Asunto(s)

COVID-19 , Enfermedades Reumáticas , SARS-CoV-2 , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , México/epidemiología , Enfermedades Reumáticas/mortalidad , Enfermedades Reumáticas/epidemiología , Femenino , Masculino , Adulto , Adulto Joven , Persona de Mediana Edad , Adolescente

RESUMEN

OBJECTIVE: To describe characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) from Argentina, Mexico and Brazil, and to assess factors associated with mortality in this population. METHODS: Data from 3 national registries, SAR-COVID (Argentina), CMR-COVID (Mexico), and ReumaCoV-Brasil (Brazil), were combined. Adult patients with IMIDs and SARS-CoV-2 infection were recruited. Sociodemographic data, comorbidities, IMID clinical characteristics and treatment, and SARS-CoV-2 infection presentation and outcomes were recorded. RESULTS: A total of 4827 individuals were included: 2542 (52.7%) from SAR-COVID, 1167 (24.2%) from CMR-COVID, and 1118 (23.1%) from ReumaCoV-Brasil. Overall, 82.1% were female with a mean age of 49.7 (SD, 14.3) years; 22.7% of the patients were hospitalized, and 5.3% died because of COVID-19 (coronavirus disease 2019). Argentina and Brazil had both 4% of mortality and Mexico 9.4%. In the multivariable analysis, older age (≥60 years; odds ratio [OR], 7.4; 95% confidence interval [CI], 4.6-12.4), male sex (OR, 1.5; 95% CI, 1.1-2.1), living in Mexico (OR, 3.0; 95% CI, 2.0-4.4), comorbidity count (1 comorbidity: OR, 1.5; 95% CI, 1.0-2.1), diagnosis of connective tissue disease or vasculitis (OR, 1.8; 95% CI, 1.3-2.4), and other diseases (OR, 2.6; 95% CI, 1.6-4.1) compared with inflammatory joint disease, high disease activity (OR, 4.2; 95% CI, 2.5-7.0), and treatment with glucocorticoids (OR, 1.9; 95% CI, 1.4-2.5) or rituximab (OR, 4.2; 95% CI, 2.7-6.6) were associated with mortality. CONCLUSIONS: Mortality in patients with IMIDs was particularly high in Mexicans. Ethnic, environmental, societal factors, and different COVID-19 mitigation measures adopted have probably influenced these results.

Asunto(s)

COVID-19 , Enfermedades Reumáticas , Adulto , Humanos , Masculino , Femenino , Persona de Mediana Edad , SARS-CoV-2 , México/epidemiología , América Latina , Argentina/epidemiología , Brasil/epidemiología , Enfermedades Reumáticas/epidemiología , Agentes Inmunomoduladores

RESUMEN

BACKGROUND: Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. METHODS: This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. FINDINGS: The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score > 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall, in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged ≥ 60 years (53%), CCI score ≥ 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age ≥ 60 years was an independent risk factor for in-hospital mortality (HR = 1.9; 95% CI 1.2-3.1; p = 0.008). INTERPRETATION: In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.

RESUMEN

A vigilância ativa é a solução encontrada pela urologia para a condução de tumores prostáticos com características de pouca agressividade. Desenvolvida especialmente após as polêmicas que envolveram a validade do rastreamento, essa abordagem vem sendo consolidada como a melhor maneira de se evitar o tratamento desnecessário do câncer de próstata e precisa ser compreendida por todos os médicos que lidam com a saúde do homem.

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Active surveillance is the solution found by urology to deal with low-aggressivity prostate tumours. Having been developed following controversies over screening strategies, this has been considered the best approach to avoid unnecessary treatment of prostate cancer and such a concept needs to be well understood by every medical doctor who deals with men's health.

Asunto(s)

Humanos , Masculino , Neoplasias de la Próstata/prevención & control , Salud del Hombre , Espera Vigilante/métodos , Enfermedades de la Próstata/diagnóstico , Urología , Medicina Preventiva , Estrategias de Salud

RESUMEN

Abstract Introduction: Although the Pilates method is commonly used to treat fibromyalgia (FM) in clinical practice, research is scarce, and little is known about its real effectiveness in pain management. Objective: Systematically review the literature to determine whether Pilates affects pain control in FM patients. Methods: The PubMed, Science Direct, PEDro and Cochrane databases were searched to identify randomized controlled trials that investigated the effects of Pilates in individuals diagnosed with FM. The descriptors used were: "pilates based exercise" OR "pilates training" OR "pilates exercise" OR "pilates" AND "fibromyalgia." Independent reviewers performed abstract/full-text screening, data extraction, and methodological quality assessments using the PEDro scale. Results: The search identified 646 potential articles, four of which were used in the analysis. The Pilates method had positive effects on pain control, physical function, quality of life and biopsychosocial factors such as stress and depression in individuals with FM in four studies. However, improvement in these parameters did not differ between intervention groups in three studies. Additionally, the control group showed no significant improvement for the same parameters in one study. The PEDro scale scores of the studies ranged from 6 to 8 points. Conclusion: Evidence suggests that Pilates influences pain control in individuals with FM, and is more effective than no intervention or minimal intervention in the treatment of FM.

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Resumo Introdução: Apesar de o método Pilates ser comumente utilizado para o tratamento da fibromialgia (FM) na prática clínica, o número de estudos é escasso e pouco se sabe a respeito da sua real eficácia no manejo da dor. Objetivo: Revisar sistematicamente a literatura para determinar se o Pilates afeta o controle da dor em pacientes com FM. Métodos: A busca nas bases de dados PubMed, Science Direct, PEDro e Cochrane foi realizada para identificar ensaios clínicos randomizados que investigaram os efeitos do Pilates na FM. Os descritores utilizados foram: "pilates based exercise" OR "pilates training" OR "pilates exercise" OR "pilates" AND "fibromyalgia". Revisores independentes realizaram triagem de resumo/texto completo, extração dos dados e avaliações da qualidade metodológica utilizando a escala PEDro. Resultados: A pesquisa identificou 646 artigos potenciais; quatro foram usados na análise. O Pilates teve efeitos positivos no controle da dor, na melhora da função física, da qualidade de vida e de fatores biopsicossociais como o estresse e a depressão em indivíduos com FM nos quatro estudos analisados. A melhora destes parâmetros não foi diferente entre os grupos de intervenção em três estudos. O grupo controle não apresentou melhora significativa para os mesmos parâmetros em um estudo. As pontuações na escala PEDro variaram de 6 a 8 pontos. Conclusão: As evidências sugerem que o Pilates tem influência no controle da dor em indivíduos com FM e que é mais efetivo do que a não intervenção ou a intervenção mínima no tratamento da FM.

RESUMEN

OBJECTIVES: to analyze the implementation of the medication time out strategy to reduce medication errors. METHODS: this is a quantitative, cross-sectional, inferential study, with direct observation of the implementation of the medication time out strategy, carried out in a cardiac intensive care unit of a university hospital in Rio de Janeiro. RESULTS: 234 prescriptions with 2,799 medications were observed. Of the prescriptions analyzed, 143 (61%) had at least one change with the use of the strategy. In the prescriptions altered, 290 medications had some type of change, and 104 (35.9%) changes were related to potentially harmful medication. During the application of the strategy, prescriptions with polypharmacy had 1.8 times greater chance of presenting an error (p-value = 0.031), which reinforces the importance of the strategy for prescriptions with multiple medications. CONCLUSIONS: the implementation of the medication time out strategy contributed to the interception of a high number of medication errors, using few human and material resources.

Asunto(s)

Errores de Medicación , Polifarmacia , Brasil , Estudios Transversales , Humanos , Errores de Medicación/prevención & control , Seguridad del Paciente , Prescripciones

RESUMEN

BACKGROUND: This article presents evidence and recommendations regarding the efficacy and safety of the approved and available therapies in Mexico to treat severe or established osteoporosis with the aim of developing a position regarding therapeutics in this stage of the disease, according to the descriptive cards of the National Drug Formulary of the National General Health Council of Mexico. METHODS: We performed a systematic and narrative review of the evidence of teriparatide and denosumab, from their pharmacological profile, effectiveness, and safety derived from clinical trials, as well as an analysis of the general recommendations of the national and international clinical practice guidelines. RESULTS: The evidence establishes that teriparatide and denosumab belong to different therapeutic classes, with biologically opposed mechanisms of action and indications of use, which are clearly differentiated in their respective national codes, therefore these drugs cannot be substitutable or interchangeable in severe osteoporosis therapy. Both represent the best options currently available for this stage of the disease; being similar in their efficacy in preventing new vertebral fragility fractures, with an RR of .35 (CI 95%; .22-.55) for teriparatide, and .32 (CI 95%: .26-.41) for denosumab. The absolute risk reduction is higher with teriparatide 9.3% (21 months) compared with denosumab at 4.8% (36 months). CONCLUSIONS: Our results agree with the recommendations available in national and international clinical practice guidelines, with both therapies proposed as a sequential, but not a substitute, treatment.

RESUMEN

ABSTRACT Objectives: to analyze the implementation of the medication time out strategy to reduce medication errors. Methods: this is a quantitative, cross-sectional, inferential study, with direct observation of the implementation of the medication time out strategy, carried out in a cardiac intensive care unit of a university hospital in Rio de Janeiro. Results: 234 prescriptions with 2,799 medications were observed. Of the prescriptions analyzed, 143 (61%) had at least one change with the use of the strategy. In the prescriptions altered, 290 medications had some type of change, and 104 (35.9%) changes were related to potentially harmful medication. During the application of the strategy, prescriptions with polypharmacy had 1.8 times greater chance of presenting an error (p-value = 0.031), which reinforces the importance of the strategy for prescriptions with multiple medications. Conclusions: the implementation of the medication time out strategy contributed to the interception of a high number of medication errors, using few human and material resources.

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RESUMEN Objetivos: analizar la implantación de la estrategia medication time out para disminuir los errores relacionados a la medicación. Métodos: se trata de un estudio cuantitativo, transversal, inferencial, con observación directa de la realización de la estrategia medication time out, llevado a cabo en una unidad de cuidados intensivos de cardiología de un hospital universitario de Río de Janeiro. Resultados: se observaron 234 prescripciones con 2.799 medicamentos. De las prescripciones analizadas, 143 (61%) sufrieron por lo menos una alteración con la utilización de la estrategia. En las prescripciones alteradas, 290 medicamentos tuvieron algún tipo de variación, de las cuales 104 (35,9%) estaban relacionadas con medicamentos potencialmente peligrosos. Durante la aplicación de la estrategia, las recetas con polifarmacia presentaban una probabilidad de error 1,8 veces mayor (valor p = 0,031), lo que refuerza la importancia de la estrategia para las recetas con múltiples fármacos. Conclusiones: la aplicación de la estrategia medication time out contribuyó a la interceptación de un elevado número de errores de medicación, valiéndose de pocos recursos humanos y materiales.

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RESUMO Objetivos: analisar a implantação da estratégia medication time out para redução de erros relacionados a medicamentos. Métodos: trata-se de um estudo quantitativo, transversal, inferencial, com observação direta da realização da estratégia medication time out, realizado em uma unidade cardiointensiva de um hospital universitário do Rio de Janeiro. Resultados: foram observadas 234 prescrições, com 2.799 medicamentos. Das prescrições analisadas, 143 (61%) sofreram pelo menos uma alteração com a utilização da estratégia. Nas prescrições alteradas, 290 medicamentos sofreram algum tipo de alteração, sendo 104 (35,9%) relacionadas a medicamentos potencialmente perigosos. Durante a aplicação da estratégia, prescrições com polifarmácia apresentaram 1,8 vezes maior chance de ocorrência de erro (p valor=0,031), o que reforça a importância da estratégia para prescrições com múltiplos medicamentos. Conclusões: a implantação da estratégia medication time out contribuiu para a interceptação de um número elevado de erros de medicação, utilizando poucos recursos humanos e materiais.

Asunto(s)

Cardiología/normas , Infecciones por Coronavirus/epidemiología , Seguridad del Paciente , Neumonía Viral/epidemiología , Betacoronavirus , COVID-19 , Humanos , Pandemias , SARS-CoV-2

Asunto(s)

Humanos , Neumonía Viral/epidemiología , Cardiología/normas , Infecciones por Coronavirus/epidemiología , Seguridad del Paciente , Infecciones por Coronavirus , Pandemias , Betacoronavirus

RESUMEN

OBJETIVO: Analisar o impacto da quarentena pela COVID-19 no número e no perfil epidemiológico de queimados no estado de Minas Gerais, Brasil. MÉTODO: Estudo retrospectivo por meio da análise de dados quantitativos e qualitativos de acidentes por queimaduras registrados pelo Corpo de Bombeiros Militar de Minas Gerais entre janeiro de 2019 e abril de 2020. RESULTADOS: Foram analisados 285 registros de queimaduras entre janeiro de 2019 e abril de 2020, com redução de 22,25% nos atendimentos, quando comparados os primeiros quatro meses dos dois anos. O tipo de queimadura mais frequente foi a térmica (86,67%) e a água quente representou o agente etiológico mais comum (19,57%), seguido do álcool (18,84%). Pacientes do gênero masculino foram mais acometidos, 60% de janeiro a abril de 2019 e 53% em 2020, e a maioria classificados como pardos (31,93%). A faixa etária com maior incidência foi entre 18 e 64 anos (77,19%) e 61,40% das lesões foram classificadas como leves. O grau de queimadura mais prevalente foi de segundo grau (17,19%) e em 32,28% dos pacientes a superfície corporal total queimada foi menor que 10%. O número de queimaduras provindas de acidente de trabalho reduziu 25% se comparados os primeiros quadrimestres de 2019 e 2020. CONCLUSÕES: Pode-se sugerir que a quarentena pela COVID-19 levou à diminuição do número de pacientes atendidos por queimaduras em Minas Gerais e teve impacto no perfil epidemiológico desses pacientes, como a queda no número de ocorrências no local de trabalho e na faixa etária economicamente ativa. (AU)

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OBJECTIVE: To analyze the impact of quarantine by COVID-19 on the number and epidemiological profile of burnings in the state of Minas Gerais, Brazil. METHODS: Retrospective study through the analysis of quantitative and qualitative data of burn injuries recorded by the Military Fire Department of Minas Gerais between January 2019 and April 2020. RESULTS: 285 burn records were analyzed between January 2019 and April 2020, with a 22.25% reduction in the number of attendances, when compared to the first four months of the two years. The most frequent type of burn was thermal (86.67%) and hot water represented the most common etiologic agent (19.57%), followed by alcohol (18.84%). Male patients were more affected, 60% from January to April 2019 and 53% in 2020, and the majority classified as brown (31.93%). The age group with the highest incidence was between 18 and 64 years of age (77.19%), and 61.40% of the lesions were classified as mild. The most prevalent burn degree was second degree (17.19%) and in 32.28% of the patients the total body surface burned was less than 10%. The number of burns from accidents at work reduced 25% compared to the first four months of 2019 and 2020. CONCLUSIONS: It can be suggested that the quarantine by COVID-19 led to a decrease in the number of burn patients in Minas Gerais and had an impact on the epidemiological profile of these patients, such as the decrease in the number of occurrences in the workplace and the economically active age group. (AU)

Asunto(s)

Humanos , Aislamiento Social , Perfil de Salud , Quemaduras/epidemiología , COVID-19/epidemiología , Accidentes de Trabajo/estadística & datos numéricos , Estudios Retrospectivos , Análisis de Datos

RESUMEN

O rastreamento do câncer de próstata é um tema controverso e extremamente importante, tanto para o urologista quanto para o clínico geral. Mudanças recentes nas recomendações internacionais a respeito desse tema precisam ser do conhecimento de todos os médicos. (AU)

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Prostate cancer screening is controversial and extremely important, both for the urologist and for the general practioner. Every medical professional must be aware of recent changes in international recommendations in this regard. (AU)

Asunto(s)

Neoplasias de la Próstata , Salud del Hombre , Medicina Preventiva , Salud Global , Diagnóstico

RESUMEN

Varios estudios han sugerido una asociación entre la periodontitissevera, la prevalencia de la bacteria Porphyromonas gingivalis y el desarrollo de artritis reumatoide. Como fundamento de esta relación, se ha observado que esta bacteria secreta una enzima, peptidil-arginina deiminasa, que es capaz de citrulinar proteínas del hospedero y así favorecer una respuesta autoinmune. Sin embargo, debido a la heterogeneidad de diseños experimentales, selección de pacientes y valoración de los desenlaces, los resultados no han mostrado la reproducibilidad deseada. Asimismo, observaciones recientes apuntan a que la actividad enzimática podría ser generada por otras especies bacterianas, lo que hace más compleja su relación. Sin embargo, por otro lado, algunos estudios sugieren que el tratamiento periodontal puede limitar el desarrollo de la artritis reumatoide.

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Various studies have suggested a link between severe periodontitis,the prevalence of Porphyromonas gingivalis, and the development ofrheumatoid arthritis. As evidence of this relationship, P. gingivalis hasbeen found to secrete an enzyme, peptidyl arginine deiminase, which isable to citrullinate host proteins and thus help activate an autoimmuneresponse. However, due to the heterogeneity of experimental designs,patient selection, and assessment of clinical outcomes, the results havenot shown the desired reproducibility. Furthermore, recent fi ndingsindicate that the enzymatic activity may be produced by other species ofbacteria, which suggests the relationship is more complex. However, anumber of studies have shown that periodontal treatment could inhibitthe development of rheumatoid arthritis.

Asunto(s)

Humanos , Artritis Reumatoide/etiología , Periodontitis/microbiología , Porphyromonas gingivalis/patogenicidad , Artritis Reumatoide/inmunología , Artritis Reumatoide/microbiología , Enfermedad Crónica , Complejo Antígeno-Anticuerpo/fisiología

RESUMEN

OBJECTIVE: To evaluate the association between the clinical activity of RA patients and serum adipocytokines (Leptin, Adiponectin and Resistin) and inflammatory cytokines. METHODS: All RA patients fulfilled ACR 1987 criteria and were treated with DMARDs. Adipocytokine and inflammatory cytokine levels were evaluated using ELISA. RESULTS: 121 patients were included in the study. Stratifying according to DAS28 (low, moderate and high activity), there were significant differences for Leptin, Resistin, IL-6 and IL-17, however, no differences were seen for Adiponectin, TNFα or IL-1ß. Clinical activity positively correlated with Leptin, Resistin, IL-17 and IL-6 levels, but not with Adiponectin, TNFα or IL-1ß. Adiponectin levels negatively correlated with TNFα and positively correlated with IL-1ß. IL-1ß positively correlated with IL-6 and negatively correlated with TNFα and IL-17. CONCLUSION: Circulating Leptin, Resistin, IL-6 and IL-17 levels positively correlate with RA clinical activity in a manner independent of the subject's BMI. Complex relationships between inflammatory cytokines were observed in RA patients suggesting that other metabolic or inflammatory factors could be involved.

Asunto(s)

Adiponectina/sangre , Artritis Reumatoide/diagnóstico , Citocinas/sangre , Leptina/sangre , Resistina/sangre , Adolescente , Adulto , Anciano , Antirreumáticos/uso terapéutico , Artritis Reumatoide/sangre , Artritis Reumatoide/tratamiento farmacológico , Biomarcadores/sangre , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Adulto Joven

RESUMEN

Muitas drogas terapêuticas produzidas pela indústria farmacêutica são estruturas químicas isoladas de organismos encontrados na natureza ou moléculas baseadas nelas. Podem ser incluídas nesse grupo drogas isoladas de organismos marinhos, como corais, esponjas e algas marinhas, conhecidos como produtores de grandes quantidades de metabólitos secundários. Com base neste fato o presente estudo teve como objetivo realizar a prospecção de moléculas bioativas com propósito farmacológico, em extratos de algas marinhas vermelhas (Rhodophyta) e pardas (Heterokontophyta) coletadas no litoral brasileiro. A prospecção foi realizada por meio de avaliação de seus potenciais antioxidante, antibacteriano, antifúngico, anticancerígeno, e antiparasitário contra organismos causadores de leishmaniose e esquistossomose. Para as avaliações foram empregadas os extratos supercríticos de 5 espécies diferentes, sendo 2 pardas: Dictyota dichotoma e D. menstrualis e três vermelhas: Chondria littoralis, Spyridia hypnoides e Plocamium brasiliense. Os extratos foram avaliados quanto aos seus potenciais bioativos e os resultados mais promissores foram selecionados para as etapas seguintes do fracionamento. Em uma avaliação geral os extratos apresentaram bons resultados e representam uma potencial fonte de bioativos. Os extratos das espécies de D. dichotoma e D. menstrualis foram então submetidos a um procedimento de fracionamento bioguiado pela atividade esquistossomicida. Incorporou-se ainda um terceiro extrato de D. mertensii aos estudos e todas as etapas do fracionamento foram monitoradas por LC-MS. Comparando-se as massas detectadas em todas as frações que apresentaram atividade, para os 3 extratos, foi verificado que a substância de m/z 271,24 estava presente em todas elas, portanto os procedimentos de isolamento foram direcionados a esta molécula para a qual foi possível isolar 7 mg. Diferentemente do que era esperado a molécula quando avaliada isoladamente não apresentou atividade esquistossomicida, levando a hipótese de que a atividade seja decorrente de uma molécula diferente para cada espécie ou ainda que a mesma seja decorrente de uma interação com outras substâncias por um mecanismo de ação aditivo ou sinérgico. O trabalho avaliado de forma geral apresentou resultados promissores e representa um grande embasamento para servir como base para posteriores trabalho de fracionamento

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Several therapeutic drugs manufactured by the pharmaceutical industry are chemical structures isolated from organisms that are found in nature or molecules based on that. May be included at this group drugs isolated from marine organisms, like corals, sponges and seaweeds, known as great secondary metabolites producers. Based on this facts the objective of the present study is to perform a prospection study to achieve bioactive molecules with pharmaceutical purposes, on extracts made from red (Rhodophyta) and brown (Heterokontophyta) seaweed collected in the Brazilian shore. The prospection studies was performed by means of evaluation of the antioxidant, antibacterial, antifungal, anticancer and antiparasitic (against Leishmania and Schistosoma) potential. In the evaluation were tested the supercritical extracts of 5 different species, including 2 brown species: Dictyota dichotoma and D. menstrualis and 3 red species: Chondria littoralis, Spyridia hypnoides and Plocamium brasiliense. The extracts were evaluated by their potential bioactive compounds and the most promising results were selected for the following fractionation steps. Overall the extracts have shown good results and may be represent a potential source of bioactive molecules. The extracts of both D. dichotoma and D. menstrualis were submitted to a bioguided fractionation process by their antischistosomal activities. It was still included a third extract from D. mertensii to the studies and every step was monitored by LC-MS techniques. Comparing the detected mass for each active fraction, it was observed the presence of a substance with m/z 271,24 in all of the extracts, so the isolating procedures were directed to obtain that specific molecule, which was obtained in a biomass of 7 mg. Differently than expected the molecule when evaluated isolated do not show the antischistosomal activity, leading to the hypothesis that the activity was related to different molecules for each species or even the observed effect is resulted by an interaction mechanism with another substances by an additive or synergist mechanism. The overall evaluation of the whole work show some promising results and it represent a great support for future fractionation works

Asunto(s)

Farmacología , Algas Marinas , Citotoxicidad Inmunológica , Rhodophyta/metabolismo , Biomarcadores Farmacológicos/metabolismo , Estramenopilos/metabolismo , Productos Biológicos/administración & dosificación , Cromatografía con Fluido Supercrítico

RESUMEN

Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36(®) and Qualiveen(®) QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36(®) questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen(®) best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.

Asunto(s)

Tratamientos Conservadores del Órgano/métodos , Calidad de Vida , Vejiga Urinaria Neurogénica/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Femenino , Humanos , Masculino , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Prospectivos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Resultado del Tratamiento

RESUMEN

PURPOSE: This study evaluated the immunohistochemical presence of Indian Hedgehog (IHH), transforming growth factor-ß (TGF-ß), and parathyroid-1 receptor (PTH1R) in calvaria bone repair, and compared these results with the histological bone matrix features in defects treated with autograft in the presence or absence of L-PRP. MATERIAL AND METHODS: An artificial bone defect measuring 5 × 1 mm was produced in the calvaria of 28 Wistar rats. Randomly the defects were treated with autograft and autograft mixed with L-PRP. The animals were euthanized at 15 and 40 days post-surgery. Data were analyzed by Student-Newman-Keuls test (p ≤ .05) for immunohistochemical interpretation. RESULTS: The results revealed that the histological characteristic of bone matrix deposited in the defect was different in the defects treated with L-PRP. The group that received only the autograft demonstrated larger haversian bone matrix deposited, whereas the group that received autograft mixed with L-PRP revealed trabecular bone deposition. These results coincided with significantly higher immunopositivity for IHH, TGF-ß1, and PTH1R in the L-PRP group. CONCLUSION: These results suggest that L-PRP altered the biological characteristic of the autograft, increasing the bone cells IHH+ but inducing a trabecular bone associated with intense quantities of TGF-ß and PTH1R.

Asunto(s)

Autoinjertos/trasplante , Matriz Ósea/fisiología , Proteínas Hedgehog/análisis , Leucocitos/fisiología , Osteogénesis/fisiología , Plasma Rico en Plaquetas/fisiología , Receptor de Hormona Paratiroídea Tipo 1/análisis , Cráneo/cirugía , Factor de Crecimiento Transformador beta1/análisis , Animales , Enfermedades Óseas/cirugía , Matriz Ósea/patología , Hueso Esponjoso/patología , Hueso Esponjoso/fisiología , Osteón/patología , Osteón/fisiología , Procesamiento de Imagen Asistido por Computador/métodos , Inmunohistoquímica , Masculino , Fotograbar/métodos , Distribución Aleatoria , Ratas , Ratas Wistar , Cráneo/patología , Cráneo/fisiología

RESUMEN

Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36® and Qualiveen® QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36® questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen® best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.

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Asunto(s)

Adulto , Femenino , Humanos , Masculino , Tratamientos Conservadores del Órgano/métodos , Calidad de Vida , Vejiga Urinaria Neurogénica/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Periodo Posoperatorio , Periodo Preoperatorio , Estudios Prospectivos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Resultado del Tratamiento

RESUMEN

OBJECTIVES: To assess whether baseline levels of leptin and adiponectin predict disease activity or response to treatment in patients with RA at 6 months, 1 and 2 years of follow-up. METHODS: A consecutive cohort of patients, classified according to the 2010 ACR/EULAR RA criteria, was evaluated at baseline, 6 months, 1 and 2 years. All were treated with steroids and/or DMARDs. None received biologics. Blood was taken at a baseline to determine plasma anti-CCP, leptin and adiponectin. The relationship between leptin, adiponectin, DAS28 and changes in DAS28 was assessed by multivariable linear and logistic regression from baseline to follow-up. RESULTS: 127 patients completed 6 months, 91 one year and 52 two years of follow-up. All were female, mean age 45 years (18-70), time since onset of disease 7.5 years (0-36). A U-shaped relationship between DAS28 and leptin baseline levels was seen. Adjusting for different factors, leptin levels at baseline predicted higher DAS28 at 6 months and, in patients who were not overweight or obese, predicted disease activity at 6 months, 1 and 2 years. In patients who were not overweight or obese, baseline leptin was able to predict response to treatment at 6 and 12 months. CONCLUSIONS: In the short term, baseline leptin levels predict disease activity in all RA patients and response to treatment in RA patients with normal weight.

Asunto(s)

Adiponectina/sangre , Antirreumáticos/uso terapéutico , Artritis Reumatoide , Glucocorticoides/uso terapéutico , Leptina/sangre , Péptidos Cíclicos/inmunología , Adulto , Artritis Reumatoide/sangre , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/fisiopatología , Autoanticuerpos/sangre , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Gravedad del Paciente , Valor Predictivo de las Pruebas , Pronóstico

RESUMEN

BACKGROUND: The pharmacologic management of rheumatoid arthritis has progressed substantially over the past years. It is therefore desirable that existing information be periodically updated. There are several published international guidelines for the treatment of rheumatoid arthritis that hardly adapt to the Mexican health system because of its limited healthcare resources. Hence, it is imperative to unify the existing recommendations and to incorporate them to a set of clinical, updated recommendations; the Mexican College of Rheumatology developed these recommendations in order to offer an integral management approach of rheumatoid arthritis according to the resources of the Mexican health system. OBJECTIVE: To review, update and improve the available evidence within clinical practice guidelines on the pharmacological management of rheumatoid arthritis and produce a set of recommendations adapted to the Mexican health system, according to evidence available through December 2012. METHODS: The working group was composed of 30 trained and experienced rheumatologists with a high quality of clinical knowledge and judgment. Recommendations were based on the highest quality evidence from the previously established treatment guidelines, meta-analysis and controlled clinical trials for the adult population with rheumatoid arthritis. RESULTS: During the conformation of this document, each working group settled the existing evidence from the different topics according to their experience. Finally, all the evidence and decisions were unified into a single document, treatment algorithm and drug standardization tables. CONCLUSIONS: This update of the Mexican Guidelines for the Pharmacologic Treatment of Rheumatoid Arthritis provides the highest quality information available at the time the working group undertook this review and contextualizes its use for the complex Mexican health system.

Asunto(s)

Artritis Reumatoide/tratamiento farmacológico , Algoritmos , Humanos