the prolonged ex vivo expansion periods required to obtain the necessary therapeutic dose promotes progressive senescence, with the concomitant reduction of their therapeutic potential. AIM AND SCOPE:A better understanding of the determinants of hADSC senescence is needed to improve biosafety while preserving therapeutic efficiency. Here, we investigated the association between deregulation of the imprinted DLK1-DIO3 region and replicative senescence in hADSC cultures. METHODS:We compared hADSC cultures at short (PS) and prolonged (PL) passages, both in standard and low [O2] (21 and 3%, respectively), in relation to replicative senescence. hADSCs were evaluated for expression alterations in the DLK1-DIO3 region on chromosome 14q32, and particularly in its main miRNA cluster. RESULTS:Comparison of hADSCs cultured at PL or PS surprisingly showed a quite significant fraction (69%) of upregulated miRNAs in PL cultures mapping to the imprinted 14q32 locus, the largest miRNA cluster described in the genome. In agreement, expression of the lncRNA MEG3 (Maternally Expressed 3; Meg3/Gtl2), cultured at 21 and 3% [O2], was also significantly higher in PL than in PS passages. During hADSC replicative senescence the AcK16H4 activating mark was found to be significantly associated with the deregulation of the entire DLK1-DIO3 locus, with a secondary regulatory role for the methylation of DMR regions. CONCLUSION:A direct relationship between DLK1-DIO3 deregulation and replicative senescence of hADSCs is reported, involving upregulation of a very significant fraction of its largest miRNA cluster (14q32.31), paralleled by the progressive overexpression of the lncRNA MEG3, which plays a central role in the regulation of Dlk1/Dio3 activation status in mice.

Aims. Prognostic thresholds to identify new type 2 diabetes mellitus (T2DM) cases using the HOMA-IR have not been defined. We studied the HOMA-IR performance to identify incident T2DM cases and to assess if the thresholds varied according to urbanization and altitude in Peru. Methods. Longitudinal analysis. The outcome was incident T2DM cases: self-report diagnosis and fasting glucose. The exposure was the HOMA-IR. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was estimated with 95% confidence intervals (95% CIs). Results are presented overall and stratified by study site (Lima, Tumbes, urban Puno, and rural Puno), rurality (urban, semiurban, and rural), and altitude (low and high). Results. A total of 3120 participants (mean age: 55.6 years, 51.2% females) contributed data to this analysis. The median baseline HOMA-IR was 1.7 (IQR 1.0–2.9), with median values ranging from 1.1 in rural Puno to 2.0 in Lima and Tumbes (p

Introduction A recent study found lower self-reported prevalence of tobacco smoking in a peri-urban area of Lima, Peru than previously reported in urban samples. These regions encompass substantial proportions of Peru’s population – ones at greater risk of disease due to reduced healthcare access – but have been less often studied. We validate low smoking prevalence with urine cotinine and characterize chronic disease and lung function outcomes between non-, occasional, and daily smokers. Material and Methods Data are from the CRONICAS Cohort Study, a population-based longitudinal study in four low-resource Peruvian settings, which began in 2010. Of a baseline cohort of 2978 adults, we prospectively followed 2583 (87%) to determine prevalence of chronic illness. Results In a baseline sub-sample of 382 participants, median adjusted cotinine was 0.0 mcg/mg (IQR 0–0) for both self-reported non-smokers and occasional smokers compared to 172.3 mcg/mg (IQR 0–709.2) for daily smokers. Creatinine-adjusted cotinine validated daily smoking prevalence of 4.7% at a cutoff of 100 mcg/mg. Kappa statistic for daily smoking and creatinine- adjusted cotinine ≥100 mcg/mg was 0.65 (95% CI 0.47, 0.83), indicating substantial agreement. At baseline, we found 3.3% daily and 8.9% occasional smoking by self-report for the full cohort. Follow-up indicated little difference in chronic disease prevalence between groups. Daily smokers trended toward having a greater decline in FVC (−1%; 95% CI -2.9, 0.8) and FEV1 (−1.3%; 95% CI -3.2, 0.6) over 40 months when compared to non-smokers, whereas the decline in lung function for occasional smokers was similar compared to non-smokers (−0.2% FVC; 95% CI -1.5, 1.0) and (0% FEV1; 95% CI -1.3, 1.3). Conclusions Our data places Peru within a previously-described pattern of smoking found in much of Latin America, favoring occasional over daily smoking and low cigarette consumption. We determine that there are not significant differences between smoking groups concerning chronic disease outcomes. We favor distinguishing between daily and occasional smokers in order to accurately characterize these low-use populations.

Introducción: El objetivo de este trabajo fue determinar la proporción de pacientes que cumplen criterios internacionales de gastrectomía en manga, así como estimar la asociación entre porcentaje de pérdida de peso con tasa de abandono del tratamiento nutricional. Materiales y métodos: Cohorte retrospectiva realizada con historias clínicas de pacientes con gastrectomía en manga entre 2008-2014 en una clínica privada. Hubo dos variables resultado de interés: los criterios de inclusión para cirugía bariátrica según criterios internacionales (IMC ≥40 kg/m2 o ≥ 35 kg/m2 con comorbilidades) y el abandono antes o durante (inasistencia ≥ 60 días desde la consulta previa sin recibir alta [IMC < 25]) del tratamiento nutricional. La exposición fue el porcentaje de peso perdido en las primeras cinco semanas después de la cirugía (< 10% vs. ≥ 10%). Se utilizaron modelos de regresión de Poisson. Se calcularon riesgos relativos e intervalos de confianza al 95% (IC95%). Resultados: La muestra incluyó 423 historias clínicas, 294 (69,5%) mujeres, edad media 39,2 (±12,3) años. 117 (27,7%) cumplieron requisitos para cirugía y 48 de esos 117 (41%) abandonaron el tratamiento nutricional antes de iniciarlo. Los pacientes que perdieron ≥10% de peso en el primer mes tuvieron un 90% menos de riesgo de abandonar la terapia nutricional que los que perdieron

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.

Con motivo del vigésimo quinto aniversario de creación de la Asociación de Cervantistas un importante número de investigadores ha querido ofrecer una síntesis de la aportación de aquella al hispanismo. Este dossier incluye las evocaciones de algunos de quienes intervinieron en su creación, como también de sus dos primeros presidentes, Alberto Sánchez y José María Casasayas; un análisis y valoración de sus reuniones académicas y de las muchas publicaciones derivadas de ellas, y un avance de sus objetivos y proyectos inmediatos.

miR-133a and miR-1 are known as muscle-specific microRNAs that are involved in cardiac development and pathophysiology. We have shown that both miR-1 and miR-133a are early and progressively upregulated during in vitro cardiac differentiation of adult cardiac progenitor cells (CPCs), but only miR-133a expression was enhanced under in vitro oxidative stress. miR-1 was demonstrated to favor differentiation of CPCs, whereas miR-133a overexpression protected CPCs against cell death, targeting, among others, the proapoptotic genes Bim and Bmf. miR-133a-CPCs clearly improved cardiac function in a rat myocardial infarction model by reducing fibrosis and hypertrophy and increasing vascularization and cardiomyocyte proliferation. The beneficial effects of miR-133a-CPCs seem to correlate with the upregulated expression of several relevant paracrine factors and the plausible cooperative secretion of miR-133a via exosomal transport. Finally, an in vitro heart muscle model confirmed the antiapoptotic effects of miR-133a-CPCs, favoring the structuration and contractile functionality of the artificial tissue.

A partir do estudo, análise e interpretação de algumas obras de Armando Corrêa da Silva e de algumas das proposições filosóficas que o influenciaram, notadamente, Sartre e Lukács, expomos e discutimos as principais contribuições teóricas desenvolvidas por Silva para os estudos geográficos no intuito de sistematizá-las ou ao menos delinear a perspectiva de abordagem que perpassa as suas diferentes obras em que o lugar e o ser são as referências discursivas. Utilizamos como referência para esta discussão a proposição teórico-metodológica de fenomenologia-ontológica estrutural e a dinâmica entre as categorias aparência, ser e forma, desenvolvidos por Silva. Esta última, submetemos à lógica de um silogismo concreto para o melhor entendimento de sua ontologia do espaço.

The vine is highly susceptible to numerous fungal diseases, the incidence and severity of which are increasing because of climate change. To fight them, large amounts of phytosanitary products are generally used, although they entail important economic and environmental costs. The new fungus resistant vine varieties (PIWI) constitute one of the most active lines of research on plant material in viticulture and are regarded as a viable solution to respond to the requirements of European Directive 2009/128/EC. In the present work, the evolution and impact of the three main fungal diseases (powdery mildew, downy mildew and botrytis bunch rot) were monitored in plots in the Somontano region (Huesca, Spain), comparing three PIWI varieties (Sauvignon Kretos, Souvignier gris and Muscaris) with a susceptible control variety (Sauvignon blanc) in real field growing conditions over three successive years (2016−2018). The main ampelographic characters of each variety were studied and a weekly follow-up was carried out to track the development of each disease, relating it to climatic variables. Regardless of the climatic conditions (one of the growing seasons was rainy and the other two corresponded to dry years, with differences in the distribution of rainfall), the three PIWI varieties hardly presented any symptoms, demonstrating a high resistance to downy mildew and powdery mildew and even to botrytis. Principal component analysis results pointed to a differential behavior versus the control and treated Sauvignon blanc plants in terms of disease resistance. Based on production results, despite the youth of the plantation, the excellent potential of Sauvignon Kretos variety was observed. However, from the analysis of the quality of wine obtained in microvinifications from these fungus resistant varieties in the second and third year, the one obtained from Muscaris seemed to have the best organoleptic properties. Apart from environmental considerations, given that these fungus resistant varieties can significantly contribute to the sustainability of wineries, they may also respond to the demand of consumers who want zero-pesticide products or of the supporters of ecological products adjusted to European regulations.

The increasingly mechanical requirements of offshore structures have established the relevance of fracture mechanics-based quality control in welded joints. For this purpose, crack tip opening displacement (CTOD) at a given distance from the crack tip has been considered one of the most suited parameters for modeling and control of crack growth, and it is broadly used at the industrial level. We have modeled, through multivariate analysis techniques, the relationships among CTOD values and other material properties (such as hardness, chemical composition, toughness, and microstructural morphology) in high-thickness offshore steel welded joints. In order to create this model, hundreds of tests were done on 72 real samples, which were welded with a wide range of real industrial parameters. The obtained results were processed and evaluated with different multivariate techniques, and we established the significance of all the chosen explanatory variables and the good predictive capability of the CTOD tests within the limits of the experimental variation. By establishing the use of this model, significant savings can be achieved in the manufacturing of wind generators, as CTOD tests are more expensive and complex than the proposed alternatives. Additionally, this model allows for some technical conclusions.

Carbon coatings are used in many different industrial areas, for example in cutting, electronics, or medical applications. On the one hand, carbon coatings have improved the functional properties of medical products because of their high biotolerance, which makes them an important material for implant coatings. On the other hand, high rigidity and abrasion resistance are properties needed in case of surgical tools. Thus, the aim of this research was to study the influence of mechanical abrasion by tumbling and chemical passivation on carbon coatings deposited by reactive magnetron sputtering (RMS) and radio frequency plasma activated chemical vapor deposition (RF PACVD) of X39Cr13 (mainly used for surgical tools) and 316LVM (mainly used for implants). Functional properties, such as roughness, coatings adhesion (scratch test), and wettability were investigated. As a result, DLC coatings applied by magnetron sputtering were found to be the optimum surface treatment in terms of adhesion and wettability properties, being more appropriate for the use of X39Cr13 base than 316LVM for carbon layer deposition.

Os Cursos Profissionais são modalidades de ensino que pretendem responder a necessidades educativas de nível secundário de educação como técnicos intermédios de nível III. Foram inseridos nas escolas secundárias públicas pelo Decreto-lei n.º 74/2004, de 26 de março, com o objetivo de formar profissionais para o exercício de uma profissão. Funcionam na base de um modelo pedagógico em que as disciplinas estão organizadas em estrutura modular. Este estudo, centrado no ensino profissional, tem como objetivo conhecer o insucesso escolar produzido pelos seus alunos em três escolas secundárias públicas de referência. O desempenho escolar dos alunos é objeto de análise estatística, a que acresce o estudo das representações dos alunos e professores sobre este tipo de ensino e seu desenvolvimento. Procurou-se não só identificar as contradições como as formas de interpretação e de ressignificação do conceito de competência no âmbito da planificação, lecionação e avaliação dos alunos. Os resultados obtidos apontam no sentido de uma apropriação superficial do conceito de competência e da sua pouca tradução no desempenho dos professores. A maioria dos alunos, para além de ser proveniente de famílias de capital cultural e económico baixos, tem percursos escolares determinados por várias retenções. O insucesso escolar marca significativamente estes alunos durante a escolaridade obrigatória de nove anos.

One of the main goals of education in the 21st Century is developing students’ autonomy and responsibility. The first is to guarantee the shaping of each individual’s identity, which at the same time entails a pledge to one’s self, to others and to the surrounding reality. The second is in response to our ability to make commitments. To this end we must first immerse ourselves in the concepts of individuality and freedom, which are at the heart of the subject’s awakening and the development of his or her identity. Second, we must outline to all people their rights and duties which will act as permanent reference points that are valid for any situation of interaction. This will finally allow us to address the idea of responsibility, a key factor in forming the moral identity of each individual. In short, the idea is to shape people so that they can live in accordance with their own identity and make a commitment to a common future with other people and other issues and realities, in a world where multiple viewpoints are possible.

The EZSCAN is a non-invasive device that, by evaluating sweat gland function, may detect subjects with type 2 diabetes mellitus (T2DM). The aim of the study was to conduct a systematic review and meta-analysis including studies assessing the performance of the EZSCAN for detecting cases of undiagnosed T2DM.We searched for observational studies including diagnostic accuracy and performance results assessing EZSCAN for detecting cases of undiagnosed T2DM. OVID (Medline, Embase, Global Health), CINAHL and SCOPUS databases, plus secondary resources, were searched until March 29, 2017. The following keywords were utilized for the systematic searching: type 2 diabetes mellitus, hyperglycemia, EZSCAN, SUDOSCAN, and sudomotor function. Two investigators extracted the information for meta-analysis and assessed the quality of the data using the Revised Version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklist. Pooled estimates were obtained by fitting the logistic-normal random-effects model without covariates but random intercepts and using the Freeman-Tukey Arcsine Transformation to stabilize variances. Heterogeneity was also assessed using the I2 measure. Four studies (n = 7,720) were included, three of them used oral glucose tolerance test as the gold standard. Using Hierarchical Summary Receiver Operating Characteristic model, summary sensitivity was 72.0% (95%CI: 60.0%- 83.0%), whereas specificity was 56.0% (95%CI: 38.0%- 74.0%). Studies were very heterogeneous (I2 for sensitivity: 79.2% and for specificity: 99.1%) regarding the inclusion criteria and bias was present mainly due to participants selection.The sensitivity of EZSCAN for detecting cases of undiagnosed T2DM seems to be acceptable, but evidence of high heterogeneity and participant selection bias was detected in most of the studies included. More studies are needed to evaluate the performance of the EZSCAN for undiagnosed T2DM screening, especially at the population level.

The aim of the study was to estimate the association between maternal perception of their child's health status and (mis)classification of their child's actual weight with future weight change. We present cross-sectional and longitudinal analyses from the Peruvian younger cohort of the Young Lives Study. For cross-sectional analysis, the exposure was maternal perception of child health status (better, same or worse); the outcome was underestimation or overestimation of the child's actual weight. Mothers were asked about their perception of their child's weight (same, lighter or heavier than other children). Actual weight status was defined with IOTF BMI cut-off points. For longitudinal analysis, the exposure was (mis)classification of the child's actual weight; the outcome was the standardized mean difference between follow-up and baseline BMI. A Generalized Linear Model with Poisson family and log-link was used to report the prevalence ratio (PR) and 95% confidence intervals (95% CI) for cross-sectional analyses. A Linear Regression Model was used to report the longitudinal analysis as coefficient estimates (β) and 95% CI. Normal weight children who were perceived as more healthy than other children were more likely to have their weight overestimated (PR = 2.06); conversely, those who were perceived as less healthy than other children were more likely to have their weight underestimated (PR = 2.17). Mean follow-up time was 2.6 (SD: 0.3) years. Overall, underweight children whose weight was overestimated were more likely to gain BMI (β = 0.44); whilst overweight children whose weight was considered to be the same of their peers (β = -0.55), and those considered to be lighter than other children (β = -0.87), lost BMI. Maternal perception of the child's health status seems to influence both overestimation and underestimation of the child's actual weight status. Such weight (mis)perception may influence future BMI.

Among different factors, diet patterns seem to be related to depression. The aim of this study was to evaluate the association between the consumption of fruits and/or vegetables and depressive symptoms.A secondary data analysis was conducted using information from a population-based survey from 25 regions from Peru. The outcome was the presence of depressive symptoms according to the Patient Health Questionnaire (cutoff ≥15 to define major depressive syndrome); whereas the exposure was the self-reported consumption of fruits and/or vegetables (in tertiles and using WHO recommendation ≥5 servings/day). The association of interest was evaluated using Poisson regression models controlling for the complex-sample survey design and potential confounders. Data from 25,901 participants were analyzed, mean age 44.2 (SD: 17.7) and 13,944 (54.0%) women. Only 910 (3.8%; 95%CI: 3.5%-4.2%) individuals reported consuming ≥5 servings of fruits and/or vegetables/day; whereas 819 (2.8%; 95%CI: 2.5%-3.1%) had depressive symptoms. Those in the lowest tertile of fruits and/or vegetables consumption had greater prevalence of depressive symptoms (PR = 1.88; 95%CI: 1.39-2.55) than those in the highest tertile. This association was stronger with fruits (PR = 1.92; 95%CI: 1.46-2.53) than vegetables (PR = 1.42; 95%CI: 1.05-1.93) alone.An inverse relationship between consumption of fruits and/or vegetables and depressive symptoms is reported. Less than 5% of subjects reported consuming the amount of fruits and vegetables recommended by the WHO. There is a need to implement strategies to promote better diet patterns with potential impact on mental health.

Heterogeneity and functional specialization among skin-resident macrophages are incompletely understood. In this study, we describe a novel subset of murine dermal perivascular macrophages that extend protrusions across the endothelial junctions in steady-state and capture blood-borne macromolecules. Unlike other skin-resident macrophages that are reconstituted by bone marrow-derived progenitors after a genotoxic insult, these cells are replenished by an extramedullary radio-resistant and UV-sensitive Bmi1+ progenitor. Furthermore, they possess a distinctive anti-inflammatory transcriptional profile, which cannot be polarized under inflammatory conditions, and are involved in repair and remodeling functions for which other skin-resident macrophages appear dispensable. Based on all their properties, we define these macrophages as Skin Transendothelial Radio-resistant Anti-inflammatory Macrophages (STREAM) and postulate that their preservation is important for skin homeostasis.

The therapeutic goals in metastatic breast cancer (MBC) remain palliative in nature, aimed at controlling symptoms, improving or maintaining quality of life and prolonging survival. The advent of new drugs and new formulations of standard agents has led to better outcomes in patients with advanced or metastatic disease. These developments have also allowed a tailored therapeutic approach, in which the molecular biology of the tumour, the treatment history, and patient attitudes are taken into account in the decision-making process. Targeting drug delivery to the tumour is a promising mean of increasing the therapeutic index of highly active agents such as the taxanes, and nanoparticle albumin-bound paclitaxel ( nab -paclitaxel), the first nanotechnology-based drug developed in cancer treatment, is one such advance. Data from randomized trials support the efficacy of single-agent nab -paclitaxel as first-line and further treatment lines in MBC at the registered 3-weekly schedule of 260 mg/m 2 , but emerging evidence suggests its activity as a weekly regimen or combined with other agents in various clinical scenarios. Thus, nab -paclitaxel seems to offer flexibility in terms of dosing schedules, allowing physicians to tailor the dose according to different clinical situations. This paper reviews the clinical trial background for nab -paclitaxel in MBC, focusing on specific ‘difficult-to-treat’ patient populations, such as taxane-pretreated or elderly women, as well as those with triple-negative, HER2-positive and poor-prognostic-factors disease. Moving beyond evidence-based information, ‘real life’ available experiences are also discussed with the aim of providing an update for daily clinical practice.

La insuficiente explotación de las patentes que surgen de las investigaciones universitarias en Cuba, específicamente en el Instituto Superior Politécnico José Antonio Echeverría (ISPJAE) y el convencimiento de su importancia para el desarrollo económico, generan la necesidad de establecer determinados recursos metodológicos que faciliten la transferencia de resultados tecnológicos protegidos a los sectores económicos. El objetivo del trabajo consiste en construir recursos teórico-metodológicos que contribuyan a la gestión innovativa. El resultado que se defiende radica en un modelo de concordancia, una metodología derivada del modelo y un buscador tecno-económico (JUMIRLY). La concepción teórico–metodológica elaborada, alcanzó el propósito de buscar una alternativa, según la cual se pudiera ofrecer un recurso para favorecer la gestión para las innovaciones tecnológicas en los sectores económicos, desde las patentes universitarias. / Insufficient exploitation of patents arising from university research in Cuba, specifically at the Polytechnic University of Havana “José Antonio Echeverría” (ISPJAE, in its Spanish acronym), and the conviction of its importance for economic development, generate the need for certain methodological resources that facilitate the transfer of protected technological results to economic sectors. The objective of this study is to construct theoretical and methodological resources that contribute to innovative management. The result lies in a concordance model, a methodology derived from the model and a techno-economic search engine (JUMIRLY). The theoretical-methodological conception that was elaborated, reached the goal of finding an alternative, under which a resource could be provided, to encourage the management for technological innovations in the economic sectors, from university patents.

OBJETIVO: Evaluar la asociación entre frecuencia de ver televisión, sobrepeso y obesidad en una muestra representativa de mujeres peruanas a nivel nacional. MÉTODOS: Análisis secundario de la Encuesta Nacional Demográfica y de Salud Familiar incluyendo mujeres de 15 a 49 años. Las variables resultados fueron obesidad (índice de masa corporal >30 kg/m²) y sobrepeso (>25 peso OBJETIVO: Analisar a associação entre frequência de assistir televisão com sobrepeso e obesidade em uma amostra representativa de mulheres peruanas em nível nacional. MÉTODOS: Análise secundária da Pesquisa Nacional Demográfica e de Saúde Familiar incluindo 27.712 mulheres de 15 a 49 anos em 2008. As variáveis-desfecho foram obesidade (índice de massa corporal > 30 kg/m2) e sobrepeso (entre 25 e 30 kg/m2); a variável de exposição foi a frequência de assistir televisão (nunca, ocasionalmente, quase todos os dias). Foi utilizada regressão logística para amostras complexas, ajustada por potenciais confundidores. Os resultados foram apresentados como odds ratios ajustados (ORa) com seus respectivos intervalos de 95% de confiança. RESULTADOS: A prevalência de sobrepeso foi de 34,7% (IC95% 33,8;35,7) e de obesidade, 14,3% (IC95% 13,6;5,1). Mulheres que assistiam televisão ocasionalmente e quase todos os dias tiveram maior probabilidade de ter obesidade em comparação às que não assistiam: ORa = 1,7 (IC95% 1,3;2,3) e ORa 2,6 (IC95% 2,0;3,5), respectivamente. A magnitude da associação foi menor para o sobrepeso: ORa 1,2 (IC95% 1,3;2,3) e ORa 1,6 (IC95% 1,1;1,4), respectivamente. A associação foi mais forte na área urbana. CONCLUSÕES: A frequência de assistir televisão esteve associada à apresentar obesidade e sobrepeso entre mulheres peruanas, e a força da associação variou de acordo com a área de residência. Estes achados podem auxiliar estratégias de prevenção da obesidade no contexto peruano.OBJECTIVE: To assess the association between frequency of television viewing, overweight and obesity in a nationally representative sample of Peruvian women. METHODS: Secondary analysis of the Demographic and Health Survey 2008 including women aged from 15 to 49 years old. The outcome variables were obesity (body mass index >30 kg/m²) and overweight (body mass index >25 but

La escasa relevancia de las patentes en la cultura innovadora en el ámbito universitario latinoamericano y en particular, en Cuba, se debe en gran medida a la no introducción dentro del sector productivo de las invenciones gestadas. El trabajo tiene como objetivo elaborar una propuesta teórico-metodológica en la generación de innovaciones hacia los sectores económicos, desde el análisis de las invenciones protegidas en el Instituto Superior Politécnico José Antonio Echeverría (ISPJAE), en el período 1977-2009. El resultado fundamental se centra en el desarrollo de un modelo de concordancia invención-innovación con el uso de las estadísticas de patentes, que incluye un criterio de toma de decisiones. La solución construida tiene alta pertinencia en el ISPJAE, al no disponerse en esta institución de procedimientos metodológicos específicos para la toma de decisiones, que permitan favorecer el desarrollo del proceso de innovación tecnológica desde las invenciones patentadas.AbstractThe scarce relevance of patents in the culture of innovation in the context of Latin American universities and particularly in Cuba, is largely due to the non-introduction of the engendered inventions into the productive sector. The work aims to develop a theoretical-methodological proposal in the generation of innovations directed to economic sectors, from the analysis of protected inventions at the Polytechnic University of Havana “José Antonio Echeverría” (ISPJAE, in its Spanish acronym), in the period from 1977 to 2009. The main result focuses on the development of a concordance model of invention-innovation with the use of patent statistics, including a criterion for decision making. The constructed solution has a high relevance in the ISPJAE, since there are not specific methodological procedures available in this institution for decision-making, which favor the development of the process of technological innovation from the patented inventions.

Postmodernism represents a social condition in its own right and symbolizes a new era, distinct from that known as modernity. The postmodern condition proclaims pluralism, difference, heterogeneous perspectives, the specificity of individual cases, and the little stories ignored by modernity. The postmodern critique has exposed the false certainties of modernity, possibly making us wiser but lacking alternatives. The processes of modernization and post-modernization have made it possible to turn in on ourselves, critically placing us between our needs and our rights. In this context, a new social vision has emerged around the critical importance of the phenomena of subjectivity and the construction of the subject. Contemporary critical pedagogy, which is especially concerned with emancipation, was founded on the old ideals of the Enlightenment and developed with modern narrative categories. After the postmodern critique and the recognition that social practices have changed profoundly, we need to conceive of emancipatory pedagogy in new ways in order to allow the subject as much protagonism as possible. This implies a profound transformation of education, which can no longer be considered merely in terms of the economic and productive development of society.

Objetivos. Explorar si existe una diferencia en la percepción y autorreporte de calidad de vida en población migrante rural-urbana en comparación con un grupo urbano no migrante. Materiales y métodos. Estudio transversal, análisis secundario del estudio PERU-MIGRANT (PEru’s Rural to Urban MIGRANTs study). Utilizando la prueba de Kruskall- Wallis y evaluando magnitud de efectos se midieron y compararon los puntajes global y por dominios obtenidos en la encuesta WHOQOL-Brief. Resultados. Se encuestó a 307 individuos. La edad promedio de fue de 47 años, 57% correspondieron al sexo femenino y 62,2% a población migrante. Comparado con el grupo urbano, el grupo migrante reportó puntajes menores de calidad de vida a nivel global y en los dominios de salud psicológica y del ambiente en elque viven y a la vez, reportaron una mejor percepción en el dominio de salud física. Conclusiones. El impacto de la migración rural-urbana en la calidad de vida indica un efecto diferencial según sus distintos dominios.Objectives. To explore if there is a difference in the perception and self reported quality of life between rural-to-urban migrants and urban groups. Materials and methods. Cross-sectional study, secondary analysis of the PERU-MIGRANT study (PEru’s Rural to Urban MIGRANTs Study). WHOQOL-Brief survey’s global scores and per specific domains obtained in the survey were compared using Kruskall-Wallis’ test and assessing size effect. Results. A total of 307 subjects (62.2% migrants, 57% female, means age 47 years-old) were surveyed. Compared with the urban group, migrants reported lower quality of life both on the global scores as well as in psychological health and the living environment domains. Migrants reported a higher score on the physical health’s domain. Conclusions. The impact of rural-to-urban migration on quality of life suggests a differential effect within its specific domains.

OBJETIVO: Validar um método para avaliação histológica da degeneração discal experimental em coelhos, baseando-se na confiabilidade da análise interobservador. MÉTODOS: Treze coelhos da raça New Zealand foram submetidos a procedimento de indução da degeneração discal através de punção direta de três discos intervertebrais (DIV) consecutivos com agulha 18G sob anestesia. Ao fim de dois meses, coletou-se a coluna vertebral completa de cada coelho e procedeu-se preparo das peças para análise histológica dos discos intervertebrais (Experimentais e Controle), sendo coradas pelo método hematoxilina-eosina. As lâminas histológicas foram avaliadas quanto à ocorrência de degeneração através da análise dos seguintes critérios: presença de vasos sanguíneos; presença de protrusão do núcleo pulposo (NP) através do ânulo fibroso (AF); e ruptura das fibras do AF. RESULTADOS: Ao final dos processos de eutanásia, retirada da coluna e preparo histológico, obteve-se 60 DIV viáveis para avaliação de degeneração. Deste total, 25 peças eram de DIV experimentais e 35 peças de DIV controle. A presença de vaso sanguíneo foi observada em 18 dos 25 DIV degenerados, com concordância de Kappa = 0,95 entre os observadores. A presença da extrusão do NP foi identificada em 19 dos 25 DIV experimentais, com concordância de Kappa = 0,78 entre os observadores. Com relação à ruptura das fibras do AF, pode-se identificar a positividade em 24 dos 25 DIV degenerados, com concordância entre os observadores de Kappa = 0,65. CONCLUSÃO: Este modelo de avaliação histológica da degeneração experimental do DIV mostrou-se viável, com alto grau de concordância entre os observadores na identificação da degeneração discal.OBJETIVO: Validar un método para evaluación histológica de la degeneración discal experimental en conejos, basándose en la confiabilidad del análisis interobservadores. MÉTODOS: Trece conejos de la raza New Zealand fueron sometidos a procedimiento de inducción de la degeneración discal a través de punción directa de tres discos intervertebrales (DIV) consecutivos con aguja 18G bajo anestesia. Al fin de dos meses, se colectó la columna vertebral completa de cada conejo y se procedió a la preparación de las piezas para análisis histológico de los discos intervertebrales (Experimentales y Controles), siendo coloreadas por el método hematoxilina-eosina. Las láminas histológicas fueron evaluadas cuanto a ocurrencia de degeneración a través del análisis de los siguientes criterios: presencia de vasos sanguíneos; presencia de protrusión del núcleo pulposo (NP) a través del anillo fibroso (AF); y rotura de las fibras del AF. RESULTADOS: Al final de los procesos de eutanasia, remoción y preparación histológica de la columna, se obtuvieron 60 DIV viables para evaluación de degeneración. De este total, 25 piezas eran de DIV experimentales y 35 piezas de DIV control. La presencia de vaso sanguíneo fue observada en 18 de los 25 DIV degenerados, con concordancia de Kappa = 0,95 entre los observadores. La presencia de la extrusión del NP fue identificada en 19 de los 25 DIV experimentales, con concordancia de Kappa = 0,78 entre los observadores. Con relación a la rotura de las fibras del AF, se puede identificar la positividad en 24 de los 25 DIV degenerados, con concordancia entre los observadores de Kappa = 0,65. CONCLUSIÓN: Este modelo de evaluación histológica de la degeneración experimental del DIV se mostró viable, con alto grado de concordancia entre los observadores en la identificación de la degeneración discal.OBJECTIVE: To validate a method for histological evaluation of disc degeneration in rabbits based on the reliability of interobserver analysis. METHODS: Thirteen New Zealand white rabbits underwent a procedure to induce disc degeneration through direct puncture of three consecutive intervertebral discs (IVD) with an 18G needle under anesthesia. After two months, the complete spine of each rabbit was collected, and further prepared for histologic examination of the intervertebral discs (Experimental and Control), and stained with the hematoxylin-eosin method. Histology slides were evaluated for the occurrence of degeneration by analyzing the following criteria: presence of blood vessel, presence of protrusion of the nucleus pulposus (NP) through the annulus fibrosus (AF), and rupture of the fibers of the AF. RESULTS: After the euthanasia procedures, collection of the spine and histological preparation, 60 viable IVD were obtained for degeneration assessment. Of a total of 60 pieces, 25 pieces were from Experimental IVD and 35 pieces were from Control IVD. The presence of blood vessel was observed in 18 of 25 degenerated IVD with agreement among observers of Kappa = 0.95. The presence of the extrusion of the NP was identified in 19 of 25 experimental IVD with interobserver agreement of Kappa = 0.78. The rupture of the fibers of AF could be identified in 24 of 25 degenerated IVD, with interobserver agreement of Kappa = 0.65. CONCLUSION: This model of histological assessment of experimental IVD degeneration is feasible, with a high degree of interobserver agreement in the identification of disc degeneration.

En las últimas décadas se ha producido un cambio tan significativo en las sociedades más desarrolladas, que puede hablarse de un proceso de postmodernización. La crítica postmoderna ha puesto de manifiesto los errores de la modernidad y ha generado cierta sabiduría, aunque no haya tenido la misma capacidad para crear alternativas. Las narrativas pedagógicas elaboradas con categorías de pensamiento moderno se agotan en los nuevos escenarios postmodernos, que han cuestionado radicalmente la constitución de la realidad. Hoy, la construcción de la identidad supone la última fuente de arraigo, convirtiéndose en una responsabilidad reflexiva, aunque destinada a la inconclusión. Una narrativa pedagógica centrada en la identidad aspira a comprender la educación como elaboración de sentido personal en la cultura.

According to Milton Santos, we must analyze the distribution and organization of technical objects thatmakes up the Internet network from three interrelated totalities, in order to identify the intention attributedto them that leads to the process of socio-spatial inclusion or exclusion.

A protocol was established to produce bioactive compounds in a callus culture of Ageratina pichinchensis by using 1 mg L−1 NAA with 0.1 mg L−1 KIN. The phytochemical study of the EtOAc extract obtained from the callus biomass, allowed the isolation and characterization of eleven secondary metabolites, of which dihydrobenzofuran (5) and 3-epilupeol (7), showed important anti-inflammatory activity. Compound 5 inhibits in vitro the secretion of NO (IC50 = 36.96 ± 1.06 μM), IL-6 (IC50 = 73.71 ± 3.21 μM), and TNF-α (IC50 = 73.20 ± 5.99 μM) in RAW (Murine macrophage cells) 264.7 macrophages, as well as the activation of NF-κB (40% at 150 μM) in RAW-blue macrophages, while compound 7 has been described that inhibit the in vivo TPA-induced ear edema, and the in vitro production of NO, and the PLA2 enzyme activity. In addition, quantitative GC-MS analysis showed that the anti-inflammatory metabolites 5 and 7 were not detected in the wild plant. Overall, our results indicated that A. pichinchensis can be used as an alternative biotechnological resource for obtaining anti-inflammatory compounds. This is the first report of the anti-inflammatory activity of compound 5 and its production in a callus culture of A. pichinchensis.

La Esclerosis Múltiple (EM) es la principal enfermedad desmielinizante a nivel mundial. La epidemiología señala una mayor prevalencia de esta entidad en áreas alejadas de la línea ecuatorial. Existen algunos estudios de prevalencia en Latinoamérica, ninguno publicado en el Perú. Objetivo: Determinar la prevalencia de Esclerosis Múltiple en Lima, Perú. Material y métodos: Se utilizó el método captura recaptura para estimar la prevalencia de EM en Lima en 4 centros de pacientes con Esclerosis Múltiple de la ciudad: Hypnos Instituto del Sueño en la Clínica San Felipe, el Hospital Nacional Cayetano Heredia, la Clínica El Golf y la Asociación "Esclerosis Múltiple Perú" (ESMUP). Resultados: Se calculó la prevalencia de EM en 7,69 x 100 000 habitantes (intervalo de confianza al 95 % 7,09 a 8,30). Conclusiones: La prevalencia estimada de EM, para la ciudad de Lima, se encuentra en rango medio bajo. (Rev Med Hered 2009;20:146-150).

OBJETIVO: avaliar a eficácia da discectomia lombar por via transforaminal, de modo quantitativo, em estudo experimental com cadáveres. MÉTODOS: este estudo utilizou cinco cadáveres humanos frescos, submetidos à discectomia pela via de acesso póstero-lateral nos níveis L3-L4 e L4-L5, visando remover a maior quantidade de material discal possível. Uma abordagem anterior complementar, expondo os mesmos discos intervertebrais, permitiu a remoção do material discal remanescente, para posterior comparação. RESULTADOS: em L3-L4, a remoção transforaminal do disco obteve, em média, 48% do volume total, e em L4-L5, cerca de 38%. CONCLUSÃO: apesar de segura e de fácil realização, a via transforaminal não é tão eficaz quanto à via anterior na remoção do disco intervertebral.OBJETIVO: evaluar la eficacia de la discectomía lumbar por vía transforaminal, de modo cuantitativo, en un estudio experimental con cadáveres. MÉTODOS: este estudio utilizó cinco cadáveres humanos frescos, sometidos à discectomía por vía de acceso posterolateral en los niveles L3-L4 y L4-L5, visando remover la mayor cantidad de material discal posible. Un abordaje anterior complementar, exponiendo los mismos discos intervertebrales, permitió la remoción del material discal remanente, para posterior comparación. RESULTADOS: en L3-L4, la remoción transforaminal del disco obtuvo en promedio 48% del volumen total y en L4-L5, cerca del 38%. CONCLUSIÓN: aunque segura y de fácil realización, la vía transforaminal no es tan eficaz como la vía anterior en la remoción del disco intervertebral.OBJECTIVE: to evaluate the quantitative efficacy of transforaminal lumbar discectomy, through a cadaver study. METHODS: this study used five fresh human cadavers, that underwent L3-L4 and L4-L5 posterolateral discectomy, aiming to remove as much disc material as possible. After that, the remaining disc material was removed through an anterior approach, for further comparison. RESULTS: in L3-L4, transforaminal discectomy allowed the removal of 48% of disc volume, and in L4-L5, 38%. CONCLUSION: although safe and relatively easy to perform, the transforaminal approach does not allow complete discectomy.

OBJETIVO: Validar a avaliação radiográfica da degeneração discal experimental em coelhos. MÉTODOS: Os discos intervertebrais lombares de coelhos New Zealand foram puncionados três vezes com uma agulha 18G com profundidade limitada de 5mm, através de abordagem lateral. Foram realizadas radiografias seriadas pré e pós-operatórias imediatas, e depois de quatro, oito e 12 semanas do procedimento, com posterior análise da altura discal, formação de osteófito, esclerose da placa vertebral e presença de degeneração discal. A análise estatística dos dados foi validada pelo coeficiente de concordância Kappa, com intervalo de confiança (IC) de 95%. RESULTADOS: Observou-se diminuição significativa do espaço discal nas radiografias em AP após 12 semanas de pós-operatório, com Kappa = 0,489 para IC 95% (0,25-0,72) com p < 0,001. Os sinais radiográficos de degeneração discal também apresentaram valor de Kappa = 0,63 para IC 95% (0,39-0,86) com p < 0,001. Os demais critérios avaliados tiveram resultados positivos, porém, com menor valor de Kappa. CONCLUSÃO: O modelo de degeneração discal em coelhos proposto neste estudo mostrou-se factível, com correlação radiológica positiva entre as imagens pré e pós-operatórias, validando a possibilidade de indução de degeneração discal nesse modelo animal para futuros estudos.OBJECTIVE: To validate radiographic evaluation of a rabbit model for disc degeneration. METHODS: Lumbar intervertebral discs of New Zealand rabbits were stabbed three times with a 18G needle at a limited depth of 5mm, through lateral approach. Serial radiographic images were taken on the early pre-and postoperative periods, and after four, eight and 12 weeks of the procedure, with subsequent analysis of disc height, osteophyte formation, endplate sclerosis, and presence of disc degeneration. The statistical analysis of data was validated by the Kappa coefficient, with a confidence interval (CI) of 95%. RESULTS: A significant reduction of disc space was found on AP X-ray images after 12 postoperative weeks, with Kappa = 0.489 for CI 95% (0.25-0.72) with p < 0.001. X-ray signs of disc degeneration also presented Kappa = 0.63 for CI 95% (0.39-0.86) with p < 0.001. The remaining assessed criteria showed positive results, but with a lower Kappa value. CONCLUSION: The disc degeneration model using rabbits as proposed in this study was shown to be feasible, with positive X-ray correlation between pre- and postoperative images, validating the potential to induce disc degeneration in this animal model for future studies.

The prokaryotic β serine recombinase (β-rec) catalyzes site-specific recombination between two directly oriented six sites (93 bp) in mammalian cells, both in episomal and in chromosomally integrated substrates. The β-rec/six exclusive intramolecular site-specific recombination (SSR) system has been proposed as a suitable approach when several independently controlled recombination events are needed in a single cell. Here we explored the use of the β-rec/six system for selective induction of genome-targeted modifications. We generated and analyzed mouse transgenic lines (Tgβ) expressing β-rec under the control of the Lck promoter. β-rec activity was demonstrated, and there was no evidence of alterations to thymic or peripheral T cell development. We developed two transgenic mouse lines harboring different target sequences (Tgrec and KOsix) and analyzed the effect of β-rec expression on these animals. The results indicate that the β-rec/six SSR system is functional for in vivo gene-targeting applications.

Objective. To develop and validate a risk score for detecting cases of undiagnosed diabetes in a resource-constrained country. Methods. Two population-based studies in Peruvian population aged ≥35 years were used in the analysis: the ENINBSC survey (n=2,472) and the CRONICAS Cohort Study (n=2,945). Fasting plasma glucose ≥7.0 mmol/L was used to diagnose diabetes in both studies. Coefficients for risk score were derived from the ENINBSC data and then the performance was validated using both baseline and follow-up data of the CRONICAS Cohort Study. Results. The prevalence of undiagnosed diabetes was 2.0% in the ENINBSC survey and 2.9% in the CRONICAS Cohort Study. Predictors of undiagnosed diabetes were age, diabetes in first-degree relatives, and waist circumference. Score values ranged from 0 to 4, with an optimal cutoff ≥2 and had a moderate performance when applied in the CRONICAS baseline data (AUC = 0.68; 95% CI: 0.62–0.73; sensitivity 70%; specificity 59%). When predicting incident cases, the AUC was 0.66 (95% CI: 0.61–0.71), with a sensitivity of 69% and specificity of 59%. Conclusions. A simple nonblood based risk score based on age, diabetes in first-degree relatives, and waist circumference can be used as a simple screening tool for undiagnosed and incident cases of diabetes in Peru.

Objective. To estimate cause of death and to identify factors associated with risk of inhospital mortality among patients with T2D. Methods. Prospective cohort study performed in a referral public hospital in Lima, Peru. The outcome was time until event, elapsed from hospital admission to discharge or death, and the exposure was the cause of hospital admission. Cox regression was used to evaluate associations of interest reporting Hazard Ratios (HR) and 95% confidence intervals. Results. 499 patients were enrolled. Main causes of death were exacerbation of chronic renal failure (38.1%), respiratory infections (35.7%), and stroke (16.7%). During hospital stay, 42 (8.4%) patients died. In multivariable models, respiratory infections (HR = 6.55, p

Objetivo: Identificar factores asociados a fracaso de terapia en pacientes con tuberculosis pulmonar durante los 2 primeros meses de tratamiento específico, basados en el peso, el índice de masa corporal (IMC) y el esputo. Materiales y Métodos: Estudio retrospectivo de tipo caso-control apareado por sexo y edad (± 2 años), llevado a cabo en Pampas de San Juan de Miraflores. Todas los fracasos a tratamiento entre el año 2000 y junio del 2005 con frotis positivo fueron incluidos como casos; y los pacientes que ingresaron al programa con prueba de esputo positiva al inicio, y que cumplieron el criterio de cura del programa fueron los controles, 2 por cada caso. Resultados: Veintiocho casos fueron apareados con 56 controles. Los factores asociados a fracaso fueron: al inicio del tratamiento, el antecedente de tratamiento previo (OR = 3,54, IC 95%: 1,22-10,26). Al mes de tratamiento, la pérdida de IMC (OR = 10,65, IC 95%: 2,02-56,01) estuvo asociado a fracaso a tratamiento, mientras que al segundo mes de seguimiento, la presencia de esputo positivo (OR = 25,58, IC 95%: 2,10-311,27) y la pérdida de IMC (OR = 7,08, IC 95%: 1,06-47,55) estuvieron asociados. Ningún control tuvo frotis positivo en o después del tercer mes de tratamiento. Conclusiones: Este estudio muestra que una parte de los pacientes que desarrollaran fracaso a tratamiento podrían detectarse durante el mismo, especialmente mediante el antecedente de tratamiento previo, la variación del IMC y el resultado positivo de esputo al segundo mes. Estos hallazgos podrían mejorar el diagnóstico de formas resistentes y la iniciación de un tratamiento apropiado. (Rev Med Hered 2007;18:123-128).

Es propósito de este estudio teórico examinar algunos trastornos en la ingesta de líquidos tanto primarios como secundarios que afectan al equilibrio hidromineral, y que se analizan a través de diversos estudios experimentales y de la descripción clínica de personas que consumen cantidades desproporcionadas de agua. En muchos de estos pacientes, la polidipsia observada es secundaria a una alteración en los mecanismos de conservación de fluidos. Es el caso de la diabetes insípida, en la cual las elevadas pérdidas de líquido son causadas por una insuficiente liberación de vasopresina (diabetes ínsípida neurogénica) o por una incapacidad renal para actuar en respuesta a la hormona antidiurética disponible (diabetes ínsípida nefrogénica). Pero también existen otros casos clínicamente relevantes en los que la activación inapropiada de los mecanismos de la sed se produce en ausencia de pérdidas anormales de líquido. Son los llamados trastornos polidípsicos primarios, que suelen subdividirse en varias categorías: polidipsia dipsogénica, polidipsia psicogénica y polidipsia gestacional. A partir de estos estudios experimentales y de los casos clínicos revisados, en este artículo se describen algunos de los sistemas neurobiológicos implicados en el control del equilibrio hidromineral y en la regulación de la ingesta de agua y en su tratamiento.

Introdução: A hipocalcemia é uma complicação frequente após tiroidectomia total e o principal motivo pelo internamento prolongado destes doentes. Material e Métodos: Estudaram-se prospectivamente 112 doentes submetidos a tiroidectomia total ou restante entre Junho de 2012 e Novembro de 2013. Foram excluídos 12 casos por apresentarem alterações pré-operatórias da função da paratiróide. Doseou-se a paratormona e cálcio pré-operatórios, imediatamente após a cirurgia, no primeiro dia e no 14º dia após a cirurgia. Resultados: Dos 100 doentes incluídos 60 desenvolveram hipocalcemia (60%), revelando-se sintomática em 14. Surgiu, maioritariamente, 24 horas após a cirurgia (76,7%). Foi definitiva em três doentes e transitória nos restantes. Nos 60 doentes com hipocalcemia, verificou-se hipoparatiroidismo em 19 doentes no doseamento imediatamente após a cirurgia, 14 no doseamento no primeiro dia mas apenas três mantiveram hipoparatiroidismo após 14 dias (doentes com hipocalcemia definitiva). Comparando o grupo de doentes com e sem hipocalcemia constatou-se uma diminuição da paratormona em ambos (imediatamente após a cirurgia e no primeiro dia) mas foi mais importante no grupo com hipocalcemia (p = 0,004 e p < 0,001). O decréscimo da paratormona foi mais acentuado no grupo com hipocalcemia, com maior significado no primeiro dia (50,29% vs 22,47% - p < 0,001). O melhor factor preditivo de hipocalcemia identificado foi o decréscimo da paratormona no primeiro dia após a cirurgia > 19,4% (sensibilidade = 82%; especificidade = 63%). Discussão: No nosso estudo verificou-se uma incidência elevada de hipocalcemia (60%), que se manifestou maioritariamente 24 horas após a cirurgia e que condicionou, nesses doentes, um tempo de internamento mais prolongado. No entanto, em apenas três doentes (3%) a hipocalcemia foi definitiva. Constatou-se ainda uma correspondência na oscilação dos valores séricos do cálcio e da paratormona que permitiu identificar o decréscimo da paratormona no primeiro dia após a cirurgia como um fiável factor predictivo de hipocalcemia. Conclusão: O decréscimo da paratormona no primeiro dia após a cirurgia > 19,4% é um bom factor preditivo de hipocalcemia após tiroidectomia total/restante, permitindo identificar os doentes com maior risco, medicá-los profilaticamente e obter altas precoces e seguras.

Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates.Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and family-related (e.g., maternal nutritional status) variables.Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up.Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.

Objetivo: Evaluar y analizar la evolución de la tuberculosis desde el año 2000 al 2004 en una zona urbano marginal de Lima. Materiales y métodos: Este es un estudio observacional de reporte de casos, realizado en Pampas de San Juan desde enero del 2000 hasta diciembre del 2004. Los datos se obtuvieron del Libro de Sintomáticos respiratorios y del Libro de Evolución y seguimiento de casos de tuberculosis del programa. Resultados: Se diagnosticaron 694 casos de tuberculosis en el periodo de estudio, de los cuales 528 casos eran nuevos (76,1%). La forma pulmonar fue la más diagnosticada con 530 casos, teniendo el 82,1% baciloscopía positiva. La incidencia ha disminuido desde 208.96 hasta 187.05 por 100000 habitantes. La condición de egreso hasta fines del 2003 fue de 427 curados (87,5%), 27 abandonos (5,5%), 13 fracasos (2,7%) y 21 fallecidos durante el tratamiento (4,3%). Conclusiones: En este estudio se demuestra la caída sostenida de los casos informados de tuberculosis en una zona marginal de Lima. Aunque los recursos son escasos, estos deben ser aprovechados al máximo para controlar la tuberculosis con los nuevos problemas que acarrea, como la asociación con la infección por VIH, las formas multi-resistentes y la mayor diseminación por el hacinamiento secundario a la pobreza existente en el lugar.(Rev Med Hered 2005;16:114-119).

An increase in multidrug-resistant tuberculosis (MDR-TB) cases is evident worldwide. Its management implies a complex treatment, high costs, more toxic anti-tuberculosis drug use, longer treatment time and increased treatment failure and mortality. The aims of this study were to compare mortality between MDR and drug-susceptible cases of tuberculosis, and to determine risk factors associated with mortality among MDR-TB cases.A retrospective cohort study was performed using data from clinical records of the National Strategy for Prevention and Control of Tuberculosis in Lima, Peru. In the first objective, MDR-TB, compared to drug-susceptible cases, was the main exposure variable and time to death, censored at 180 days, the outcome of interest. For the second objective, different variables obtained from clinical records were assessed as potential risk factors for death among MDR-TB cases. Cox regression analysis was used to determine hazard ratios (HR) and 95% confidence intervals (95%CI). A total of 1,232 patients were analyzed: mean age 30.9 ±14.0 years, 60.0% were males. 61 patients (5.0%) died during treatment, whereas the MDR-TB prevalence was 19.2%. MDR-TB increased the risk of death during treatment (HR = 7.5; IC95%: 4.1-13.4) when compared to presumed drug-susceptible cases after controlling for potential confounders. Education level (p = 0.01), previous TB episodes (p

In resourced-constrained settings, daily cooking practices are still the norm. Replacing sodium in regular salt to produce potassium-enriched salts are potential alternative routes to reduce sodium intake, paired with the benefit associated with potassium intake. This change would likely have effects on palatability and taste of prepared foods, yet a threshold to discriminate sensorial changes can be determined. The main goal of this study was to assess if the use of potassium-enriched salt substitutes lead to perceived differences in taste utilizing a sensory discrimination test.A triangle taste test was conducted and participants were offered samples of cooked rice prepared with different salts. The only ingredient that differed in the preparation was the salt used: 100%NaCl (regular salt) and salts where sodium was replaced by 50%, 33% or 25% KCl (potassium-enriched salt). Comparisons were carried out according to the minimum number of correct judgments. A total of 156 subjects, 49% males, mean age 41.0 years (SD±15.5) years, participated in the study. Samples using 25% potassium-enrichment were indistinguishable in terms of taste from regular salt, whereas samples with 33% and 50% potassium-enrichment were distinguishable. Results were consistent when stratified by sex and age. Less than 10% of participants attributed the differences to bitterness or metallic flavor.The 25% potassium-enriched salt is indistinguishable from regular salt. These findings suggest a potential to achieve sodium intake reduction strategies in cooking practices by substituting regular salt with potassium-enriched salt without affecting palatability.

OBJECTIVE:We aimed to characterize metabolic status by body mass index (BMI) status. METHODS:The CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru's capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used. Individuals were classified by BMI as normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2), and as metabolically healthy (0-1 metabolic abnormality) or metabolically unhealthy (≥2 abnormalities). Abnormalities included individual components of the metabolic syndrome, high-sensitivity C-reactive protein, and insulin resistance. RESULTS:A total of 3088 (age 55.6±12.6 years, 51.3% females) had all measurements. Of these, 890 (28.8%), 1361 (44.1%) and 837 (27.1%) were normal weight, overweight and obese, respectively. Overall, 19.0% of normal weight in contrast to 54.9% of overweight and 77.7% of obese individuals had ≥3 risk factors (p

Background. Sleep duration, either short or long, has been associated with diseases such as obesity, type-2 diabetes and cardiovascular diseases. Characterizing the prevalence and patterns of sleep duration at the population-level, especially in resource-constrained settings, will provide informative evidence on a potentially modifiable risk factor. The aim of this study was to explore the patterns of sleep duration in the Peruvian adult and adolescent population, together with its socio-demographic profile.Material and Methods. A total of 12,424 subjects, mean age 35.8 years (SD ±17.7), 50.6% males, were included in the analysis. This is a cross-sectional study, secondary analysis of the Use of Time National Survey conducted in 2010. We used weighted means and proportions to describe sleep duration according to socio-demographic variables (area and region; sex; age; education attainment; asset index; martial and job status). We used Poisson regressions, taking into account the multistage sampling design of the survey, to calculate crude and adjusted prevalence ratios (PR) and 95% confidence intervals (95% CI). Main outcomes were short- (

Notre travail analyse le symbolisme des images produites à l’occasion des funérailles de Marie-Louise d’Orléans dans un contexte permettant de supposer des interprétations parfois peu élogieuses à l’égard du pouvoir dont elles émanent. La structure de l’emblème encourage une lecture devant être complétée par le lecteur ou le spectateur de la cérémonie funèbre, lui laissant une marge variable pour son déchiffrement.