Fuerzas Armadas y Policiales de la República del PerúYimy_Honores
Las fuerzas Armadas y Policiales de un Estado son instituciones que sirven de mecanismo de defensa de la seguridad y el orden!
¿Y el Servicio Militar ?
EL servicio militar es el desarrollo militar por un individuo.
En el Perú, el servicio militar es voluntario por ley.
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
This article is all about what AI trends will emerge in the field of creative operations in 2024. All the marketers and brand builders should be aware of these trends for their further use and save themselves some time!
Fuerzas Armadas y Policiales de la República del PerúYimy_Honores
Las fuerzas Armadas y Policiales de un Estado son instituciones que sirven de mecanismo de defensa de la seguridad y el orden!
¿Y el Servicio Militar ?
EL servicio militar es el desarrollo militar por un individuo.
En el Perú, el servicio militar es voluntario por ley.
2024 State of Marketing Report – by HubspotMarius Sescu
https://www.hubspot.com/state-of-marketing
· Scaling relationships and proving ROI
· Social media is the place for search, sales, and service
· Authentic influencer partnerships fuel brand growth
· The strongest connections happen via call, click, chat, and camera.
· Time saved with AI leads to more creative work
· Seeking: A single source of truth
· TLDR; Get on social, try AI, and align your systems.
· More human marketing, powered by robots
ChatGPT is a revolutionary addition to the world since its introduction in 2022. A big shift in the sector of information gathering and processing happened because of this chatbot. What is the story of ChatGPT? How is the bot responding to prompts and generating contents? Swipe through these slides prepared by Expeed Software, a web development company regarding the development and technical intricacies of ChatGPT!
Product Design Trends in 2024 | Teenage EngineeringsPixeldarts
The realm of product design is a constantly changing environment where technology and style intersect. Every year introduces fresh challenges and exciting trends that mold the future of this captivating art form. In this piece, we delve into the significant trends set to influence the look and functionality of product design in the year 2024.
How Race, Age and Gender Shape Attitudes Towards Mental HealthThinkNow
Mental health has been in the news quite a bit lately. Dozens of U.S. states are currently suing Meta for contributing to the youth mental health crisis by inserting addictive features into their products, while the U.S. Surgeon General is touring the nation to bring awareness to the growing epidemic of loneliness and isolation. The country has endured periods of low national morale, such as in the 1970s when high inflation and the energy crisis worsened public sentiment following the Vietnam War. The current mood, however, feels different. Gallup recently reported that national mental health is at an all-time low, with few bright spots to lift spirits.
To better understand how Americans are feeling and their attitudes towards mental health in general, ThinkNow conducted a nationally representative quantitative survey of 1,500 respondents and found some interesting differences among ethnic, age and gender groups.
Technology
For example, 52% agree that technology and social media have a negative impact on mental health, but when broken out by race, 61% of Whites felt technology had a negative effect, and only 48% of Hispanics thought it did.
While technology has helped us keep in touch with friends and family in faraway places, it appears to have degraded our ability to connect in person. Staying connected online is a double-edged sword since the same news feed that brings us pictures of the grandkids and fluffy kittens also feeds us news about the wars in Israel and Ukraine, the dysfunction in Washington, the latest mass shooting and the climate crisis.
Hispanics may have a built-in defense against the isolation technology breeds, owing to their large, multigenerational households, strong social support systems, and tendency to use social media to stay connected with relatives abroad.
Age and Gender
When asked how individuals rate their mental health, men rate it higher than women by 11 percentage points, and Baby Boomers rank it highest at 83%, saying it’s good or excellent vs. 57% of Gen Z saying the same.
Gen Z spends the most amount of time on social media, so the notion that social media negatively affects mental health appears to be correlated. Unfortunately, Gen Z is also the generation that’s least comfortable discussing mental health concerns with healthcare professionals. Only 40% of them state they’re comfortable discussing their issues with a professional compared to 60% of Millennials and 65% of Boomers.
Race Affects Attitudes
As seen in previous research conducted by ThinkNow, Asian Americans lag other groups when it comes to awareness of mental health issues. Twenty-four percent of Asian Americans believe that having a mental health issue is a sign of weakness compared to the 16% average for all groups. Asians are also considerably less likely to be aware of mental health services in their communities (42% vs. 55%) and most likely to seek out information on social media (51% vs. 35%).
AI Trends in Creative Operations 2024 by Artwork Flow.pdfmarketingartwork
This article is all about what AI trends will emerge in the field of creative operations in 2024. All the marketers and brand builders should be aware of these trends for their further use and save themselves some time!
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...Applitools
During this webinar, Anand Bagmar demonstrates how AI tools such as ChatGPT can be applied to various stages of the software development life cycle (SDLC) using an eCommerce application case study. Find the on-demand recording and more info at https://applitools.info/b59
Key takeaways:
• Learn how to use ChatGPT to add AI power to your testing and test automation
• Understand the limitations of the technology and where human expertise is crucial
• Gain insight into different AI-based tools
• Adopt AI-based tools to stay relevant and optimize work for developers and testers
* ChatGPT and OpenAI belong to OpenAI, L.L.C.
More than Just Lines on a Map: Best Practices for U.S Bike Routes
This session highlights best practices and lessons learned for U.S. Bike Route System designation, as well as how and why these routes should be integrated into bicycle planning at the local and regional level.
Presenters:
Presenter: Kevin Luecke Toole Design Group
Co-Presenter: Virginia Sullivan Adventure Cycling Association
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...DevGAMM Conference
Has your project been caught in a storm of deadlines, clashing requirements, and the need to change course halfway through? If yes, then check out how the administration team navigated through all of this, relocating 160 people from 3 countries and opening 2 offices during the most turbulent time in the last 20 years. Belka Games’ Chief Administrative Officer, Katerina Rudko, will share universal approaches and life hacks that can help your project survive unstable periods when there seem to be too many tasks and a lack of time and people.
A report by thenetworkone and Kurio.
The contributing experts and agencies are (in an alphabetical order): Sylwia Rytel, Social Media Supervisor, 180heartbeats + JUNG v MATT (PL), Sharlene Jenner, Vice President - Director of Engagement Strategy, Abelson Taylor (USA), Alex Casanovas, Digital Director, Atrevia (ES), Dora Beilin, Senior Social Strategist, Barrett Hoffher (USA), Min Seo, Campaign Director, Brand New Agency (KR), Deshé M. Gully, Associate Strategist, Day One Agency (USA), Francesca Trevisan, Strategist, Different (IT), Trevor Crossman, CX and Digital Transformation Director; Olivia Hussey, Strategic Planner; Simi Srinarula, Social Media Manager, The Hallway (AUS), James Hebbert, Managing Director, Hylink (CN / UK), Mundy Álvarez, Planning Director; Pedro Rojas, Social Media Manager; Pancho González, CCO, Inbrax (CH), Oana Oprea, Head of Digital Planning, Jam Session Agency (RO), Amy Bottrill, Social Account Director, Launch (UK), Gaby Arriaga, Founder, Leonardo1452 (MX), Shantesh S Row, Creative Director, Liwa (UAE), Rajesh Mehta, Chief Strategy Officer; Dhruv Gaur, Digital Planning Lead; Leonie Mergulhao, Account Supervisor - Social Media & PR, Medulla (IN), Aurelija Plioplytė, Head of Digital & Social, Not Perfect (LI), Daiana Khaidargaliyeva, Account Manager, Osaka Labs (UK / USA), Stefanie Söhnchen, Vice President Digital, PIABO Communications (DE), Elisabeth Winiartati, Managing Consultant, Head of Global Integrated Communications; Lydia Aprina, Account Manager, Integrated Marketing and Communications; Nita Prabowo, Account Manager, Integrated Marketing and Communications; Okhi, Web Developer, PNTR Group (ID), Kei Obusan, Insights Director; Daffi Ranandi, Insights Manager, Radarr (SG), Gautam Reghunath, Co-founder & CEO, Talented (IN), Donagh Humphreys, Head of Social and Digital Innovation, THINKHOUSE (IRE), Sarah Yim, Strategy Director, Zulu Alpha Kilo (CA).
Trends In Paid Search: Navigating The Digital Landscape In 2024Search Engine Journal
The search marketing landscape is evolving rapidly with new technologies, and professionals, like you, rely on innovative paid search strategies to meet changing demands.
It’s important that you’re ready to implement new strategies in 2024.
Check this out and learn the top trends in paid search advertising that are expected to gain traction, so you can drive higher ROI more efficiently in 2024.
You’ll learn:
- The latest trends in AI and automation, and what this means for an evolving paid search ecosystem.
- New developments in privacy and data regulation.
- Emerging ad formats that are expected to make an impact next year.
Watch Sreekant Lanka from iQuanti and Irina Klein from OneMain Financial as they dive into the future of paid search and explore the trends, strategies, and technologies that will shape the search marketing landscape.
If you’re looking to assess your paid search strategy and design an industry-aligned plan for 2024, then this webinar is for you.
5 Public speaking tips from TED - Visualized summarySpeakerHub
From their humble beginnings in 1984, TED has grown into the world’s most powerful amplifier for speakers and thought-leaders to share their ideas. They have over 2,400 filmed talks (not including the 30,000+ TEDx videos) freely available online, and have hosted over 17,500 events around the world.
With over one billion views in a year, it’s no wonder that so many speakers are looking to TED for ideas on how to share their message more effectively.
The article “5 Public-Speaking Tips TED Gives Its Speakers”, by Carmine Gallo for Forbes, gives speakers five practical ways to connect with their audience, and effectively share their ideas on stage.
Whether you are gearing up to get on a TED stage yourself, or just want to master the skills that so many of their speakers possess, these tips and quotes from Chris Anderson, the TED Talks Curator, will encourage you to make the most impactful impression on your audience.
See the full article and more summaries like this on SpeakerHub here: https://speakerhub.com/blog/5-presentation-tips-ted-gives-its-speakers
See the original article on Forbes here:
http://www.forbes.com/forbes/welcome/?toURL=http://www.forbes.com/sites/carminegallo/2016/05/06/5-public-speaking-tips-ted-gives-its-speakers/&refURL=&referrer=#5c07a8221d9b
ChatGPT and the Future of Work - Clark Boyd Clark Boyd
Everyone is in agreement that ChatGPT (and other generative AI tools) will shape the future of work. Yet there is little consensus on exactly how, when, and to what extent this technology will change our world.
Businesses that extract maximum value from ChatGPT will use it as a collaborative tool for everything from brainstorming to technical maintenance.
For individuals, now is the time to pinpoint the skills the future professional will need to thrive in the AI age.
Check out this presentation to understand what ChatGPT is, how it will shape the future of work, and how you can prepare to take advantage.
A brief introduction to DataScience with explaining of the concepts, algorithms, machine learning, supervised and unsupervised learning, clustering, statistics, data preprocessing, real-world applications etc.
It's part of a Data Science Corner Campaign where I will be discussing the fundamentals of DataScience, AIML, Statistics etc.
Time Management & Productivity - Best PracticesVit Horky
Here's my presentation on by proven best practices how to manage your work time effectively and how to improve your productivity. It includes practical tips and how to use tools such as Slack, Google Apps, Hubspot, Google Calendar, Gmail and others.
The six step guide to practical project managementMindGenius
The six step guide to practical project management
If you think managing projects is too difficult, think again.
We’ve stripped back project management processes to the
basics – to make it quicker and easier, without sacrificing
the vital ingredients for success.
“If you’re looking for some real-world guidance, then The Six Step Guide to Practical Project Management will help.”
Dr Andrew Makar, Tactical Project Management
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...Applitools
During this webinar, Anand Bagmar demonstrates how AI tools such as ChatGPT can be applied to various stages of the software development life cycle (SDLC) using an eCommerce application case study. Find the on-demand recording and more info at https://applitools.info/b59
Key takeaways:
• Learn how to use ChatGPT to add AI power to your testing and test automation
• Understand the limitations of the technology and where human expertise is crucial
• Gain insight into different AI-based tools
• Adopt AI-based tools to stay relevant and optimize work for developers and testers
* ChatGPT and OpenAI belong to OpenAI, L.L.C.
More than Just Lines on a Map: Best Practices for U.S Bike Routes
This session highlights best practices and lessons learned for U.S. Bike Route System designation, as well as how and why these routes should be integrated into bicycle planning at the local and regional level.
Presenters:
Presenter: Kevin Luecke Toole Design Group
Co-Presenter: Virginia Sullivan Adventure Cycling Association
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...DevGAMM Conference
Has your project been caught in a storm of deadlines, clashing requirements, and the need to change course halfway through? If yes, then check out how the administration team navigated through all of this, relocating 160 people from 3 countries and opening 2 offices during the most turbulent time in the last 20 years. Belka Games’ Chief Administrative Officer, Katerina Rudko, will share universal approaches and life hacks that can help your project survive unstable periods when there seem to be too many tasks and a lack of time and people.
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...
05 anemia ferropenica-ucsm[1]
1. AANNEEMMIIAA FFEERRRROOPPEENNIICCAA
La deficiencia de hierro es la causa más común de anemia a nivel mundial, asi
como también la forma mas frecuente de malnutrición, afecta aproximadamente
a 2 billones de personas.
1. Definición: Se define anemia ferropenica como la presencia de anemia con
evidencia bioquimica de deficiencia de hierro.
2. Etiologia: la causa mas frecuente de deficiencia de hierro es la carencia en la
ingesta seguida del incremento en las perdidas.
2. EFECTO DE LLAA HHEEPPCCIIDDIINNAA SSOOBBRREE LLAA
EERRIITTRROOPPOOYYEESSIISS
hepcidina
disminuye
la eritropoyesis in
vitro
cuando la
concentración de
eritropoyetina es
menor de 0,5 U/ml
efecto
directo, no mediado
por el hierro
modelo in vivo,
Papel directo de la
hepcidina es escaso
cambios en la
eritropoyesis serian
debido a los
cambios inducidos
en el metabolismo
férrico
3. 33.. FFiissiiooppaattoollooggiiaa
El hierro es un elemento esencial para el normal desarrollo y funcionamiento de
multiples células, un adulto promedio posee 3-5 g de hierro, 2/3 partes en la
molecula hemoglobina.
El metabolismo del hierro esta controlado por la tasa de absorción a nivel de
duodeno y yeyuno alto donde se absorbe en su forma ferrosa, favorecido por el
medio acido del estomago.
Es excretado básicamente por el riñón, se absorbe 1mg y se excreta 1mg. La
dieta occidental promedio provee entre 10 y 15 mg de hierro del cual se absorbe
5-10%.
4. HHEEPPCCIIDDIINNAA
falta del dominio
catalítico de
matriptasa-2
marcado incremento de
la expresión de
hepcidina hepática
anemia micrócitica.
confirmado por estudios
en la supresión del
TMPRSS6
mutaciones de homocigotos o
heterocigotos compuestos en TMPRSS6
para los inicios de la anemia hierro-refractaria
por deficiencia de hierro
(IRIDA).
Hormona peptidica
encargada de la
regulación del
mecanismo del hierro
Por consecuencia de la
sobreexpresión
por imposibilidad
movilizar el Fe
proveniente de
macrófagos
No producen
nuevos eritrocitos
Lo que indica
poca
respuesta al
Fe parenteral
Fe se queda en
macrófago no
utilizado en
eritropoyesis
5.
6. FFIISSIIOOPPAATTOOLLOOGGIIAA
En condiciones fisiológicas se aumenta la absorción de hierro al doble
(infancia, crecimiento) o triple (embarazo, lactancia).
Una vez absorbido el hierro en epitelio intestinal es transportado a la sangre a
través de un canal ferroportina hacia moléculas de transferrina, las cuales
llevaran al hierro ferrico a diferentes órganos donde se utilizara.
La hormona hepcidina producida principalmente en el hígado regula la
absorción de hierro al inducir la translocacion citoplasmática y posterior
degradación de ferroportina, con lo cual se produce un bloqueo en la absorción
de hierro.
8. HHEEPPCCIIDDIINNAA
Regulador negativo de la absorción del hierro en el
intestino delgado y de su liberacion por los
macrófagos.
HEPCIDINA Anemia
HEPCIDINA Hemocromatosi
s
12. INFLAMACIÓN YY LLAA RREEGGUULLAACCIIÓÓNN
LLOOCCAALLIIZZAADDAA DDEE HHEEPPCCIIDDIINNAA
hepcidina rol importante en
la anemia crónica
Las
citoquinas
inflamatorias
Interleucina-& (IL6 induce la
señalización y
activación del Stat3
vincula con la
región promotora
de hepcidina para
activar la
transcripción
alterar la homeostasis del
hierro
macrófagos hepatocitos expresan hepcidina
en la estimulación
de la ruta Stat3 por
IL-6
receptora 4 después
de la ingestión de
microbios
Pseudomonas
aeruginosa
liberación
no está determinado
estreptococos
13. La absorción del hierro eenn llaa ddiieettaa ssee
rreegguullaa llooccaallmmeennttee ppoorr::
Factor Indicador de hipoxia (HIF)
Proteínas Reguladoras de Hierro
(IPRs)
Hepcidina Hepática
14. INTRODUCCION
Los seres humanos poseen mecanismos para mantener
la homeostasis , que regula de manera coordinada .
absorción reciclaje movilización
HIERRO
15. ABSORCION Y PERDIDA DEL HIERRO
Bajo condiciones normales , la mayor parte del
hierro del organismo esta fuertemente ligado a:
Moléculas funcionales HEMOGLOBI
NA
Proteínas de transporte
Proteínas de almacenamiento
TRANSFERRI
NA
FERRITINA
16. EL ROL CENTRAL DE LA
HEPCIDINA EN LA HOMEOSTASIS
DEL HIERRO
La hepcidina es una molécula péptica de 25 aminoácidos.
La hepcidina es secretada en la sangre para controlar y regular el FPN
(ferroportina) uniéndose a ella con activacion de una kinasa (Jak2) e
induce su internalización y posterior degradación de la FPN.
La hepcidina regula negativamente el consumo de hierro de la
Tf (transferrina), fuente mas grande de hierro para la sintesis de
la Hb.
Al incrementarse la hepcidina, limita la eritropoyesis y
favorece la aparicion de la anemia y enf.cronicas.
17. HEPCIDINA
Su expresión es
regulada por
Proteina
morfogenetica osea
(BMP)
Los factores de
eritrocitos Inflamacion
Niveles del Hierro
18. • Es decir la hepcidina bloquea la entrega de hierro desde el enterocito hacia el plasma
• Lo que se traduce en menor disponibilidad de hierro para ser utilizado por el organismo.
19. RECICLAJE DEL HIERRO
El reciclaje del hierro del grupo hemo para eritrocitos
senescentes constituye la fuente principal de hierro para
la eritropoyesis.
Agentes macrófagos en el hígado y bazo son los
responsables del reciclaje de hierro.
El grupo hemo derivado de la hemoglobina es
catabolizado por la oxigenasa -1 citosólica hemo para
liberar hierro, el cual es subsecuentemente exportado
hacia la circulación por el FPN.
20. FFIISSIIOOPPAATTOOLLOOGGIIAA
En presencia de estimulos inflamatorios se incrementa la cantidad de
hepcidina producida en hígado lo que determina la menor absorción de
hierro.
Este balance finamente regulado del metabolismo del hierro dependerá
de la cantidad de hierro
ofertado en la dieta,
de perdidas de sangre,
cualquiera sea su naturaleza (sangrado gastrointestinal, traumatismos,
menorragias, etc),
y del incremento en los requerimientos de hierro bajo determinadas
condiciones fisiológicas.
21. EEppiiddeemmiioollooggiiaa::
Constituye la forma mas frecuente de anemia.
En el Perú hasta el 50% de niños sufre de anemia, así
como el 38% de mujeres en edad fértil, la mayoría de
estos casos correspondería a anemia por deficiencia de
hierro.
22. IIIIII..FFAACCTTOORREESS DDEE RRIIEESSGGOO
En algunas poblaciones la cantidad de hierro absorbido
de la dieta es insuficiente para satisfacer los
requerimientos fisiológicos cuando son altos
(especialmente en infantes, de 6 meses a 2 años, y en
gestantes).
En tales casos la cantidad de hierro ofertado por la dieta
muchas veces no puede ser aumentado por lo que se
requiere del uso de suplementos de hierro.
El suplemento de hierro durante la gestación, la infancia
y periodos de crecimiento (adolescencia), es razonable y
costo efectivo.
23. IIIIII..FFAACCTTOORREESS DDEE RRIIEESSGGOO
·Edad: infantes, adolescentes, adultos mayores.
·Sexo: Incremento de riesgo en mujeres.
·Tracto gastrointestinal: cambio en apetito y/o peso, cambios en habito intestinal,
cirugía, historia de sangrado.
·Medicamentos: especialmente uso de AINES.
· Estilos de vida: vegetarianos.
· Fisiologicos: infancia, adolescencia, embarazo, lactancia.
24. Tabla de requerimientos (notar que se absorbe aprx
un 10% del hierro de la dieta) :
Cantidad (mg)
Hombre 1
Adolescente 2-3
Mujer en edad fertile 2-3
Mujer embarazada 4
Infancia 1
Biodisponibilidad maxima de la dieta 4
25. IIVV.. CCUUAADDRROO CCLLIINNIICCOO
La sintomatologia dependera de la rapidez con que se instale la
anemia.
En caso de perdidas pequeñas crónicas los pacientes pueden
tolerar concentraciones de hemoglobina extremadamente bajas
(<7g/dL),
con muy pocos síntomas: letargia, disnea de instalación
progresiva, síntomas mas inusuales son cefalea, tinitus
(percepcion de sonidos sin estimulo), disgeusia (sabor
desagradable), pica (comer ladrillo).
Al examen físico se puede observar
atrofia cutánea,
Koiloniquia (las uñas son aplanadas y tienen cavidades)
estomatitis angular (boquera)
glositis,
raramente anillos faríngeos y esofágicos (especialmente en mujeres de
edad media).