RESUMO
Dysphagia might affect 12 % of the general population, and its complications include pneumonia, malnutrition, social isolation, and death. No validated Spanish symptom survey exists to quantify dysphagia symptoms among Latin Americans. Therefore, we performed a prospective cohort study in a tertiary care university hospital to validate the Spanish version of the 10-Item Eating-Assessment-Tool (EAT-10spa) for use in Colombia. After an interdisciplinary committee of five bilingual specialists evaluated the EAT-10spa (translated and validated in Spain) and deemed it appropriate for the Colombian culture, its feasibility, reliability, validity, sensitivity to change, and diagnostic capacity were evaluated. As a reference standard, we used the flexible endoscopic evaluation of swallowing with sensory testing and a standardized clinical evaluation. All assessments were blinded. In total, 133 subjects were included (52 % women, mean age 55 years) and completed the EAT-10spa (median completion time: 2 min [IQR 1-3 min]), 39 % of whom had an elementary-level education. Cronbach's α coefficient: 0.91; test-retest intra-class correlation coefficient: 0.94. The Spearman's correlation coefficient of the EAT-10spa with the 8-point penetration-aspiration scale was 0.54 (P < 0.001). The area under the receiver-operating-characteristic-curve (AUC-ROC) for dysphagia and aspiration were 0.79 (P < 0.001) and 0.81 (P < 0.001), respectively. The best cut-off points for dysphagia and aspiration were EAT-10spa ≥2 (sensitivity 93.6 %, specificity 36.4 %) and EAT-10spa ≥4 (sensitivity 94.3 %, specificity 49.5 %), respectively. A reduction in the EAT-10 ≥3 was the best cut-off point for a clinically significant improvement (AUC-ROC 0.83; P < 0.0001). The EAT-10spa showed excellent psychometric properties and discriminatory capacity for use in Colombia.
Assuntos
Transtornos de Deglutição/diagnóstico , Inquéritos e Questionários/normas , Avaliação de Sintomas/normas , Adulto , Idoso , Área Sob a Curva , Colômbia , Deglutição , Transtornos de Deglutição/psicologia , Ingestão de Alimentos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Método Simples-Cego , Estatísticas não Paramétricas , Avaliação de Sintomas/métodos , TraduçõesRESUMO
Resultados: se encontró un 80% de los estetoscopios contaminados, con una mediana de colonización de 2.58 Unidades Formadoras de Colonias (UFC)/cm2 y un 100% de los teléfonos móviles contaminados con una mediana de 0.401 UFC/cm2. En estetoscopios se aislaron SAMR (n=3) y Enterobacterias resistentes a cefalosporinas de tercera generación (n=2). En teléfonos móviles se aislaron SAMR(n=1), Candida spp (n=1) y Enterobacterias (n=5). La encuesta permitió establecer una tendencia de hábitos de higiene inapropiados sobre el uso de los fómites. Conclusiones: el hallazgo de bacterias resistentes en estos fómites los convierte en fuentes potenciales de transmisión cruzada y de brotes de infección intrahospitalaria. Estos resultados deben orientar el desarrollo de protocolos para el uso racional de dispositivos médicos y tecnología portátil dentro de ambientes hospitalarios.
Results: 80% of the stethoscopes (n=40) were found contaminated with a median count of 2,58 CFU/cm2 meanwhile 100% of cellular phones where found contaminated with a median count of 0,401 CFU/cm2. MRSA (n=3) and third generation cephalosporin-resistant Enterobacteriaceae (n=2) were isolated from stethoscopes, whereas in cellular phones MRSA (n=1), Candida (n=1) and third generation cephalosporin-sensitive Enterobacteriaceae (n=5) where found. Survey results indicated a trend towards inappropriate hygiene habits with fomites; however no statistical correlation could be established between these habits and colonization. Conclusion: The finding of nosocomial pathogens in these fomites transforms them in potential sources of crosscontamination and hospital-acquired infections outbreaks. Present results must steer development of protocols for rational use of medical devices and portable technology gadgets within hospital controlled environments.
Assuntos
Humanos , Masculino , Feminino , Enterobacteriaceae , Infecção Hospitalar , Controle de Infecções , Staphylococcus aureus , Unidades de Terapia Intensiva NeonatalRESUMO
El objetivo del presente artículo es revisar los conceptos actuales de mayor importancia que se vienen manejando sobre un tema que ha despertado gran interés en el estudio de la biología de los mecanismos asociados al DNA y a la expresión del gen. Se estudiará una modificación bioquímica de la larga cadena de nucleótidos, que ha sido llamada METILACION DEL DNA; analizando la manera como ocurre esta modificación; en qué sitios de la secuencia ocurre; en qué momento del ciclo celular y con qué frecuencia sucede; cuáles son los tipos de cambios que pueden presentarse; y, lo más relevante, cuál es el posible papel que cumple la metilación del DNA dentro de procesos genéticos y fenómenos patológicos humanos como el cáncer y el envejecimiento celular