RESUMEN
INTRODUCTION: Proton pump inhibitors (PPIs) are among the most commonly prescribed medications. Recently, PPI use has been linked to the development of chronic kidney disease (CKD) and cardiovascular events. Our study aimed to investigate the relationship between PPI use and the incidence of chronic kidney disease using a systematic review and meta-analysis. METHODS: We performed a comprehensive literature search in PubMed, Embase, and Cochrane databases from their inception until March 2024 for relevant studies. We compared outcomes between patients using PPIs, those not using PPIs, and those using histamine-2 receptor antagonists (H2RAs). Endpoints were pooled using the DerSimonian-and-Laird random-effects model as the hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS: Our analysis included twelve studies with a total of 700,125 participants (286,488 on PPIs, 373,848 not on PPIs, and 39,789 on H2RAs), with follow-up periods ranging from three months to 14 years. The current meta-analysis revealed that PPI use is associated with a statistically significant increased risk of incident CKD (HR: 1.26, 95% CI: 1.16-1.38, p < 0.001) compared with non-users. Moreover, the risk of incident CKD is significantly higher in patients with PPI use compared to H2RA use (HR: 1.34, 95% CI: 1.13-1.59, p < 0.001). The results remained unchanged in terms of magnitude and direction after a leave-one-out analysis for both outcomes. CONCLUSIONS: Our multifaceted analysis showed that PPI use was associated with a higher incidence of CKD when compared to non-PPI use and H2RA use, respectively. These findings advocate for heightened vigilance and judicious use of long-term PPIs. Further large prospective longitudinal studies are warranted to validate these observations.
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Introducción y objetivo: La formación y la docencia son dos objetivos fundamentales de la Federación Ibero Latinoamericana de Cirugía Plástica (FILACP), entidad compuesta por las Sociedades Nacionales de Cirugía Plástica de 22 países de Ibero Latinoamérica. El objetivo de nuestro trabajo fue poner en común y discutir la situación de la formación especializada en Cirugía Plástica en los diferentes países miembros de la FILACP, en una reunión en la que estuvieron presentes tutores acreditados por cada una de la Sociedades Nacionales de Cirugía Plástica que componen la Federación. Material y método: Se realizaron encuestas y entrevistas personales a tutores y representantes de las sociedades nacionales miembros de la FILACP, en las que se recabó información sobre oferta docente anual y servicios acreditados, proceso de admisión, duración del periodo formativo, financiación de la formación, periodos lectivos anuales, métodos de supervisión y métodos de evaluación. Los resultados obtenidos se contrastaron y pusieron en común durante el Encuentro Internacional de Tutores de la FILACP celebrado en abril de 2022 en San José, Costa Rica. Resultados: En los paises de la Federación se formó en 2021 a un total de 539 residentes en 245 servicios docentes acreditados, siendo aproximadamente la oferta media de 1 residente por cada 700.000 habitantes. El examen fue la principal vía de acceso a la especialidad, cuya duración osciló entre 3 y 5 años, siendo 3 años lo más frecuente. Los periodos lectivos anuales estuvieron en rangos entre 1920 y 4150 horas, siendo la cifra más frecuente en torno a 2500 horas al año. La supervisión por plantilla y el jefe de residentes fueron figuras establecidas en muchos centros, y el examen fue el método de evaluación más extendido. (AU)
Background and objective: Training and teaching are two fundamental objectives of the Ibero-Latin American Federation of Plastic Surgery (FILACP), an entity composed of the National Societies of Plastic Surgery of 22 Ibero-Latin American countries. The aim of our work was to share and discuss the situation of specialized training in Plastic Surgery in the different member countries of FILACP, in a meeting where tutors accredited from all the Plastic Surgery National Societies of the Federation were present. Methods: Surveys and personal interviews were carried out with tutors and representatives of the national societies members of FILACP, in which information was collected on the annual teaching offer and accredited services, admission process, duration of the training period, financing of the training, annual teaching periods, supervision methods and evaluation methods. The results obtained were contrasted and shared during the FILACP International Meeting of Tutors held in April 2022 in San José, Costa Rica. Results: In the Federation countries, a total of 539 residents were formed in 2021 in 245 accredited teaching services, the average supply being approximately 1 resident per 700.000 inhabitants. The examination was the main access route to the specialty, the duration of which ranged from 3 to 5 years, with 3 years being the most frequent. Annual teaching periods ranged from 1920 to 4150 hours, the most frequent figure being around 2500 hours per year. Supervision by staff and chief resident were established figures in many centers, and examination was the most widespread method of evaluation. (AU)
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Humanos , Cirugía Plástica/educación , Educación Especial , Encuestas y Cuestionarios , Organizaciones de Normalización Profesional , América LatinaRESUMEN
Atrial fibrillation (AF) affects 1-2% of the population. Twenty percent of all strokes are caused by AF. In this study, we represented the clinical knowledge in the European Society of Cardiology guideline using Guideline Definition Language (GDL), a format that binds openEHR archetypes, rule languages, and reference terminologies together. The computerized guidelines are applied to electronic health record (EHR) data retrospectively in order to identify possible gaps between current clinical practice and optimal care recommended by the evidence-based guidelines. Treatment compliance is checked in two patient groups: one received treatment from a cardiologist who is responsible for AF treatment in the region (n=514) and the other was a much larger patient group from the whole region (n=8130). The compliance checking shows the cardiologist group has substantially higher percentage of compliant treatment compared with that of the general population group. Based on this important finding, we are now implementing at-point-of-care clinical decision support reusing the same computerized guideline knowledge in GDL format in order to increase the guideline adherence of the treatment.
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Fibrilación Atrial/epidemiología , Fibrilación Atrial/terapia , Sistemas de Apoyo a Decisiones Clínicas/normas , Adhesión a Directriz/estadística & datos numéricos , Guías como Asunto , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/prevención & control , Anciano , Causalidad , Comorbilidad , Humanos , Incidencia , Masculino , Factores de Riesgo , Suecia , Resultado del TratamientoRESUMEN
Se realizó un estudio descriptivo, de corte transversal en el Policlínico "Felo Echezarreta Mulkay" del municipio San José de las Lajas en 40 mujeres (100 por ciento del universo), con edades comprendidas entre 25 y 65 años, que tenían diagnosticado en sus citologías NIC I, NIC II, NIC III y Carcinoma in situ, inasistentes a la consulta de patología de cuello durante el período de 12 meses comprendidos entre enero y diciembre del 2006. Se les aplicó un cuestionario, con el objetivo de identificar las principales causas de inasistencia. Además se supervisaron los consultorios a los que pertenecen estas pacientes para constatar acciones y estrategias llevadas a cabo con ellas. Se estudiaron las variables: edad, nivel educacional, estadíos de las NIC, tiempo de inasistencia, conocimientos sobre su enfermedad, acciones de salud realizadas y principales causas de inasistencia. Se concluyó que las mujeres estudiadas desconocen sobre su patología, tratamiento y pronóstico, se ofrece escasa información por los equipos de salud, así como no son suficientes las acciones que realizan, la inasistencia está relacionada principalmente con dificultades en el funcionamiento de la consulta y el temor por el diagnóstico
A cross-sectional and descriptive study was performed in "Felo Echezarreta Mulkay" Polyclinic in San José de las Lajas Municipality among 40 females aged 25-65 (100 per cent of the study group) that were diagnosed CIN I, CIN II, CIN III and in situ carcinoma in their cytologies. They had been absent from the cervical pathology department during 12 months, from January to December 2006. A questionnaire was applied to identify the main causes of absence. The family physician's offices where these females received attention were supervised to confirm the actions and strategies carried out with them. The following variables were studied: age, educational level, CIN staging, absence period, knowledge on their disease, health actions taken, and main causes of absence. It was concluded that the studied females do not know about their pathology, treatment, and prognosis, that the health team provide little information, and that the actions taken are insufficient. Absence is mainly related to the difficulties in the functioning of the cervical pathology department, and to the fact that they fear the diagnosis(AU)
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Neoplasias del Cuello UterinoRESUMEN
Se realizó un estudio descriptivo, de corte transversal en el Policlínico "Felo Echezarreta Mulkay" del municipio San José de las Lajas en 40 mujeres (100 por ciento del universo), con edades comprendidas entre 25 y 65 años, que tenían diagnosticado en sus citologías NIC I, NIC II, NIC III y Carcinoma in situ, inasistentes a la consulta de patología de cuello durante el período de 12 meses comprendidos entre enero y diciembre del 2006. Se les aplicó un cuestionario, con el objetivo de identificar las principales causas de inasistencia. Además se supervisaron los consultorios a los que pertenecen estas pacientes para constatar acciones y estrategias llevadas a cabo con ellas. Se estudiaron las variables: edad, nivel educacional, estadíos de las NIC, tiempo de inasistencia, conocimientos sobre su enfermedad, acciones de salud realizadas y principales causas de inasistencia. Se concluyó que las mujeres estudiadas desconocen sobre su patología, tratamiento y pronóstico, se ofrece escasa información por los equipos de salud, así como no son suficientes las acciones que realizan, la inasistencia está relacionada principalmente con dificultades en el funcionamiento de la consulta y el temor por el diagnóstico(AU)
A cross-sectional and descriptive study was performed in "Felo Echezarreta Mulkay" Polyclinic in San José de las Lajas Municipality among 40 females aged 25-65 (100 per cent of the study group) that were diagnosed CIN I, CIN II, CIN III and in situ carcinoma in their cytologies. They had been absent from the cervical pathology department during 12 months, from January to December 2006. A questionnaire was applied to identify the main causes of absence. The family physician's offices where these females received attention were supervised to confirm the actions and strategies carried out with them. The following variables were studied: age, educational level, CIN staging, absence period, knowledge on their disease, health actions taken, and main causes of absence. It was concluded that the studied females do not know about their pathology, treatment, and prognosis, that the health team provide little information, and that the actions taken are insufficient. Absence is mainly related to the difficulties in the functioning of the cervical pathology department, and to the fact that they fear the diagnosis(AU)
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Humanos , Femenino , Adulto , Persona de Mediana Edad , Carcinoma in Situ/patología , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/patología , Epidemiología Descriptiva , Estudios Transversales , Encuestas y CuestionariosAsunto(s)
Resistencia a la Proteína C Activada/diagnóstico , Enfermedades Cerebelosas/diagnóstico , Infarto Cerebral/diagnóstico , Embolia Paradójica/diagnóstico , Defectos del Tabique Interatrial/diagnóstico , Resistencia a la Proteína C Activada/complicaciones , Resistencia a la Proteína C Activada/terapia , Adulto , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Cateterismo Cardíaco , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/terapia , Infarto Cerebral/complicaciones , Infarto Cerebral/terapia , Diagnóstico Diferencial , Embolia Paradójica/complicaciones , Embolia Paradójica/terapia , Fibrinolíticos/uso terapéutico , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Masculino , Ilustración Médica , Inhibidores de Agregación Plaquetaria/uso terapéutico , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/terapia , Ultrasonografía , Warfarina/uso terapéuticoRESUMEN
OBJECTIVE: To determine the prevalence of liver changes in workers at an oil refinery located in the state of Bahia, Brazil, as compared to a reference population with no occupational exposure to chemical products, and to describe the factors associated with the observed differences in prevalence. METHODS: We studied workers at the refinery and at the company's central management office located in the city of Salvador, which is the state capital. Blood samples of 692 refinery workers and 377 workers from the reference population were analyzed. Cases were defined as individuals presenting high serum levels of both gammaglutamyltransferase (GGT) and alanine aminotransferase (ALT) (GGT > 50 U/L for males and > 32 U/L for females; ALT > 50 U/L). Data were collected on age, sex, weight, height, years working for the company, use of alcohol, smoking habits, physical exercise, occupational exposure to chemical products, use of personal safety equipment, and medical history of hepatitis, jaundice, and obesity. RESULTS: The prevalence of liver changes among refinery workers was 15.3% (95% CI: 12.5 to 18.1), vs. 3.8% (95% CI: 1,8 to 5,8) in the reference population. According to multiple logistic regression analysis, the prevalence of liver changes among refinery workers was 3.56 times greater (95% CI: 1,99 to 6,38) than in the reference population, regardless of the presence of other relevant co-variables, such as obesity, exercise, smoking, and alcohol consumption. CONCLUSIONS: These results suggest that occupational exposure may play a major role in the development of liver changes among workers at the oil refinery where the study was carried out.
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Enfermedad Hepática Inducida por Sustancias y Drogas , Exposición Profesional , Petróleo/efectos adversos , Adulto , Anciano , Brasil/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Hepatopatías/sangre , Hepatopatías/epidemiología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/epidemiología , Prevalencia , Análisis de Regresión , Factores de RiesgoRESUMEN
Objetivo. Determinar a prevalência de alterações nas enzimas hepáticas de trabalhadores de uma refinaria de petróleo localizada no Estado da Bahia em comparação a uma população de referência não ocupacionalmente exposta a produtos químicos, e descrever os fatores associados à variação nessa prevalência. Método. Foram avaliados os trabalhadores da refinaria e os funcionários do escritório da gerência administrativa da empresa, situada em Salvador, capital do Estado da Bahia. Estudaram-se amostras de sangue de 692 trabalhadores da refinaria e de 377 trabalhadores da população de referência. Classificaram-se como casos de alterações hepáticas indivíduos que apresentaram valo res acima dos padrões de referência simultaneamente para gama-glutamiltransferase (GGT) (> 50 U/L para o sexo masculino e > 32 U/L para o sexo feminino) e alanina aminotrans ferase (ALT) (> 50 U/L). Foram coletadas informações sobre idade, sexo, peso, altura, tempo de serviço, uso de álcool, hábito de fumar, exercício físico, exposição ocupacional a produtos químicos, uso de equipamento de proteção individual e antecedentes médicos de hepatite, icterícia e obesidade. Resultados. A prevalência de alterações hepáticas na refinaria foi de 15,3% (IC95%: 12,5 a 18,1), contra 3,8% (IC95%: 1,8 a 5,8) na população de referência. A análise de regressão logística múltipla estimou que os trabalhadores da refinaria apresentavam uma prevalência de alterações hepáticas 3,56 vezes maior (IC95%: 1,99 a 6,38) do que a prevalência observada na população de referência, independentemente de outras covariáveis relevantes, como obesidade, prática de exercícios físicos, fumo e bebida alcoólica. Conclusões. Os resultados sugerem que a exposição ocupacional desempenha um papel importante na determinação das alterações hepáticas nos trabalhadores dessa refinaria de petróleo
Objective. To determine the prevalence of liver changes in workers at an oil refinery located in the state of Bahia, Brazil, as compared to a reference population with no occupational exposure to chemical products, and to describe the factors associated with the observed differences in prevalence. Methods. We studied workers at the refinery and at the company's central management office located in the city of Salvador, which is the state capital. Blood samples of 692 refinery workers and 377 workers from the reference population were analyzed. Cases were defined as individuals presenting high serum levels of both gammaglutamyltransferase (GGT) and alanine aminotransferase (ALT) (GGT > 50 U/L for males and > 32 U/L for females; ALT > 50 U/L). Data were collected on age, sex, weight, height, years working for the company, use of alcohol, smoking habits, physical exercise, occupational exposure to chemical products, use of personal safety equipment, and medical history of hepatitis, jaundice, and obesity. Results. The prevalence of liver changes among refinery workers was 15.3% (95% CI: 12.5 to 18.1), vs. 3.8% (95% CI: 1,8 to 5,8) in the reference population. According to multiple logistic regression analysis, the prevalence of liver changes among refinery workers was 3.56 times greater (95% CI: 1,99 to 6,38) than in the reference population, regardless of the presence of other relevant co-variables, such as obesity, exercise, smoking, and alcohol consumption. Conclusions. These results suggest that occupational exposure may play a major role in the development of liver changes among workers at the oil refinery where the study was carried out