Universidad Privada del Valle

Introduction Diabetes mellitus is a complex disease in terms of its causes and pathophysiological processes, it produces a significant impact on health and leads to complications that are difficult to manage. Content This review summarizes and analyzes recent advances in the understanding of the mechanisms of diabetes mellitus and how apitherapy affects them. Also present the available clinical evidence on its application. Summary Apitherapy (complementary-integral use of beehive products) is a potentially useful therapeutic system with a significant level of evidence. This review shows and analyzes the preclinical and clinical evidence on the use of apitherapy in diabetes mellitus. Outlook Apitherapy shows significant effects on epigenetics, chronic inflammation, oxidative stress, metabolic control, dysbiosis, premature cell death and tissue remodeling. Clinical evidence shows an impact on these mechanisms. Apitherapy is a very useful complementary medicine in the treatment of diabetes mellitus.

Background The International Society of Nephrology proposes an acute kidney disease (AKD) management strategy that includes a risk score to aid AKD identification in low- and low-middle-income countries (LLMICs). We investigated the performance of the risk score and determined kidney and patient outcomes from AKD at multiple LLMIC sites. Methods and findings Adult patients presenting to healthcare facilities in Bolivia, Brazil, South Africa, and Nepal were screened using a symptom-based risk score and clinical judgment. Those at AKD risk underwent serum creatinine testing, predominantly with a point-of-care (POC) device. Clinical data were collected prospectively between September 2018 and November 2020. We analyzed risk score performance and determined AKD outcomes at discharge and over follow-up of 90 days. A total of 4,311 patients were at increased risk of AKD, and 2,922 (67.8%) had AKD confirmed. AKD prevalence was 80.2% in patients enrolled based on the risk score and 32.5% when enrolled on clinical judgment alone (p < 0.0001). The area under the receiver operating characteristic curve was 0.73 for the risk score to detect AKD. Death during admission occurred in 84 (2.9%) patients with AKD and 3 (0.2%) patients without kidney disease (p < 0.0001). Death after discharge occurred in 206 (9.7%) AKD patients, and 1865 AKD patients underwent reassessment of kidney function after discharge; 902 (48.4%) patients had persistent kidney disease including 740 (39.7%) patients reclassified with de novo or previously undiagnosed chronic kidney disease (CKD). The study was pragmatically designed to assess outcomes as part of routine healthcare, and there was heterogeneity in clinical practice and outcomes between sites, in addition to selection bias during cohort identification. Conclusions The use of a risk score can aid AKD identification in LLMICs. High rates of persistent kidney disease and mortality after discharge highlight the importance of AKD follow-up in low-resource settings.

Background: Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p < 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes. Results: Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p<0.001). AMI in hematological malignancies was associated with an increased risk of in-hospital mortality (OR = 1.71; 95% CI 1.57 to 1.86; p<0.001), bleeding event (OR = 1.30; 95% CI 1.12 to 1.60; p<0.001), and stroke (OR = 1.24; 95% CI 1.09 to 1.42) compared with AMI in the general population. Patients admitted due to AMI in hematologic malignancies also experienced an increased length of stay (SMD = 0.25; 95% CI 0.20 to 0.28; p<0.001) compared with AMI in the general population. There was no significant difference between the two groups in terms of the likelihood of undergoing invasive procedures (OR = 0.62; 95% CI 0.56 to 0.69) or total hospital expenditure (SMD = 0.09; 95% CI -0.01 to 0.19). Conclusion: While hematological malignancies do not appear to increase the incidence of acute myocardial infarction (AMI), patients who experience AMI episodes are at higher odds of in-hospital complications.

Background: Catheter ablation has been increasingly used for managing atrial fibrillation (AF), to restore and maintain normal sinus rhythm. Despite its widespread use, it is unclear if there are differences in clinical outcomes, particularly in maintaining rhythm control and safety outcomes, between younger and older adults undergoing catheter ablation. The objective of this meta-analysis was to compare the outcomes following catheter ablation in younger and older adults. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using random effect models, mantel-Haenszel odds ratios and associated 95% confidence intervals were calculated to report the overall effect size. The primary endpoints were AF/atrial tachycardia (AT) recurrence and re-ablation requirement. Secondary outcomes included in-hospital complications such as stroke/TIA, cardiac tamponade/pericardial effusion, and vascular complications such as bleeding, hematoma, AV fistula, and femoral pseudoaneurysm. The young adult group varied between studies, ranging from under 30 years to under 45 years. Results: Data from 10 articles, with a sample size of about 126,141 AF patients, were considered. Our analysis indicated that catheter ablation for AF in the younger age group was linked to reduced odds of AF/AT reoccurrence (OR: 0.60; 95% CI: 0.44 to 0.83; p=0.002) and a decreased need for re-ablation after the index procedure (OR: 0.72; 95% CI: 0.53 to 0.97; p=0.03). Furthermore, catheter ablation in younger adults was found to be associated with a lower risk of in-hospital procedural complications like stroke/TIA (OR: 0.59; 95% CI: 0.43 to 0.80; p=0.0008) and cardiac tamponade/pericardial effusion (OR: 0.53; 95% CI: 0.42 to 0.68; p<0.0001). There was no difference between the two groups concerning vascular complications during the procedure (OR: 0.60; 95% CI: 0.28 to 1.27; p=0.18). Conclusion: This meta-analysis demonstrates that younger adults undergoing catheter ablation for atrial fibrillation reported significantly better clinical outcomes than older adults.

Introduction: Cardiovascular diseases are among the leading causes of morbidity and mortality worldwide. A key component is arteriopathy due to oxidative stress, involving homocysteine as a modifiable risk factor by supplementing folic acid. Hypothesis: This meta-analysis hypothesizes that folic acid supplementation reduces the risk of cardiovascular diseases by lowering homocysteine levels. Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Cochrane, Scopus, Web of Science, CINAHL, and EMBASE databases up to March 18, 2024. Randomized controlled trials (RCTs) were included, comparing folic acid supplementation with placebo or alternative treatments in adult patients. The primary outcomes were impact on cardiovascular diseases, stroke, coronary heart disease, peripheral arterial disease, and mortality. Data were extracted and analyzed using random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CI). Results: Our analysis included 16 studies with 39,034 participants meeting the inclusion criteria. The meta-analysis found a statistically significant reduction in stroke risk [RR: 0.87; 95%CI: 0.79, 0.96; P = 0.004] and mortality [RR: 0.92; 95%CI: 0.85, 0.99; P = 0.01]. It showed no statistically significant risk reduction in cardiovascular disease, coronary heart disease, or peripheral arterial disease. Additionally, when evaluating its effectiveness on HDL and LDL, folic acid supplementation showed no statistically significant difference in any of these values between the studies. Conclusions: Folic acid supplementation showed efficacy in reducing the risk of stroke and mortality. However, future research is necessary to investigate homocysteine's role in cardiovascular diseases and events. Systematic review registration number: PROSPERO registry— CRD42024525945.

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular benefits beyond glycemic control, including potential anti-arrhythmic effects. The impact of SGLT2 inhibitors on atrial fibrillation (AF) recurrence following catheter ablation in diabetic patients is an area of emerging interest. The purpose of this meta-analysis was to evaluate the impact of SGLT2 inhibitors on AF recurrence following catheter ablation in patients with diabetes. Methods: A comprehensive literature search was carried out using PubMed, Embase, and Google Scholar databases for the studies comparing SGLT2 inhibitors with other antidiabetic drugs in AF patients undergoing catheter ablation. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Statistical significance was set at p < 0.05. Egger's regression test and Begg-Mazumdar's rank test were used to assess publication bias. The primary endpoint was the reoccurrence of atrial fibrillation after catheter ablation during the follow-up period, which varied between studies and ranged from 12 to 33 months. Results: The analysis included six studies, involving a sample size of around 5,765 AF patients. Our study reported that the use of SGLT2 inhibitors in diabetic patients undergoing catheter ablation for AF was associated with lower odds of AF reoccurrence (OR: 0.46; 95% CI: 0.32 to 0.65; p<0.0001) compared with other antidiabetic medications. This outcome has moderately associated heterogeneity, with I2 of 59%. Egger's regression test and Begg-Mazumdar's rank test showed no evidence of publication bias (p > 0.05). Conclusion: The use of SGLT2 inhibitors was associated with improved outcomes post-catheter ablation for AF diabetic patients. Further large-scale, randomized controlled trials are warranted to confirm these findings and elucidate the underlying mechanisms.

Abstract: In the current consumer context, the trend towards a healthy lifestyle has significantly increased the demand for healthy foods. This study aims to identify the relationship between the brand image (BI) and purchase intention (PI) of these products and how variables such as perceived brand quality (BPQ) and brand satisfaction (BS) influence brand trust (BT) and brand loyalty (BL) in this relationship. The methodology includes a quantitative approach, using non-probability convenience sampling. Using an online survey, data were collected from 637 consumers. Analyses were performed using structural equation modeling (SEM-PLS). The results show no significant correlation between BI and PI, but BI significantly impacts BPQ, BS, BT, and BL. Furthermore, BPQ positively influences BS, BT, and BL, but it does not have a direct influence on PI. The findings suggest that a positive brand image satisfies consumers and generates long-term trust and loyalty. However, perceived quality does not always translate into purchase intention due to various barriers. Practical implications highlight the importance of building a strong and positive brand image to encourage demand for healthy products.

Pediatric leukemia, encompassing acute lymphoblastic leukemia (ALL) and acute myeloid leukemia, remains a formidable challenge despite significant treatment advancements. This review examines recent developments in immunotherapy, chemotherapy, and bone marrow transplantation for pediatric leukemia through a comprehensive analysis of recent literature, focusing on critical studies and clinical trials. Immunotherapy, including monoclonal antibodies, such as blinatumomab and inotuzumab ozogamicin, and chimeric antigen receptor T-cell therapies, such as tisagenlecleucel and brexucabtagene autoleucel, have demonstrated promising results in relapsed or refractory B-cell ALL (B-ALL), achieving notable remission rates with manageable side effects. Chemotherapy continues to be the primary treatment, utilizing multiphase regimens tailored to individual risk profiles. Bone marrow transplantation, especially allogeneic stem cell transplantation, offers potential cures for high-risk or relapsed cases, though it poses risks including graft-versus-host disease and infections. Despite these advancements, treatment resistance, toxicity, and accessibility persist. This review also discusses the long-term outcomes among pediatric leukemia survivors, focusing on late-onset side effects associated with treatments such as chemotherapy and bone marrow transplantation, encompassing secondary malignancies, organ dysfunction, and neurocognitive impacts. Ongoing research and clinical trials are crucial to refine these therapies, enhance their efficacy, and reduce adverse effects, ultimately improving young patients' survival and quality of life.

Currently, unmanned aerial vehicles (UAVs) have a variety of applications in the civil construction industry, including activities related to evaluating the condition of buildings. The objective of this article is to organize information on the use of UAVs in inspecting and evaluating heritage buildings through a Systematic Literature Review. The methodology involved selecting 34 articles from the Scopus and Web of Science databases from the past five years. In general, UAVs are combined with other technologies for data acquisition to produce more precise results, such as Terrestrial Laser Scanning and digital cameras. The most used product of UAVs is a 3D model, which integrates different platforms such as Building Information Modeling and Finite Element Modeling. While UAVs are an important tool for providing accurate diagnoses and evaluations, further research is needed on their limitations in cultural heritage. For example, the applicability of UAVs depends on factors such as flight autonomy, location system, and standardization of procedures. More in-depth research is necessary for both data processing and improving the physical components of UAVs to establish their use in inspecting and evaluating heritage buildings.

In Bolivia, the Madidi National Park is home to the Tacana Indigenous Community “San Miguel del Bala,” which, within the framework of the plurinational process, obtained its title as a Community Territory of Origin in 2021. Concurrently, during the 1990s, the government began establishing the first protected areas, adopting regulations with a primary focus on biodiversity conservation. In some cases, this led to restrictions and limitations on economic and subsistence activities rooted in ancestral practices. Community-based tourism, implemented by San Miguel del Bala, emerged as one of the few possibilities to alleviate and address these restrictions. Simultaneously, it became a means of revaluing the culture. The overlapping of San Miguel del Bala as a Community Territory of Origin and a protected area involves constitutional rights for shared management, a process that currently has several limitations. Adding to this complex situation is the entrance of extractive projects that contradict conservation regulations and the rights of prior consultation with indigenous populations regarding resource exploitation. As a result, they pose threats to the lives, cultures, and territories of the Tacana. In this context, the development of indigenous community tourism is transforming into a strategy for the defense of ancestral Indigenous territory. Information © The Authors 2024

Introducción: El uso inadecuado de antibióticos contribuye al aumento de la resistencia bacteriana, las cepas resistentes son muy difíciles de tratar con los antibióticos disponibles. Objetivo: Evaluar la efectividad del tratamiento farmacológico empírico con Cefotaxima y Ceftriaxona en servicios clínicos y quirúrgicos del hospital “Dr. Benigno Sánchez” de Quillacollo, durante la gestión 2022. Metodología: Es un estudio observacional de tipo analítico, subtipo casos y controles, longitudinal prospectivo. La población fue pacientes 1395, obteniendo una muestra de 884 pacientes subdividiendo en grupos casos n=741 y controles n=126. Resultados: En el servicio quirúrgico la frecuencia entre varones y mujeres fue de 45 % y 55 % respectivamente; 73 % del total no presentó enfermedades de base, el 90 % del total tuvo una hospitalización de menos de una semana con 95 % de mejoría sin diferencia significativa entre casos y controles. En el servicio de clínico, 60 % fueron mujeres el resto varones, 50 % del total no presentó enfermedades de base, el 78 % del total tuvo una hospitalización de menos de una semana con 85 % de mejoría sin diferencia significativa entre casos y controles. Discusión: Las características sociodemográficas, el presente estudio identificó que en el servicio quirúrgico a la edad media fue 43 años, de estos 45 % fueron varones y 55 % mujeres, en cambio en el servicio clínico, la edad media fue de 55 años, 60 % mujeres el resto varones. El presente estudio identificó que, en el servicio quirúrgico, el 95 % de los casos cuentan con mejoría, sin que exista una relación entre la terapia empleada o no. En el servicio clínico se apreció un 85 % de mejoría sin que exista diferencia entre los grupos. No existe una diferencia significativa entre los grupos, en los servicios medico quirúrgicos, con respecto a la mejoría.

En los últimos años, los Vehículos Aéreos No Tripulados (VANT) han presentado una variedad de aplicaciones. Estudios recientes demuestran sus ventajas al momento de cuantificar áreas para la estimación de escorrentía pluvial. Sin embargo, existen incertidumbres sobre su alcance real. Ante ello, el objetivo del estudio es estimar el volumen pluvial captado por cubiertas mediante VANT. La metodología consistió en seleccionar una zona de estudio compuesta por una variedad de cubiertas, en el que las áreas fueron medidas digitalmente, esta última por medio del procesamiento de imágenes captadas por VANT. Para el cálculo de volumen de escurrimiento, se tomaron los datos de precipitación media mensual de los últimos 11 años, y se consideraron los Coeficientes de Escorrentía (Ce) reportados en la literatura. A continuación, se calculó el volumen de escurrimiento medio mensual para cada cubierta. Los resultados muestran que las cubiertas estudiadas (Coliseo - Biblioteca), tienen la capacidad de captar un volumen anual de 2237.75 m3. Con un volumen promedio de 406.74 m3 durante la época lluviosa (noviembre a marzo) y 29.15 m3 en la época seca (abril a octubre). Aunque el uso de VANT permite determinar uno de los valores dentro del cálculo de volumen de escorrentía, para lograr un resultado más exacto, es preciso analizar y evaluar las otras variables (Ce y precipitación).