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We characterized five carbapenemase-producing Enterobacterales (CPE) isolates from two health care institutions in Lima, Peru. The isolates were identified as Klebsiella pneumoniae (n = 3), Citrobacter portucalensis (n = 1), and Escherichia coli (n = 1). All were identified as blaOXA-48-like gene carriers using conventional PCR. Whole-genome sequencing found the presence of the blaOXA-181 gene as the only carbapenemase gene in all isolates. Genes associated with resistance to aminoglycosides, quinolones, amphenicols, fosfomycins, macrolides, tetracyclines, sulfonamides, and trimethoprim were also found. The plasmid incompatibility group IncX3 was identified in all genomes in a truncated Tn6361 transposon flanked by ΔIS26 insertion sequences. The qnrS1 gene was also found downstream of blaOXA-181, conferring fluoroquinolone resistance to all isolates. CPE isolates harboring blaOXA-like genes are an increasing public health problem in health care settings worldwide. The IncX3 plasmid is involved in the worldwide dissemination of blaOXA-181, and its presence in these CPE isolates suggests the wide dissemination of blaOXA-181 in Peru. IMPORTANCE Reports of carbapenemase-producing Enterobacterales (CPE) isolates are increasing worldwide. Accurate detection of the ß-lactamase OXA-181 (a variant of OXA-48) is important to initiate therapy and preventive measures in the clinic. OXA-181 has been described in CPE isolates in many countries, often associated with nosocomial outbreaks. However, the circulation of this carbapenemase has yet to be reported in Peru. Here, we report the detection of five multidrug-resistant CPE clinical isolates harboring blaOXA-181 in the IncX3-type plasmid, a potential driver of dissemination in Peru.
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Infecções por Enterobacteriaceae , Enterobacteriaceae , Humanos , Enterobacteriaceae/genética , América Latina , Proteínas de Bactérias/genética , beta-Lactamases/genética , Escherichia coli/genética , Klebsiella pneumoniae/genética , Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana , Infecções por Enterobacteriaceae/epidemiologiaRESUMO
This paper assesses the association of the insertion/deletion ACE (angiotensin-converting enzyme) variant (rs1799752 I/D) and the serum ACE activity with the severity of COVID-19 as well as its impact on post-COVID-19, and we compare these associations with those for patients with non-COVID-19 respiratory disorders. We studied 1252 patients with COVID-19, 104 subjects recovered from COVID-19, and 74 patients hospitalized with a respiratory disease different from COVID-19. The rs1799752 ACE variant was assessed using TaqMan® Assays. The serum ACE activity was determined using a colorimetric assay. The DD genotype was related to risk for invasive mechanical ventilation (IMV) requirement as an indicator of COVID-19 severity when compared to the frequencies of II + ID genotypes (p = 0.025, OR = 1.428, 95% CI = 1.046-1.949). In addition, this genotype was significantly higher in COVID-19 and post-COVID-19 groups than in the non-COVID-19 subjects. The serum ACE activity levels were lower in the COVID-19 group (22.30 U/L (13.84-32.23 U/L)), which was followed by the non-COVID-19 (27.94 U/L (20.32-53.36 U/L)) and post-COVID-19 subjects (50.00 U/L (42.16-62.25 U/L)). The DD genotype of the rs1799752 ACE variant was associated with the IMV requirement in patients with COVID-19, and low serum ACE activity levels could be related to patients with severe disease.
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COVID-19 , Polimorfismo Genético , Humanos , COVID-19/genética , Genótipo , Peptidil Dipeptidase A/genética , Carboxipeptidases/metabolismoRESUMO
BACKGROUND: Mexico declared an obesity epidemic in 2000, and in response, became an early adopter of public policies in the form of natural experiments, which have not been evaluated for their effect on high BMI. We focus on children younger than 5 years due to the long-term outcomes of childhood obesity. METHODS: We used the Global Burden of Disease data to evaluate time trends in high BMI, defined as being overweight or obese based on the International Obesity Task Force standards, between 1990 and 2019. Marginalisation and poverty estimates from Mexico's Government were used to identify differences in socioeconomic groups. The time variable reflects the introduction of policies between 2006 and 2011. Our hypothesis was that poverty and marginalisation modify the effects of public policies. We tested for the change in prevalence of high BMI over time using Wald-type tests, correcting for the effect of repeated measures. We stratified the sample by gender, marginalisation index, and households under the poverty line. Ethics approval was not required. FINDINGS: Between 1990 and 2019, high BMI in children younger than 5 years increased from 23·5% (95% uncertainty interval 38·6-14·3) to 30·2% (46·0-20·4). After a period of sustained increase to 28·7% (44·8-18·6) in 2005, high BMI decreased to 27·3% (42·4-17·4; p<0·001) in 2011. Afterwards, high BMI increased constantly. We found an average gender gap of 12·2%, with a higher rate in males, in 2006, which remained constant. With respect to marginalisation and poverty, we observed a reduction in high BMI across all strata, except for the uppermost quintile of marginalisation in which high BMI remained flat. INTERPRETATION: The epidemic affected groups across different socioeconomic levels, thus weakening economic explanations for the decrease in high BMI, while gender gaps point to behavioural explanations of consumption. The observed patterns warrant investigation through more granular data and structural models to isolate the effect of the policy from secular trends in the population, including other age groups. FUNDING: Tecnológico de Monterrey Challenge-Based Research Funding Program.
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Obesidade Infantil , Criança , Masculino , Humanos , Análise de Séries Temporais Interrompida , Índice de Massa Corporal , México/epidemiologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Política PúblicaRESUMO
México enfrenta retos de salud sin precedentes y es necesario pensar en estrategias que con- tribuyan a su solución con un enfoque hacia el personal de enfermería, que es el recurso humano más numeroso. En este sentido, se desarrolló un programa de capacitación integral, el cual considera un diplomado virtual de 165 horas y componentes semipresenciales para fortalecer el conocimiento en el abordaje integral de diabetes para enfermería en el primer nivel de atención (PNA). Este programa se inscribe dentro de la Estrategia Integral para la Ampliación del Rol de Enfermería (EIARE) en el PNA. La implementación del programa educativo tendrá un pilotaje en el sur del país, donde se consideran el seguimiento y la evaluación para identificar y solventar áreas susceptibles de mejora y buscar su implementación en otros estados. El programa educativo y la EIARE permitirán el desarrollo de una nueva carrera para la enfermería en el PNA y mejoras sustantivas a la salud.
Mexico faces unprecedented health challenges, and it is necessary to think of mindful strategies to solve this, focusing on the nursing workforce, which is the most numerous human resource. In this sense, it was developed a comprehensive training program, which considers a virtual diploma program of 165 hours, and blended-learning components to strengthen knowledge in comprehensive diabetes care to nursing in the primary level of care (PLC). This training program is part of the Estrategia Integral para la Ampliación del Rol de Enfermería (Comprehensive Strategy for Amplifying the Role of NursesEIARE, according to its initialism in Spanish]) in PLC. The implementation of the training program will have a pilot in the southern area of Mexico, where monitoring and evaluation are considered to identify and solve areas susceptible to improvement and seek its implementation in other states of Mexico. This training program and the EIARE will allow the development of a new career for nursing in PLC and substantive improvements to health.
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Humanos , Atenção Primária à Saúde , Diabetes Mellitus , Educação Continuada em Enfermagem , Recursos Humanos de Enfermagem , Estratégias de Saúde , MéxicoRESUMO
Otoba is the third largest genus of Myristicaceae in the Neotropics with 12 species, nine of them native to Colombia. Two new species from the department of Antioquia, O. scottmorii sp. nov. and O. squamosa sp. nov., are described and illustrated. Otoba scottmorii occurs in humid, lowland forests, while O. squamosa occurs in premontane forest. Previously, Otoba scottmorii was confused with O. acuminata (which here is considered restricted to Costa Rica and Panama), while O. squamosa was confused with O. gordoniifolia. The similarities and differences between these and other species are discussed.
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To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.
Assuntos
Sistemas de Informação Geográfica , Acessibilidade aos Serviços de Saúde , Instalações de Saúde , Humanos , México , Cobertura Universal do Seguro de SaúdeRESUMO
Abstract To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.
Resumo Descrever uma visão geral da prestação de serviços de saúde no México e analisar geoespacialmente a atual distribuição e acessibilidade das unidades de APS para contribuir com novas abordagens para melhorar o planejamento da saúde no México. Realizamos uma análise espacial de dados oficiais para analisar as distâncias atuais das unidades de saúde à população, para determinar as áreas descobertas de prestação de serviços de saúde em 3 estados selecionados usando uma classificação de indicadores. Estimamos a cobertura da área de serviço das unidades de APS com redes viárias de 3 estados do México (Chiapas, Guerrero e Oaxaca). Nossas estimativas fornecem uma visão geral do acesso espacial à saúde da população mexicana nos três estados mais pobres do México. Não consideramos seguridade social nem prestadores privados. O acesso geoespacial às unidades de saúde é fundamental para alcançar a cobertura universal de saúde e uma cobertura eficaz. Países, como o México, devem medir isso para identificar áreas não merecidas com falta de acesso geoespacial à saúde para resolvê-lo. Os governos devem gerar políticas e mecanismos para distribuir efetivamente novas instalações de saúde para aumentar o acesso geoespacial efetivo à saúde, bem como para evitar instalações de saúde não planejadas.
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Humanos , Sistemas de Informação Geográfica , Acessibilidade aos Serviços de Saúde , Cobertura Universal do Seguro de Saúde , Instalações de Saúde , MéxicoRESUMO
Resumen ANTECEDENTES: El lupus eritematoso sistémico es una enfermedad autoinmunitaria y multisistémica. El daño pericárdico es la complicación cardiaca más común y el taponamiento cardiaco es infrecuente, más aún en embarazadas y con lupus eritematoso sistémico. OBJETIVO: Exponer las características clínicas, diagnósticas, tratamiento y evolución del taponamiento cardiaco en una embarazada que inició con lupus eritematoso sistémico y valorar la información de la bibliografía a propósito de otros casos. CASO CLÍNICO: Paciente de 24 años, con 27.5 semanas de embarazo, con anasarca, disnea que evolucionó a ortopnea y dolor torácico punzante de tres semanas de evolución. La radiografía de tórax mostró cardiomegalia grado II, campos pulmonares congestivos y derrame pleural a la altura de los senos cardiofrénicos. En el ecocardiograma se encontró derrame pericárdico de 500 mL, con datos de taponamiento cardiaco. Tuvo deterioro progresivo con afectación de la capacidad pulmonar e insuficiencia renal aguda con aumentos progresivos de creatinina; se encontró hemodinámica inestable, con pulso paradójico e hipotensión. Anticuerpos antinucleares positivos y proteinuria. La biopsia renal reportó patrones histopatológicos correspondientes a nefritis lúpica. Se trató con pulsos esteroideos y ciclofosfamida por vía intravenosa. El derrame pericárdico desapareció por medio de una ventana subxifoidea y la extracción del líquido del pericardio. La evolución posterior fue satisfactoria para la madre y su hijo. CONCLUSIÓN: El taponamiento cardiaco es infrecuente en pacientes con lupus eritematoso sistémico y más raro aún durante el embarazo. Es una urgencia clínica que requiere atención multidisciplinaria porque el embarazo, en una paciente con lupus eritematoso sistémico, implica mayor riesgo de complicaciones sistémicas, como se señala en la bibliografía.
Abstract BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic, multisystemic disease of unknown etiology, whose clinical manifestations are heterogeneous. Pericardial involvement is the most common cardiac complication; however, the development of cardiac tamponade is rare, and even more so in pregnant patients presenting with SLE. OBJECTIVE: To present the clinical characteristics, diagnosis, treatment, and evolution of cardiac tamponade in a pregnant patient that presents with systemic lupus erythematosus. CLINICAL CASE: A 24-year-old patient, who is 27.5 weeks pregnant, presenting with anasarca, dyspnea that evolved to orthopnea and stabbing chest pain for three weeks. Her chest X-ray showed cardiomegaly grade II, congestive lung fields and pleural effusion at the level of cardiophrenic sinuses. The echocardiogram found a 500 mL pericardial effusion with evidence of cardiac tamponade. Progressive deterioration with compromised lung capacity, and the appearance of acute renal failure with progressive increases in creatinine; showing hemodynamic instability characterized by paradoxical pulse and hypotension. With positive Antinuclear Antibodies (ANA) and proteinuria, renal biopsy reports histopathological patterns corresponding to lupus nephritis, treated with steroid pulses and intravenous cyclophosphamide in a risk-benefit assessment, with subsequent satisfactory maternal-fetal evolution. CONCLUSION: Cardiac tamponade is not common in patients with SLE, and it is even rarer as the initial manifestation, even more so during pregnancy. It is a clinical emergency and requires multidisciplinary management since pregnancy in a patient with SLE implies an increased risk of systemic complications.
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BACKGROUND: Crohn's disease (CD) is a multifactorial disease characterized by chronic intestinal inflammation. The increased visceral adiposity near the affected intestinal area, of which mesenteric adipose tissue (MAT) is the main component, is a feature of CD. Both protective and pathological roles have been attributed to this disease-associated tissue in CD. To understand the contribution of MAT to CD pathophysiology, a molecular and cellular signature of disease-associated MAT in CD patients was provided. METHODS: We performed an observational study with whole transcriptional analysis by RNA sequencing (RNA-seq) of MAT and ileal mucosa from CD patients with active disease and controls. qPCR and immunohistology were performed for validation analysis. RESULTS: RNA-seq identified 17 significantly regulated genes (|FC| > 1.5; FDR < 0.05) in CD-MAT compared to non-IBD controls, with a marked upregulation of plasma cell genes (i.e., IGLL5, MZB1, CD79A, POU2AF1, FCRL5, JCHAIN, DERL3, SDC1, PIM2). A less strict statistical cutoff value (|FC| > 1.5, nominal p ≤ 0.05) yielded a larger list of 651 genes in CD-MAT compared to controls. CD ileum showed the significant regulation compared to control ileum of 849 genes (|FC| > 1.5; FDR < 0.05) or 2654 genes (|FC| > 1.5, nominal p ≤ 0.05). Ingenuity Pathway Analysis revealed the significant regulation of pathways related to T- and B cell functionality in the MAT of CD patients. Despite the differences between the MAT and ileal signatures of CD patients, we identified a subset of 204 genes significantly modulated in both tissues compared to controls. This common signature included genes related to the plasma cell signature. Genes such as S100A8, S100A9 (calprotectin) and IL1B, which are associated with acute inflammatory response, were exclusively regulated in the ileal mucosa of CD disease. In contrast, some genes encoding for lymphocyte receptors such as MS4A1, CD3D and CD79A were exclusively regulated in CD-MAT, exhibiting a different pattern of immune cell activation compared to the ileal mucosa in CD patients. qPCR and immunohistology confirmed the presence of large infiltrates of CD3+ CD20+ lymphocytes and CD138+ plasma cells in CD-MAT. CONCLUSION: Our data strongly supports the role of CD-associated MAT as a site for T-, B- and plasma cell activation, and suggests that it could also act as a reservoir of memory immune responses.
Assuntos
Doença de Crohn , Tecido Adiposo , Linfócitos B , Doença de Crohn/genética , Humanos , Íleo , Mucosa Intestinal , Mesentério , Plasmócitos , Transdução de Sinais/genética , Linfócitos TRESUMO
Several screening tests have been used for cognitive evaluation in Parkinson's disease (PD). OBJECTIVE: To evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) in patients with Parkinson's disease and no cognitive impairment complaints. METHODS: A total of 40 PD patients with no complaints of cognitive problems were included. Patients were selected using the Mini-Mental State Examination (MMSE) and the MoCA was then administered. RESULTS: 80% of patients exhibited Mild Cognitive Impairment (MCI) according to the MoCA. Statistically significant differences in visuospatial, attention and delayed recall functions were evident between the normal and abnormal MoCA groups. CONCLUSION: The study results suggest that MoCA may be a good screening test in patients with PD who do not present cognitive complaints.
Vários testes de triagem foram utilizados para avaliação cognitiva na doença de Parkinson (DP). OBJETIVO: Avaliar a utilidade da Avaliação Cognitiva de Montreal (MoCA) em pacientes com doença de Parkinson sem queixa de comprometimento cognitivo. MÉTODOS: Um total de 40 pacientes com TP sem queixas de problemas cognitivos foram admitidos e com o Estado de Exame do Estado Mental Mini (MEEM) foram selecionados e receberam o MoCA. RESULTADOS: 80% apresentaram dados de Comprometimento Cognitivo Leve (ICM) segundo o MoCA, sendo as funções visoespaciais, atenção e memória atrasada aquelas que apresentaram diferenças estatisticamente significantes entre os grupos MoCA normal e anormal. CONCLUSÃO: Este estudo sugere que o MoCA pode ser um bom teste de triagem em pacientes com DP que não apresentam queixas cognitivas.
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ABSTRACT: Several screening tests have been used for cognitive evaluation in Parkinson's disease (PD). Objective: To evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) in patients with Parkinson's disease and no cognitive impairment complaints. Methods: A total of 40 PD patients with no complaints of cognitive problems were included. Patients were selected using the Mini-Mental State Examination (MMSE) and the MoCA was then administered. Results: 80% of patients exhibited Mild Cognitive Impairment (MCI) according to the MoCA. Statistically significant differences in visuospatial, attention and delayed recall functions were evident between the normal and abnormal MoCA groups. Conclusion: The study results suggest that MoCA may be a good screening test in patients with PD who do not present cognitive complaints.
RESUMO: Vários testes de triagem foram utilizados para avaliação cognitiva na doença de Parkinson (DP). Objetivo: Avaliar a utilidade da Avaliação Cognitiva de Montreal (MoCA) em pacientes com doença de Parkinson sem queixa de comprometimento cognitivo. Métodos: Um total de 40 pacientes com TP sem queixas de problemas cognitivos foram admitidos e com o Estado de Exame do Estado Mental Mini (MEEM) foram selecionados e receberam o MoCA. Resultados: 80% apresentaram dados de Comprometimento Cognitivo Leve (ICM) segundo o MoCA, sendo as funções visoespaciais, atenção e memória atrasada aquelas que apresentaram diferenças estatisticamente significantes entre os grupos MoCA normal e anormal. Conclusão: Este estudo sugere que o MoCA pode ser um bom teste de triagem em pacientes com DP que não apresentam queixas cognitivas.
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Humanos , Doença de Parkinson/diagnóstico , Triagem , Disfunção Cognitiva , Testes de Estado Mental e DemênciaRESUMO
RESUMEN El útero didelfo forma parte de las anomalías müllerianas, este se produce tras a una falla en la fusión de los conductos müllerianos, resultando dos cavidades uterinas divergentes y dos cérvix que se fusionan en el segmento inferior uterino. En la mayoría de los casos esta malformación se asocia a septo vaginal longitudinal o septo unilateral con formación de una hemivagina. Todo esto debido a deficiencias en el proceso de organogénesis de los conductos müllerianos. Esta revisión relata el caso de una paciente con útero didelfo, quién obtuvo un embarazo gemelar en un hemiútero, sin métodos de apoyo para alcanzar el embarazo, del cual se obtuvieron dos productos sanos tras cesárea de emergencia por amenaza de parto gemelar prematuro en la semana 34,5 de gestación. Los embarazos gemelares en úteros didelfos se estiman en 1 por cada millón de habitantes, pero a la actualidad solo se encuentran reportados alrededor de 20 casos.
ABSTRACT The uterus didelphys is part of the müllerian anomalies, this occurs after a failure in the fusion of the müllerian ducts, resulting in two divergent uterine cavities and two cervix that fuse in the lower uterine segment. In most cases, this malformation is associated with a longitudinal vaginal septum or unilateral septum with the formation of a hemivagina. All this due to deficiencies in the process of organogenesis of the müllerian ducts. This review reports the case of a patient with a uterus didelphis, who obtained a twin pregnancy in a hemi-uterus, without support methods to achieve pregnancy, from which two healthy products were obtained after emergency cesarean by threat of premature twin delivery in the week 34,5 of gestation. Twin pregnancies in uterus didelphys are estimated at 1 per million inhabitants, but currently only about 20 cases are reported.
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Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Útero/anormalidades , Gravidez de Gêmeos , Útero/diagnóstico por imagem , Imageamento por Ressonância Magnética , Resultado da Gravidez , Ductos Paramesonéfricos/anormalidadesRESUMO
The mirid Engytatus varians (Distant) is a promising biological control agent of the tomato borer, Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae), one of the most destructive pests of tomato (Solanum lycopersicum L.). The effects of five insecticides commonly used on tomato crops in Brazil were evaluated on E. varians in laboratory and semifield conditions. Glass Petri dish with residues of chlorfenapyr, thiamethoxam, and abamectin caused Ë90% mortality in both stages of the predator 72 h post-treatment, except imidacloprid that caused 78% of nymphs mortality. Teflubenzuron caused 24 and 66% mortality on adults and nymphs, respectively. The offspring of females derived from treated nymphs with teflubenzuron was significantly lower than the control but not when females were treated as adults. Longevity of males derived from nymphs treated with teflubenzuron was significantly reduced, but no effects were observed on females. When males and females were treated as adults with teflubenzuron there were no effects on their longevity. In the greenhouse-aged tomato plants, the 2 h-old residues of thiamethoxam, chlorfenapyr, and abamectin caused more than 70% of mortality of third instar of E. varians at 72 h post-treatment, 12 day-old residues of all three compounds caused a mortality lower than 30%. These data suggest that teflubenzuron can be associated with releases of E. varians adults, while the use of other evaluated pesticides should be avoided in this situation. Although, the low persistence of these products indicate that their spraying and later releases of E. varians adults on tomato crops are a possible strategy to control T. absoluta.
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Heterópteros/efeitos dos fármacos , Inseticidas/toxicidade , Comportamento Predatório/efeitos dos fármacos , Animais , Brasil , Feminino , Heterópteros/crescimento & desenvolvimento , Larva/crescimento & desenvolvimento , Masculino , Mariposas/crescimento & desenvolvimento , Ninfa/efeitos dos fármacos , Ninfa/crescimento & desenvolvimento , Controle Biológico de VetoresRESUMO
Two new species of Protium (Burseraceae) are described and illustrated: Protium aguilariisp. nov., from the Pacific slope of the Osa Peninsula, Puntarenas Province, Costa Rica; and Protium hammeliisp. nov., from wet forests on the Caribbean slopes of Nicaragua and Costa Rica. In addition, Protium brenesiicomb. nov., is proposed as a new combination based on Trichilia brenesii, a name that was based on a specimen collected with flowers in the mountains near San Ramón, Alajuela Province, Costa Rica. It is compared with Protium costaricense, a similar species with which it has been confused for more than 90 years. Finally, illustrations and specimen citations are provided for all the aforementioned taxa, and some others with which they have been confused.
ResumenSe describen e ilustran dos nuevas especies de Protium (Burseraceae): Protium aguilariisp. nov., de la vertiente del Pacífico en la Península de Osa, provincia de Puntarenas, Costa Rica; y Protium hammeliisp. nov., de los bosques húmedos de la vertiente del Caribe en Nicaragua y Costa Rica. Además, se propone la combinación Protium brenesiicomb. nov., basada en Trichilia brenesii, un nombre que fue descrito en base en un ejemplar con flores recolectado en las montañas de San Ramón, provincia de Alajuela, Costa Rica. Se compara con Protium costaricense, especie similar, con la cual se confundió por más de 90 años. Finalmente, se proveen ilustraciones y listas de los ejemplares examinados para todos los taxones antes mencionados, y además algunos otros similares.
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Antecedentes: la demencia es una entidad clínica cada vez más prevalente en nuestro medio, cuya incidencia aumenta con la edad. El objetivo del presente estudio es identificar los principales tipos de demencia atendidos en una unidad de trastornos de memoria. Métodos: registro consecutivo y estandarizado de pacientes diagnosticados con demencia en la Unidad de Trastornos de Memoria y Conducta, del Hospital Nacional de Geriatría y Gerontología. Resultados: se evaluó 1659 casos, de los cuales el 65,8% reunió criterios de demencia. El 42,9% correspondió a enfermedad de Alzheimer, el 28,5% a demencia secundaria a patología vascular, el 17,1% a formas mixtas, y el 11,5% a tipos varios. La edad media fue de 79,6 + 6,7 años, y el 66,2% fueron mujeres. La escolaridad promedio fue 4,95 + 4,09 años; el 41,7% estaba casado; el 47,3% tenía un hijo como cuidador; el tiempo promedio entre la aparición de los síntomas y el diagnóstico clínico fue de 3,18 + 2,6 años. La puntuación media del test Minimental fue de 18,35 + 5,9 puntos; en el test de dibujo del reloj fue de 3,4 + 2,5, y el Clinical Dementia Rating fue de 1,7 + 0,7; el 45,2% de los casos correspondió a CDR de 1. El 24% de los casos tenía antecedente familiar de demencia, y el 95,7% presentaba uno o más factores de riesgo cardiovascular, siendo la HTA el más frecuente, en un 70,2%. El 27,1% de los casos fue demencias leves; el 31,9%, moderadas; el 39,3% moderadas-severas, y el 1,7%, severas. El 90% de los casos presentó uno o más trastornos neuroconductuales. Conclusiones: la determinación de los principales tipos de demencia en la población adulta mayor y sus principales características, ha permitido registrar gran cantidad de información que se desconocía y que será de útil para la gestión y planificación de estrategias de atención en salud pública.
Background: Dementia is an increasingly prevalent clinical entity in the medical field, whose incidence increases with age. The purpose of this study is to identify the main types of dementia treated in a memory-disorders unit. Methodology: A consecutive and standardized register of patients diagnosed with dementia at the Memory Disorders Unit of the National Geriatrics and Gerontology Hospital. Results: 1659 cases were evaluated, 65.8% met criteria for dementia. 42.9% of the cases were Alzheimers disease, 28.5% secondary vascular dementia pathology, mixed forms represented 17.1% and 11.5% were diverse types. The mean age was 79.6 + 6.7 years and 66.2% were women. Average schooling was 4.95+ 4.09 years, 41.7% were married, 47.3% had a child as a caregiver, the average time between onset of symptoms and the clinical diagnosis was 3.18 + 2.6 years. The mean Minimental test score was 18.35 + 5.9 points, in the clock drawing test it was 3.4 + 2.5 and the Clinical Dementia Rating was 1.7 + 0.7; 45.2% of cases were CDR 1. 24% of cases had a family history of dementia and 95.7% had one or more cardiovascular risk factors, with AHT being the most common in 70.2%. 27.1% of dementia cases were mild, 31.9% moderate, 39.3% moderatesevere and 1.7% were severe. 90% of patients had one or more neurobehavioral disorders. Conclusions: The determination of the main types of dementia in the elderly population and their main features has allowed the registry of abundant information that was unknown and that will be useful for the management and strategic planning of public health care.
Assuntos
Doença de Alzheimer , Costa Rica , Demência , Geriatria , Transtornos da Memória , Saúde PúblicaRESUMO
Dementia and mild cognitive impairment (MCI) are an increasingly prevalent clinical entity in our , showing an increasing incidence with age. Objective: The purpose of this study was to identify the main types of dementia and MCI treated in a memory disorders unit in Costa Rica. Methods: A consecutive and standardized register of patients diagnosedwith dementia and MCI at the memory disorders unit of the National Geriatrics and Gerontology Hospital (NGGH) was analyzed. Results: Dementia was diagnosed in 63.5% of the 3572 cases, whereas 10.6% met criteria for MCI. The most frequent type of dementia was Alzheimers disease (47.1%), followed by vascular pathology (28.9%), mixed forms (17.2%) and other types (6.8%). In MCI, 69.5% were of amnestic multiple domain type and 14.3% were non-amnestic multiple domain, while 41.3% were of vascular and 35.8% of neurodegenerative etiology. Mean age was 79.6±6.7 years and 64.7% were women in dementia cases whereas mean age was 76.4±6.9 years and 62.1% were women in MCI. Mean years of schooling was 4.95±4.09 years and 6.87±4.71, while mean time between onset of symptoms and clinical diagnosis was 3.2±2.6 years and 2.67±2.69 years, in dementia and MCI, respectively. Conclusion: The determination of the main types of dementia and MCI in Costa Rica and their main features has allowed the registration of comprehensive, hitherto unavailable information that will be useful for the management and strategic planning of public health care.
Demência e transtorno cognitivo leve (CCL) é uma entidade clínica cada vez mais prevalente, mostrando uma incidência crescente com a idade. Objetivo: O objetivo deste estudo foi o de identificar os principais tipos de demência e CCL tratados em uma unidade de transtornos da memória de Costa Rica. Métodos: Um registo consecutivo e padronizado de pacientes com diagnóstico de demência e CCL na unidade de transtorno de memória do Hospital Geral de Geriatria e Gerontologia. Resultados: Demência foi diagnosticada em 63,5% dos 3.572 casos, enquanto 10,6% tiveram diagnóstico de CCL. O tipo mais frequente de demência foi a doença de Alzheimer (47,1%), seguido de doença vascular (28,9%), formas mistas (17,2%) e outros tipos (6,8%). No CCL, 69,5% eram de tipo amnéstico de múltiplos domínios e 14,3% eram não amnésticos de múltiplos domínios, enquanto 41,3% eram de etiologia vascular e 35,8% de etiologia neurodegenerativa. A média de idade foi de 79,6±6,7 anos e 64,7% eram mulheres em casos de demência ao passo que a média de idade foi de 76,4±6,9 anos e 62,1% eram mulheres nos casos de CCL. A média de anos de estudo foi de 4,95±4,09 anos e 6,87±4,71, o tempo entre o início dos sintomas e o diagnóstico clínico médio foi de 3,2±2,6 anos e 2,67±2,69 anos em demência e CCL, respectivamente. Conclusão: A determinação dos principais tipos de demência e CCL na Costa Rica e as suas principais características permitiu o registro de informação abundante que era desconhecida e que será útil para a gestão e planejamento estratégico da saúde pública.
Assuntos
Humanos , Epidemiologia , Demência , Doença de Alzheimer , Disfunção Cognitiva , MemóriaRESUMO
Dementia and mild cognitive impairment (MCI) are an increasingly prevalent clinical entity in our field, showing an increasing incidence with age. OBJECTIVE: The purpose of this study was to identify the main types of dementia and MCI treated in a memory disorders unit in Costa Rica. METHODS: A consecutive and standardized register of patients diagnosed with dementia and MCI at the memory disorders unit of the National Geriatrics and Gerontology Hospital (NGGH) was analyzed. RESULTS: Dementia was diagnosed in 63.5% of the 3572 cases, whereas 10.6% met criteria for MCI. The most frequent type of dementia was Alzheimer's disease (47.1%), followed by vascular pathology (28.9%), mixed forms (17.2%) and other types (6.8%). In MCI, 69.5% were of amnestic multiple domain type and 14.3% were non-amnestic multiple domain, while 41.3% were of vascular and 35.8% of neurodegenerative etiology. Mean age was 79.6±6.7 years and 64.7% were women in dementia cases whereas mean age was 76.4±6.9 years and 62.1% were women in MCI. Mean years of schooling was 4.95±4.09 years and 6.87±4.71, while mean time between onset of symptoms and clinical diagnosis was 3.2±2.6 years and 2.67±2.69 years, in dementia and MCI, respectively. CONCLUSION: The determination of the main types of dementia and MCI in Costa Rica and their main features has allowed the registration of comprehensive, hitherto unavailable information that will be useful for the management and strategic planning of public health care.
Demência e transtorno cognitivo leve (CCL) é uma entidade clínica cada vez mais prevalente, mostrando uma incidência crescente com a idade. OBJETIVO: O objetivo deste estudo foi o de identificar os principais tipos de demência e CCL tratados em uma unidade de transtornos da memória de Costa Rica. MÉTODOS: Um registo consecutivo e padronizado de pacientes com diagnóstico de demência e CCL na unidade de transtorno de memória do Hospital Geral de Geriatria e Gerontologia. RESULTADOS: Demência foi diagnosticada em 63,5% dos 3.572 casos, enquanto 10,6% tiveram diagnóstico de CCL. O tipo mais frequente de demência foi a doença de Alzheimer (47,1%), seguido de doença vascular (28,9%), formas mistas (17,2%) e outros tipos (6,8%). No CCL, 69,5% eram de tipo amnéstico de múltiplos domínios e 14,3% eram não-amnéstcios de múltiplos domínios, enquanto 41,3% eram de etiologia vascular e 35,8% de etiologia neurodegenerativa. A média de idade foi de 79,6±6,7 anos e 64,7% eram mulheres em casos de demência ao passo que a média de idade foi de 76,4±6,9 anos e 62,1% eram mulheres nos casos de CCL. A média de anos de estudo foi de 4,95±4,09 anos e 6,87±4,71, o tempo entre o início dos sintomas eo diagnóstico clínico médio foi de 3,2±2,6 anos e 2,67±2,69 anos em demência e CCL, respectivamente. CONCLUSÃO: A determinação dos principais tipos de demência e CCL na Costa Rica e as suas principais características permitiu o registro de informação abundante que era desconhecida e que será útil para a gestão e planejamento estratégico da saúde pública.
RESUMO
La hemorragia del tercer trimestre del embarazo y el posparto se han identificado como causas de mortalidad materna, generalmente ocurren en el tercer trimestre, las cuales pueden deberse a la presencia de placenta previa y desprendimiento prematuro de placenta. Objetivo: Establecer la prevalencia de placenta previa y desprendimiento prematuro de placenta en el Hospital Escuela, Bloque Materno Infantil. Materiales y métodos: Se realizó un estudio descriptivo transversal. El universo fue de 3.128 mujeres atendidas en el Hospital Escuela, Bloque Materno Infantil en el período del 22 de septiembre al 2 de diciembre de 2008. El número de embarazadas diagnosticadas con placenta previa o desprendimiento prematuro de placenta normoinserta fue 11. Para la recolección de datos se aplicó un instrumento que contiene variables cuantitativas (edad gestacional y materna, paridad, cesáreas previas, peso del recién nacido, APGAR) y cualitativas (antecedentes gíneco-obstétricos, variantes de placenta previa, datos del parto, datos del recién nacido y complicacion esmaterno-neonatales). Resultados: La prevalencia de placenta previa (0.31%) encontrada en el estudio, fue mayor en relación a los casos de desprendimiento prematuro de la placenta (0.03%); Los factores de riesgo presentes fueron la multiparidad y las cicatrices uterinas. De los 10 casos de Placenta previa 9 fueron sometidos a cesárea; el único caso de desprendimiento....(AU)
Assuntos
Humanos , Feminino , Gravidez , Placenta Prévia/história , Descolamento Prematuro da Placenta , Complicações na Gravidez , HondurasRESUMO
BACKGROUND: Allergic rhinitis is an inflammatory disease of the nasal mucosa, with common symptoms, which is essentially characterized by nasal itching, nasal congestion, sneezing, hyaline rhinorrhea and repetitive sneezing. The disease is very common, 15% of the population worldwide suffers it. Among many treatments that have been used to relieve the symptoms of this disease there is a selective inhibitor of H1 receptors, ebastine. OBJECTIVE: To evaluate patient satisfaction using the scale of Treatment Satisfaction Questionnaire for Medication (TSQM). MATERIAL AND METHODS: A multicentric, retrospective, observational study performed in 250 Mexican patients with the diagnosis of intermittent allergic rhinitis (IAR) or persistent allergic rhinitis (PER), confirmed by prick test, specific IgE, or both, treated with lyophilised ebastine in fast-dissolving (FDT) 20 mg at any time in the last two months, prescribed for at least two weeks by their doctor to relieve the symptoms of intermittent allergic rhinitis or persistent allergic rhinitis. We used a validated questionnaire assessment scales, TSQM. RESULTS: The presentation of ebastine fast-dissolving (FDT) is effective and has good tolerability, over 80% of patients reported comfort and satisfaction using it. CONCLUSIONS: Assessment of overall satisfaction, efficacy, tolerability and comfort showed that ebastine in fast-dissolving is an antihistamine with clear benefits to encourage compliance.
Assuntos
Butirofenonas/administração & dosagem , Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Piperidinas/administração & dosagem , Rinite Alérgica Perene/tratamento farmacológico , Rinite Alérgica Sazonal/tratamento farmacológico , Adolescente , Adulto , Butirofenonas/uso terapêutico , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Satisfação do Paciente , Piperidinas/uso terapêutico , Estudos Retrospectivos , Solubilidade , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND AIMS: Many studies suggest that the different steps of the atherosclerotic process may be mediated by metalloproteases (MMPs). MMP-9 and MMP-2, which are highly expressed in the vulnerable regions of the atherosclerotic plaques, have been suggested to be causally involved in plaque rupture. In another manner linked with LDL, lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) hydrolyzes phospholipids generating proinflammatory and proatherogenic products. Our aim was to evaluate plasma activity of MMP-2 and 9, as well as Lp-PLA(2), in subjects with coronary artery stenosis in comparison with controls and to correlate these activities with lipoprotein profile and general biomarkers of inflammation. METHODS: Forty two subjects who had undergone coronary angiography were divided into two groups: patients with coronary vessels with at least 45% stenosis (CAD [coronary artery disease], n = 24) and patients without angiographically detectable coronary artery disease (controls, n = 18). Plasma activity of MMP-2 and MMP-9 was measured and correlated with markers of systemic inflammation (hs-CRP), subendothelial inflammation (Lp-PLA(2)) and lipoprotein profile. RESULTS: Plasma activity of both MMPs was consistently higher in patients than in controls (p <0.01). Pro-MMP-2 (r = 0.34, p <0.01) and MMP-9 (r = 0.51, p <0.02) activities correlated with apoprotein B. Pro-MMP-2 correlated with hs-CRP (r = 0.47, p <0.01) and inversely with HDL cholesterol (r = -0.35, p <0.02). No differences were observed in Lp-PLA(2) between patients and controls (15.2 +/- 4.0 vs. 15.4 +/- 4.5 micromol/mL/h, p = NS, respectively), and no correlation was observed with MMPs. CONCLUSIONS: MMP activity was higher in CAD than in controls. The correlation observed between pro-MMP-2 and high-sensitive C-reactive protein (hs-CRP) may be due to specific systemic inflammatory processes. No correlation was observed between Lp-PLA(2) and MMPs.