Abstract Background: No-reflow (NR) is characterized by an acute reduction in coronary flow that is not accompanied by coronary spasm, thrombosis, or dissection. Inflammatory prognostic index (IPI) is a novel marker that was reported to have a prognostic role in cancer patients and is calculated by neutrophil/lymphocyte ratio (NLR) multiplied by C-reactive protein/albumin ratio. Objective: We aimed to investigate the relationship between IPI and NR in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Methods: A total of 1541 patients were enrolled in this study (178 with NR and 1363 with reflow). Lasso panelized shrinkage was used for variable selection. A nomogram was created based on IPI for detecting the risk of NR development. Internal validation with Bootstrap resampling was used for model reproducibility. A two-sided p-value <0.05 was accepted as a significance level for statistical analyses. Results: IPI was higher in patients with NR than in patients with reflow. IPI was non-linearly associated with NR. IPI had a higher discriminative ability than the systemic immune-inflammation index, NLR, and CRP/albumin ratio. Adding IPI to the baseline multivariable logistic regression model improved the discrimination and net-clinical benefit effect of the model for detecting NR patients, and IPI was the most prominent variable in the full model. A nomogram was created based on IPI to predict the risk of NR. Bootstrap internal validation of nomogram showed a good calibration and discrimination ability. Conclusion: This is the first study that shows the association of IPI with NR in STEMI patients who undergo pPCI. Background Noreflow No reflow (NR spasm thrombosis dissection (IPI neutrophillymphocyte neutrophil lymphocyte NLR (NLR Creactive C reactive proteinalbumin protein albumin Objective STsegment ST segment (STEMI pPCI . (pPCI) Methods 154 178 (17 136 reflow) selection development reproducibility twosided two sided pvalue p value 005 0 05 <0.0 analyses Results nonlinearly non linearly immuneinflammation immune inflammation CRPalbumin CRP netclinical net clinical Conclusion (pPCI 15 17 (1 13 00 <0. 1 ( <0 <

Resumo Fundamento: O no-reflow (NR) é caracterizado por uma redução aguda no fluxo coronário que não é acompanhada por espasmo coronário, trombose ou dissecção. O índice prognóstico inflamatório (IPI) é um novo marcador que foi relatado como tendo um papel prognóstico em pacientes com câncer e é calculado pela razão neutrófilos/linfócitos (NLR) multiplicada pela razão proteína C reativa/albumina. Objetivo: Nosso objetivo foi investigar a relação entre IPI e NR em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) submetidos a intervenção coronária percutânea primária (ICPp). Métodos: Um total de 1.541 pacientes foram incluídos neste estudo (178 com NR e 1.363 com refluxo). A regressão penalizada LASSO (Least Absolute Shrinkage and Select Operator) foi usada para seleção de variáveis. Foi criado um nomograma baseado no IPI para detecção do risco de desenvolvimento de NR. A validação interna com reamostragem Bootstrap foi utilizada para reprodutibilidade do modelo. Um valor de p bilateral <0,05 foi aceito como nível de significância para análises estatísticas. Resultados: O IPI foi maior em pacientes com NR do que em pacientes com refluxo. O IPI esteve associado de forma não linear com a NR. O IPI apresentou maior capacidade discriminativa do que o índice de imunoinflamação sistêmica, NLR e relação PCR/albumina. A adição do IPI ao modelo de regressão logística multivariável de base melhorou a discriminação e o efeito do benefício clínico líquido do modelo para detecção de pacientes com NR, e o IPI foi a variável mais proeminente no modelo completo. Foi criado um nomograma baseado no IPI para prever o risco de NR. A validação interna do nomograma Bootstrap mostrou uma boa capacidade de calibração e discriminação. Conclusão: Este é o primeiro estudo que mostra a associação de IPI com NR em pacientes com IAMCSST submetidos a ICPp. Fundamento noreflow reflow (NR dissecção (IPI neutrófiloslinfócitos neutrófilos linfócitos (NLR reativaalbumina reativa albumina reativa/albumina Objetivo (IAMCSST ICPp . (ICPp) Métodos 1541 1 541 1.54 178 (17 1363 363 1.36 refluxo refluxo) Least Operator variáveis 005 0 05 <0,0 estatísticas Resultados sistêmica PCRalbumina PCR PCR/albumina completo Conclusão (ICPp 154 54 1.5 17 (1 136 36 1.3 00 <0, 15 5 1. ( 13 3 <0 <

ABSTRACT Introduction: Nursing care management in the elderly is a current challenge for the profession. This implies planning and coordinating safe and quality care, processes requiring to integrate theoretical approach and their praxis into systemic and dynamic care to the person in a total reality. Objective: To analyze the meeting points between the theories of Swanson and Roy in the continuous care of the elderly with prostate cancer. Methods: Systematic bibliographic review, carried out during 2019, of articles published from 2009 to 2019 in the SciELO and Google Scholar databases. The guiding question was developed through the acronym PICO. The search strategy was carried out by accepting the following descriptors in Health Sciences (DeCS): teorías de enfermería [nursing theories], modelo de adaptación de Callista Roy [Callista Roy’s adaptation model], teoría de Kristen Swanson [Kristen Swanson’s theory], cuidados continuos [continuous cares], adulto mayor [elderly], neoplasia de la próstata [prostate neoplasm] and enfermedades crónicas [chronic diseases] with the Boolean operator AND. The flow diagram (PRISMA) was used. Content analysis allowed to interpret the theoretical references and to organize knowledge of the thirteen selected bibliographies. Conclusions: There is limited scientific production found about the scope of Swanson’s and Roy´s theories regarding the care of patients with cancer. Both theories include implicitly, in the foundation of their components, a biopsychosocial approach to the way of caring, in clinical praxis, as well as the culture of continuous care for the elderly with prostate cancer, from the nursing perspective.

RESUMEN Introducción: La gestión del cuidado de enfermería, en las personas mayores es un desafío actual para la profesión. Lo que implica planificar y coordinar cuidados seguros y de calidad. Donde se atribuye la necesidad de integrar el enfoque de las teorías y su práctica en el cuidado sistémico y dinámico a la persona en su realidad total. Objetivo: Analizar los puntos de encuentro entre las teorías de Swanson y Roy en el cuidado continuo del adulto mayor con cáncer de próstata. Métodos: Revisión bibliográfica sistemática, durante 2019, de artículos publicados desde 2009 hasta 2019 en las bases de datos SciELO y Google académico. La pregunta guía se elaboró a través del acrónimo PICo. La estrategia de búsqueda se realizó mediante aceptación de los descriptores en Ciencias de la Salud (DeCS) “Teorías de enfermería”, “Modelo de adaptación de Callista Roy”, “Teoría de Kristen Swanson”, “Cuidados continuos”, “Adulto mayor”, “Neoplasia de la próstata” y “Enfermedades crónicas” con el operador booleano AND, se utilizó el diagrama de flujo (PRISMA). El análisis de contenido permitió interpretar los referentes teóricos y la organización del conocimiento de las 13 bibliografías seleccionadas. Conclusiones: Resulta limitada la producción científica encontrada en relación al alcance de las teorías de Swanson y Roy en la atención al paciente con cáncer. Ambas teorías tienen implícitas, en la fundamentación de sus componentes, un acercamiento biopsicosocial al modo de cuidar en la práctica clínica y la cultura del cuidado continuo en el adulto mayor con cáncer de próstata, desde la perspectiva de enfermería.

SUMMARY OBJECTIVE: This retrospective study aimed to determine the predictive values of the C-reactive protein (CRP)/albumin ratio (CAR), fibrinogen/albumin ratio (FAR), and neutrophil/lymphocyte ratio (NLR) parameters, which reflect the systemic inflammatory status, for the severity of COVID-19. METHODS: A total of 188 patients diagnosed with COVID-19 were enrolled in this study. Among them, 118 were in the severe group, and 70 were in the non-severe group. Levels of albumin, CRP, D-dimer, procalcitonin, fibrinogen, and hemoglobin; leukocyte, neutrophil, lymphocyte, and monocyte counts; and the FAR, CAR, and NLR were compared between the two groups. RESULTS: The CAR, FAR, and NLR values were significantly higher in the severe group compared to the non-severe group. CAR, FAR, and NLR were positively correlated with leukocyte and neutrophil counts and CRP, procalcitonin, and fibrinogen levels. On the other hand, they were inversely correlated with monocyte (except for NLR) and lymphocyte counts. Receiver operator characteristic analysis showed that the area under the curve (AUC) for CAR, FAR, and NLR was 0.841, 0.737, and 0.802, respectively. CONCLUSIONS: Our investigation revealed that the CAR, FAR, and NLR indices can be used to predict the severity of COVID-19, among which CAR was the best predictor of severe COVID-19.

RESUMEN Objetivo: Al considerar la vulnerabilidad del sector eléctrico colombiano al cambio climático y los posibles riesgos que pueden presentarse como: incumplimientos en obligaciones de energía firme (OEF) por las unidades de generación, los atrasos de proyectos de generación con energía firme comprometida (caso Hidroituango entre otros) y la disponibilidad de energía firme en el mercado, implican un riesgo sistémico para la provisión de energía eléctrica a mediano plazo. Por tanto, este artículo realiza un análisis de riesgo con base en las previsiones y consideraciones aplicadas en documentos técnicos oficiales y resoluciones vigentes de la Comisión de Regulación de Energía y Gas (CREG) en el balance de demanda y OEF a mediano plazo, con el fin de determinar el riesgo existente y las acciones que la entidad debe realizar para mitigarlo. Metodología: A través del estudio sistemático de documentos técnicos y resoluciones recientes de la CREG, se llevó a cabo una reconstrucción de los balances de obligaciones de energía firme (OEF) y demanda proyectada a mediano plazo (cinco vigencias desde 2018 - 2019 hasta la 2022 - 2023) con información proveniente de operador del sistema eléctrico (XM), con el fin de llevar a cabo análisis basados en dos (2) escenarios considerados en documentos técnicos de la CREG relacionados al tema (Doc. CREG 050-2018 y Doc. CREG 0752018), determinando así las fuentes de riesgo y las medidas adoptadas al respecto. Resultados: Acorde con los escenarios planteados y al análisis de riesgo realizado en este artículo, se observó que la cantidad de OEF actual, en especial para el segundo escenario planteado, requiere toda la energía firme para el cargo por confiabilidad (ENF!CC) base que pueda ofrecer Hidroituango, a pesar de ser un proyecto con atrasos y que probablemente no pueda ingresar para las vigencias donde hay riesgo de desabastecimiento, por lo cual es pertinente solicitar una subasta de reconfiguración para esas vigencias. Conclusiones: Se confirma la alta probabilidad de riesgo de desabastecimiento para la última vigencia bajo estudio (2022-2023) en los dos (2) escenarios propuestos por la CREG, dado el nivel de ENFICC incrementales (ENF!CC con riesgo de oportunidad) y por la disponibilidad de energía firme disponible para satisfacer la demanda, en especial por las OEF adquiridas por el proyecto Hidroituango. (déficit de 2500 GWh-año y 4550 GWh-año respectivamente). Financiamiento: Universidad Autónoma de Occidente.

ABSTRACT Objective: When considering the climate change vulnerability of the Colombian electricity sector and the possible risks that may arise, such as: non-compliance with firm energy obligations (FEO) by generation units, delays in generation projects with firm energy commitments (the Hidroituango case, among others) and the availability of firm energy in the market, imply a systemic risk for the provision of electricity in the medium term. Therefore, this article performs a risk analysis based on the forecasts and considerations applied in official technical documents and current resolutions of the Energy and Gas Regulation Commission (CREG) in the demand balance and OEF in the medium term, in order to determine the existing risk and the actions that the entity must take to mitigate it. Methodology: Through the systematic study of recent technical documents and resolutions of the CREG, a reconstruction of the balances of firm energy obligations (FEO) and projected demand in the medium term (five periods from 2018 - 2019 to 2022 -2023) was carried out with information from the electricity system operator (XM), in order to carry out analyses based on two (2) scenarios considered in CREG technical documents related to the subject (Doc. CREG 050-2018 and Doc. CREG 075-2018), thus determining the sources of risk and the measures adopted in this regard. Results: According to the proposed scenarios and the risk analysis carried out in this article, it was observed that the current amount of OEF, especially for the second proposed scenario, requires all the firm energy for the base reliability charge (ENF!CC) that Hidroituango can offer, in spite of being a project with delays and that probably cannot enter for the periods where there is a risk of lack of supply, for which reason it is pertinent to request a reconfiguration auction for those periods. Conclusions: The high probability of shortage risk for the last term under study (2022-2023) is confirmed in the two (2) scenarios proposed by the CREG, given the level of incremental ENFICCs (ENF!CC with opportunity risk) and by the availability of firm energy available to meet demand, especially by the OEF acquired by the Hidroituango project (deficit of 2500 GWh-year and 4550 GWh-year respectively). Financing: Universidad Autónoma de Occidente

RESUMO Comparação dos sistemas de escores radiológicos, escores clínicos razão neutrófilo/linfócito e níveis séricos de proteína C-reativa para determinação da gravidade e mortalidade em casos de pancreatite aguda OBJETIVO Comparar sistemas de escores radiológicos, escores clínicos, os níveis séricos de proteína C-reativa (PCR) e a razão neutrófilo/linfócitos (RNL) como métodos de previsão de gravidade e mortalidade em casos de pancreatite aguda (PA). MATERIAIS E MÉTODOS Dados demográficos, clínicos e radiográficos de 80 pacientes com PA foram avaliados retrospectivamente. Os valores de Harmless Acute Pancreatitis Score (HAPS), Síndrome da Resposta Inflamatória Sistêmica (SIRS), Índice de Gravidade na Pancreatite Aguda à Beira do Leito (BISAP), escore de Ranson, escore de Balthazar, Índice Modificado de Gravidade por Tomografia Computadorizada (CTSI), escore de Inflamação Extrapancreática em Tomografia Computadorizada (EPIC) e grau renal foram registrados. O desempenho prognóstico dos sistemas de escores clínicos e radiológicos e RNL no momento da internação e os níveis séricos de PCR após 48 horas foram comparados quanto à gravidade, de acordo com os critérios de Atlanta revisados e mortalidade. Os dados foram avaliados pelo cálculo das curvas ROC e da área sob a curva ROC (AUROC). RESULTADOS De 80 pacientes, 19 (23,8%) tinham PA grave e 9 (11,3%) morreram. A AUROC para o escore BISAP foi de 0,836 (95%CI: 0.735-0.937), com o valor mais alto de gravidade. Com um valor de corte de BISAP ≥ 2 , a sensibilidade e a especificidade foram de 68,4% e 78,7%, respectivamente. A AUROC para o a RNL foi de 0,915 (95%CI: 0.790-1), com o valor mais alto de mortalidade. Com um valor de corte de RNL > 11,91, a sensibilidade e a especificidade foram de 76,5% e 94,1%, respectivamente. Entre os sistemas de escore radiológico, o EPIC apresentou o maior valor de AUROC, 0,773 (95%CI: 0.645-0.900) para gravidade e 0,851 (95%CI: 0.718-0.983) para mortalidade com um valor de corte ≥6. CONCLUSÃO O escore BISAP e a RNL podem ser preferíveis como determinantes precoces de gravidade e mortalidade na PA. O escore EPIC pode ser sugerido entre os atuais sistemas de escores radiológicos.

SUMMARY Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis BACKGROUND/AIMS To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Out of 80 patients, 19 (23.8%) had severe AP, and 9 (11.3%) died. The AUROC for the BISAP score was 0.836 (95%CI: 0.735-0.937), with the highest value for severity. With a cut-off of BISAP ≥2, sensitivity and specificity were 68.4% and 78.7%, respectively. The AUROC for NLR was 0.915 (95%CI: 0.790-1), with the highest value for mortality. With a cut-off of NLR >11.91, sensitivity and specificity were 76.5% and 94.1%, respectively. Of all the radiological scoring systems, the EPIC score had the highest AUROC, i.e., 0.773 (95%CI: 0.645-0.900) for severity and 0.851 (95%CI: 0.718-0.983) for mortality, with a cut-off value ≥6. CONCLUSION The BISAP score and NLR might be preferred as early determinants of severity and mortality in AP. The EPIC score might be suggested from the current radiological scoring systems.

In many countries, the work of mining, quarrying, construction of tunnels and galleries, abrasive jet cleaning and smelting continue to present significant risks of silica exposure and silicosis epidemics still occur, even in developed countries. Patients with silicosis are particularly susceptible to opportunistic lung infections such as aspergillosis and tuberculosis. Occasionally silicosis is associated with scleroderma, systemic lupus erythematosus, nephritis and cancer. Early detection of silicosis is made by chest X-ray method, being the presence of rounded opacities the main sign of illness. However, no systematic information is available that allows use as a standard method of evaluation because their interpretation remains operator dependent both conventional radiological technique, digital and interpretation of computed tomography with high resolution.

En muchos países del mundo, los trabajos de minería, canteras, construcción de túneles y galerías, limpieza por abrasión a chorro y fundición continúan presentando riesgos importantes de exposición al sílice, y siguen produciéndose epidemias de silicosis, incluso en los países desarrollados. Los pacientes con silicosis son particularmente susceptibles a infecciones oportunistas del pulmón como la aspergilosis y la tuberculosis. Ocasionalmente la silicosis se asocia a esclerodermia, lupus eritematoso sistémico, nefritis y cáncer. La detección precoz de la silicosis se realiza mediante el método radiológico de tórax, constituyendo la presencia de opacidades redondas el principal signo de enfermedad. Sin embargo no se dispone de información sistemática que permita utilizarla como método estándar de evaluación debido a que su interpretación sigue siendo operador dependiente tanto en la técnica radiológica convencional, digital y en la interpretación de la tomografía axial computarizada con alta resolución.

Arguments have been provided against the use of the eigenvector as the operator that derives priorities. A highlight of the arguments is that the eigenvector solution does not always respect the condition of ordinal preference (COP) based on the decision maker's judgments. While this condition may be reasonable when dealing with measurable concepts (such as distance or time) that lead to consistent matrices, it is questionable whether it is to be expected in all situations, particularly when the information provided by the decision maker is not fully consistent. The judgments that lead to inconsistency may also contain valuable information that must be considered in the priority assessment process as well. By the other hand, the analytic hierarchy process (AHP) use the eigenvector operator to derive the priorities that represent the cardinal decision maker preferences from a pairwise comparison matrix, which do not always respect the COP condition. The AHP and still deeper the ANP (the mathematical generalization of AHP) start from concepts of ordinal metric of dominance and system theory, which is well supported by graph theory and ordinal topology with the Cesaro sum as its fundamental pillar to build metric of dominance. These mathematic concepts has no relation with COP preservation moreover, this two way of thinking are in a course of collision since the second (COP) inhibit the first (Cesaro sum). Systems theory claims that the whole is more than its standalone components, and that internal relationships provide additional information as well. Given that the pairwise comparison matrix is an interrelated system and not just a collection of standalone judgments, we plan to show that the eigenvector, because it is a systemic operator, is the most suitable to represent and capture the behavior of the whole system and its emerging properties.

Se han entregado argumentos en la literatura contra el uso del vector propio para obtener prioridades. Uno de los principales argumentos dice que el vector propio no respeta la condición de ordinalidad de preferencia (COP) obtenida del decisor. Si bien, esta condición suena razonable cuando tratamos con conceptos clásicos de medida como distancia o tiempo, que conllevan intrínsicamente niveles de consistencia completa, es cuestionable que este comportamiento deba ser esperado en todo tipo de situaciones y variables, particularmente cuando la información entregada por el decisor no es completamente consistente. Los juicios que conllevan inconsistencia, normalmente contienen información valiosa, la que debe ser considerada en el proceso de evaluación. Por otro lado, el AHP usa el vector propio para derivar las prioridades cardinales que representan las preferencias del decisor a partir de una matriz de comparaciones a pares, la que no siempre respeta la condición COP. El AHP y con mayor fuerza aún el ANP, parten de los conceptos de métrica ordinal de dominancia y de la teoría de sistemas, las que son bien sustentadas por teoría de grafos y topología de ordinales, a través de la suma de Cesaro como su pilar fundamental para la construcción de esta métrica de dominancia. Estos conceptos matemáticos no guardan ninguna relación con la preservación de COP, mas aún, estas dos formas de pensamiento se hallan en curso de colisión, ya que la segunda (COP) coarta a la primera (suma de Cesaro). Uno de los principales pilares de la teoría de sistemas corresponde al hecho indiscutible que el todo es más importante que la suma de sus partes aisladas, y que las relaciones internas del sistema, proveen información adicional relevante. Dado que la matriz de comparaciones a pares es un sistema interrelacionado y no una colección de juicios sueltos, nosotros planteamos mostrar que el vector propio, como un operador eminentemente sistémico, es el más adecuado para capturar y representar el comportamiento del sistema como un todo, incluyendo sus propiedades emergentes.