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BACKGROUND: The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. PATIENTS AND METHODS: We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. RESULTS: We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08-0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06-0.69, p < 0.001), particularly allergic rhinitis and food allergy. CONCLUSIONS: We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.
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Enteritis , Eosinofilia , Esofagitis Eosinofílica , Gastritis , Infecciones por Helicobacter , Helicobacter pylori , Hipersensibilidad Inmediata , Adulto , Humanos , Esofagitis Eosinofílica/complicaciones , Esofagitis Eosinofílica/epidemiología , Esofagitis Eosinofílica/diagnóstico , Estudios Retrospectivos , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/diagnóstico , Hipersensibilidad Inmediata/complicacionesRESUMEN
Primary pancreatic lymphoma is one of the rare primary pancreatic tumors with a low incidence compared to adenocarcinoma, which is the most frequent. Currently there are diagnostic tools such as percutaneous biopsy and endoscopic ultrasound to reach its diagnosis. Primary lymphoma of the pancreas has defined therapeutic targets as well as a better prognosis compared to other tumors.
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Adenocarcinoma , Linfoma , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Linfoma/diagnóstico por imagen , Páncreas/patología , Neoplasias PancreáticasRESUMEN
Introducción: la neumonía es la principal causa de derrame pleural (DP) en los niños. Un elevado número de los pacientes ingresan a las unidades de cuidados intensivos pediátricos con derrame pleural paraneumónico (DPP), terminando en el empiema pleural. Objetivo: identificar los factores de riesgo que influyen de forma independiente en la aparición de neumonía adquirida en la comunidad, complicada con empiema pleural. Métodos: se realizó un estudio observacional analítico de casos y controles, se seleccionaron 30 casos y 90 controles. Con una proporción de 1:3. Se realizó el análisis estadístico univariado y multivariado. Resultados: en el análisis univariado, la edad menor de 5 años y el sexo masculino se mostraron sin influencia estadísticamente significativa, mientras que el multivariado mostró que el factor con independencia más importante fue el uso previo de antimicrobiano (OR 6,329 ajustado IC 95% 2,764-8,678), seguido del diagnóstico tardío (OR ajustado 5,492IC 95% 2,559-8,522) y la presencia de comorbilidad (OR ajustado 4,341 IC 95% 2,321−7,529) de manera similar. Conclusiones: los factores de mayor riesgo que contribuyeron al riesgo de desarrollar la neumonía complicada con empiema pleural fueron el uso previo de antimicrobiano, el diagnóstico tardío de empiema y la presencia de comorbilidad.
Introduction: pneumonia is the main cause of pleural effusion (PE) in children. A high number of patients enter pediatric intensive care units with parapneumonic pleural effusion (PPE), ending in pleural empyema. Objective: to identify the risk factors that independently influences the occurrence of community-acquired pneumonia, complicated by pleural empyema. Methods: an analytical observational study of cases and controls was carried out, 30 cases and 90 controls were selected. With a ratio of 1:3. Univariate and multivariate statistical analysis was performed. Results: in the univariate analysis, age under 5 years and male sex showed no statistically significant influence, while the multivariate analysis showed that the most important independent factor was the previous use of antimicrobial (OR 6.329 adjusted CI 95% 2.764-8.678), followed by late diagnosis (adjusted OR 5.492 CI 95% 2.559-8.522) and the presence of comorbidity (adjusted OR 4.341 CI 95% 2.321−7.529) similarly. Conclusions: the highest risk factors that contributed to the risk of developing pneumonia complicated with pleural empyema were previous use of antimicrobials, late diagnosis of empyema, and the presence of comorbidity.
Introdução: A pneumonia é a principal causa de derrame pleural (DP) em crianças. Um número elevado de pacientes é admitido em unidades de terapia intensiva pediátrica com derrame pleural parapneumônico (DPP), terminando em empiema pleural. Objetivo: Identificar os fatores de risco que influenciam independentemente a ocorrência de pneumonia adquirida na comunidade complicada por empiema pleural. Métodos: Foi realizado um estudo observacional analítico caso-controle, selecionados 30 casos e 90 controles. Com uma proporção de 1:3. Foram realizadas análises estatísticas univariada e multivariada. Resultados: Na análise univariada, idade menor de 5 anos e sexo masculino não foram estatisticamente significativos, enquanto a análise multivariada mostrou que o fator independente mais importante foi o uso prévio de antimicrobianos (OR ajustado 6,329 IC 95% 2,764-8,678), seguido pelo diagnóstico tardio (OR ajustado 5,492 IC 95% 2,559-8,522) e presença de comorbidade (OR ajustado 4,341 IC 95% 2,321−7, 529) da mesma forma. Conclusões: Os maiores fatores de risco que contribuíram para o desenvolvimento de pneumonia complicada com empiema pleural foram o uso prévio de antimicrobianos, o diagnóstico tardio de empiema e a presença de comorbidade.
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Introducción: las infecciones asociadas a los cuidados sanitarios (IACS), tienen un fuerte impacto social y económico; asimismo, constituyen un indicador de la calidad de atención en hospitales. Objetivo: identificar los factores de riesgo que influyen de forma independiente para adquirir bacteriemia asociada a los cuidados sanitarios. Métodos: se realizó un estudio observacional, analítico de casos y controles, se seleccionaron 48 casos y 144 controles. Con una proporción de 1: 3. Se realizó el análisis estadístico univariado y multivariado. Resultados: en el análisis univariado, la comorbilidad, el uso de sonda nasogástrica y sonda vesical se mostraron sin influencia estadísticamente significativa, mientras que el multivariado mostró que el factor con independencia más importante fue el uso de catéter venoso central (OR 11,837 ajustado IC 95% 4,493-31,180), seguido de la presencia de shock séptico al ingreso en UCIP (OR 4,908 ajustado IC 95% 1,152-20,907) y la presencia de ostomías (OR ajustado 10.44 IC 95% 2,806−17,836) de manera similar. Conclusiones: la comorbilidad, el uso de sonda nasogástrica y uso de sonda vesical no contribuyeron al riesgo de adquirir bacteriemia asociada a los cuidados sanitarios. La presencia de catéter venoso central, presencia de shock séptico al ingreso en UCIP y la presencia de ostomías resultaron ser los factores de mayor riesgo.
Introduction: infections associated with health care (IACS) have a strong social and economic impact; likewise, they constitute an indicator of the quality of care in hospitals. Objective: to identify the risk factors that influence independently to acquire bacteremia associated with health care. Methods: an observational, analytical study of cases and controls was carried out, 48 cases and 144 controls were selected. With a ratio of 1:3. Univariate and multivariate statistical analysis was performed. Results: in the univariate analysis, comorbidity, the use of a nasogastric tube and a bladder catheter did not show a statistically significant influence, while the multivariate analysis showed that the most important independent factor was the use of a central venous catheter (OR 11,837 adjusted CI 95% 4,493-31,180), followed by the presence of septic shock on admission to the PICU (OR 4,908 adjusted 95% CI 1,152-20,907) and the presence of ostomies (adjusted OR 10.44 95% CI 2,806−17,836) in a similar way. Conclusions: comorbidity, the use of a nasogastric tube and the use of a bladder catheter did not contribute to the risk of acquiring healthcare-associated bacteremia. The presence of a central venous catheter, the presence of septic shock on admission to the PICU, and the presence of ostomies were the highest risk factors.
Introdução: as infecções associadas aos cuidados de saúde (IACS) têm um forte impacto social e económico; Eles também são um indicador da qualidade do atendimento nos hospitais. Objetivo: identificar os fatores de risco que influenciam independentemente a aquisição de bacteremia associada à assistência à saúde. Métodos: foi realizado um estudo observacional e analítico de casos e controles, selecionados 48 casos e 144 controles. Com uma proporção de 1: 3. Foram realizadas análises estatísticas univariada e multivariada. Resultados: na análise univariada, a comorbidade, o uso de sonda nasogástrica e cateter urinário foram mostrados sem influência estatisticamente significativa, enquanto o multivariado mostrou que o fator independente mais importante foi o uso de cateter venoso central (OR 11,837 ajustado IC 95% 4,493-31,180), seguido pela presença de choque séptico na admissão na UTIP (OR 4,908 ajustado IC 95% 1,152-20,907) e a presença de ostomias (OR ajustado 10,44 IC 95% 2,806−17, 836) da mesma forma. Conclusões: comorbidade, uso de sonda nasogástrica e cateter vesical não contribuíram para o risco de adquirir bacteremia associada à assistência à saúde. A presença de cateter venoso central, a presença de choque séptico na admissão na UTIP e a presença de ostomias foram os maiores fatores de risco.
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Life on earth is the result of the work of proteins, the cellular nanomachines that fold into elaborated 3D structures to perform their functions. The ribosome synthesizes all the proteins of the biosphere, and many of them begin to fold during translation in a process known as cotranslational folding. In this work we discuss current advances of this field and provide computational and experimental data that highlight the role of ribosome in the evolution of protein structures. First, we used the sequence of the Ankyrin domain from the Drosophila Notch receptor to launch a deep sequence-based search. With this strategy, we found a conserved 33-residue motif shared by different protein folds. Then, to see how the vectorial addition of the motif would generate a full structure we measured the folding on the ribosome of the Ankyrin repeat protein. Not only the on-ribosome folding data is in full agreement with classical in vitro biophysical measurements but also it provides experimental evidence on how folded proteins could have evolved by duplication and fusion of smaller fragments in the RNA world. Overall, we discuss how the ribosomal exit tunnel could be conceptualized as an active site that is under evolutionary pressure to influence protein folding.
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Eosinophilic esophagitis (EoE) has high prevalence/incidence in Western Europe, Canada, United States of America and Australia where it has significantly increased over the past three decades to the extent that some consider it an epidemic.
Asunto(s)
Esofagitis Eosinofílica , Adulto , Enteritis , Eosinofilia , Esofagitis Eosinofílica/epidemiología , Esofagitis Eosinofílica/terapia , Esofagoscopía , Gastritis , Humanos , Incidencia , PrevalenciaRESUMEN
INTRODUCTION: Angiodysplasias are responsible of 50% of small bowel bleeding. An endoscopic method that allows measuring its severity is not available. AIMS: The aim of the study was to validate a new endoscopic score with VCE to measure the severity of small bowel angiodysplasias (SBAD). METHODS: Four endoscopists independently reviewed VCE videos of 22 patients with SBAD. The score graded 3 variables: A - extent of lesions: E1, located in one half of the intestine and E2, in both halves; B - number of lesions: N1, <5; N2, 5-10; and N3, >10 lesions; C - probability of bleeding: P1, pale red spots; P2, bright red spots; P3, bleeding stigmata; and P4, active bleeding. Capsule Endoscopy Small Bowel Angiodysplasia Activity Index (CESBAI) was calculated as follows: E × 1 + N × 2 + P × 3. Interobserver variability was analyzed by Spearman's correlation and agreement Kappa statistic tests. RESULTS: The mean CESBAI scores by observers were O1= 11.6 ± 4.1; O2 = 11.3 ± 4.8; O3 = 11.1 ± 4.9; and O4 = 11.8 ± 4.2 (p > 0.05). Spearman's correlation values of CESBAI between every 2 observers were from 0.61 to 0.94 (p < 0.001) with a global correlation of 0.73 among all observers. Kappa values of CESBAI between every 2 observers ranged from 0.42 to 0.87 (p < 0.001) with a global agreement of 0.57 among all observers. All evaluators stated that the method was easy to use. CONCLUSIONS: CESBAI is a reliable and reproducible score. Nevertheless, these results must be validated in other studies with larger population before assessing its power for predicting bleeding recurrence.
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Angiodisplasia , Endoscopía Capsular , Angiodisplasia/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Humanos , Intestino Delgado/diagnóstico por imagen , Variaciones Dependientes del ObservadorRESUMEN
Introducción: los pacientes pediátricos hospitalizados en unidades de cuidados intensivos (UCI) tienen un riesgo elevado de adquirir infecciones asociadas a la propia atención sanitaria. Objetivo: identificar los factores pronósticos de Bacteriemia asociada al uso de catéter venoso central. Métodos: se realizó un estudio observacional analítico prospectivo, en pacientes que ingresaron en la Unidad de Cuidados Intensivos del Hospital Provincial Pediátrico Docente General Milanés de Bayamo, Granma, en el periodo 2017-2019. Resultados: en el análisis univariado resultaron factores influyentes de muerte, con significación estadística y en orden de asociación: la presencia de hipoalbuminemia, (OR: 10,05; p: 0,027; IC 95 por ciento); el uso de catéter venoso central por más de 7 días, (OR 8,333; p 0,006; IC 95 por ciento) y la edad menor de 1 año (OR 3,631; p 0,036 IC 95 por ciento). No presentaron significación estadística la presencia de comorbilidad (OR 2,860; p 0,112; IC 95 por ciento) ni el sexo masculino (OR 2,603; p 0,219; IC 95 por ciento). El análisis multivariado mostró que el factor con independencia más importante fue la presencia de hipoalbuminemia, (OR 6,888; p 0,032; IC 95 por ciento), seguido del uso de catéter venoso central por más de 7 días (OR 4,822; p 0,016; IC 95 por ciento). Conclusiones: los factores investigados, contribuyeron al riesgo de morir por bacteriemia asociada al uso del catéter venoso central excepto el sexo y la presencia de comorbilidad(AU)
Introduction: pediatric patients hospitalized in intensive care units (ICU) have a high risk of acquiring infections associated with their own health care. Objective: to identify the prognostic factors of Bacteremia associated with the use of a central venous catheter. Methods: a prospective analytical observational study was carried out in patients admitted to the Intensive Care Unit of the Hospital Provincial Pediátrico Docente General Milanés de Bayamo, Granma, in the period 2017-2019. Results: in the univariate analysis, factors influencing death were found, with statistical significance and in order of association: the presence of hypoalbuminemia, (OR: 10.05; p: 0.027; 95 percent CI); the use of a central venous catheter for more than 7 days (OR 8.333; p 0.006; 95 percent CI) and age less than 1 year (OR 3.631; p 0.036 95 percent CI). The presence of comorbidity (OR 2.860; p 0.112; 95 percent CI) or male sex (OR 2.603; p 0.219; 95 percent CI) did not show statistical significance. The multivariate analysis showed that the most important independent factor was the presence of hypoalbuminemia, (OR 6.888; p 0.032; 95 percent CI), followed by the use of a central venous catheter for more than 7 days (OR 4.822; p 0.016; CI 95 percent). Conclusions: the investigated factors contributed to the risk of dying from bacteraemia associated with the use of the central venous catheter, except for sex and the presence of comorbidity(AU)
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Humanos , Masculino , Niño , Bacteriemia/diagnóstico , Unidades de Cuidado Intensivo Pediátrico , Hipoalbuminemia , Pronóstico , Métodos de Análisis de Laboratorio y de Campo , Estudios Prospectivos , Cateterismo Venoso CentralRESUMEN
RESUMEN Introducción: los pacientes pediátricos hospitalizados en unidades de cuidados intensivos (UCI) tienen un riesgo elevado de adquirir infecciones asociadas a la propia atención sanitaria. Objetivo: identificar los factores pronósticos de Bacteriemia asociada al uso de catéter venoso central. Métodos: se realizó un estudio observacional analítico prospectivo, en pacientes que ingresaron en la Unidad de Cuidados Intensivos del Hospital Provincial Pediátrico Docente General Milanés de Bayamo, Granma, en el periodo 2017-2019. Resultados: en el análisis univariado resultaron factores influyentes de muerte, con significación estadística y en orden de asociación: la presencia de hipoalbuminemia, (OR: 10,05; p: 0,027; IC 95%); el uso de catéter venoso central por más de 7 días, (OR 8,333; p 0,006; IC 95%) y la edad menor de 1 año (OR 3,631; p 0,036 IC 95%). No presentaron significación estadística la presencia de comorbilidad (OR 2,860; p 0,112; IC 95%) ni el sexo masculino (OR 2,603; p 0,219; IC 95%). El análisis multivariado mostró que el factor con independencia más importante fue la presencia de hipoalbuminemia, (OR 6,888; p 0,032; IC 95%), seguido del uso de catéter venoso central por más de 7 días (OR 4,822; p 0,016; IC 95%). Conclusiones: los factores investigados, contribuyeron al riesgo de morir por bacteriemia asociada al uso del catéter venoso central excepto el sexo y la presencia de comorbilidad.
ABSTRACT Introduction: pediatric patients hospitalized in intensive care units (ICU) have a high risk of acquiring infections associated with their own health care. Objective: to identify the prognostic factors of Bacteremia associated with the use of a central venous catheter. Methods: a prospective analytical observational study was carried out in patients admitted to the Intensive Care Unit of the Hospital Provincial Pediátrico Docente General Milanés de Bayamo, Granma, in the period 2017-2019. Results: in the univariate analysis, factors influencing death were found, with statistical significance and in order of association: the presence of hypoalbuminemia, (OR: 10.05; p: 0.027; 95% CI); the use of a central venous catheter for more than 7 days (OR 8.333; p 0.006; 95% CI) and age less than 1 year (OR 3.631; p 0.036 95% CI). The presence of comorbidity (OR 2.860; p 0.112; 95% CI) or male sex (OR 2.603; p 0.219; 95% CI) did not show statistical significance. The multivariate analysis showed that the most important independent factor was the presence of hypoalbuminemia, (OR 6.888; p 0.032; 95% CI), followed by the use of a central venous catheter for more than 7 days (OR 4.822; p 0.016; CI 95 %). Conclusions: the investigated factors contributed to the risk of dying from bacteraemia associated with the use of the central venous catheter, except for sex and the presence of comorbidity.
RESUMO Introdução: pacientes pediátricos internados em unidades de terapia intensiva (UTI) apresentam alto risco de adquirir infecções associadas aos próprios cuidados de saúde. Objetivo: identificar os fatores prognósticos da Bacteremia associada ao uso de cateter venoso central. Métodos: foi realizado um estudo observacional analítico prospectivo em pacientes internados na Unidade de Terapia Intensiva do Hospital Provincial Pediátrico Docente General Milanés de Bayamo, Granma, no período 2017-2019. Resultados: na análise univariada, foram encontrados fatores que influenciam o óbito, com significância estatística e em ordem de associação: presença de hipoalbuminemia, (OR: 10,05; p: 0,027; IC95%); uso de cateter venoso central por mais de 7 dias (OR 8,333; p 0,006; IC 95%) e idade menor que 1 ano (OR 3,631; p 0,036 IC 95%). A presença de comorbidade (OR 2,860; p 0,112; IC 95%) ou sexo masculino (OR 2,603; p 0,219; IC 95%) não apresentou significância estatística. A análise multivariada mostrou que o fator independente mais importante foi a presença de hipoalbuminemia, (OR 6,888; p 0,032; IC 95%), seguido do uso de cateter venoso central por mais de 7 dias (OR 4,822; p 0,016; IC 95 %). Conclusões: os fatores investigados contribuíram para o risco de morrer por bacteriemia associada ao uso do cateter venoso central, exceto sexo e presença de comorbidade.
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Diabetic retinopathy is one of the leading causes of visual impairment and morbidity worldwide, being the number one cause of blindness in people between 27 and 75 years old. It is estimated that ~191 million people will be diagnosed with this microvascular complication by 2030. Its pathogenesis is due to alterations in the retinal microvasculature as a result of a high concentration of glucose in the blood for a long time which generates numerous molecular changes like oxidative stress. Therefore, this narrative review aims to approach various biomarkers associated with the development of diabetic retinopathy. Focusing on the molecules showing promise as detection tools, among them we consider markers of oxidative stress (TAC, LPO, MDA, 4-HNE, SOD, GPx, and catalase), inflammation (IL-6, IL-1ß, IL-8, IL-10, IL-17A, TNF-α, and MMPs), apoptosis (NF-kB, cyt-c, and caspases), and recently those that have to do with epigenetic modifications, their measurement in different biological matrices obtained from the eye, including importance, obtaining process, handling, and storage of these matrices in order to have the ability to detect the disease in its early stages.
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Introducción: las terapias intensivas pediátricas son esenciales en el funcionamiento hospitalario, pues la asistencia al niño crítico es uno de sus objetivos prioritarios. Objetivo: caracterizar la morbilidad y los principales indicadores de calidad, establecidos por el Ministerio de Salud Pública (MINSAP), durante 11 años (2008-2018). Método: se realizó un estudio descriptivo, retrospectivo, epidemiológico en la UCIP Bayamo, con pacientes ingresados de 2008-2017, para estudiar el comportamiento de indicadores hospitalarios (ingresos directos, mortalidad neta y bruta, supervivencia general y del ventilado, promedio de estadía, índices ocupacional y tasa de infección asociada a la asistencia sanitaria) y de la morbilidad (ingresos, egresos, evaluación de los ingresos según grupos etarios, motivo de ingreso, tipo y estado nutricional). Resultados: de los ingresos: el 64.2 por ciento fue directos, de ellos el 63,6 por ciento procedió del cuerpo de guardia y de los intrahospitalarios el 49,3 por ciento fueron de gastro; el 50,1 por ciento menores de un año, el 18,2 por ciento desnutrido, el 14,2 por ciento quirúrgicos, en 61,3 por ciento por causa infecciosa. Entre los indicadores: tasa de mortalidad neta (2.7 por ciento) y la bruta (3.4 por ciento), promedio de estadía (5.6), índice ocupacional (77.7 por ciento) y tasa de infecciones asociadas a los cuidados sanitarios (5.3). La supervivencia general (96,5 por ciento), supervivencia del ventilado (86,1 por ciento) y en menores de un año de 96,8 por ciento y 85,0 por ciento, respectivamente. Conclusiones: se cumplen los indicadores hospitalarios con una elevada supervivencia general y en el paciente ventilado; hay un adecuado aprovechamiento de las camas y dentro de los ingresos predominaron los menores de un año, las causas infecciosas y los procedentes del cuerpo de guardia(AU)
Introduction: pediatric intensive therapies are essential in hospital operation, since the care of the critical child is one of their priority objectives. Objective: to characterize morbidity and the main quality indicators, established by the Ministry of Public Health (MINSAP), for 11 years (2008-2018). Method: a retrospective, epidemiological, descriptive study was carried out in the PICU Bayamo, with patients admitted from 2008-2017, to study the behavior of hospital indicators (direct admissions, net and gross mortality, general and ventilated survival, average stay, indices occupational and infection rate associated with health care) and morbidity (income, expenses, evaluation of income according to age groups, reason for admission, type and nutritional status). Results: of the admissions: 64.2 percent were direct, of them 63.6 percent came from the guardhouse and from the in-hospital 49.3 percent were from gastro; 50.1 percent under one year of age, 18.2 percent malnourished, 14.2 percent surgical, in 61.3 percent due to infectious causes. Among the indicators: net mortality rate (2.7 percent) and gross (3.4 percent), average length of stay (5.6), occupational index (77.7 percent) and rate of infections associated with health care (5.3). Overall survival (96.5 percent), ventilated survival (86.1 percent) and in children under one year of age of 96.8 percent and 85.0 percent, respectively. Conclusions: hospital indicators are met with a high overall survival and in the ventilated patient; there is an adequate use of the beds and within the income the minors of one year, the infectious causes and those coming from the body of the guard predominated(EU)
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Humanos , Niño , Unidades de Cuidado Intensivo Pediátrico , Morbilidad , Mortalidad Hospitalaria , Supervivencia , Estudios Epidemiológicos , Epidemiología Descriptiva , Estudios RetrospectivosRESUMEN
Introducción: las infecciones asociadas a cuidados sanitarios (IACS) son un problema de salud pública en todo el mundo. Objetivo: identificar los factores de riesgo para la aparición de esta enfermedad. Método: se realizó un estudio analítico de casos y testigos en pacientes atendidos en la Unidad de Cuidados Intensivos (UCI) Pediátricos de Bayamo, los cuales adquirieron una infección durante su ingreso, en el periodo 2018-2019. Resultados: en el análisis univariado la alimentación parenteral y el uso de sonda vesical no constituyeron factor de riesgo para la aparición de la enfermedad, mientras que en el multivariado mostró que el factor con independencia más importante fue el uso de catéter venoso central (OR ajustado 19.44 IC 95 por ciento 6.83-55.29), seguido de la presencia de la desnutrición (OR ajustado 10.41 IC 95 por ciento 3.27-33.14) y la ventilación mecánica artificial (OR 10.41 ajustado IC 3.32-34.14). Conclusiones: con los valores del modelo de la regresión logística binaria para los factores de infecciones, se podrá estimar el riesgo de enfermar(AU)
Introduction: Healthcare Associated Infections (IACS) are a public health problem worldwide. Objective: to identify the risk factors for the appearance of this disease. Method: an analytical study of cases and controls was carried out in patients treated in the Pediatric Intensive Care Unit (ICU) of Bayamo, who acquired an infection during their admission, in the period 2018-2019. Results: in the univariate analysis, parenteral feeding and the use of a bladder catheter did not constitute a risk factor for the onset of the disease, while in the multivariate analysis it was shown that the most important factor independently was the use of a central venous catheter (adjusted OR 19.44 95 percent CI 6.83-55.29), followed by the presence of malnutrition (adjusted OR 10.41 95 percent CI 3.27-33.14) and artificial mechanical ventilation (adjusted OR10.41 IC 3.32-34.14). Conclusions: with the values of the binary logistic regression model for the infection factors, the risk of becoming ill can be estimated(EU)
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Humanos , Niño , Infección Hospitalaria , Factores de Riesgo , Unidades de Cuidado Intensivo Pediátrico , Métodos de Análisis de Laboratorio y de CampoRESUMEN
Diabetes mellitus (DM) is a progressive disease induced by a sustained state of chronic hyperglycemia that can lead to several complications targeting highly metabolic cells. Diabetic retinopathy (DR) is a multifactorial microvascular complication of DM, with high prevalence, which can ultimately lead to visual impairment. The genesis of DR involves a complex variety of pathways such as oxidative stress, inflammation, apoptosis, neurodegeneration, angiogenesis, lipid peroxidation, and endoplasmic reticulum (ER) stress, each possessing potential therapeutic biomarkers. A specific treatment has yet to be developed for early stages of DR since no management is given other than glycemic control until the proliferative stage develops, offering a poor visual prognosis to the patient. In this narrative review article, we evaluate different dietary regimens, such as the Mediterranean diet, Dietary Pattern to Stop Hypertension (DASH) and their functional foods, and low-calorie diets (LCDs). Nutraceuticals have also been assessed in DR on account of their antioxidant, anti-inflammatory, and antiangiogenic properties, which may have an important impact on the physiopathology of DR. These nutraceuticals have shown to lower reactive oxygen species (ROS), important inflammatory factors, cytokines, and endothelial damage biomarkers either as monotherapies or combined therapies or concomitantly with established diabetes management or nonconventional adjuvant drugs like topical nonsteroidal anti-inflammatory drugs (NSAIDs).
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Quimioterapia Adyuvante/métodos , Retinopatía Diabética/dietoterapia , Inflamación/metabolismo , Estrés Oxidativo/fisiología , Progresión de la Enfermedad , HumanosRESUMEN
RESUMEN Introducción: las infecciones asociadas a cuidados sanitarios (IACS) son un problema de salud pública en todo el mundo. Objetivo: identificar los factores de riesgo para la aparición de esta enfermedad. Método: se realizó un estudio analítico de casos y testigos en pacientes atendidos en la Unidad de Cuidados Intensivos (UCI) Pediátricos de Bayamo, los cuales adquirieron una infección durante su ingreso, en el periodo 2018-2019. Resultados: en el análisis univariado la alimentación parenteral y el uso de sonda vesical no constituyeron factor de riesgo para la aparición de la enfermedad, mientras que en el multivariado mostró que el factor con independencia más importante fue el uso de catéter venoso central (OR ajustado 19.44 IC 95% 6.83-55.29), seguido de la presencia de la desnutrición (OR ajustado 10.41 IC 95% 3.27- 33.14) y la ventilación mecánica artificial (OR10.41 ajustado IC 3.32-34.14). Conclusiones: con los valores del modelo de la regresión logística binaria para los factores de infecciones, se podrá estimar el riesgo de enfermar.
ABSTRACT Introduction: health care Associated Infections (IACS) are a public health problem worldwide. Objective: to identify the risk factors for the appearance of this disease. Method: an analytical study of cases and controls was carried out in patients treated in the Pediatric Intensive Care Unit (ICU) of Bayamo, who acquired an infection during their admission, in the period 2018-2019. Results: in the univariate analysis, parenteral feeding and the use of a bladder catheter did not constitute a risk factor for the onset of the disease, while in the multivariate analysis it was shown that the most important factor independently was the use of a central venous catheter (adjusted OR 19.44 95% CI 6.83-55.29), followed by the presence of malnutrition (adjusted OR 10.41 95% CI 3.27- 33.14) and artificial mechanical ventilation (adjusted OR10.41 IC 3.32-34.14). Conclusions: with the values of the binary logistic regression model for the infection factors, the risk of becoming ill can be estimated.
RESUMO Introdução: as Infecções Associadas à Saúde (SIGC) são um problema de saúde pública em todo o mundo. Objetivo: identificar os fatores de risco para o aparecimento desta doença. Método: foi realizado um estudo analítico de casos e controles em pacientes atendidos na Unidade de Terapia Intensiva Pediátrica (UTI) de Bayamo, que adquiriram uma infecção durante a internação, no período 2018-2019. Resultados: na análise univariada, a alimentação parenteral e o uso de cateter de bexiga não constituíram fator de risco para o aparecimento da doença, enquanto na análise multivariada foi demonstrado que o fator mais importante de forma independente foi o uso de cateter venoso central (OR ajustado 19,44 IC95% 6,83-55,29), seguido pela presença de desnutrição (OR ajustado 10,41 IC95% 3,27-33,14) e ventilação mecânica artificial (OR10,41 IC ajustado 3,32-34,14). Conclusões: com os valores do modelo de regressão logística binária para os fatores de infecção, pode-se estimar o risco de adoecer.
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RESUMEN Introducción: las terapias intensivas pediátricas son esenciales en el funcionamiento hospitalario, pues la asistencia al niño crítico es uno de sus objetivos prioritarios. Objetivo: caracterizar la morbilidad y los principales indicadores de calidad, establecidos por el Ministerio de Salud Pública (MISAP), durante 11 años (2008-2018). Método: se realizó un estudio descriptivo retrospectivo, epidemiológico en la UCIP Bayamo, con pacientes ingresados de 2008-2017, para estudiar el comportamiento de indicadores hospitalarios (ingresos directos, mortalidad neta y bruta, supervivencia general y del ventilado, promedio de estadía, índices ocupacional y tasa de infección asociada a la asistencia sanitaria) y de la morbilidad(ingresos, egresos, evaluación de los ingresos según grupos etarios, motivo de ingreso, tipo y estado nutricional). Resultados: de los ingresos: el 64.2% fue directos, de ellos el 63,6% procedió del cuerpo de guardia y de los intrahospitalarios el 49,3% fueron de gastro; el 50,1% menores de un año, el 18,2% desnutrido, el 14,2% quirúrgicos, en 61,3% por causa infecciosa. Entre los indicadores: tasa de mortalidad neta (2.7%) y la bruta (3.4%), promedio de estadía (5.6), índice ocupacional (77.7%) y tasa de infecciones asociadas a los cuidados sanitarios (5.3). La supervivencia general (96,5%), supervivencia del ventilado (86,1%) y en menores de un año de 96,8% y 85,0%, respectivamente. Conclusiones: se cumplen los indicadores hospitalarios con una elevada supervivencia general y en el paciente ventilado; hay un adecuado aprovechamiento de las camas y dentro de los ingresos predominaron los menores de un año, las causas infecciosas y los procedentes del cuerpo de guardia.
ABSTRACT Introduction: pediatric intensive therapies are essential in hospital operation, since the care of the critical child is one of their priority objectives. Objective: to characterize morbidity and the main quality indicators, established by the Ministry of Public Health (MISAP), for 11 years (2008-2018). Method: a retrospective, epidemiological descriptive study was carried out in the PICU Bayamo, with patients admitted from 2008-2017, to study the behavior of hospital indicators (direct admissions, net and gross mortality, general and ventilated survival, average stay, indices occupational and infection rate associated with health care) and morbidity (income, expenses, evaluation of income according to age groups, reason for admission, type and nutritional status). Results: of the admissions: 64.2% were direct, of them 63.6% came from the guardhouse and from the in-hospital 49.3% were from gastro; 50.1% under one year of age, 18.2% malnourished, 14.2% surgical, in 61.3% due to infectious causes. Among the indicators: net mortality rate (2.7%) and gross (3.4%), average length of stay (5.6), occupational index (77.7%) and rate of infections associated with health care (5.3). Overall survival (96.5%), ventilated survival (86.1%) and in children under one year of age of 96.8% and 85.0%, respectively. Conclusions: hospital indicators are met with a high overall survival and in the ventilated patient; there is an adequate use of the beds and within the income the minors of one year, the infectious causes and those coming from the body of the guard predominated.
RESUMO Introdução: as terapias intensivas pediátricas são essenciais na operação hospitalar, uma vez que o cuidado à criança crítica é um de seus objetivos prioritários. Objetivo: caracterizar a morbidade e os principais indicadores de qualidade, estabelecidos pelo Ministério da Saúde Pública (MISAP), por 11 anos (2008-2018). Método: estudo epidemiológico descritivo, retrospectivo, realizado na UTIP Bayamo, com pacientes internados de 2008 a 2017, para estudar o comportamento dos indicadores hospitalares (admissões diretas, mortalidade líquida e bruta, sobrevida geral e ventilada, permanênciamédia, índices taxa ocupacional e de infecção associada aos cuidados de saúde) e morbidade (renda, alta, avaliação de renda de acordó com a faixa etária, motivo da internação, tipo e estado nutricional). Resultados: das internações: 64,2% foram diretas, 63,6% vieram da guarita e do hospital, 49,3% foram gastro; 50,1% abaixo de um ano de idade, 18,2% desnutridos, 14,2% cirúrgicos, em 61,3% por causas infecciosas. Entre os indicadores: taxa de mortalida de líquida (2,7%) e bruta (3,4%), tempo médio de permanência (5,6), índice ocupacional (77,7%) e taxa de infecções associadas à assistência à saúde (5,3). Sobrevida global (96,5%), sobrevida ventilada (86,1%) e em crianças menores de um ano de 96,8% e 85,0%, respectivamente. Conclusões: os indicadores hospitalares são encontrados com alta sobrevida global e no paciente ventilado; existe um uso adequado dos leitos e, dentro da renda, predominaram os menores de um ano, as causas infecciosas e as provenientes do corpo da guarda.
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INTRODUCTION: Cirrhosis and liver cancer are currently common causes of death worldwide. The global epidemic of obesity has increased the incidence of nonalcoholic fatty liver disease (NAFLD) and cirrhosis in recent years. Advanced fibrosis increases the morbimortality rate in NAFLD. The Mexican population has one of the highest prevalence of obesity and diabetes mellitus (DM) worldwide. AIM: To determine the prevalence of advanced liver fibrosis in Mexican general population. METHODS: Adult individuals, without a history of liver disease nor heavy alcohol consumption were randomly sampled from 20,919 participants of a health and nutrition survey applied to the general population. Clinical and laboratory evaluations were performed to calculate the NAFLD fibrosis score (NFS) (an extensively validated non-invasive method). Two cut-off points were used. Advanced fibrosis was defined as a result >0.676. RESULTS: In total 695 individuals were included. The mean age was 47.8±16.4. The majority were between 20 and 50 years (59%), 70.2% were female, 35.5% showed obesity and 15.8% DM. The 93% had normal serum ALT. Based on the NFS results, 56 individuals (8.1%) had a high probability of fibrosis. Most patients from this subgroup showed normal serum ALT (92.9%), 89.3% were >45yr. old, 52% were obese and 27% suffered from DM. CONCLUSIONS: Based on these results, 8.1% of Mexican general population without a history of liver disease is at high risk of having advanced liver fibrosis and complications and death derived from cardiovascular disease and cirrhosis. Most of them showed normal ALT serum levels.
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Diabetes Mellitus Tipo 2/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Obesidad/epidemiología , Adulto , Anciano , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Femenino , Humanos , Cirrosis Hepática , Masculino , Tamizaje Masivo , México/epidemiología , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/sangre , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Recuento de Plaquetas , Prevalencia , Albúmina Sérica/metabolismoRESUMEN
Eosinophilic enteritis is a rare disease with nonspecific symptoms, often representing a diagnostic challenge. Video capsule endoscopy (VCE) has enabled examination of the full small bowel. However, capsule retention is an unfortunate complication. We present the case of a female patient admitted for abdominal pain. Appendectomy without resolution of symptoms was performed. A normal computed tomography and magnetic resonance imaging were obtained. The diagnosis was made by VCE and double balloon enteroscopy with biopsy. Asymptomatic capsule retention was resolved after corticosteroid therapy. The patient showed a favorable clinical and endoscopic response, confirmed through a second VCE after 3 months of treatment.
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Esofagitis Eosinofílica , Esofagitis , Eosinofilia , Reflujo Gastroesofágico , Hispánicos o Latinos , Humanos , Microbiota , PrevalenciaRESUMEN
Diverse proinflammatory biomarkers and oxidative stress are strongly associated with advanced epithelial ovarian cancer (EOC). Objective. To determine the behavior of markers of oxidative stress and inflammation in plasma and ascites fluid in patients with platinum-sensitive, platinum-resistant, and platinum-refractory EOC. Methods. A prospective cohort study. The colorimetric method was used to determine levels of the markers 8-isoprostanes (8-IP), lipid peroxidation products (LPO), and total antioxidant capacity (TAC) in plasma and ascites fluid; and with ELISA, the levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were determined in patients with EOC. Results. In ascites fluid, a significant increase in 8-IP versus baseline plasma levels was found (p = 0.002). There was an important leakage of the TAC levels in ascites fluid versus baseline plasma levels (p < 0.001). The IL-6 was elevated in ascites fluid versus baseline plasma levels (p = 0.003), and there were diminished levels of TNF-α in ascites fluid versus baseline plasma levels (p = 0.001). Discussion. We hypothesize that the ascites fluid influences the behavior and dissemination of the tumor. Deregulation between oxidants, antioxidants, and the proinflammatory cytokines was found to vary among platinum-sensitive, platinum-resistant, and platinum-refractory patients.