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Aunque en la actualidad la lesión renal aguda en mujeres embarazadas es una complicación poco común, esta se correlaciona con peores desenlaces maternos y fetales. Sus causas son múltiples y varían según el trimestre de presentación. Los cambios fisiológicos renales durante el embarazo hacen que los criterios diagnósticos de lesión renal aguda en la población general no sean fácilmente extrapolables a las pacientes obstétricas, por lo que la sospecha temprana y eltratamiento oportuno son fundamentales para evitar la progresión del daño renal y sus complicaciones sistémicas asociadas, incluidas las metabólicas, urémicas e hidroelectrolíticas.

La enfermedad renal crónica (ERC), definida como una alteración estructural o funcional renal que persiste por más de 3 meses con o sin deterioro de la función renal o como un filtrado glomerular (FG) < 60 mL/min/1,73 m 2 sin otros signos de enfermedad renal, es una condición prevalente en la población general; sin embargo, no es tan frecuente en mujeres embarazadas. A pesar de su baja frecuencia en gestantes, el antecedente de enfermedad renal se asocia con peores desenlaces maternos y fetales cuando se presenta ERC. Las fórmulas estándar (CKD-EPI, Cockroft-Gault y MDRD) utilizadas para determinar la tasa de filtrado glomerular en población no obstétrica tienen poca precisión en las embarazadas debido a que subestiman la función renal en aproximadamente un 20%. Ante esto, el aclaramiento de creatinina medido utilizando recolecciones de orina de 24 horas y la estimación de creatinina sérica que se correlaciona estrechamente con el aclaramiento de inulina (estándar de oro) son opciones que pueden utilizarse durante el embarazo. Asimismo, el reconocimiento temprano de la enfermedad, la optimización de las estrategias de nefroprotección, el evitar las drogas nefrotóxicas y la instauración de un tratamiento específico para la etiología garantizan una mayor sobrevida y un menor número de complicaciones derivadas de la enfermedad renal.

Background. In Colombia, maternal near miss morbidity is monitored in the health surveillance system. The National Health Institute included a special report on cases that met three or more World Health Organization criteria according to the World Health Organization criteria. Objective. To estimate the relationship between variables related to opportune access to health care services in Colombia during 2013 depending on inclusion criteria –three or more– for maternal near miss morbidity. Materials and methods. A cross-sectional analysis of the national registry of obligatory notification on maternal near miss morbidity was performed. Cases with three or more criteria were compared with those with one or two according to some variables related to the timely access of health care services. Results. A total of 8 434 maternal near miss morbidity cases were reported, women were aged between 12 and 51 years old (M=26.4, SD=7.5). 961 (11.4%) lived in remote rural areas; 4 537 (53.8%) were uninsured under the health system, or they were affiliated to either the subsidized or special health care regime; 845 (10.0%) belonged to an ethnic minority; 3 696 (44.4%) were referred to a more complex service; 4 097 (49.2%) were admitted to the intensive care unit; and 3 975 (47.1%) met three or more of the inclusion criteria for maternal near miss morbidity. They were combined to meet three or more of the case inclusion criteria: intensive care unit admission (OR=5.58;IC95% 5.06-6.15); being uninsured or affiliated to the subsidized or special regime (OR=1.57; IC95% 1.42-1.74); and referral to a more complex service (OR=1.18; IC95% 1.07-1.31). Conclusions. In Colombia, the timely access of health care services is related to maternal near miss morbidity with three or more inclusion criteria.

Aunque en la actualidad la lesión renal aguda en mujeres embarazadas es una complicación poco común, esta se correlaciona con peores desenlaces maternos y fetales. Sus causas son múltiples y varían según el trimestre de presentación. Los cambios fisiológicos renales durante el embarazo hacen que los criterios diagnósticos de lesión renal aguda en la población general no sean fácilmente extrapolables a las pacientes obstétricas, por lo que la sospecha temprana y eltratamiento oportuno son fundamentales para evitar la progresión del daño renal y sus complicaciones sistémicas asociadas, incluidas las metabólicas, urémicas e hidroelectrolíticas.

La enfermedad renal crónica (ERC), definida como una alteración estructural o funcional renal que persiste por más de 3 meses con o sin deterioro de la función renal o como un filtrado glomerular (FG) < 60 mL/min/1,73 m 2 sin otros signos de enfermedad renal, es una condición prevalente en la población general; sin embargo, no es tan frecuente en mujeres embarazadas. A pesar de su baja frecuencia en gestantes, el antecedente de enfermedad renal se asocia con peores desenlaces maternos y fetales cuando se presenta ERC. Las fórmulas estándar (CKD-EPI, Cockroft-Gault y MDRD) utilizadas para determinar la tasa de filtrado glomerular en población no obstétrica tienen poca precisión en las embarazadas debido a que subestiman la función renal en aproximadamente un 20 %. Ante esto, el aclaramiento de creatinina medido utilizando recolecciones de orina de 24 horas y la estimación de creatinina sérica que se correlaciona estrechamente con el aclaramiento de inulina (estándar de oro) son opciones que pueden utilizarse durante el embarazo. Asimismo, el reconocimiento temprano de la enfermedad, la optimización de las estrategias de nefroprotección, el evitar las drogas nefrotóxicas y la instauración de un tratamiento específico para la etiología garantizan una mayor sobrevida y un menor número de complicaciones derivadas de la enfermedad renal.

Background. In Colombia, maternal near miss morbidity is monitored in the health surveillance system. The National Health Institute included a special report on cases that met three or more World Health Organization criteria according to the World Health Organization criteria.Objective. To estimate the relationship between variables related to opportune access to health care services in Colombia during 2013 depending on inclusion criteria –three or more– for maternal near miss morbidity.Materials and methods. A cross-sectional analysis of the national registry of obligatory notification on maternal near miss morbidity was performed. Cases with three or more criteria were compared with those with one or two according to some variables related to the timely access of health care services.Results. A total of 8 434 maternal near miss morbidity cases were reported, women were aged between 12 and 51 years old (M=26.4, SD=7.5). 961 (11.4%) lived in remote rural areas; 4 537 (53.8%) were uninsured under the health system, or they were affiliated to either the subsidized or special health care regime; 845 (10.0%) belonged to an ethnic minority; 3 696 (44.4%) were referred to a more complex service; 4 097 (49.2%) were admitted to the intensive care unit; and 3 975 (47.1%) met three or more of the inclusion criteria for maternal near miss morbidity. They were combined to meet three or more of the case inclusion criteria: intensive care unit admission (OR=5.58; IC95% 5.06-6.15); being uninsured or affiliated to the subsidized or special regime (OR=1.57; IC95% 1.42-1.74); and referral to a more complex service (OR=1.18; IC95% 1.07-1.31).Conclusions. In Colombia, the timely access of health care services is related to maternal near miss morbidity with three or more inclusion criteria. Antecedentes. En Colombia, la morbilidad materna extrema es monitoreada en el sistema de vigilancia epidemiológica. El Instituto Nacional de Salud incluyó el análisis particular de los casos que reunieran tres o más criterios de inclusión de definición de caso.Objetivo. Estimar la relación entre variables relacionadas con el acceso oportuno a la prestación de los servicios en salud y los criterios de inclusión –tres o más– para morbilidad materna extrema en Colombia durante 2013.Materiales y métodos. Se realizó un análisis transversal del registro nacional de notificación obligatoria sobre morbilidad materna extrema; los casos con tres criterios o más se compararon con aquellos con uno o dos según algunas variables relacionadas con el acceso oportuno a la prestación de servicios en salud.Resultados. Se notificaron 8.434 casos de morbilidad materna extrema, edades entre 12 y 51 años (M=26.4; DE=7.5). 961 (11.4%) residentes en zona rural remota, 4.537 (53.8%) en régimen no asegurado, subsidiado o especial, 845 (10.0%) pertenecientes a minoría étnica, 3.696 (44.4%) fueron remitidas a un servicio de mayor complejidad, 4.097 (49.2%) recibieron servicios en unidad de cuidados intensivos y 3.975 (47.1%) reunieron tres o más criterios de inclusión de caso morbilidad materna extrema. Se asociaron a reunir tres o más criterios de inclusión de caso: el ingreso a unidad de cuidados intensivos (OR=5.58; IC95% 5.06-6.15), régimen no asegurado, subsidiado o especial (OR=1.57; IC95% 1.42-1.74) y remisión a servicio de mayor complejidad (OR=1.18; IC95% 1.07-1.31).Conclusiones. En Colombia, el acceso oportuno a los servicios de atención en salud se relaciona con morbilidad materna extrema de tres o más criterios de inclusión.

Recently, the interest in using nucleic acids for therapeutic applications has been increasing. DNA molecules can be manipulated to express a gene of interest for gene therapy applications or vaccine development. Plasmid DNA can be developed to treat different diseases, such as infections and cancer. In most cancers, the immune system is limited or suppressed, allowing cancer cells to grow. DNA vaccination has demonstrated its capacity to stimulate the immune system to fight against cancer cells. Furthermore, plasmids for cancer gene therapy can direct the expression of proteins with different functions, such as enzymes, toxins, and cytotoxic or proapoptotic proteins, to directly kill cancer cells. The progress and promising results reported in animal models in recent years have led to interesting clinical results. These DNA strategies are expected to be approved for cancer treatment in the near future. This review discusses the main strategies, challenges, and future perspectives of using plasmid DNA for cancer treatment.

This study evaluated the discriminative potential of a machine learning model using movement features during functional tasks to distinguish between patients with non-traumatic chronic neck pain and asymptomatic controls. The study included patients with chronic mechanical neck pain and asymptomatic controls. Inertial sensors analyzed kinematics during two tasks: elevated weight transfer task and water drinking. Movement was characterized using fifteen features, incorporated into machine learning models to assess how movement patterns relate to patient condition. Features included range of motion, peak velocity, smoothness, spatiotemporal inter-plane coordination, energy distribution by frequencies, and movement heterogeneity. Fifty-three patients with neck pain (36.27 ± 14.3 years; 14 men and 39 women) and 53 asymptomatic participants (35.43 ± 14.65 years; 32 men and 21 women) completed the study. Permutation tests evaluated the discriminative potential of neck movement features between groups. The elevated weight transfer task showed significant discriminative power ( P  = .0337 ± .0239; Accuracy = 0.618 ± 0.02), while the water drinking task did not ( P  = .215 ± .202). Movement heterogeneity was the most important discriminative feature, with chronic neck pain patients showing higher movement intensity fluctuations over time. Although the elevated weight transfer task showed statistically significant discriminative potential between asymptomatic individuals and those with chronic neck pain, the models correctly classified participants only 61.8% of the time. This result questions the potential of kinematic analysis to identify patients with chronic neck pain. Future research should investigate these models during more challenging tasks in samples of patients with higher neck pain intensity or disability levels.

The energy industry significantly contributes to anthropogenic methane emissions, which add to global warming and have been linked to an increased risk of cardiovascular diseases (CVD). This study aims to evaluate the relationship between energy-related methane emissions and the burden of CVD, measured in disability-adjusted life years (DALYs), in 2019. We conducted a cross-sectional analysis of datasets from 73 countries across all continents. The analyzed datasets included information from 2019 on environmental energy-related methane emissions, burden of DALYs due to CVD. The age-standardized prevalence of obesity in adults and life expectancy at birth were retrieved. The relationship between the variables of interest was evaluated using multiple linear regression models. In the multiple model, we observed a positive linear association between methane emissions and the log-transformed count of DALYs related to CVD. Specifically, for each unit increase in energy-related methane emissions, the burden of CVD increased by 0.06% (95% CI 0.03–0.09%, p  < 0.001). The study suggests that reducing methane emissions from the energy industry could improve public health for those at risk of CVD. Policymakers can use these findings to develop strategies to reduce methane emissions and protect public health.

Background The craniocervical flexion test (CCFT) is recommended when examining patients with neck pain related conditions and as a deep cervical retraining exercise option. During the execution of the CCFT the examiner should visually assess that the amount of craniocervical flexion range of motion (ROM) progressively increases. However, this task is very subjective. The use of inertial wearable sensors may be a user-friendly option to measure and objectively monitor the ROM. The objectives of our study were (1) to measure craniocervical flexion range of motion (ROM) associated with each stage of the CCFT using a wearable inertial sensor and to determine the reliability of the measurements and (2) to determine craniocervical flexion ROM targets associated with each stage of the CCFT to standardize their use for assessment and training of the deep cervical flexor (DCF) muscles. Methods Adults from a university community able to successfully perform the CCFT participated in this study. Two independent examiners evaluated the CCFT in two separate sessions. During the CCFT, a small wireless inertial sensor was adhered to the centre of the forehead to provide real-time monitoring and to record craniocervical flexion ROM. The intra- and inter-rater reliability of the assessment of craniocervical ROM was calculated. This study was approved by the Research Ethics Committee of CEU San Pablo University (236/17/08). Results Fifty-six participants (18 males, 23 females; mean [SD] age, 21.8 [3.45] years) were included in the study and successfully completed the study protocol. All interclass correlation coefficient (ICC) values indicated good or excellent reliability of the assessment of craniocervical ROM using a wearable inertial sensor. There was high variability between subjects on the amount of craniocervical ROM necessary to achieve each stage of the CCFT. Conclusions The use of inertial sensors is a reliable method to measure the craniocervical flexion ROM associated with the CCFT. The great variability in the ROM limits the possibility to standardize a set of targets of craniocervical flexion ROM equivalent to each of the pressure targets of the pressure biofeedback unit.