RESUMEN
Malnutrition is a prevalent condition in chronic diseases, significantly impacting morbidity and mortality. Point-of-care ultrasound (POCUS) is increasingly utilized in clinical practice as a rapid and accessible tool for evaluating muscle mass. Here, we present two cases of females with chronic diseases who presented with acute exacerbations of their conditions accompanied by fluid overload. Suspected of experiencing nutritional alterations, they underwent ultrasound evaluation to confirm muscle mass loss. These cases highlight the potential of ultrasound in guiding effective muscle mass assessment, particularly in pathologies prone to fluid overload, such as chronic kidney disease and heart failure.
Asunto(s)
Índice de Masa Corporal , Desnutrición , Ultrasonografía , Humanos , Femenino , Ultrasonografía/métodos , Músculo Esquelético/diagnóstico por imagen , Anciano , Persona de Mediana Edad , Estado Nutricional , Evaluación Nutricional , Sistemas de Atención de Punto , Insuficiencia Renal Crónica/complicacionesRESUMEN
BACKGROUND: Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas. METHODS: We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters. RESULTS: We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients. CONCLUSIONS: Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.
The frequencies of mental disorders vary by geographic region. Investigating such variations may lead to more equitable access to mental healthcare and to scientific discoveries that reveal specific localized factors that contribute to the causes of mental illness. This study examined the frequency of three disorders with a major impact on public health schizophrenia, bipolar disorder, and major depressive disorder by analyzing electronic health records from a hospital providing comprehensive mental health care for a large region in Colombia. We show that individuals receiving outpatient care mainly live relatively near the facility. Those receiving inpatient care live throughout the region, but cluster in a few scattered locations. Future research could lead to strategies for more equitable provision of mental healthcare in Colombia and identify environmental or genetic factors that affect the likelihood that someone will develop one of these disorders.
RESUMEN
Therapeutic plasma exchange (TPE) or plasmapheresis has been used in various life-threatening diseases as a primary treatment or in combination with other therapies. It was first successfully employed in the 1960s for diseases like Waldenström's disease and myeloma. Since then, TPE techniques using apheresis membranes have been introduced. Apheresis therapies separate plasma components from blood using membrane screening or centrifugation methods. TPE aims to remove substances involved in the pathophysiology of diseases. It selectively removes high-molecular-weight molecules, substances with prolonged half-life, and those associated with disease pathogenesis. TPE can be performed using membranes or centrifugation, with replacement of extracted plasma volume using albumin or fresh frozen plasma. TPE requires specific competencies in nephrology and can be prescribed and monitored by nephrologists and performed by dialysis nursing staff. TPE can be combined with adsorption-based therapies to enhance its effect, and this approach is called plasma filtration adsorption. Another variation is double plasma filtration, which selectively removes substances based on molecular size. TPE can also be combined with lipoprotein removal strategies for managing familial hypercholesterolemia. TPE is an affordable extracorporeal therapy that benefits patients with life-threatening diseases. It requires collaboration between nephrologists and other specialists, and our results demonstrate successful TPE without anticoagulation in general hospitalization or outpatient settings.
Asunto(s)
Eliminación de Componentes Sanguíneos , Nefrología , Humanos , Diálisis Renal , Eliminación de Componentes Sanguíneos/métodos , Intercambio Plasmático/métodos , Plasmaféresis/métodosRESUMEN
Bipolar Disorder (BD) is a severe and chronic disorder characterized by recurrent episodes of depression, mania, and/or hypomania. Most BD patients initially present with depressive symptoms, resulting in a delayed diagnosis of BD and poor clinical outcomes. This study leverages electronic health record (EHR) data from the Clínica San Juan de Dios Manizales in Colombia to identify features predictive of the transition from Major Depressive Disorder (MDD) to BD. Analyzing EHR data from 13,607 patients diagnosed with MDD over 15 years, we identified 1,610 cases of conversion to BD. Using a multivariate Cox regression model, we identified severity of the initial MDD episode, the presence of psychosis and hospitalization at first episode, family history of mood or psychotic disorders, female gender to be predictive of the conversion to BD. Additionally, we observed associations with medication classes (prescriptions of mood stabilizers, antipsychotics, and antidepressants) and clinical features (delusions, suicide attempt, suicidal ideation, use of marijuana and alcohol use/abuse) derived from natural language processing (NLP) of clinical notes. Together, these risk factors predicted BD conversion within five years of the initial MDD diagnosis, with a recall of 72% and a precision of 38%. Our study confirms many previously identified risk factors identified through registry-based studies (such as female gender and psychotic depression at the index MDD episode), and identifies novel ones (specifically, suicidal ideation and suicide attempt extracted from clinical notes). These results simultaneously demonstrate the validity of using EHR data for predicting BD conversion as well as underscore its potential for the identification of novel risk factors and improving early diagnosis.
RESUMEN
RESUMEN INTRODUCCIÓN: La leucodistrofia metacromática (LDM) es una enfermedad poco frecuente que se caracteriza por desmielinización progresiva a nivel del sistema nervioso central y periférico. En la mayoría de los casos, es causada por una actividad deficiente de la enzima arilsulfatasa-A. Pertenece al grupo de las leucodistrofias, que son trastornos hereditarios de la sustancia blanca asociados con una variabilidad fenotípica y una heterogeneidad genética importante. El fenotipo de la LDM suele relacionarse con la edad de presentación, que puede variar desde la infancia hasta la adultez. Cuando se presenta en la edad adulta, puede debutar con manifestaciones neuropsiquiátricas, lo que lleva con frecuencia a diagnósticos erróneos. REPORTE DE CASO: Se presenta el caso de una paciente adulta que debutó con un cuadro clínico caracterizado por cambios comportamentales progresivos, con posterior inicio de manifestaciones clínicas motoras. El diagnóstico de LDM se sospechó a partir de la clínica y los hallazgos típicos en la resonancia magnética (RM) cerebral, y se confirmó con la detección de actividad deficiente de la arilsulfatasa-A (ARSA) y la secuenciación del gen ARSA que confirmó la mutación en estado homocigoto, compatible con este diagnóstico. DISCUSIÓN: Destacamos en este caso la importancia de la sospecha clínica, el reconocimiento temprano y el manejo multidisciplinario como factores pronósticos del curso de la enfermedad, ya que en la actualidad no hay tratamiento definitivo para la enfermedad.
ABSTRACT INTRODUCTION: Metachromatic leukodystrophy (MLD) is an infrequent disease characterized by progressive demyelination of the central and peripheral nervous system. In most cases, it is caused by deficient activity of arylsulfatase-A. It belongs to the group of leukodystrophies, which are inherited white matter disorders that can be associated with significant phenotypic variability and genetic heterogeneity. The phenotype in MLD is usually related to the age of onset, which can vary from childhood to adulthood. Adult-onset MLD can debut with neuropsychiatry symptoms, which can often lead to misdiagnosis. CASE REPORT: We report the case of an adult female patient who presented with progressive behavioral changes, followed by motor manifestations. MLD was initially suspected based on the clinical presentation and the characteristic findings on brain magnetic resonance imaging (MRI), with subsequent confirmation by detection of deficient arylsulfatase-A (ARSA) activity and ARSA gene sequencing, which demonstrated homozygosity, compatible with this diagnosis. DISCUSSION: We highlight the importance of clinical suspicion, early recognition and multidisciplinary management as a prognostic factor for the course of the disease, since there is currently no definitive treatment for the disease.
Asunto(s)
Cerebrósido Sulfatasa , Trastornos Heredodegenerativos del Sistema Nervioso , Leucodistrofia Metacromática , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Common bean is an important staple crop in the tropics of Africa, Asia and the Americas. Particularly smallholder farmers rely on bean as a source for calories, protein and micronutrients. Drought is a major production constraint for common bean, a situation that will be aggravated with current climate change scenarios. In this context, new tools designed to understand the genetic basis governing the phenotypic responses to abiotic stress are required to improve transfer of desirable traits into cultivated beans. RESULTS: A multiparent advanced generation intercross (MAGIC) population of common bean was generated from eight Mesoamerican breeding lines representing the phenotypic and genotypic diversity of the CIAT Mesoamerican breeding program. This population was assessed under drought conditions in two field trials for yield, 100 seed weight, iron and zinc accumulation, phenology and pod harvest index. Transgressive segregation was observed for most of these traits. Yield was positively correlated with yield components and pod harvest index (PHI), and negative correlations were found with phenology traits and micromineral contents. Founder haplotypes in the population were identified using Genotyping by Sequencing (GBS). No major population structure was observed in the population. Whole Genome Sequencing (WGS) data from the founder lines was used to impute genotyping data for GWAS. Genetic mapping was carried out with two methods, using association mapping with GWAS, and linkage mapping with haplotype-based interval screening. Thirteen high confidence QTL were identified using both methods and several QTL hotspots were found controlling multiple traits. A major QTL hotspot located on chromosome Pv01 for phenology traits and yield was identified. Further hotspots affecting several traits were observed on chromosomes Pv03 and Pv08. A major QTL for seed Fe content was contributed by MIB778, the founder line with highest micromineral accumulation. Based on imputed WGS data, candidate genes are reported for the identified major QTL, and sequence changes were identified that could cause the phenotypic variation. CONCLUSIONS: This work demonstrates the importance of this common bean MAGIC population for genetic mapping of agronomic traits, to identify trait associations for molecular breeding tool design and as a new genetic resource for the bean research community.
Asunto(s)
Phaseolus , África , Asia , Mapeo Cromosómico , Sequías , Phaseolus/genética , Fenotipo , Fitomejoramiento , Sitios de Carácter CuantitativoRESUMEN
In plant and animal breeding, genomic prediction models are established to select new lines based on genomic data, without the need for laborious phenotyping. Prediction models can be trained on recent or historic phenotypic data and increasingly available genotypic data. This enables the adoption of genomic selection also in under-used legume crops such as common bean. Beans are an important staple food in the tropics and mainly grown by smallholders under limiting environmental conditions such as drought or low soil fertility. Therefore, genotype-by-environment interactions (G × E) are an important consideration when developing new bean varieties. However, G × E are often not considered in genomic prediction models nor are these models implemented in current bean breeding programs. Here we show the prediction abilities of four agronomic traits in common bean under various environmental stresses based on twelve field trials. The dataset includes 481 elite breeding lines characterized by 5,820 SNP markers. Prediction abilities over all twelve trials ranged between 0.6 and 0.8 for yield and days to maturity, respectively, predicting new lines into new seasons. In all four evaluated traits, the prediction abilities reached about 50-80% of the maximum accuracies given by phenotypic correlations and heritability. Predictions under drought and low phosphorus stress were up to 10 and 20% improved when G × E were included in the model, respectively. Our results demonstrate the potential of genomic selection to increase the genetic gain in common bean breeding. Prediction abilities improved when more phenotypic data was available and G × E could be accounted for. Furthermore, the developed models allowed us to predict genotypic performance under different environmental stresses. This will be a key factor in the development of common bean varieties adapted to future challenging conditions.
RESUMEN
Introducción: La peritonitis bacteriana espontánea requiere un diagnóstico temprano para el inicio de antibioticoterapia. El estudio diagnóstico ideal es el citoquímico del líquido ascítico, el cual puede ser costoso, demorado y de disponibilidad limitada en centros primarios de atención en salud. Objetivo: Evaluar la utilidad y precisión diagnóstica de las tiras reactivas Multistix 10SG para el diagnóstico de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis. Materiales y métodos: Estudio observacional descriptivo de prueba diagnóstica en pacientes cirróticos con ascitis. Se determinó el conteo de leucocitos del líquido ascítico por la escala colorimétrica de la tira reactiva Multistix 10SG y se comparó con el gold standard para el diagnóstico (polimorfonucleares ≥ 250 células/mm³). Resultados: De 174 pacientes con ascitis (51,7% mujeres, promedio de edad 59 años) 30 fueron diagnosticados con peritonitis bacteriana espontánea. Con un punto de corte grado ++, la tira reactiva tuvo sensibilidad 73,3%, especificidad 96,5%, valor predictivo positivo 81,4%, valor predictivo negativo 94,5%, razón de probabilidad positiva 21,2 y razón de probabilidad negativa 0,27. Conclusiones: Las tiras reactivas tienen adecuada especificidad y valor predictivo negativo, siendo una herramienta de bajo costo, uso sencillo, rápida interpretación y fácil acceso, para apoyar la decisión de no iniciar antibiótico en pacientes con ascitis y sospecha de peritonitis bacteriana espontánea. Por su baja sensibilidad no reemplazan al estudio citoquímico como prueba de elección para el diagnóstico definitivo, pero si es útil para optimizar el abordaje inicial de estos pacientes.
Introduction: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. Objective: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Materials and methods: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). Results: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. Conclusions: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/diagnóstico , Ascitis/complicaciones , Tiras Reactivas , Infecciones Bacterianas/diagnóstico , Diagnóstico Precoz , Cirrosis Hepática/complicaciones , Peritonitis/microbiología , Ascitis/microbiología , Infecciones Bacterianas/microbiología , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Recuento de Leucocitos , Cirrosis Hepática/microbiologíaRESUMEN
BACKGROUND: The apomictic reproductive mode of Brachiaria (syn. Urochloa) forage species allows breeders to faithfully propagate heterozygous genotypes through seed over multiple generations. In Brachiaria, reproductive mode segregates as single dominant locus, the apospory-specific genomic region (ASGR). The AGSR has been mapped to an area of reduced recombination on Brachiaria decumbens chromosome 5. A primer pair designed within ASGR-BABY BOOM-like (BBML), the candidate gene for the parthenogenesis component of apomixis in Pennisetum squamulatum, was diagnostic for reproductive mode in the closely related species B. ruziziensis, B. brizantha, and B. decumbens. In this study, we used a mapping population of the distantly related commercial species B. humidicola to map the ASGR and test for conservation of ASGR-BBML sequences across Brachiaria species. RESULTS: Dense genetic maps were constructed for the maternal and paternal genomes of a hexaploid (2n = 6x = 36) B. humidicola F1 mapping population (n = 102) using genotyping-by-sequencing, simple sequence repeat, amplified fragment length polymorphism, and transcriptome derived single nucleotide polymorphism markers. Comparative genomics with Setaria italica provided confirmation for x = 6 as the base chromosome number of B. humidicola. High resolution molecular karyotyping indicated that the six homologous chromosomes of the sexual female parent paired at random, whereas preferential pairing of subgenomes was observed in the apomictic male parent. Furthermore, evidence for compensated aneuploidy was found in the apomictic parent, with only five homologous linkage groups identified for chromosome 5 and seven homologous linkage groups of chromosome 6. The ASGR mapped to B. humidicola chromosome 1, a region syntenic with chromosomes 1 and 7 of S. italica. The ASGR-BBML specific PCR product cosegregated with the ASGR in the F1 mapping population, despite its location on a different carrier chromosome than B. decumbens. CONCLUSIONS: The first dense molecular maps of B. humidicola provide strong support for cytogenetic evidence indicating a base chromosome number of six in this species. Furthermore, these results show conservation of the ASGR across the Paniceae in different chromosomal backgrounds and support postulation of the ASGR-BBML as candidate genes for the parthenogenesis component of apomixis.
Asunto(s)
Apomixis , Brachiaria/genética , Mapeo Cromosómico , Partenogénesis/genética , Cromosomas de las Plantas , Genómica , Cariotipificación , Translocación GenéticaRESUMEN
INTRODUCTION: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. OBJECTIVE: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. MATERIALS AND METHODS: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). RESULTS: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. CONCLUSIONS: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.
Asunto(s)
Ascitis/complicaciones , Infecciones Bacterianas/diagnóstico , Diagnóstico Precoz , Cirrosis Hepática/complicaciones , Peritonitis/diagnóstico , Tiras Reactivas , Ascitis/microbiología , Infecciones Bacterianas/microbiología , Femenino , Humanos , Recuento de Leucocitos , Cirrosis Hepática/microbiología , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Community-acquired pneumonia (CAP) continues to be associated with significant mortality and morbidity. As with other infectious diseases, in recent years there has been a marked increase in resistance to the antibiotics commonly used against the pathogens that cause CAP. Antimicrobial stewardship denotes coordinated interventions to improve and measure the appropriate use of antibiotics by encouraging the selection of optimal drug regimens. Areas covered: Several elements can be applied to antibiotic stewardship strategies for CAP in order to maintain or improve patient outcomes. In this regard, antibiotic de-escalation, duration of antibiotic treatment, adherence to CAP guidelines recommendations about empirical treatment, and switching from intravenous to oral antibiotic therapy may each be relevant in this context. Antimicrobial stewardship strategies, such as prospective audit with intervention and feedback, clinical pathways, and dedicated multidisciplinary teams, that have included some of these elements have demonstrated improvements in antimicrobial use for CAP without negatively affecting clinical outcomes. Expert commentary: Although there are a limited number of randomized clinical studies addressing antimicrobial stewardship strategies in CAP, there is evidence that antibiotic stewardship initiatives can be securely applied, providing benefits to both healthcare systems and patients.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Neumonía Bacteriana/tratamiento farmacológico , Administración Intravenosa , Administración Oral , Infecciones Comunitarias Adquiridas/microbiología , Manejo de la Enfermedad , Esquema de Medicación , Cálculo de Dosificación de Drogas , Humanos , Neumonía Bacteriana/microbiología , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Therecent development and availability of different genotype by sequencing (GBS) protocols provided a cost-effective approach to perform high-resolution genomic analysis of entire populations in different species. The central component of all these protocols is the digestion of the initial DNA with known restriction enzymes, to generate sequencing fragments at predictable and reproducible sites. This allows to genotype thousands of genetic markers on populations with hundreds of individuals. Because GBS protocols achieve parallel genotyping through high throughput sequencing (HTS), every GBS protocol must include a bioinformatics pipeline for analysis of HTS data. Our bioinformatics group recently developed the Next Generation Sequencing Eclipse Plugin (NGSEP) for accurate, efficient, and user-friendly analysis of HTS data. RESULTS: Here we present the latest functionalities implemented in NGSEP in the context of the analysis of GBS data. We implemented a one step wizard to perform parallel read alignment, variants identification and genotyping from HTS reads sequenced from entire populations. We added different filters for variants, samples and genotype calls as well as calculation of summary statistics overall and per sample, and diversity statistics per site. NGSEP includes a module to translate genotype calls to some of the most widely used input formats for integration with several tools to perform downstream analyses such as population structure analysis, construction of genetic maps, genetic mapping of complex traits and phenotype prediction for genomic selection. We assessed the accuracy of NGSEP on two highly heterozygous F1 cassava populations and on an inbred common bean population, and we showed that NGSEP provides similar or better accuracy compared to other widely used software packages for variants detection such as GATK, Samtools and Tassel. CONCLUSIONS: NGSEP is a powerful, accurate and efficient bioinformatics software tool for analysis of HTS data, and also one of the best bioinformatic packages to facilitate the analysis and to maximize the genomic variability information that can be obtained from GBS experiments for population genomics.
Asunto(s)
Genes de Plantas , Técnicas de Genotipaje , Secuenciación de Nucleótidos de Alto Rendimiento , Biología Computacional , Genotipo , Manihot/genética , Phaseolus/genética , Análisis de Secuencia de ADNRESUMEN
Background: Treatment failure in patients receiving antiretroviral therapy against human immunodeficiency virus (HIV) is always a concern. Objective: To examine the correlates associated with treatment failure in patients living in the Colombian Caribbean city of Barranquilla, an aspect that was poorly studied in this region. Methods: Treatment failure (TF) was evaluated in a cross-sectional study from virological, immunological and clinical standpoints. Results: It was established that 29.5% of patients under highly active antiretroviral therapy (ART) could be considered in TF. Among those, virological failure was most frequent (20.9%), followed by immunological- (14.0%) and clinical failure (4.7%). In patients showing lack of adherence to the treatment, the likelihood of suffering from treatment- and virogical-failure were respectively increased by 6.67-fold and 12.19-fold, compared with patients showing good adherence. Although there was no statistically significant association, TF tended to be more frequent in young adults, in patients with low income and, low level of education. When ART regimens were compared, there was no apparent difference in TF between regimens based on non-nucleoside reverse transcriptase inhibitors and those based on protease inhibitors. This is very important in the context of recent ART strategies, such as early-initiated ART, aimed at achieving long-term infection control. Conclusions: Is confirmed the importance of treatment adherence to avoid TF and further highlights the importance of educating HIV-infected patients in all parts of the world, especially those individuals with a lower socio-economic status.
Antecedentes: El fracaso terapéutico (FT) en pacientes que están recibiendo terapia antirretroviral contra el Virus de la Inmunodeficiencia Humana (VIH) ha sido siempre preocupante. Objetivo: Examinar las variables asociadas con el FT, un problema que ha sido pobremente estudiado en la región, en pacientes que habitan en Barranquilla, ciudad del Caribe colombiano. Métodos: El FT fue evaluado en un estudio transversal desde los puntos de vista virológico, inmunológico y clínico. Resultados: Se determinó que el 29.5% de los pacientes bajo terapia antirretroviral (TAR) de gran actividad podría considerase en FT. El fracaso virológico fue el más frecuente (20.9%), seguido por el inmunológico (14.0%) y el clínico (4.7%). En pacientes que mostraron falta de adherencia al tratamiento, las posibilidades de presentar un FT y virológico fue mayor, 6.67 y 12.19 veces, respectivamente, comparados con pacientes que mostraron buena adherencia. Aun cuando no hubo una asociación estadística significativa, el FT tendió a ser más frecuente en adultos jóvenes, en pacientes con bajos ingresos y bajo nivel de educación. Cuando se compararon diferentes regímenes de TAR no hubo una diferencia aparente entre el FT en los regímenes basados en inhibidores no nucleósidos de la transcriptasa inversa y en aquellos basados en inhibidores de la proteasa. Esto es muy importante en el contexto de recientes estrategias de TAR, como es el caso de las iniciadas en forma temprana con el fin de lograr el control de la infección a largo plazo. Conclusiones: Se confirma la importancia de la adherencia al tratamiento para evitar el FT y la importancia de educar a los pacientes infectados con el VIH, especialmente aquellos individuos con un nivel socioeconómico bajo.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Educación del Paciente como Asunto/métodos , Fármacos Anti-VIH/administración & dosificación , Colombia , Estudios Transversales , Factores Socioeconómicos , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Treatment failure (TF) in patients receiving antiretroviral therapy against human immunodeficiency virus (HIV) is always a concern. OBJECTIVE: To examine the correlates associated with TF in patients living in the Colombian Caribbean city of Barranquilla, an aspect that was poorly studied in this region. METHODS: Treatment failure was evaluated in a cross-sectional study from virological, immunological and clinical standpoints. RESULTS: It was established that 29.5% of patients under highly active antiretroviral therapy (ART) could be considered in TF. Among those, virological failure was most frequent (20.9%), followed by immunological- (14.0%) and clinical failure (4.7%). In patients showing lack of adherence to the treatment, the likelihood of suffering from TF and virogical failure were respectively increased by 6.67-fold and 12.19-fold, compared with patients showing good adherence. Although there was no statistically significant association, TF tended to be more frequent in young adults, in patients with low income and, low level of education. When ART regimens were compared, there was no apparent difference in TF between regimens based on non-nucleoside reverse transcriptase inhibitors and those based on protease inhibitors. This is very important in the context of recent ART strategies, such as early-initiated ART, aimed at achieving long-term infection control. CONCLUSIONS: Is confirmed the importance of treatment adherence to avoid TF and further highlights the importance of educating HIV-infected patients in all parts of the world, especially those individuals with a lower socio-economic status.
OBJETIVOS: El fracaso terapéutico (FT) en pacientes que están recibiendo terapia antirretroviral contra el Virus de la Inmunodeficiencia Humana (VIH) ha sido siempre preocupante. OBJETIVO: Examinar las variables asociadas con el fracaso terapéutico, un problema que ha sido pobremente estudiado en la región, en pacientes que habitan en Barranquilla, ciudad del Caribe colombiano. MÉTODOS: El fracaso terapéutico fue evaluado en un estudio transversal desde los puntos de vista virológico, inmunológico y clínico. RESULTADOS: Se determinó que el 29.5% de los pacientes bajo terapia antirretroviral (TAR) de gran actividad podría considerase en fracaso terapéutico. El fracaso virológico fue el más frecuente (20.9%), seguido por el inmunológico (14.0%) y el clínico (4.7%). En pacientes que mostraron falta de adherencia al tratamiento, las posibilidades de presentar un fracaso terapéutico y virológico fue mayor, 6.67 y 12.19 veces, respectivamente, comparados con pacientes que mostraron buena adherencia. Aun cuando no hubo una asociación estadística significativa, el fracaso terapéutico tendió a ser más frecuente en adultos jóvenes, en pacientes con bajos ingresos y bajo nivel de educación. Cuando se compararon diferentes regímenes de TAR no hubo una diferencia aparente entre el fracaso terapéutico en los regímenes basados en inhibidores no nucleósidos de la transcriptasa inversa y en aquellos basados en inhibidores de la proteasa. Esto es muy importante en el contexto de recientes estrategias de TAR, como es el caso de las iniciadas en forma temprana con el fin de lograr el control de la infección a largo plazo. CONCLUSIONES: Se confirma la importancia de la adherencia al tratamiento para evitar el fracaso terapéutico y la importancia de educar a los pacientes infectados con el VIH, especialmente aquellos individuos con un nivel socioeconómico bajo.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Educación del Paciente como Asunto/métodos , Adulto , Fármacos Anti-VIH/administración & dosificación , Colombia , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
Objective. To determine the prevalence and impact of autoimmune thyroid disease (AITD) in patients with rheumatoid arthritis (RA). Methods. Eight-hundred patients were included. The association between AITD and RA was analyzed was analyzed by bivariate and multivariate analysis. In addition, a literature review was done focusing on geographical variations. Results. In our cohort the prevalence of AITD was 9.8% while the presence of antibodies was 37.8% for antithyroperoxidase enzyme (TPOAb) and 20.8% for antithyroglobulin protein (TgAb). The presence of type 2 diabetes, thrombosis, abnormal body mass index, and a high educational level was positively associated with AITD. The literature review disclosed a geographical variation of AITD in RA ranging from 0.5% to 27%. Autoantibody prevalence ranges from 6% to 31% for TgAb, 5% to 37% for TPOAb, and from 11.4% to 32% for the presence of either of the two. Conclusion. AITD is not uncommon in RA and should be systematically assessed since it is a risk factor for developing diabetes and cardiovascular disease. These results may help to further study the common mechanisms of autoimmune diseases, to improve patients' outcome, and to define public health policies. An international consensus to accurately diagnose AITD is warranted.
RESUMEN
BACKGROUND: Data on the effect of gender in rheumatoid arthritis (RA) in non-Caucasian populations is scarce. Latin America and the Caribbean (LAC) is a large population with unique characteristics, including high admixture. OBJECTIVE: Our aim was to examine the effect of gender in patients with RA in LAC. METHODS: This was a 2-phase study. First we conducted a cross-sectional and analytical study in which 1128 consecutive Colombian patients with RA were assessed. Second, a systematic review of the literature was done to evaluate the effect of gender in LAC patients with RA. RESULTS: Our results show a high prevalence of RA in LAC women with a ratio of 5.2 women per man. Colombian women with RA are more at risk of having an early age at onset and developing polyautoimmunity and abdominal obesity, and they perform more household duties than their male counterparts. However, male gender was associated with the presence of extra-articular manifestations. Of a total of 641 potentially relevant articles, 38 were considered for final analysis, in which several factors and outcomes related to gender were identified. CONCLUSIONS: RA in LAC women is not only more common but presents with some clinical characteristics that differ from RA presentation in men. Some of those characteristics could explain the high rates of disability and worse prognosis observed in women with RA in LAC.
Asunto(s)
Artritis Reumatoide/epidemiología , Adulto , Edad de Inicio , Anciano , Artritis Reumatoide/etnología , Enfermedades Cardiovasculares/epidemiología , Distribución de Chi-Cuadrado , Colombia/epidemiología , Comorbilidad , Estudios Transversales , Dispepsia/epidemiología , Femenino , Tareas del Hogar , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Obesidad Abdominal/epidemiología , Prevalencia , Factor Reumatoide/sangre , Factores Sexuales , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Trombosis/epidemiología , Tiroiditis Autoinmune/epidemiologíaRESUMEN
Bee (Apis mellifera, Hymenoptera: Apoidea) visitation to cantaloupe Cucumis melo (Cucurvitaceae) flowers in Panama. Flower visits by bees were observed in a melon cultivated field of San Lorenzo district, in Chiriquí, Panama, from January 6 to February 19, 2002, from 6:30 am to 4:30 pm We recorded the duration of each foraging event and the type of resource collected. Flower visits were mostly for nectar collection (∼75 %). Pollen foraging was concentrated in the first hours of the morning and ended by 11:00 am The mean collection time was similar for both food resources, but was different between flower sexes. Flower visits to female flowers took longer (Student's t test, p<0.0001), with a mean time duration of 8.4±4.4 s, whereas in male flowers mean visitation time was of 4.0±1.5 s. Finally, the mean time for each floral sex remained practically constant through the evolution of the crop. Our results were similar to the found ones in temperate zone crops, so apparently tropical conditions of Panama do not change the bee visit patterns on melon flowers. Rev. Biol. Trop. 55 (2): 677-680. Epub 2007 June, 29.
Se observaron las visitas observadas a flores seleccionadas en un cultivo del Distrito de San Lorenzo, Chiriquí, del 6 de Enero y el 19 de Febrero del 2002, desde las 6:30 am hasta las 4:30 pm, y se anotaron características de las visita, como el tiempo de visita y el tipo de recurso colectado. Las visitas fueron mayormente para la recolección de néctar (casi 3/4). La recolección de polen se concentró hacia las primeras horas de la mañana, cesando definitivamente a las 11:00 am. El tiempo medio de recolección fue similar para ambos recursos, pero fue marcadamente distinto para cada sexo floral. Las visitas a flores femeninas fueron significativamente (Prueba t Student, p<0.0001) más largas, con un tiempo medio de duración de 8.4±4.4 s, mientras que en las flores masculinas, el tiempo medio de visita fue 4.0±1.5 s. Por último, el tiempo medio de recolección por sexo floral permaneció prácticamente constante conforme evolucionó el cultivo. Nuestros resultados fueron similares a los encontrados en cultivos de zonas templadas, por lo que aparentemente las condiciones tropicales de Panamá no cambian los patrones de visita que presentan las abejas en las flores de melón.
Asunto(s)
Animales , Abejas/fisiología , Conducta Animal/fisiología , Cucumis melo , Flores/fisiología , Polinización/fisiología , Panamá , Piridinas , Tetrazoles , Factores de TiempoRESUMEN
Flower visits by bees were observed in a melon cultivated field of San Lorenzo district, in Chiriqui, Panama, from January 6 to February 19, 2002, from 6:30 am to 4:30 pm We recorded the duration of each foraging event and the type of resource collected. Flower visits were mostly for nectar collection (approximately 75 %). Pollen foraging was concentrated in the first hours of the morning and ended by 11:00 am The mean collection time was similar for both food resources, but was different between flower sexes. Flower visits to female flowers took longer (Student's t test, p<0.0001), with a mean time duration of 8.4+/-4.4 s, whereas in male flowers mean visitation time was of 4.0+/-1.5 s. Finally, the mean time for each floral sex remained practically constant through the evolution of the crop. Our results were similar to the found ones in temperate zone crops, so apparently tropical conditions of Panama do not change the bee visit patterns on melon flowers.
Asunto(s)
Abejas/fisiología , Conducta Animal/fisiología , Cucumis melo , Flores/fisiología , Polinización/fisiología , Animales , Panamá , Piridinas , Tetrazoles , Factores de TiempoRESUMEN
We studied the seasonal activity of Bombus pennsylvanicus sonorus Say in subtropical conditions of the Mexican Central Plateau. Monthly during 1998, we recorded caste of active individuals (inferred form corporal size measured as wing length), presence and activity of reproductive individuals, and mating activity. Also, we recorded the flower plants used as resources. Subtropical conditions of the Mexican Central Plateau do not seem to modify phenological features of B. pennsylvanicus sonorus since the species presents annual colonies and a clearly defined period of inactivity. The size of individuals progressively increased between the first recorded activity period in middle April and the end of the colonies in November. Reproductive bees were observed since the second half of the year. The presence of males was recorded between July and November and queens and mating pairs were observed during November and December. Then mating queens were noted seeking hibernation places. Activity resumed in February of the following year. Seasonal activity seems to be more related to availability of floral resources (which, in turn, is related to rain regime), than to changes in temperature and day length. Some of the main food resources used by B. pennsylvanicus sonorus were Tithonia tubiformis, Cosmos bipinnatus, Anoda cristata, Solanum rostratum and Jacaranda mimosaefolia.