RESUMEN

The organ donation and transplantation (ODT) system heavily relies on the willingness of individuals to donate their organs. While it is widely believed that public trust plays a crucial role in shaping donation rates, the empirical support for this assumption remains limited. In order to bridge this knowledge gap, this article takes a foundational approach by elucidating the concept of trust within the context of ODT. By examining the stakeholders involved, identifying influential factors, and mapping the intricate trust relationships among trustors, trustees, and objects of trust, we aim to provide a comprehensive understanding of trust dynamics in ODT. We employ maps and graphs to illustrate the functioning of these trust relationships, enabling a visual representation of the complex interactions within the ODT system. Through this conceptual groundwork, we pave the way for future empirical research to investigate the link between trust and organ donation rates, informed by a clarified understanding of trust in ODT. This study can also provide valuable insights to inform interventions and policies aimed at enhancing organ donation rates.

Asunto(s)

RESUMEN

OBJECTIVE: To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing. METHODS: Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient's father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing. RESULTS: Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son's health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88). CONCLUSIONS: We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents' self-perception of error management was regular and not modified by the debriefing.

Asunto(s)

RESUMEN

INTRODUCTION: There is a discrepancy in the literature as to whether authorising or refusing the recovery of organs for transplantation is of direct benefit to families in their subsequent grieving process. This study aims to explore the impact of the family interview to pose the option of posthumous donation and the decision to authorise or refuse organ recovery on the grieving process of potential donors' relatives. METHODS AND ANALYSIS: A protocol for mixed methods, prospective cohort longitudinal study is proposed. Researchers do not randomly assign participants to groups. Instead, participants are considered to belong to one of three groups based on factors related to their experiences at the hospital. In this regard, families in G1, G2 and G3 would be those who authorised organ donation, declined organ donation or were not asked about organ donation, respectively. Their grieving process is monitored at three points in time: 1 month after the patient's death, when a semistructured interview focused on the lived experience during the donation process is carried out, 3 months and 9 months after the death. At the second and third time points, relatives' grieving process is assessed using six psychometric tests: State-Trait Anxiety Inventory, Beck Depression Inventory-II, Inventory of Complicated Grief, The Impact of Event Scale: Revised, Posttraumatic Growth Inventory and Connor-Davidson Resilience Scale. Descriptive statistics (means, SDs and frequencies) are computed for each group and time point. Through a series of regression models, differences between groups in the evolution of bereavement are estimated. Additionally, qualitative analyses of the semistructured interviews are conducted using the ATLAS.ti software. ETHICS AND DISSEMINATION: This study involves human participants and was approved by Comité Coordinador de Ética de la Investigación Biomédica de Andalucía (CCEIBA) ID:1052-N-21. The results will be disseminated at congresses and ordinary academic forums. Participants gave informed consent to participate in the study before taking part.

Asunto(s)

RESUMEN

ABSTRACT Objective: To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing. Methods: Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient's father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing. Results: Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son's health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88). Conclusions: We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents' self-perception of error management was regular and not modified by the debriefing.

RESUMO Objetivo: Determinar o desempenho de grupos de residentes pediátricos de um hospital de Buenos Aires, em termos de reconhecimento e comunicação correta de um erro médico (EM),em cenário de simulação. Descrever as reações e tentativas de comunicação após o EM e a autopercepção pelos estagiários antes e depois de um questionário. Métodos: Estudo quase experimental não controlado realizado em centro de simulação. Participaram residentes pediátricos do primeiro e terceiro anos. Concebeu-se um caso de simulação em que ocorreu um EM com deterioração de um paciente. Durante a simulação, os participantes tiveram que fornecer informações relacionadas à comunicação do EM ao pai do paciente. Avaliou-se o desempenho da comunicação e, adicionalmente, os participantes completaram um inquérito de autopercepção sobre a gestão da EM, antes e depois de um questionário. Resultados: Onze grupos de residentes participaram. Dez (90,9%) identificaram corretamente o EM, mas apenas 27,3% (n=3) deles comunicaram que havia ocorrido o EM. Nenhum dos grupos disse ao pai que iria dar notícias importantes sobre a saúde do seu filho. Todos os 18 residentes que participaram ativamente da comunicação completaram o questionário de autopercepção com uma pontuação média antes e depois do questionário de 5,00 e 5,05 (máximo: 10 pontos) (p=0,88). Conclusões: Observamos elevado número de grupos que reconheceram a presença de um EM, mas a ação de comunicação foi rara. A capacidade de comunicação foi insuficiente e a autopercepção da gestão de erros por parte dos residentes foi regular, não sendo modificada pelo debriefing.

RESUMEN

Introduction: Chronic noncommunicable diseases (NCDs) account for leading causes of death in Argentina and early identification of their risk factors (RF) is key to prevention.Objective: The objective of this study was to describe the frequency of RF for NCDs among students from Universidad Nacional de la Matanza. Methods: A cross-sectional study was performed, using a self-reported survey adapted from the "National survey of risk factors", to describe risk factors and their association with sociodemographic characteristics. Results: A total of 130 students participated; 6.9% identified their health as "fair" and 48.5% referred some degree of anxiety or depression, 26.2% reported a low level of physical activity and almost all respondents ate less than 5 fruits or vegetables per day, 6.2% were smokers and 38.5% were exposed to tobacco smoke. The prevalence of overweight and obesity was 23.2% and 6.4% respectively. Occasional high cholesterol and blood pressure were reported by 20.4% and 16.8% of respondents, respectively. Conclusion: The university is an ideal setting for activities aimed at the promotion and prevention of these RF.

INTRODUCCIÓN: Las Enfermedades Crónicas No Transmisibles (ECNT) representan las principales causas de muerte en Argentina y la identificación temprana de sus factores de riesgo (FR) es clave para su prevención. El objetivo de este estudio fue describir la frecuencia de FR y ECNT en estudiantes de la Universidad Nacional de La Matanza. MÉTODOS: Se realizó un estudio de corte transversal, utilizando un cuestionario adaptado de la Encuesta Nacional de Factores de Riesgo por autorreporte, para describir los FR y su asociación con características sociodemográficas. RESULTADOS: Se encuestaron 130 estudiantes de ambos sexos. El 6,9% identificó su salud como "regular" y un 48,5% algún grado de ansiedad o depresión. El 26,2% reportó bajo nivel de actividad física y casi todos los encuestados consumieron menos de 5 porciones de frutas y verduras al día. Un 6,2% reportó ser fumador y un 38,5% estar expuesto al humo del tabaco. La prevalencia de sobrepeso fue de 23,2% y de obesidad de 6,4%. El 20,4% y el 16,8% de los estudiantes informaron respectivamente colesterol y presión arterial elevados "alguna vez". CONCLUSIÓN: El ámbito universitario es un espacio ideal para el abordaje de actividades de promoción y prevención de estos FR.

Asunto(s)

RESUMEN

Introducción: La falta de adherencia al tratamiento farmacológico es uno de los principales problemas en pacientes con enfermedades crónicas. Una falta de adherencia se relaciona con un aumento de la discapacidad y de los costes sanitarios. El objeti-vo principal de este artículo es conocer el grado de adherencia al tratamiento en pacientes con la enfermedad de Parkinson. Método: se ha realizado un estudio observacional, longitudinal y prospectivo en colaboración con la Federación de Asociaciones de Parkinson de la Región de Murcia (FEPAMUR) y farmacias colabo-radoras de la Región de Murcia. Se llevó a cabo un procedimiento de recogida de datos demográficos del paciente (sexo y edad) con el fin de caracte-rizarlos, y se evaluó la adherencia al tratamiento mediante el Test de Morisky-Green y el test de Hermes.Resultados: Al estudiar la adherencia con el Test de Morisky-Green se aprecia que el 64% obtuvo una adherencia baja al tratamiento, el 19% presentó una adherencia media, mientras que sólo el 17% de los pacientes fue muy adherente. Según el test de Hermes se observa que un 42% de los pacientes son adherentes al tratamiento. Conclusiones: Existe una baja adherencia al trata-miento farmacológico, según el test de Hermes y el test de Morisky-Green. En función del sexo se con-cluye que las mujeres son más adherentes que los hombres y si nos enfocamos en la edad, se erigen como más adherentes aquellos pacientes con una edad menor a 60 años. (AU)

Introduction: Lack of adherence to drug treatment is one of the main problems in patients with chronic diseases. A lack of adherence is related to an in-crease in disability and healthcare costs. The main objective of this article is to evaluate the degree of adherence to treatment in patients with Parkinson's disease. Method: An observational, longitudinal and pros-pective study has been carried out in collaboration with the Federation of Parkinson's Associations of the Region of Murcia (FEPAMUR) and collaborating pharmacies of the Region of Murcia. A patients demographic data collection procedure (sex and age) was carried out in order to characterize them. Besides, adherence to treatment was evaluated using the Morisky-Green test and the Hermes test.Results: When studying adherence with the Moris-ky-Green Test, it could be seen that 64% had low adherence to treatment, 19% had medium adhe-rence, while only 17% of the patients were highly adherent. According to the Hermes test, it was observed that 42% of the patients were adherent to treatment.Conclusions: There is a low adherence to pharma-cological treatment, according to the Hermes test and the Morisky-Green test. According to sex, we conclude that women are more adherent than men, and if we focus on the age, patients under 60 years of age are more adherent. (AU)

Asunto(s)

RESUMEN

BACKGROUND: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management. OBJECTIVE: The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic. METHODS: In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed. RESULTS: A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries. CONCLUSIONS: Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective.

RESUMEN

Theorists of the ethics and politics of care, with their feminist and intersectional analyses, have spent decades trying to leave their mark on clinical practice and political structures . In them, extensive processes of humanization of the relationship between professionals and people who need their care are required, without neglecting inequalities due to gender, social class or belonging to vulnerable minority groups that go through health and disease experiences in the community. society. It is evident that our institutions must be extensively rethought in their foundations; from nursing homes to highly technological ICUs; from the saturation of primary care to the lack of specialized personnel. In areas such as nursing, great emphasis is placed on models based on interdependence and the particular context to generate another care framework , while fighting for hierarchies and invisibilities related to highly feminized professions . Not surprisingly, the reflections that follow are signed by three women with hybrid profiles who have dedicated part of our working life to the field of primary and hospital care (both in nursing and in physiotherapy) and, in turn, to research and teaching in bioethics, philosophy and humanities. We have experienced in our flesh the contradictions between a will to serve and some axes of oppression connatural to the institutions.

Las teóricas de las éticas y políticas del cuidado, con sus análisis en clave feminista e interseccional, llevan décadas intentando dejar huella en la práctica clínica y en las estructuras políticas . En ellas, se requieren amplios procesos de humanización de la relación entre profesionales y personas que necesitan su atención, sin dejar de lado las desigualdades por motivos de género, clase social o pertenencia a colectivos vulnerables minoritarios que atraviesan las vivencias de salud y enfermedad en la sociedad. Es evidente que nuestras instituciones deben ser ampliamente repensadas en sus fundamentos; desde las residencias de ancianos a las UCI altamente tecnologizadas; desde la saturación de la atención primaria a la falta de personal especializado. En ámbitos como la enfermería se hace gran hincapié en los modelos basados en la interdependencia y el contexto particular para generar otro marco de asistencia , a la vez que se lucha por las jerarquías e invisibilidades relacionadas con las profesiones altamente feminizadas . No en vano las reflexiones que siguen las firman tres mujeres con perfiles híbridos que hemos dedicado parte de nuestra vida laboral al ámbito de la atención primaria y hospitalaria (tanto en enfermería como en fisioterapia) y, a su vez, a la investigación y la docencia en bioética, filosofía y humanidades. Hemos vivido en nuestras carnes las contradicciones entre una voluntad de servicio y unos ejes de opresión connaturales a las instituciones.

Asunto(s)

Asunto(s)

RESUMEN

Objetivo: Determinar la prevalencia de úlceras de pierna y caracterizar los pacientes afectados, las lesiones y el tratamiento recibido. Método: Estudio observacional, transversal de prevalencia. Se diseñó un cuestionario online ad hoc que se envió a todas las enfermeras de Atención Primaria de la Gerencia de Atención Integrada de Cuenca (España), y se recogieron variables relativas a los pacientes estudiados (sociodemográficas y clínicas), a las lesiones y a las intervenciones recibidas (preventivas y de tratamiento). Resultados: Contestaron 152 profesionales (tasa de respuesta=98,1%), y fue posible estudiar a 131.190 habitantes. En total, se identificaron 63 pacientes (edad=75,5±12,6 años) con 75 lesiones, por lo que la prevalencia global fue de 0,480‰ (IC 95%: 0,375-0,614), y las lesiones se distribuyeron como: úlcera de etiología venosa 0,274‰ (n=36), pie diabético 0,145‰ (n=19), y úlcera de etiología arterial 0,061‰ (n=8). La prevalencia fue similar en hombres y mujeres (0,535‰ vs. 0,426‰ respectivamente, p=0,365), pero los hombres mostraron más pie diabético (0,214‰ vs. 0,076‰, P=0,037). Para los tres tipos de lesiones, las prevalencias aumentaron al subir la edad, llegando a 1,743‰ en mayores de 65 años. La mediana de duración y el área corregida de las úlceras fue 190,0±340,0 días y 5,0±13,7 cm2, respectivamente, y el 74,7% fueron recurrentes. Conclusiones: La prevalencia de úlceras de pierna encontrada es inferior a la de otros estudios, aunque con altas tasas de recurrencia. Los estimadores globales de estudios anteriores pueden haber sobreestimado la prevalencia, especialmente en regiones con un alto componente rural.(AU)

Objective: To determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment. Method: Observational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the “Gerencia de Atención Integrada de Cuenca” (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected. Results: In total, 152 professionals (response rate=98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5±12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n=36), diabetic foot 0.145‰ (n=19), and arterial ulcer 0.061‰ (n=8). The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p=.365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p=.037).In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64+age group.The median of the leg ulcer duration and corrected area were 190.0±340.0 days and 5.0±13.7cm2, respectively, with a recurrence rate of 74.7%. Conclusions: The prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.(AU)

Asunto(s)

RESUMEN

OBJECTIVE: To determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment. METHOD: Observational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the "Gerencia de Atención Integrada de Cuenca" (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected. RESULTS: In total, 152 professionals (response rate = 98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5 ± 12.6 years old) with 75 ulcers were identified, finding an overall prevalence of .480‰ (CI 95%: .375-.614), distributed as: venous ulcer .274‰ (n = 36), diabetic foot .145‰ (n = 19), and arterial ulcer .061‰ (n = 8). The prevalence was similar regarding gender (.535‰ vs .426‰, respectively, p = .365), but men exhibited more diabetic foot (.214‰ vs .076‰, p = .037). In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64+ age group. The median of the leg ulcer duration and corrected area were 190.0 ± 340.0 days and 5.0 ± 13.7 cm2, respectively, with a recurrence rate of 74.7%. CONCLUSIONS: The prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.

Asunto(s)

RESUMEN

The success on the design of new oral nanocarriers greatly depends on the identification of the best physicochemical properties that would allow their diffusion across the mucus layer that protects the intestinal epithelium. In this context, particle tracking (PT) has arisen in the pharmaceutical field as an excellent tool to evaluate the diffusion of individual particles across the intestinal mucus. In PT, the trajectories of individual particles are characterized by the mean square displacement (MSD), which is used to calculate the coefficient of diffusion (D) and the anomalous diffusion parameter (α) as MSD=4Dτα. Unfortunately, there is no stablished criteria to evaluate the goodness-of-fit of the experimental data to the mathematical model. This work shows that the commonly used R2 parameter may lead to an overestimation of the diffusion capacity of oral nanocarriers. We propose a screening approach based on a combination of R2 with further statistical parameters. We have analyzed the effect of this approach to study the intestinal mucodiffusion of lipid oral nanocarriers, compared to the conventional screening approach. Last, we have developed software able to perform the whole PT analysis in a time-saving, user-friendly, and rational fashion.

RESUMEN

BACKGROUND: The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). METHODS: We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC's catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC's staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). RESULTS: A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. CONCLUSION: The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

Asunto(s)

RESUMEN

OBJECTIVE: To determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment. METHOD: Observational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the "Gerencia de Atención Integrada de Cuenca" (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected. RESULTS: In total, 152 professionals (response rate=98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5±12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n=36), diabetic foot 0.145‰ (n=19), and arterial ulcer 0.061‰ (n=8). The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p=.365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p=.037). In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64+age group. The median of the leg ulcer duration and corrected area were 190.0±340.0 days and 5.0±13.7cm2, respectively, with a recurrence rate of 74.7%. CONCLUSIONS: The prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.

RESUMEN

Ampicillin plus ceftriaxone (AC) is a well-recognized inpatient regimen for Enterococcus faecalis infective endocarditis (IE). In this regimen, ceftriaxone is usually administered 2 g every 2 h (AC12). The administration of AC in outpatient parenteral antibiotic treatment (OPAT) programs is challenging because multiple daily doses are required. AC regimens useful for OPAT programs include once-daily high-dose administration of ceftriaxone (AC24) or AC co-diluted and jointly administered in bolus every 4 h (ACjoined). In this retrospective analysis of prospectively collected cases, we aimed to assess the clinical effectivity and safety of three AC regimens for the treatment of E. faecalis IE. Fifty-nine patients were treated with AC combinations (AC12 n = 32, AC24 n = 17, and ACjoined n = 10). Six relapses occurred in the whole cohort: five (29.4%) treated with AC24 regimen and one (10.0%) with ACjoined. Patients were cured in 30 (93.3%), 16 (94.1%), and eight (80.0%) cases in the AC12, AC24 and ACjoined groups, respectively. Unplanned readmission occurred in eight (25.0%), six (35.3%), and two (20.0%) patients in the AC12, AC24 and ACjoined groups, respectively. The outcome of patients with E. faecalis IE treated with AC in OPAT programs relies on an optimization of the delivery of the combination. AC24 exhibit an unexpected rate of failures, however, ACjoined might be an effective alternative which clinical results should corroborate in further studies.

RESUMEN

OBJETIVOS: Analizar la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica avanzada y determinar su relación con la dependencia para las actividades instrumentales de la vida diaria. MATERIAL Y MÉTODO: Se realizó un estudio descriptivo transversal en el Servicio de Nefrología del Hospital Universitario Reina Sofía de Córdoba, en el que se incluyeron pacientes con enfermedad renal crónica avanzada en estadios 4-5. Se utilizaron los siguientes cuestionarios: KDQOL-SF, para analizar la calidad de vida relacionada con la salud; Lawton y Brody, para dependencia para las actividades instrumentales de la vida diaria. RESULTADOS: Se estudiaron 105 pacientes con una edad de 67,8±15,7 años; 35 mujeres (33,3%). En el KD-QOL-SF, las dimensiones más afectadas fueron los Cambios en el estado de salud, Situación laboral, Carga de la enfermedad renal, Salud general, Vitalidad y Rol físico. El 57,1% de la muestra tenían algún grado de dependencia para las actividades instrumentales de la vida diaria. Los pacientes con mayor grado de dependencia presentaron peores puntuaciones en las dimensiones Efectos de la enfermedad renal, Situación laboral, Función cognitiva, Sueño, Función física, Rol físico, Dolor, Función social y Vitalidad. CONCLUSIONES: Los pacientes en prediálisis tienen disminuida la calidad de vida relacionada con la salud en las dimensiones Cambios en el estado de salud, Situación laboral, Carga de la enfermedad renal, Salud general, Vitalidad y Rol físico. Más de la mitad de la muestra presentan algún tipo grado de dependencia para la realización de las actividades instrumentales de la vida diaria

OBJECTIVES: To analyze the health-related quality of life (HRQoL) in patients with advanced chronic kidney disease in pre-dialysis and the relationship with the dependency for the instrumental activities of daily living (IADL). MATERIAL AND METHOD: A descriptive and cross-sectional study was carried out in the Nephrology Service of the Reina Sofía University Hospital in Córdoba. It was a non-probability accidental sampling. The following questionnaires were used: KDQOL-SF to analyze HRQoL and Lawton y Brody for IADL dependency. RESULTS: 105 patients on pre-dialysis were studied with an age of 67,8±15,7 years and 35 women (33,3%). With regards to the KDQOL, the most affected dimensions were Changes in health status, Work situation, Burden of kidney disease, General health, Vitality and Physical role. 57.1% of the participants had some degree of dependence for the instrumental activities of daily life. Patients with a higher degree of dependency had worse scores in the dimensions Effects of kidney disease, Work situation, Cognitive function, Sleep, Physical function, Physical role, Pain, Social function and Vitality. CONCLUSIONS: Pre-dialysis patients have a decreased health-related quality of life in the dimensions Changes in health status, Work situation, Burden of kidney disease, General health, Vitality and Physical role. More than half of the participants show some type of dependency to carry out the instrumental activities of daily life

Asunto(s)

Asunto(s)

RESUMEN

La tuberculosis pulmonar es un problema de salud pública a nivel mundial. La Organización Mundial de la Salud en el año 2018 reportó alrededor de 10 millones de enfermos y 1,5 millones de muertes. Mycobacterium tuberculosis es un patógeno intracelular y el agente causal de la enfermedad. Estudios experimentales de virulencia han permitido determinar un conjunto de genes de virulencia, que le confieren la capacidad de resistir el ambiente hostil en el macrófago, superar la actividad de la respuesta inmune y persistir en el hospedero. El objetivo de la publicación es presentar una revisión de las investigaciones de los últimos 20 años que han demostrado los genes o factores de virulencia de M. tuberculosis que contribuyen a la evasión de la respuesta inmune. Según los resultados de las investigaciones, existen múltiples factores y genes de virulencia que participan en la evasión de la respuesta inmune innata como ESAT-6, PknG, PhoP, ManLAM, SapM, katG, tpx, nuoG, sodA/secA2, pknE y Rv3654c/Rv3655c, mientras existen elementos capaces de modular la respuesta inmune adaptativa. La comprensión de la interacción entre los genes de virulencia y la actividad del sistema inmune, son importantes para estudiar nuevos métodos de diagnóstico, el diseño de nuevas vacunas y por ende, mejorar las medidas de control, prevención y tratamiento de la tuberculosis(AU)

Pulmonary tuberculosis is a public health problem worldwide. The World Health Organization in 2018 reported about 10 million patients and 1.5 million deaths. Mycobacterium tuberculosis, an intracellular pathogen, is the causative agent of the disease. Experimental virulence studies have allowed to determine a set of virulence genes that confer the ability to resist the hostile environment in the macrophage, overcome the activity of the immune response and persist in the host. The objective of the publication is to present a review of the last 20 years investigations that have shown the genes or virulence factors of M. tuberculosis that contribute to the evasion of the immune response. According to the results of the investigations, there are multiple virulence factors and genes that participate in the evasion of the innate immune response such as ESAT-6, PknG, PhoP, ManLAM, SapM, katG, tpx, nuoG, sodA/secA2, pknE and Rv3654c/Rv3655c, while there are elements capable of modulating the adaptive immune response. The understanding of the interaction between the virulence genes and the activity of the immune system, are important to study new diagnostic methods, the design of new vaccines and therefore, to improve the control, prevention and treatment measures of tuberculosis(AU)

Asunto(s)