bluuebunny/crossref_metadata_2025 huggingface dataset:
Solar Energy in Low Temperature District Heating
Authors: Pakere Ieva , Blumberga Dagnija
Published: December 2019

Solar technologies are flexible and can be used for both centralized and decentralized energy production. The main aim of this article is to compare different solar technologies and configurations for integration into the DH system. The multi-criteria analyses method is used to rank different alternatives based on several criterions. The evaluation of criterions has been based on previous studies conducted. The multi-criteria analyses allow to compare different solar system alternatives that cannot be compared directly due to differences in their scale, type of energy produced and consumed, investment levels, etc. For the particular DH system researched, the most desirable solution is the PVT panel integration with an area of 1000 m2 which is aligned with the actual DH company’s power consumption. However, the results are strongly impacted by the assumed investment levels, efficiency of the technologies and other assumptions that could be further analysed by the help of sensitivity analyses.
Sustainability Analysis of Manufacturing Industry
Authors: Kubule Anna , Blumberga Dagnija
Published: December 2019

This study provides an analysis to identify the comparative sustainability of the subsectors of the manufacturing industry in Latvia. Authors assess the availability of national statistics data for the development of absolute and specific indicators, which are further used for sustainability evaluation by multi-criteria analysis, specifically the TOPSIS method. Overall eight separate indicators were used for the description of three sustainability pillars. The results provide the distribution of manufacturing sub-sectors according to their comparative sustainability, and thus the rubber and non-mineral metal manufacturing sectors and wood and wood products manufacturing are evaluated as having the lowest comparative sustainability and most appropriate for further investigation regarding the development of sector-specific energy efficiency benchmark.
Solar Facade Module for Nearly Zero Energy Building. Optimization Strategies
Authors: Sirmelis Raivis , Vanaga Ruta , Freimanis Ritvars , Blumberga Andra
Published: December 2019

The study presented in this paper is a continuation of small-scale passive solar wall module testing to evaluate: 1) the impact of phase change material embedded in building envelope on indoor air temperature in comparison to reference wall insulated with mineral wool 2) the impact of Fresnel lens on heat transfer processes in designed module compared to PMMA acrylic glass. Six different solar wall modules and a reference wall module were built and tested in a laboratory under controlled conditions. Compared to previous studies, changes in the experimental setup were made - solar radiation intensified, simulated outdoor temperature adjusted. The study shows explicitly the phase change melting processes in different modules tested, describing the differences between modules and impact of Fresnel lenses and insulation solutions. Room temperature with solar wall modules after the full cycle of charging and discharging latent and sensible energy (24 h) is higher than in the reference wall. Two of 3 of the proposed solar wall modules with Fresnel lens are more effective than modules with PMMA.
Analysis of Energy Supply Solutions of Dwelling Buildings
Authors: Prodanuks Toms , Veidenbergs Ivars , Kirsanovs Vladimirs , Kamenders Agris , Blumberga Dagnija
Published: December 2019

Individual heating consumption for dwelling buildings has an important part in Latvia’s energy balance. Increasing energy efficiency and reducing primary energy in the household sector can play a role in national energy targets. This paper analyses three different heating systems which focus on a pellet boiler and solar collector combined system. The performance of existing solar collectors is analysed and the solar collector system performance ratio is determined. Costs including investments, fuel and maintenance have been analysed and a comparison between systems is made using the indicator – costs per produced energy. Results show that the performance of the solar collector system should be increased or investments should decrease to meet the cost effectiveness of other analysed heating systems.
Empirical Model of Cost Reduction in Local DH Systems. Low Temperature Approach
Authors: Blumberga Dagnija , Gulbis Raimonds , Ievina Linda , Vitolins Valdis , Vigants Girts , Selivanovs Jevgenijs , Jaunzems Dzintars
Published: December 2019

Improving the efficiency of heating systems can give a tremendous contribution towards the EU energy efficiency target for 2030. Significant heat losses are one of the main disadvantages of the dominating high temperature district heating (DH). Even in summer, the high retention time of water in the network leads to thermal losses from domestic hot water reaching up to about 30 %. An empirical model based on experimental data of heat energy consumption in multi-apartment buildings is created for economical optimization of the operation of DH systems. A methodology has been developed that allows estimating the total energy cost savings (including losses) of buildings associated with the reduction of heat loss in the system, by reducing the supply flow temperature, and increasing electricity consumption by increasing the mass flow rate of water in the network.
Mechanical Behaviour of Polylactic Acid Foam as Insulation Under Increasing Temperature
Authors: Doyle Lucia , Weidlich Ingo
Published: December 2019

Measures to increase the share of renewables in heat generation, combined with increased energy efficiency provide a direct emissions reduction on the heating sector. Energy efficiency measures, as well as the role-out of sustainable heating technologies such as district heating networks have one key actor: insulation. However, state of the art insulating materials such as polyurethane or polystyrene have severe environmental drawbacks incompatible with today’s transition to the circular economy, and are the Achilles’ heel of the sector in terms of sustainability. Biobased and biodegradable polylactic acid (PLA) foam could be a promising replacement for fossil-based polymeric insulating foams. This study provides data on the mechanical behaviour of expanded PLA foam under different temperatures, which will help to assess its potential use as insulation where the foam is subject to heat.
Implementation of Blockchain Technology in Insurance Contracts Against Natural Hazards: A Methodological Multi-Disciplinary Approach
Authors: Pagano Andrea Jonathan , Romagnoli Francesco , Vannucci Emanuele
Published: December 2019

Risk insurance for disasters plays a relevant part in the implementation of risk reduction strategies during the pre-disaster phase. This is essential to support risk management towards decreasing the marginal risk allowing policy holders to transfer risk to avoid considerable financial loads from the costs incurred during the recovery phase in a post-disaster phase. There is evidence that the introduction of an integrated risk insurance strategy for community resilience planning is still lacking. Thus, this undermines the possibility to have proper optimized holistic risk management; on the one hand this strengthens pre-disaster risk mitigation measures, mostly relying on mitigative infrastructural solutions, and on the other hand it better defines risk prevention strategies mostly connected to land planning and urban development. This paper will show how insurance markets can play a key role towards mitigating the economic consequences of natural and climate change disasters, and how essential it is to better quantify the beneficial effects and costs of engineer-based mitigative solutions. In this context, the legal framework into which the actuarial quantitative model can be implemented will support the creation of an integrated multidisciplinary approach with potential implementation on a novel platform capable of collecting and processing information from different sources and dimensions such as blockchain technology. The scientific community is, in fact, increasingly interested in implementing blockchain technology to overcome problems linked to the contractual dimension of natural disaster risk insurance which can be interpreted as a sort of smart contracting. Through a study that involved four distinct areas, namely: law, environmental engineering, insurance and IT, this paper proposes a specific multidisciplinary methodology to achieve the drafting and implementation of a digital insurance contract on a blockchain platform against natural hazards. This paper proposes the basis to advance a quantitative concept to optimize the impact of catastrophe risk insurance onto the community resilience; in fact providing a key synergy for definition of pre-disaster conditions.
Is the High Quality Baukultur a Monkey Wrench in the Global Climate Challenges?
Authors: Blumberga Andra , Vanaga Ruta , Antuzs Juris , Freimanis Ritvars , Bondars Edgars , Treija Sandra
Published: December 2019

The EU 2030 climate package calls for raising energy efficiency, increasing usage of RES and decreasing the carbon footprint. There are stringent requirements for new buildings, but the energy efficiency potential in the existing building stock is still not fully explored. The latest trend in urban energy efficiency is the Positive Energy Block (PEB) strategies for new developments. It includes raising building energy efficiency, optimizing energy flow and implementing renewable energy sources (RES). Transforming all existing blocks in a city centre to a PEB would radically change the pattern of energy supply and consumption. European cities have historic centres with great architectural and cultural value. Any urban regeneration strategies must respect and preserve historic values. This paper describes double multi-criteria analysis evaluating urban blocks from both the energy efficiency and cultural heritage perspective with the goal to select the sample block for a “Smart urban regeneration – transition to the Positive Energy Block” case study. Proposed criteria for multi-criteria analysis to evaluate cultural heritage, liveability and energy efficiency potential describes specific qualities of the urban block. The obtained results show that blocks with higher cultural value show less energy efficiency potential and vice versa. It is recommended to apply cultural value and liveability qualities in the Smart urban regeneration process to those blocks with high energy efficiency potential.
Integration of Sun PV Electricity in Centralized Heating Systems
Authors: Delle Marta , Civcisa Iveta , Vitolins Valdis , Lauka Dace , Blumberga Dagnija
Published: December 2019

During the experimental research, an algorithm was developed as a guide for the introduction of solar panels (PV) in centralized heat supply (CHS) companies and a SWOT analysis of the developed algorithm action blocks was performed. SWOT analysis was carried out for a project implemented in practise and, as a result of which the centralized heat supply system uses solar power with a total capacity of 30 kW. We found that in Latvia, the areas that are suitable for solar panels are several times higher than those required by the systems. Main tasks of the work: to analyse and study available literature and information on solar PV integration into CHS; analyse available solar PV power generation equipment and technologies; develop a roadmap for easy and understandable deployment of solar panels in the company.
Paper Waste Recycling. Circular Economy Aspects
Authors: Ozola Zanda U. , Vesere Rudite , Kalnins Silvija N. , Blumberga Dagnija
Published: December 2019

Paper waste is a raw material for a lot of products with different added value. The engineering, economic and environmental aspects of paper waste recycling are analysed for production of composite material, cellulose nanofibers and nanocrystals, bricks with paper components, porous carbon, film of biopolymer, enzymatic sugar and bioenergy: bioethanol, hydrogen and biofuel. Through multicriteria analysis, it was possible to determine the most feasible paper waste recycling product in case of four product groups: egg packaging boxes, cardboard, reused paper, cellulose nanomaterials (nanofibers and nanocrystals). The production of cellulose nanofibres and cellulose nanocrystals has an advantage over egg packaging and cardboard production as well as reusable paper.
Tourist Transportation Generated Carbon Dioxide (CO2) Emissions in Latvia
Authors: Grizane Tamara , Jurgelane-Kaldava Inguna
Published: December 2019

The tourism has a close relation to the travel and tourism transport. Transport is the source of CO2 emissions. The aim of the research was to inspect the tourist transportation (TT) CO2 emissions caused by the tourist overnight trips, because any similar analysis up until now has not been made. For the determination of CO2 emissions from the TT a hybrid (top-down and bottom up) approach, correlation, regression was used. The author’s proposed algorithm for determining CO2 emissions from the TT is useful in the circumstances when there is not sufficient statistical data. In the research of regions of Latvia (NUTS 3) from 2012 to 2017, it was determined that the TT overnight trips indicated a reduction of CO2 emissions of 475 t/year. It is a positive approach in order to reach reduction of CO2 emissions according to the EU criteria for 2030; however, it left a negative impact on the national GDP. Finding solution to this economical problem is the aim of the next researches.
Implementing User Behaviour on Dynamic Building Simulations for Energy Consumption
Authors: Jimenez-Bescos Carlos , Oregi Xabat
Published: December 2019

User behaviour influences the energy consumption of domestic properties with different range of variations and this has an effect on the results of building simulations based on default or general values, as opposed to implementing user behaviour. The aim of this paper is to evaluate and quantify the effect of implementing user behaviour in building dynamic simulation to calculate heating and domestic how water energy consumption to reduce the performance gap. The results for space heating and domestic hot water from dynamic building simulations will be compare to actual energy bills for a general building simulation technique and a calibrated building simulation, incorporating user behaviour details. By using user behaviour details to create calibrated building simulations, a correlation to actual energy bills of over 90 % can be achieved for a dataset of 22 properties. This study has shown that by incorporating user behaviour into building simulations, a more accurate estimation of energy consumption can be achieved. More importantly, the methodology approach allows the user behaviour parameters to be collected by means of a questionnaire, providing an easy and low budget approach to incorporate user behaviour into dynamic building simulations to reduce the performance.
Sprayed Water Flowrate, Temperature and Drop Size Effects on Small Capacity Flue Gas Condenser’s Performance
Authors: Priedniece Vivita , Kalnins Elvis , Kirsanovs Vladimirs , Dzikevics Mikelis , Blumberga Dagnija , Veidenbergs Ivars
Published: December 2019

One of the main pollution types is air pollution, which has a significant impact on the surrounding environment and on living beings. Major source of air pollution is combustion processes. There are many flue gas treatment technologies around the world. In this paper a new, innovative flue gas treatment technology – fog unit – is introduced. The goal of the fog unit is to treat flue gases that are emitted from households. In the European Union, including Latvia, at the beginning of 2020, a directive will come into effect that will set limits for emissions and the effectiveness for incinerators in households. The main focus of this study was to determine the most optimal operating mode for the fog unit by changing different operating parameters: sprayed water temperature, sprayed water flowrate and types of nozzles (drop diameters). Results show that the most optimal operating mode in terms of flue gas treatment efficiency and recovered energy is at water temperature: 20 °C, sprayed water flowrate: 250 l/h and nozzle: MPL1.12 M. However, electrical consumption of water circulation pump leaves negative effect on this operating mode.
KONTROL OPTIMAL PADA MODEL PENYEBARAN VIRUS KOMPUTER DENGAN KLASIFIKASI PENGAMANAN
Authors: DARAJAT PANGESTUTI PRIMA , HUSADANINGSIH TYAS
Published: December 2019

In this paper, a model of the spread of computer viruses  with security classification and nonlinear infection rates is formulated. From the short analysis, is found that the model does not have a virus-free equilibrium point. This show that the virus will always exist in the system and increasingly that can not be avoided. Therefore, control strategy by installing antivirus on subpopulation susceptible low-security level and infective subpopulation aims to minimize the number of infective computers, and  minimize the cost related to these strategies. Hence, an important tool, in this case is, optimal control theory. The system solved numerically by using Forward-Backward Sweep method in combination with the fourth-order Runge-Kutta method. Based on the simulation results, the combination of the two controls is effective in suppressing the spread of computer viruses. However, controlling by installing an antivirus on an infected computer has a great influence in suppressing the spread of the computer virus.
PERAMALAN JUMLAH KUNJUNGAN WISATAWAN MANCANEGARA KE BALI MENGGUNAKAN METODE SINGULAR SPECTRUM ANALYSIS
Authors: SARI MIRA AYU NOVITA , SUMARJAYA I WAYAN , SUSILAWATI MADE
Published: December 2019

Singular spectrum analysis (SSA) is a method to decompose the original time series into a summation of a small number of components that can be interpreted as varied trends, oscillatory, and noise components. The purpose of this research is to model and to find out the results of forecasting the number of foreign tourists arrival to Bali using SSA method. In this research, the accuracy of forecasting results will be calculated using the SSA model with reccurent singular spectrum analysis (RSSA) method. The best SSA model was obtained with a window length (L=94) and produces MAPE value of 7,65%.
PERAMALAN VOLATILITAS SAHAM MENGGUNAKAN MODEL EXPONENTIAL GARCH DAN THRESHOLD GARCH
Authors: NINGSIH SITI RAHAYU , SUMARJAYA I WAYAN , SARI KARTIKA
Published: December 2019

In financial data there is asymmetric volatility, which denotes the different movements on conditional volatility of increase and decrease financial asset returns. The exponential GARCH and threshold GARCH models can be used to capture asymmetric volatility, called leverage effect. The aim of this research is to determine the best model between exponential GARCH and threshold GARCH models, and to know the results of forecasting volatility the LQ-45 stock index using the best model. The research showed that the best model to predicting volatility is EGARCH(2,1), because it has the smallest AIC value compared to other models. Then forecasting volatility of the LQ-45 stock index using EGARCH(2,1) showed that volatility increase from the first period until fourteenth period, this means that it has high volatility.
Ectopic submental thyroid tissue, with no evidence of orthotopic thyroid: a case report
Authors: Banezhad Farnaz , Askari Emran , Abbasian Hamideh , Sadri Keyvan , Soltani Salman , Aghaei Atena
Published: December 2019

Background:

Thyroid ectopia refers to a congenital disease with abnormal descending of the thyroid gland. The most common subtype is lingual thyroid ectopia. Sublingual and submental thyroid ectopia are much less common. It may also be found in other neck locations and distant positions .70%–90% of patients with ectopic thyroid do not have eutopic thyroid tissue. It is necessary to distinguish ectopic thyroid from other causes of neck masses.

Case Presentation:

A 18-year-old man was referred for the evaluation of a palpable mass in the submental region. On biochemical examination, the thyroid function tests were normal while receiving levothyroxine therapy. Ultrasonography revealed a mass measuring 4.2 × 2.7 × 2.6 cm in the submental region. The thyroid scan did not show any uptake in the thyroid region. A zone of the tracer activity was noted in the central neck, compatible with the palpated mass in the submental region. CT images showed a hyperdense soft tissue in the submental region, too.

Conclusion:

Thyroid ectopia is a rare condition and it is often accompanied by hypothyroidism. Ectopia often occurs in lingual and sublingual locations, and submental one is less common. Thyroid scintigraphy is the best imaging modality for the detection of thyroid ectopia. For precise localization, the CT scan correlation may be needed.
Rivaroxaban-induced skin necrosis: a case report
Authors: Soliman Mosaad , Mowafy Khaled , Elsaadany Nashaat , Awad Sameh , Soliman Rana , Soliman Reem
Published: December 2019

Background:

Even though rivaroxaban has been mainly associated with hemorrhage-related adverse effects, rivaroxaban-induced skin necrosis has received less attention or went unrecognized. Little has been documented about hypersensitivity reactions caused by the treatment with rivaroxaban.

Case Presentation:

This paper reports a skin necrosis with an apparent similarity to skin adverse events caused by the different anticoagulants. It happened in a 30-year-old female patient during rivaroxaban treatment. The correlation of the skin lesions to the used drug was made by the act of repeated discontinuation and reuse of rivaroxaban and the noticed remission and exacerbation of skin necrosis.

Conclusion:

This case highlights the vigilance required by healthcare in recognizing potential adverse effects of newly marketed drugs and in making medication changes whenever necessary.
Salmonella enteritidis sepsis, a rare cause of splenic abscess: a case report
Authors: Cheo Seng Wee , Mow Wei Chin , Low Qin Jian
Published: December 2019

Background:

Salmonella infection usually causes mild self-limiting gastroenteritis. Nontyphoidal salmonella can sometimes cause bacteremia and extra-intestinal infection. In rare occasions, it can result in splenic abscess.

Case Presentation:

We reported a case of splenic abscess resulting from Salmonella enteritidis infection. Our patient is a 57-year-old man with diabetes mellitus, came with acute febrile illness associated with epigastric pain. He was diagnosed to have splenic abscess based on computed tomography and subsequently recovered well after antibiotic therapy and abscess drainage.

Conclusion:

Diagnosis of splenic abscess is often difficult and requires high index of suspicion. Early diagnosis is often associated with better outcome. Abscess drainage is an important treatment modality of splenic abscess.
Multi-focal skeletal tuberculosis, bone scan appearance: a case report
Authors: Rubab Nayyar , Afzal Shehzad , Imran Muhammad Babar , Alam Muhammad Mahboob
Published: December 2019

Background:

Skeletal tuberculosis accounts for 1% to 5% of all tuberculosis (TB) cases. Multifocal skeletal tuberculosis is rare. Early diagnosis of multifocal skeletal TB is crucial and challenging for proper treatment and to prevent development of complications. The purpose of this case report is to highlight importance of bone scan in suspected cases of skeletal tuberculosis.

Case Presentation:

We describe a case of 24-year-old female, referred to Nuclear Medicine Department for bone scintigraphy. Patient had complaint of neck stiffness and generalized body aches. Patient underwent 99mTc-methylene diphosphonate scintigraphy which showed multifocal bony pathology mimicking bony metastasis. However, patient was treated with anti-tuberculous therapy and showed excellent response on follow up bone scan. Post-therapy: patient recovered without developing any complications.

Conclusion:

Multifocal skeletal tuberculosis must be kept in the differential diagnosis of multifocal bony pathology seen on bone scintigraphy.
Albendazole-induced liver injury: a case report
Authors: Ríos David , Restrepo Juan Carlos
Published: December 2019

We report a case of a 47-year-old male, who was referred to the clinical hepatology services at Pablo Tobón Uribe Hospital for evaluation of a jaundice syndrome. After undergoing several exams, we diagnosed hepatic hydatidosis and the patient was treated with albendazole; however, after five months of uninterrupted treatment the patient again consulted and his liver test showed marked hepatocellular damage. This time, the patient was diagnosed with drug-induced liver injury due to albendazole, based on information from the clinical record, history of drug consumption, clinical and laboratory tests improved after discontinuing the medication and after discarding other possible causes; this diagnosis was supported by the CIOMS/RUCAM scale, which showed a “likely” correlation between hepatocellular damage and drug toxicity etiology.
Multicentric study of epidemiological and clinical characteristics of persons injured in motor vehicle accidents in Medellín, Colombia, 2009-2010
Authors: Lugo Luz Helena , García Héctor Iván , Cano Blanca Cecilia , Arango Lasprilla Juan Carlos , Alcaraz Olga Lucia
Published: December 2019

Introduction: Traffic accidents (TA) cause 1.23 million deaths each year worldwide while between 20 and 50 million persons are injured each year. In 2011 in Medellin, Colombia, there were 307 traffic deaths and 23,835 injured with 411 accidents for each 10,000 vehicles.
Objective: The purpose of the study was to describe the epidemiologic and clinical characteristics, as well as the quality of life and disability outcomes for those injured in traffic accidents in Medellin.
Methods: This prospective, descriptive, cross-sectional study collected data from 834 patients that were classified with the New Injury Severity Score (NISS) , the WHODAS-II (Disability Assessment) Scale and the SF-36 Health Survey.
Results: Three-fourths (75.8%) of the patients were male. Eightyone percent of patients were involved in motorcycle accidents, with 45.6% suffering moderate trauma, and 32.6% experiencing severe trauma. Of the patients with severe trauma, 8.5% were not wearing helmets. Half of the sample (49.7%) injured their extremities. The WHODAS-II domains most affected were: Activities outside the home (62.0 %), Housework (54.3%) and Moving in one’s environment (45.2 %). Quality of life areas affected were: Physical role (20.3%), Body pain (37.3 %) Emotional role (44.1%), Physical functioning (52.6 %).
Conclusions: Patients with more severe injuries had higher levels of disability and a worse quality of life. Motorcycles made up a large proportion of traffic accidents in this city and mitigation strategies to reduce this public health problem should particularly focus on this high-risk group.
Association between periodontal disease and plasma levels of cholesterol and triglycerides
Authors: Jaramillo Adriana , Lafaurie Gloria Inés , Millán Lina Viviana , Ardila Carlos Martin , Duque Andrés , Novoa Camilo , López Diego , Contreras Adolfo
Published: December 2019

Objective: Untreated periodontal disease seems to cause low grade systemic inflammation and blood lipid alteration leading to increased cardiovascular disease risk. To start testing this hypothesis in Colombian patients, a multicentre study was conducted including the three main state capitals: Bogotá, Medellín and Cali. Methods: In this study 192 (28.4%) advanced and 256 (37.8%) moderate periodontitis patients were  investigated for socio-demographic variables, city of precedence, periodontal parameters, smoking, red complex periodontopathic bacteria, serum antibodies against Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and blood lipids including total cholesterol, HDL, LDL and triglycerides (TG). Those parameters were compared to 229 (33.8%) controls having periodontal health or gingivitis. Results: Advanced periodontitis had worst periodontal indexes, than moderate periodontitis and controls. Interestingly, higher HDL and TG levels were present in periodontitis. BMI <30 and smoking were associated with increased HDL, HDL-35, LDL and TG, while glycemia >100 mg/dL associated with HDL, HDL-35 and TG. Tannerella forsythia showed a significant association with HDL-35 in bivariate analysis and serum IgG1 against P. gingivalis associated with HDL-35 and serum IgG1 against T. forsythia associated with TG and serum IgG2 against A. actinomycetemcomitans correlated with levels of HDL y HDL-35. In logistic regression the periodontitis patients from Cali presented reduced HDL levels as compared to Bogotá and Medellín patients. Presence of IgG1 antibodies against P. gingivalis and A. actinomycetemcomitans correlated with reduced HDL levels. Conclusion: This study confirmed that untreated periodontitis generates alteration in serum lipid levels and systemic bacterial exposure against important periodontopathic bacteria seems to be the biological link.
Determination of the HER2 amplification status by in situ fluorescent hybridization and concordance with immunohistochemistry for breast cancer samples in Colombia
Authors: Plata Adriana , Torres María Mercedes , López Rocío , Andrade Rafael E.
Published: December 2019

Objectives: To determine the status of the HER2 amplification in Breast cancer performed in peripheral laboratories in Colombia by immunohistochemistry and its comparison with central laboratories and the FISH status. Methods: Four thousand one hundred and five cases referred for the determination of the HER2 status by FISH and/or IHQ to the Department of Pathology of the Fundacion Santa Fe were studied. The analysis included correlation between the IHQ HER2 score submitted by the peripheral laboratory (PL), the HER2 score emitted in the LC and the FISH studies performed in the central laboratory (CL). Results: two thousand five hundred and eight HER2 IHQ studies were performed in the (CL), using the Dako Herceptest. With the following results: 68.2 % negative (0-1+); 16.4% indeterminate (2+); 15.3% 3+ and 2.3 % not adequate. 1360/ 1719 cases studied by FISH came from the (PL), and 329 (19.1%) from the (Lc). Comparing the IHQ score emitted by the PL and the positive FISH status showed: 6/28 0+ were positive (21.4%); 7/31 1+ (22.5%); 397/1.240 2+ (32.8%) and 74/91 3+ (81.3%). In the CL the results were 1/9 0+ (11.1%); 3/18 1+ (16.7%); 154/292 2+ (53.0%); and 9/9 3+ (100%). Only 1/4 negative cases (0/1+) was in house.Conclusion: The false negative rate (22.0%), and false positive results (18.7%), of the HER2 status performed by IHQ in peripheral laboratories in Colombia is unacceptable high as well as the inadequacy of tissue indicating that pre-analytical factors have to be improved in Colombia in order to get optimal results
Expression and activation of intracellular receptors TLR7, TLR8 and TLR9 in peripheral blood monocytes from HIV-infected patients.
Authors: Valencia Guillermo , Pinzon Francisco Javier , De la Cruz Juan Jose , Vera Ligia del Carmen , Pavia Norma , Santos Adrián , Sanchez Saulo , Puerto Fernando
Published: December 2019

Introduction: TLR´s play a role in host defense in HIV infection recognizing the viral DNA or RNA. Their activation induces a signaling pathway that includes the proteins MyD88, IRAK4, TRAF6 and the transcription factor NF-kBp65.
Objective: To determine the expression of TLR7, TLR8 and TLR9, and activation of its signaling pathway in monocytes from patients infected with HIV. Methods. Expression of TLR7, TLR8 and TLR9 was determined in monocytes from HIV-infected patients (n = 13) and control subjects (n = 13), which were activated with specific ligands. The expression of MyD88 and NF-kBp65 were determined by flow cytometry; IRAK4 and TRAF6 were studied by immunoblotting.
Results: No statistical difference was found in the expression of TLR7, 8 and 9 in monocytes from patients compared to controls, but we observed the non-significant increased expression of TLR9 in patients. The activation showed no significant difference in the expression of MyD88 and NF-kBp65 in patients when compared to controls, but were decreased in stimulated cells over non-stimulated cells. IRAK4 and TRAF6 were not detected.
Conclusions: No statistical difference was observed in the expression of intracellular TLRs, MyD88 and NFkBp65 in monocytes from patients compared to controls. This was probably due to effective antiretroviral therapy being received at the time of study entry. Additional studies are needed (ARTV) under controlled conditions that include infected patients with and without ARVT, responders and non- responders, and work with different cell populations.
Remifentanil at induction of general anesthesia for cesarean section: Double blind, randomized clinical trial
Authors: Behdad Shokoufeh , Ayatollahi Vida , Harrazi Hamid , Nazemian Naderali , Heiranizadeh Najemh , Baghianimoghadam Behnam
Published: December 2019

Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either and intravenous bolus of 0.5 µg/kg remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the remifentanil group as compared with the control group (p<0.05). There were no significant differences regarding heart rate between groups at any time (p>0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration. Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.
International accreditation and quality medical education
Authors: Pulido Pablo A.
Published: December 2019

The Pan American Federation of Associations of Faculties (Schools) of Medicine - FEPAFEM/PAFAMS - is a non-governmental, on-profit academic organization that joins the National Associations of Medical Schools for the Hemisphere. For some countries the growth in the number of schools and colleges has been explosive in recent decades to where now there are, in fact, about 706 medical schools in the Americas: 181 in North America, 190 in Central America and the Caribbean region and 335 in South America. This represents approximately 31% of the world total. Of these, 559 (79%) of the hemisphere´s medical schools are affiliated with FEPAFEM/PAFAMS.
An insider’s view of the new diagnostic and statistical manual of North American psychiatry (DSM-5)
Authors: Escobar Javier I.
Published: December 2019

The relevance/ and visibility of psychiatric disorders within the realm of medicine has significantly increased in recent times, possibly due to their high frequency and the negative impact they have on cost, disability and quality of life. The subjective nature of these disorders, their clinical complexity and the absence of reliable markers, keep us completely dependent on anamnesis and clinical examination. All of this, forces us, periodically, to review and refine diagnostic systems, hoping to improve the recognition and effective management of mental disorders. The scientific progress in basic neuroscience, observed during and following the “decade of the brain”, coupled with a lack of satisfaction with the existing system (DSM-IV) suggested it was the moment to embark in this task, hence the process leading to DSM-5.
Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes.
Authors: Gómez Montes José Fernando , Curcio Carmen-Lucia , Alvarado Beatriz , Zunzunegui Maria Victoria , Guralnik Jack
Published: December 2019

Objectives: To assess the validity (convergent and construct) and reliability of the Short Physical Performance Battery (SPPB) among non-disabled adults between 65 to 74 years of age residing in the Andes Mountains of Colombia.
Methods: Design: Validation study; Participants: 150 subjects aged 65 to 74 years recruited from elderly associations (day-centers) in Manizales, Colombia.Measurements: The SPPB tests of balance, including time to walk 4 meters and time required to stand from a chair 5 times were administered to all participants.  Reliability was analyzed with a 7-day interval between assessments and use of repeated ANOVA testing. Construct validity was assessed using factor analysis and by testing the relationship between SPPB and depressive symptoms, cognitive function, and self rated health (SRH), while the concurrent validity was measured through relationships with mobility limitations and disability in Activities of Daily Living (ADL). ANOVA tests were used to establish these associations.
Results: Test-retest reliability of the SPPB was high: 0.87 (CI95%: 0.77-0.96). A one factor solution was found with three SPPB tests. SPPB was related to self-rated health, limitations in walking and climbing steps and to indicators of disability, as well as to cognitive function and depression. There was a graded decrease in the mean SPPB score with increasing disability and poor health.
Conclusion: The Spanish version of SPPB is reliable and valid to assess physical performance among older adults from our region.  Future studies should establish their clinical applications and explore usage in population studies.
The effects of Plasmodium vivax gestational malaria on the clinical and immune status of pregnant women in Northwestern Colombia
Authors: Yasnot Maria Fernanda , Perkins Douglas Jay , Corredor Mauricio , Yanow Stephanie , Carmona-Fonseca Jaime , Maestre Amanda Elena
Published: December 2019

Objective: The study concerned the effects of Plasmodium vivax infection on the balance of pro- versus anti-inflammatory cytokines and chemokines and their relationship with some clinical and epidemiology outcomes.Methods: Thirty-five pregnant women were involved in this study.  Of these, 15 subjects were included at delivery (GMP+), and 20 had no exposition to infection throughout the pregnancy (GMP-C-). Epidemiological and clinical data were recorded after reviewing the clinical records. At delivery, whole blood from the mother as well as placental tissue was collected. Diagnosis of infection was performed by thick smear and real time PCR. Pro-inflammatory and anti-inflammatory cytokines and chemokines were measured by real time PCR.Results: The clinical and epidemiological variables explored were similar in both groups, with the exception of gestational age. When comparing the GMP+ group with the GMP-C- group, it is clear that although the differences generally are not significant, pro-inflammatory cytokines are elevated in both maternal blood and placental; the anti-inflammatories are elevated in the mother and reduced in the placenta, and the chemokines are reduced in both, except for  MCP-1 which is elevated in both.Conclusion: The results appear to be strongly affected by the small number of women with GM by P. vivax in childbirth. Additional studies are needed with more women from both this region and elsewhere.
Synthetic dural graft septoplasty in epistaxis from hereditary hemorrhagic telangiectasia
Authors: Guerra Claudia Patricia , Burckhardt B Wilfred
Published: December 2019

It   is an autosomal dominant vascular disorder, which has a variety of clinical manifestations, with epistaxis being one of the most common. Many treatment options exist for epistaxis, but with no consensus on which is the method of choice. We describe the case of a patient with hereditary hemorrhagic telangiectasia (HHT) secondary epistaxis with septoplasty managed with synthetic hard graft, which improved intensity and frequency of bleeding episodes. This technique is a variant of the septodermoplasty described by several authors, but the use of synthetic dura can help in obtaining better results and avoid taking skin grafts from other sites different from the surgical site.
Descriptive epidemiology of childhood cancer in Cali, Colombia 1977-2011
Authors: Bravo Luis Eduardo , García Luz Stella , Collazos Paola , Ramirez Oscar
Published: December 2019

Introduction: Yearly more than 160,000 childhood cancer cases are diagnosed worldwide and around 90,000 die because of this disease.  In Colombia, this represents  the 2nd leading cause of childhood deaths for those more than one year old.Objective: To describe the occurrence and survival patterns of childhood cancer patients over the last 20 years in Cali.Methods:Information was obtained from the Cancer Population Registry in Cali and the Municipal Department of Health.  The International Classification for childhood Cancer (ICCC) was used. Vital status data was obtained from MDH death certificates and hospital databases. Additionally, clinical records were reviewed and, in some cases, telephone contact was made to gather data. Follow-up was completed until December 31, 2011. Incident (IR) and mortality rates (MR) were estimated and adjusted for age. Life-tables were made to estimate overall survival. Results:  Between  1977-2011 there were 2,311 cases of cancer identified in children less than 15 years of age. The IR and MR for Cali were found to be 141.2 and 55.6 per million of people per year. Leukemias, lymphomas, Central nervous system (CNS) tumors and soft tissue sarcomas showed IR´s of 60.1, 20.5, 25.7 and 9.4, respectively. 5-years OS was 48%, and showed an improvement from 24.9%±4.3 to 51.8%±4.6, compared 1992-96 vs 2002-06 periods.Conclusion: The IR found is comparable with those from affluent countries. Taking into account that pediatric cancer is curable in about 75-80% of the cases,  an enormous challenge is presented to the Colombian health system: to improve current clinical results.
Self-reported tooth loss and cognitive function: Data from the Hispanic established populations for epidemiologic studies of the elderly (Hispanic EPESE)
Authors: Reyes Ortiz Carlos A , Luque John S , Eriksson Charlotta K , Soto Libia
Published: December 2019

Objective: To explore the association between tooth loss and cognitive functioning among persons 65 years and older.Methods: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (Wave 1: 1993-1994, n= 3,032; Wave 2: 1995-1996, n= 2,424; and Wave 3: 1998-1999, n= 1,967). The dependent variables were the scores from the total Mini-Mental State Examination (MMSE: score 0-30) and its global domains (memory: score 0-6; and no-memory: score 0-24). Independent variables included the  number of teeth (0-12 vs. 13-32), socio-demographic characteristics, last dental office visit, medical conditions, depressive symptoms, and functional limitations which were tested for associations with the dependent variables.Results: In bivariate analyses, participants with fewer teeth (0-12) tended to have significantly lower mean scores for memory, no-memory, and total MMSE when compared to those with more teeth (13-32), both at baseline and at follow-up. In fully adjusted longitudinal-mixed models, participants with fewer teeth had a greater decline in total MMSE through five years of follow-up with a decrease of 0.12 fewer points each year (SE ± 0.05, p <0.01), when compared to those with more teeth.Conclusion: Having fewer teeth was associated with greater cognitive decline over time.
Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study
Authors: Sanabria Alvaro , Gomez Ximena , Vega Valentin , Dominguez Luis Carlos , Osorio Camilo
Published: December 2019

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients.Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09)  The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation.Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.
International Accreditation and Quality Medical Education; the Need for Establishment in Middle East
Authors: Khani Afshin , Zarghami Amin
Published: December 2019

We read with a great interest the recent article by Pulido1 that published in your journal in which he addressed the role of increasing number of medical schools on the efficacy of medical education and the training of futures doctors. In this article the author emphasized on the social accountability and the commitment of medical schools for reflect critically and enhancing the quality of their graduates. Finally he suggest an accreditation system with certain objectives including adjustment of medical education with modern technologies, preparing doctors for needs and expectations of a globalized society and educating lifelong learning skills to physicians.
Status of allele frequency and diversity of Plasmodium falciparum msp1, msp2 and glurp before implementation of artemisinin based combined therapy in Northwest Colombia
Authors: Maestre Amanda , Arango Eliana , Carmona-Fonseca Jaime
Published: December 2019

Introduction: msp1, msp2 and glurp allele frequency and diversity of P. falciparum in Northwest Colombia before introduction of artemisinin combined schemes has been explored by few authors and in relatively small number of samples from this highly endemic region.
Objective: To evaluate the msp1, msp2, and glurp allele frequency and diversity of P. falciparum in two Colombian regions before use of artemisinin combined therapy.
Methods: This study was part of a major antimalarial efficacy trial designed as a random clinical controlled study, in which 224 subjects were recruited.  Region 2 of msp1 and msp2 (central region) were amplified by a nested PCR; glurp (region RII) was amplified by a semi-nested PCR.
Results: For msp1, five genotypes were observed, representing K1, MAD20, and RO33 allelic families. All samples corresponded with a MAD20 150 bp allele. For msp2 (IC family), two alleles were detected and for glurp, eight were observed. A total 33 haplotypes were detected
Conclusions: Analysis of glurp can be used to successfully genotype parasite populations in new studies in Colombia aimed at exploring Plasmodium spp. population dynamics.  In addition, analysis of msp1 and msp2 can also be of value to compare with past studies, but not when the objective is to study parasites obtained from the same patient in a reduced period of time, for instance, during treatment efficacy studies.