RESUMO

Resumen Objetivo: Explorar y discutir literatura científica teórica y práctica para comparar la diversificación y la especialización deportivas tempranas como un enfoque deportivo y educativo. Métodos: Se realizó una revisión sistemática siguiendo las pautas PRISMA, se incluyó un total de 61 estudios. Resultados: Entrenadores, padres e hijos consideran que la mejor forma de desarrollar el talento deportivo y alcanzar la élite en el deporte es participar en una sola disciplina y hacerlo lo antes posible para lograr la especialización y las máximas habilidades técnicas, físicas y psicológicas. Los caminos de especialización deportiva pueden conducir a una situación física, social y mental que comprometa su desarrollo integral. Conclusión: Se puede plantear, en primer lugar, la diversificación deportiva en edades tempranas y luego la especialización; una vez alcanzadas las bases de la fuerza, el acondicionamiento y el entrenamiento neuromuscular, así como una maduración psicomotora específica, para que su rendimiento deportivo y su salud no se vean comprometidos en el mediano o largo plazo. Es necesario considerar que pocos niños logran obtener un lugar en los deportes de élite, por lo que, para muchos de ellos, la educación en torno al deporte será la base para el ejercicio de su ciudadanía como personas activas.

Abstract Purpose: To explore and discuss theoretical and practical scientific literature to compare sports diversification and early sports specialization as a sport and educational approach. Methods: A systematic review was conducted following PRISMA guidelines, and 61 studies were included. Results: Coaches, parents, and children consider that the best way to develop sports talent and enter the elite in sports is to practice a single discipline as early as possible to achieve specialization and maximum technical skills and physical and psychological conditions. Sports specialization paths may lead to a physical, social, and mental state that compromises their integral development. Conclusion: Sports diversification should be considered first at an early age and, afterward, the specialization once the bases of strength, conditioning, neuromuscular training, and a specific psychomotor maturation have been achieved, so that sports performance and health are not compromised in the medium or long term. It is necessary to consider that few children enter elite sports, so for many of them, sports education will be the basis for exercising their citizenship as active people.

Resumo Objetivos: Explorar e discutir literatura científica teórica e prática para comparar a diversificação e especialização esportiva precoce como uma abordagem esportiva e educacional. Métodos: uma revisão sistemática foi realizada seguindo as diretrizes do PRISMA, um total de 61 estudos foram incluídos Resultados: Treinadores, pais e crianças acreditam que a melhor maneira de desenvolver talentos esportivos e ingressar na elite do esporte é participar de uma única disciplina e fazer o mais cedo possível para alcançar a especialização e o máximo de habilidades técnicas, físicas e psicológicas. Os caminhos da especialização esportiva podem levar a uma situação física, social e mental que comprometa seu desenvolvimento integral. Conclusão: Primeiro, a diversificação esportiva pode ser considerada em uma idade precoce e depois a especialização, uma vez que os princípios básicos de força, condicionamento e treinamento neuromuscular tenham sido alcançados, bem como a maturação psicomotora específica para que seu desempenho esportivo e saúde não sejam comprometidos a médio ou longo prazo. É necessário considerar que poucas crianças conseguem obter um lugar nos esportes de elite, de modo que, para muitas delas, a educação em torno do esporte será a base para o exercício de sua cidadania como pessoas ativas.

RESUMO

Obesity and type 2 diabetes mellitus (T2DM) are chronic pathologies with a high incidence worldwide. They share some pathological mechanisms, including hyperinsulinemia, the production and release of hormones, and hyperglycemia. The above, over time, affects other systems of the human body by causing tissue hypoxia, low-grade inflammation, and oxidative stress, which lay the pathophysiological groundwork for cancer. The leading causes of death globally are T2DM and cancer. Other main alterations of this pathological triad include the accumulation of advanced glycation end products and the release of endogenous alarmins due to cell death (i.e., damage-associated molecular patterns) such as the intracellular proteins high-mobility group box protein 1 and protein S100 that bind to the receptor for advanced glycation products (RAGE) - a multiligand receptor involved in inflammatory and metabolic and neoplastic processes. This review analyzes the latest advanced reports on the role of RAGE in the development of obesity, T2DM, and cancer, with an aim to understand the intracellular signaling mechanisms linked with cancer initiation. This review also explores inflammation, oxidative stress, hypoxia, cellular senescence, RAGE ligands, tumor microenvironment changes, and the "cancer hallmarks" of the leading tumors associated with T2DM. The assimilation of this information could aid in the development of diagnostic and therapeutic approaches to lower the morbidity and mortality associated with these diseases.

RESUMO

BACKGROUND: Increasing cesarean section (CS) rates are a global concern because they are related to higher maternal and neonatal complication rates and do not provide positive childbirth experiences. In 2019, Brazil ranked second globally, given its overall CS rate of 57%. According to the World Health Organization (WHO), populational CS rates of 10-15% are associated with decreased maternal, neonatal, and infant mortality rates. This study aimed to investigate whether multidisciplinary care following evidence-based protocols associated with a high motivation of both women and professionals for a vaginal birth leads to less overuse of CS in a Brazilian private practice (PP). METHODS: This cross-sectional study evaluated CS rates by Robson group for women who sought vaginal birth in a private practice in Brazil comparing with Swedish data. Collaborative care of midwives and obstetricians who adopted evidence-based guidelines was offered. CS rates, overall and by Robson group, contribution of each Robson group to the overall CS rate, clinical and nonclinical interventions, vaginal birth, pre-labor CS, and intrapartum CS proportions were estimated. The expected CS rate was calculated using the World Health Organization C-model tool. The analysis used Microsoft Excel and R Studio (version 1.2.1335. 2009-2019). RESULTS: The PP overall CS rate was 15.1% (95%CI, 13.4-17.1%) versus the 19.8% (95%CI, 14.8-24.7%) rate expected by the WHO C-model tool. The population included 43.7% women in Robson Group 1 (nulliparous, single, cephalic, at term, spontaneous labor), 11.4% in Group 2 (nulliparous, single, cephalic, at term, induced labor or CS before labor), and 14.9% in Group 5 (multiparous women with previous CS), the greatest contributors to higher CS rates (75.4% of them). The Swedish overall CS rate was 17.9% (95%CI, 17.6-18.1%) in a population of 27% women in Robson Group 1, 10.7% in Group 2, and 9.2% in Group 5. CONCLUSIONS: Multidisciplinary care following evidence-based protocols, associated with high motivation of both women and professionals for vaginal birth, may lead to a significant and safe reduction of CS rates even in contexts such as Brazil, with high medicalization of obstetric care and excess CS.

Assuntos

RESUMO

Resumen: Propósito 1: Este estudio determinó el efecto de un programa de entrenamiento sensoriomotor sobre el equilibrio estático en nadadores con síndrome de Down (SD) y discapacidad intelectual (DI). Metodología: Participantes: 13 personas. Instrumentos y materiales: Se utilizó el Modified Clinical Test for Sensory Integration for Balance para determinar el equilibrio y un equipo Wii Balance Board y computadora con programa de análisis del centro de gravedad. Procedimientos: se aplicó un pretest y luego se aplicó un entrenamiento neuromotor (3 sesiones semanales, de 30 minutos, durante 4 semanas), al terminar se aplicó el postest. Por tratarse de deportistas activos continuaron con su rutina sin alteraciones en la carga de entrenamiento. Se usó estadística descriptiva y ANOVA de dos vías 2X2, mediciones y grupos. Resultados: No hubo diferencias estadísticamente significativas entre la variable mediciones (F = 0.14; p = 0.7162) ni por grupos (F = 0.2; p = 0.6659) en variable ojos abiertos estable. En la variable ojos cerrados inestable sí hubo diferencias significativas (F = 0.952; p = 0.350), por grupos (F = 6.066; p = 0.320), en la variable ojos abiertos inestable no hubo diferencias ni en mediciones (F = 0.852; p = 0.376) ni en grupos (F = 2.484; p = 0.143). En variable ojos cerrados estable no hubo diferencias en mediciones (F = 0.716; p = 0.415) ni por grupos (F = 0.801; p = 0.390). Se demostró que este entrenamiento en esa población produce mejora en la variable equilibrio ya que muestra una diferencia significativa p < 0.05 en la variable ojos abiertos inestable 0.32.

Abstract: Purpose2: This study seeks to determine the effect of a sensorimotor training program on static equilibrium in swimmers with Down syndrome and intellectual disability. Method: Participants: a total of 13 swimmers. Instruments and materials: the Modified Clinical Test for Sensory Integration for Balance, a Wii device with a platform, and a computer with a program to analyze the center of gravity were used in the study. Procedures: a pretest was applied, then a neuromotor training was delivered for four weeks, in three sessions of 30 minutes each, and finally, a posttest was applied. Since they were active athletes, they continued their routine without altering the training load. Statistical analysis: descriptive statistics and a two-way ANOVA (2x2, measures and groups) were used. Results: there were no statistically significant differences between the variables measured (F = 0.14, p = 0.7162) or per groups (F = 0.2, p = 0.6659) for the variable open eyes on a stable surface. For the variable closed eyes on an unstable surface, there were significant differences between the variables measured (F = 0.952, p = 0.350) and between groups (F = 6.066, p = 0.320), while for open eyes on an unstable surface there were no differences between the variables measured (F = 0.852, p = 0.376) or between groups (F = 2, .484, p = 0.143). For the variable closed eyes on a stable surface there were no significant differences between the variables measured (F = 0.716, p = 0.415) or between groups (F = 0.801, p = 0.390). It was found that this training in this population produced an improvement (p <0.05) for the variable closed eyes on a stable surface 0.32.

Resumo: Propósito 3: Este estudo determinou o efeito de um programa de treinamento sensório-motor sobre o equilíbrio estático em nadadores com síndrome de Down e deficiência intelectual. Metodologia: Participarem 13 nadadores. Instrumentos e materiais: Se utilizo o Modified Clinical Test for Sensory Integration for Balance (Teste Clínico Modificado de Integração Sensorial para Equilíbrio) para determinar o equilíbrio e um dispositivo Wii Balance Board e computador com um programa de análise do centro de gravidade. Procedimentos: Foi aplicado um pre-teste, quando foi iniciado o treinamento neuromotor por quatro semanas, três sessões de 30 minutos cada uma; ao finalizar o programa, o pós-teste foi aplicado. Pois como eram atletas ativos, eles continuaram com uma carga constante. Foram usadas estatísticas descritivas e ANOVA 2X2 bidirecional, medições e grupos. Resultados: Não houve diferenças estatisticamente significantes entre a variável medições (F = 0,14; p = 0,7162) nem por grupos (F = 0,2; p = 0,6659) na variável olhos abertos estável. Na variável olhos fechados instável houve diferenças significativas (F = 0,952; p = 0,350) e por grupos (F = 6,066; p = 0,320); mas na variável olhos abertos instável não houve diferenças nem em medições (F = 0,852; p = 0,376) nem em grupos (F = 2, 484; p = 0,143). Na variável olhos fechados estável, não houve diferenças significativas em medições (F = 0,716; p = 0,415) nem por grupos (F = 0,801; p = 0,390). Foi demonstrado que este treinamento nestas pessoas melhora a variável equilíbrio, já que mostra uma diferença estatisticamente significante p <0,05 na variável olhos abertos instável 0,32.

Assuntos

RESUMO

Superparamagnetic iron oxide nanoparticles (SPIONs) have some limitations in the physiological environment, however, a modification on their surface, such as a core-shell structure with gold (SPIONs@Au), can enhance their applicability. In this study, SPIONs were synthesized by the chemical coprecipitation method, stabilized by sodium citrate, and followed by the gold-coating process. SPIONs@Au were functionalized with EGF-α-lipoic acid and chlorin e6 (Ce6)-cysteamine complexes, composing a Theranostic Nanoprobe (TP). The outcomes showed that the SPIONs@Au had changed in color to red and had an absorption band centered at 530 nm. The coating was verified in the TEM micrographs in bright and dark fields by EDS mapping, which indicated the presence of Au and Fe. The Ce6-cysteamine complex had a resonant band at 670 nm that enabled the diagnosis of biological samples using fluorescence analysis. In the measure of TNBC cell uptake, the maximum value of TP fluorescence intensity was obtained within 4 h of internalization. At 2 h, the incorporation of the TP in the cytoplasm as well as in the nuclei was observed, suggesting that it could be employed as a diagnostic marker. The PTT results showed significant percentages of apoptosis in the TNBC cell line, which confirms the efficacy of the TP.

RESUMO

Resumen Rojas-Valverde, D., Fallas-Campos, A., y Alpízar-Alpízar, M. (2020). Esports en tiempos de una pandemia global: oportunidades y futuros desafíos al transformar el juego en un deporte en Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 18(2), 1- 11. En respuesta a la pandemia relacionada con COVID-19, el mundo ha sufrido una serie de cambios drásticos. Debido a ellos, se han anunciado aplazamientos y cancelaciones de múltiples grandes eventos anuales en los deportes, las cuales dan paso a nuevas alternativas digitales que responden a las disposiciones de aislamiento del gobierno. Los eSports se muestran como una alternativa en rápida evolución para mantener el espíritu deportivo y la pasión que los deportes provocan en la población en general. En Costa Rica, este deporte ha comenzado su crecimiento, tal como sucedió en todo el mundo, y se ha acelerado con una alta tasa de evolución. En este sentido, el país enfrenta grandes desafíos para su promoción, incluyendo la de futuros eventos, el desarrollo de profesionales y la creación de una estructura organizacional para su práctica óptima. Este manuscrito busca analizar cómo la pandemia global expone la necesidad de poner atención a las alternativas deportivas digitales como el eSport y los desafíos futuros que enfrenta Costa Rica al tratar de desarrollarlo de manera efectiva y eficiente.

Abstract Rojas-Valverde, D., Fallas-Campos, A., & Alpízar-Alpízar, M. (2020). Esports in times of a global pandemic: opportunities and future challenges when transforming gaming into a sport in Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 18(2), 1-11. In response to the COVID-19 global pandemic, the world has undergone a series of drastic changes. Due to this, postponement and cancellation of multiple annual big sports events have been announced, giving way to new digital alternatives that follow government isolation provisions. eSports has shown to be a rapidly evolving alternative to maintain the sportsmanship and passion that sports bring to the general population. In Costa Rica, like everywhere else, this sport has seen accelerated growth with a high rate of evolution. In this regard, the country faces significant challenges to promote future eSports events, professional development, and the creation of an organizational structure for its optimal practice. This paper aims to analyze how the global pandemic exposes the need to direct the attention to digital sports alternatives such as eSport and the future challenges that Costa Rica will face to develop it in an effective and efficient way.

Resumo Rojas-Valverde, D., Fallas-Campos, A., e Alpízar-Alpízar, M. (2020). Os esportes eletrônicos em tempos de uma pandemia global: oportunidades e futuros desafios ao transformar o jogo em um esporte na Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 18(2), 1-11. Como resposta à pandemia relacionada com a COVID-19, o mundo sofreu uma série de mudanças drásticas. Devido a isso, foram anunciados adiamentos e cancelamentos de múltiplos eventos esportivos de grande porte levados a cabo anualmente, abrindo espaço para novas alternativas digitais que respondem às disposições governamentais no que diz respeito ao isolamento. Os Esportes Eletrônicos ou eSports demonstram ser uma alternativa em rápida evolução para manter o espírito esportivo e a paixão que os esportes provocam na população em geral. Na Costa Rica, esse esporte começou a crescer, assim como aconteceu em todo o mundo, e acelerou com uma alta taxa de evolução. Neste sentido, o país enfrenta grandes desafios para sua promoção, incluindo a de futuros eventos, o desenvolvimento de profissionais e a criação de uma estrutura organizacional para que a prática seja adequada. Este manuscrito busca analisar como a pandemia global expõe a necessidade de estar alerta às alternativas esportivas digitais como o eSport e aos desafios futuros enfrentados pela Costa Rica para desenvolvê-las efetiva e eficientemente.

Assuntos

RESUMO

BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.

Assuntos

RESUMO

Abstract In response to the COVID-19 global pandemic, the world has undergone a series of drastic changes. Due to this, postponement and cancellation of multiple annual big sports events have been announced, giving way to new digital alternatives that follow government isolation provisions. eSports has shown to be a rapidly evolving alternative to maintain the sportsmanship and passion that sports bring to the general population. In Costa Rica, like everywhere else, this sport has seen accelerated growth with a high rate of evolution. In this regard, the country faces significant challenges to promote future eSports events, professional development, and the creation of an organizational structure for its optimal practice. This paper aims to analyze how the global pandemic exposes the need to direct the attention to digital sports alternatives such as eSport and the future challenges that Costa Rica will face to develop it in an effective and efficient way.

Resumen En respuesta a la pandemia relacionada con COVID-19, el mundo ha sufrido una serie de cambios drásticos. Debido a ellos, se han anunciado aplazamientos y cancelaciones de múltiples grandes eventos anuales en los deportes, las cuales dan paso a nuevas alternativas digitales que responden a las disposiciones de aislamiento del gobierno. Los eSports se muestran como una alternativa en rápida evolución para mantener el espíritu deportivo y la pasión que los deportes provocan en la población en general. En Costa Rica, este deporte ha comenzado su crecimiento, tal como sucedió en todo el mundo, y se ha acelerado con una alta tasa de evolución. En este sentido, el país enfrenta grandes desafíos para su promoción, incluyendo la de futuros eventos, el desarrollo de profesionales y la creación de una estructura organizacional para su práctica óptima. Este manuscrito busca analizar cómo la pandemia global expone la necesidad de poner atención a las alternativas deportivas digitales como el eSport y los desafíos futuros que enfrenta Costa Rica al tratar de desarrollarlo de manera efectiva y eficiente.

Resumo Como resposta à pandemia relacionada com a COVID-19, o mundo sofreu uma série de mudanças drásticas. Devido a isso, foram anunciados adiamentos e cancelamentos de múltiplos eventos esportivos de grande porte levados a cabo anualmente, abrindo espaço para novas alternativas digitais que respondem às disposições governamentais no que diz respeito ao isolamento. Os Esportes Eletrônicos ou eSports demonstram ser uma alternativa em rápida evolução para manter o espírito esportivo e a paixão que os esportes provocam na população em geral. Na Costa Rica, esse esporte começou a crescer, assim como aconteceu em todo o mundo, e acelerou com uma alta taxa de evolução. Neste sentido, o país enfrenta grandes desafios para sua promoção, incluindo a de futuros eventos, o desenvolvimento de profissionais e a criação de uma estrutura organizacional para que a prática seja adequada. Este manuscrito busca analisar como a pandemia global expõe a necessidade de estar alerta às alternativas esportivas digitais como o eSport e aos desafios futuros enfrentados pela Costa Rica para desenvolvê-las efetiva e eficientemente.

Assuntos

RESUMO

We evaluated the effects of acute intake of biscuits (B) containing either spent coffee grounds (SCG), (added with fructooligosaccharides; SC-FOS) or SCG antioxidant dietary fiber (SCF), on satiety, energy intake as well as gastrointestinal tolerance of healthy overweight volunteers. The addition of SCG and SCF to the biscuits (SC-FOS-B and SCF-B) increased their protein (11.4% and 12.2%), and total dietary fiber (8.4% and 11.8%) contents. The SCF-B significantly increased satiety perception, impacting ad libitum energy intake compared to the traditional biscuits recipe (TB; no added fiber). Moreover, SC-FOS-B and SCF-B decreased (no-observed-adverse effect) the most frequently reported symptoms by the participants, demonstrating that doses up to 5 g of SCF (per biscuit portion; 45 g) are well tolerated. The use of SCF and SCG as functional ingredients represents a sustainable strategy for the coffee industry and also potentiates the reduction of overweight, one of the leading health problems among the population. PRACTICAL APPLICATIONS: The addition of SCF or SCG as food ingredients increases protein and the dietary fiber content of traditional biscuits. SCF can slow gastric emptying, modulate appetite and thus body weight. SCF attenuates carbohydrate digestion blunting post-prandial blood glucose spikes reducing the risk of type 2 diabetes. SCF can be used as a functional ingredient to formulate foods with health benefits.

Assuntos

RESUMO

BACKGROUND: Levator ani avulsion is defined as the interruption of the insertion of this muscle on the pubic bone. It is currently recognized as an important triggering factor for genital prolapse. Although surgical interventions are available, there are no conservative strategies for this muscular injury. DESCRIPTION: A 40-year-old female presented with urinary incontinence and levator ani avulsion, which was confirmed on transperineal three-dimensional ultrasound (3DUS). Upon referral for physiotherapy, she presented with incorrect and weak contractions of the pelvic floor. Her treatment comprised 13 sessions of intravaginal electrotherapy followed by pelvic floor muscle (PFM) exercises in different positions. At the end of the sessions, another transperineal 3DUS was performed, and it revealed rapprochement of the levator ani muscle. The avulsed levator ani muscle can be reinserted using physiotherapeutic interventions, especially a combination of electrotherapy and PFM exercises. CONCLUSION: Transperineal 3DUS is an important approach for the follow-up of conservative treatment until full recovery.

RESUMO

Introducción: El ensayo clínico es la manera más rigurosa de conducir los experimentos en seres humanos. Desde su introducción en investigación biomédica se han implementado cambios en el modo de establecer las bases para el diagnóstico, pronóstico y la terapéutica en la práctica clínica. Se han realizado estudios para identificar los ensayos clínicos publicados en diferentes áreas médicas, pero hasta el momento ninguno había identificado los ensayos clínicos publicados en el Boletín Médico del Hospital Infantil de México (BMHIM). El objetivo de este trabajo fue identificar y describir los ensayos clínicos controlados (ECC) publicados en el BMHIM. Métodos: Se realizó búsqueda manual y sistemática en cada uno de los números y volúmenes del BMHIM de 1968 a 2016. Se registraron los ECC para obtener sus principales características. Adicionalmente, se evaluó su calidad metodológica mediante la herramienta de riesgo de sesgo. Los resultados se presentan de forma descriptiva, gráfica y temporal. Resultados: Se revisaron 73 números con 363 volúmenes, analizando 4925 artículos. La proporción de ECC identificados en el BMHIM fue del 1% (67/4925). En general, los ensayos clínicos se realizaron en el contexto nacional, en el tercer nivel de atención, con un tamaño de muestra reducido, y las intervenciones farmacológicas fueron las más utilizadas. La calidad metodológica de los estudios fue baja, con alto riesgo de sesgo. Conclusiones: Los ensayos clínicos representan el 1% de todos los artículos de investigación originales publicados en el BMHIM. Aún existen áreas de investigación pediátrica, las cuales requieren del desarrollo de ECC para mejorar la práctica clínica, así como para elevar la calidad de la investigación. Background: Controlled clinical trials (CCT) are the study design with the highest accuracy and evidence level. From its introduction in biomedical research, changes have been implemented in the way of establishing the basis for diagnosis, prognosis and treatment in clinical practice. Studies to identify published CCTs regarding different medical fields have been carried out. To date, none of them has identified the clinical trials that have been published in the Boletín Médico del Hospital Infantil de México (BMHIM). The aim of this study was to identify and describe the controlled clinical trials published in the BMHIM. Methods: A manual and systematic search was performed in each of the volumes of the BMHIM from 1968 to 2016. CCTs were recorded to obtain their main characteristics. Additionally, their methodological quality was assessed through the "risk of bias" tool. Results are presented in a descriptive, graphic and time-based manner. Results: In total, 73 issues with 363 volumes were reviewed, and 4925 articles were analyzed. The proportion of CCTs identified in the BMHIM was 1% (67/4925). In general, clinical trials were performed in the national context and in the third-level of medical care. CCTs also presented reduced sample sizes; pharmacological interventions were the most frequent. The methodological quality of the studies was low with a high risk of bias. Conclusions: Clinical trials represented 1% of all the original research articles published in the BMHIM. There are still pediatric research fields that require CCTs to be developed in order to improve clinical practice, as well as to increase the quality of the research.

Assuntos

RESUMO

Resumen Introducción: El ensayo clínico es la manera más rigurosa de conducir los experimentos en seres humanos. Desde su introducción en investigación biomédica se han implementado cambios en el modo de establecer las bases para el diagnóstico, pronóstico y la terapéutica en la práctica clínica. Se han realizado estudios para identificar los ensayos clínicos publicados en diferentes áreas médicas, pero hasta el momento ninguno había identificado los ensayos clínicos publicados en el Boletín Médico del Hospital Infantil de México (BMHIM). El objetivo de este trabajo fue identificar y describir los ensayos clínicos controlados (ECC) publicados en el BMHIM. Métodos: Se realizó búsqueda manual y sistemática en cada uno de los números y volúmenes del BMHIM de 1968 a 2016. Se registraron los ECC para obtener sus principales características. Adicionalmente, se evaluó su calidad metodológica mediante la herramienta de riesgo de sesgo. Los resultados se presentan de forma descriptiva, gráfica y temporal. Resultados: Se revisaron 73 números con 363 volúmenes, analizando 4925 artículos. La proporción de ECC identificados en el BMHIM fue del 1% (67/4925). En general, los ensayos clínicos se realizaron en el contexto nacional, en el tercer nivel de atención, con un tamaño de muestra reducido, y las intervenciones farmacológicas fueron las más utilizadas. La calidad metodológica de los estudios fue baja, con alto riesgo de sesgo. Conclusiones: Los ensayos clínicos representan el 1% de todos los artículos de investigación originales publicados en el BMHIM. Aún existen áreas de investigación pediátrica, las cuales requieren del desarrollo de ECC para mejorar la práctica clínica, así como para elevar la calidad de la investigación.

Abstract Background: Controlled clinical trials (CCT) are the study design with the highest accuracy and evidence level. From its introduction in biomedical research, changes have been implemented in the way of establishing the basis for diagnosis, prognosis and treatment in clinical practice. Studies to identify published CCTs regarding different medical fields have been carried out. To date, none of them has identified the clinical trials that have been published in the Boletín Médico del Hospital Infantil de México (BMHIM). The aim of this study was to identify and describe the controlled clinical trials published in the BMHIM. Methods: A manual and systematic search was performed in each of the volumes of the BMHIM from 1968 to 2016. CCTs were recorded to obtain their main characteristics. Additionally, their methodological quality was assessed through the "risk of bias" tool. Results are presented in a descriptive, graphic and time-based manner. Results: In total, 73 issues with 363 volumes were reviewed, and 4925 articles were analyzed. The proportion of CCTs identified in the BMHIM was 1% (67/4925). In general, clinical trials were performed in the national context and in the third-level of medical care. CCTs also presented reduced sample sizes; pharmacological interventions were the most frequent. The methodological quality of the studies was low with a high risk of bias. Conclusions: Clinical trials represented 1% of all the original research articles published in the BMHIM. There are still pediatric research fields that require CCTs to be developed in order to improve clinical practice, as well as to increase the quality of the research.

Assuntos

RESUMO

Over the past few decades, progress has been made toward understanding the mechanisms of coralline algae mineralization. However, the relationship between the mineral phase and the organic matrix in coralline algae has not yet been thoroughly examined. The aim of this study was to describe the cell wall ultrastructure of Lithothamnion crispatum, a cosmopolitan rhodolith-forming coralline algal species collected near Salvador (Brazil), and examine the relationship between the organic matrix and the nucleation and growth/shape modulation of calcium carbonate crystals. A nanostructured pattern was observed in L. crispatum along the cell walls. At the nanoscale, the crystals from L. crispatum consisted of several single crystallites assembled and associated with organic material. The crystallites in the bulk of the cell wall had a high level of spatial organization. However, the crystals displayed cleavages in the (104) faces after ultrathin sectioning with a microtome. This organism is an important model for biomineralization studies as the crystallographic data do not fit in any of the general biomineralization processes described for other organisms. Biomineralization in L. crispatum is dependent on both the soluble and the insoluble organic matrix, which are involved in the control of mineral formation and organizational patterns through an organic matrix-mediated process. This knowledge concerning the mineral composition and organizational patterns of crystals within the cell walls should be taken into account in future studies of changing ocean conditions as they represent important factors influencing the physico-chemical interactions between rhodoliths and the environment in coralline reefs.

Assuntos

RESUMO

Introducción: el envejecimiento poblacional mundial ha aumentado la incidencia de fracturas de cadera, este cambio genera un alto impacto económico, social y constituye un reto para la salud pública. Este estudio busca evaluar la satisfacción con el manejo posquirúrgico en adultos mayores con fracturas de cadera al año de la intervención y conocer los desenlaces en este tiempo. Materiales y métodos: estudio exploratorio, observacional, descriptivo de corte transversal, mediante encuesta telefónica en adultos de 65 o más años, un año después de intervención quirúrgica por fracturas de cadera en Méderi - Hospital Universitario Mayor, de Bogotá. Se describen variables evaluativas de satisfacción y atención en salud, así como otras relacionadas. Resultados: de 287 pacientes, 116 cumplen los criterios de inclusión y aceptan participar. El rango de edad oscila entre 65 y 99 años, media de 81,3 ± 8,17. Las mujeres y los hombres representan, respectivamente, 76% y 24% de la muestra. Mortalidad anual 28%, por género: 23% mujeres y 43% hombres. 29,3% presenta reingresos hospitalarios, 50% recupera su habilidad para la marcha. 81% considera buena la atención intrahospitalaria por ortopedia. 64% no califica el servicio intrahospitalario por fisioterapia ya que no lo recibe. 70% expresa satisfacción con los servicios ambulatorios de ortopedia y rehabilitación. Conclusiones: estudio novedoso y único que da voz como sujeto activo al paciente para evaluar el sistema de salud, sugiere el grado de dolor como elemento trazador de calidad de vida y obliga a implementar programas y servicios para adultos mayores con fracturas de cadera.

Introduction: World aging increases the incidence of hip fracture in adults over sixty years of age, pathology of economic and social burden being a challenge for public health. This study seeks to assess patient degree of satisfaction with health care services and assess outcomes. Materials and methods: Exploratory, observational, descriptive cross sectional study, with a telephone survey in patients 65 years or older, one year after hip fracture surgical intervention in Méderi - Hospital Universitario Mayor, Bogotá. Results: Of 287 patients 116 met the inclusion-exclusion criteria and accepted to participate. Age ranges between 65 and 99 years with a mean of 81,3 ± 8,17. Women and men represent respectively 76% and 24% of the sample. Mortality a year after is 28%, gender: 23% women and 43% men. 29,3% of the patients reentered the hospital, 50% recovered their previous functional capacity. 81% express as good the inpatient care by orthopedic service. 64% does not grade inpatient care by rehabilitation services because it was not given. 70% are satisfied with the outpatient services of orthopedic and rehabilitation. Conclusions: This study represents a novel and unique approach as it gives voice to the patient allowing assessment of the health services. Suggests the degree of pain as a tracer of quality of life and brings upon compulsory attention to implement health services improvement programs for hip fractures in the elderly.

Introdução: o envelhecimento populacional mundial tem aumentado a incidência de fraturas de quadril, mudanças que gera um alto impacto económico, social e constitui um desafio para a saúde pública. O estudo busca avaliar a satisfação com o manejo pós-cirúrgico em idosos com fraturas de quadril no ano posterior à intervenção e conhecer os desenlaces neste tempo. Materiais e métodos: estudo exploratório, observacional, descritivo, de corte transversal, mediante questionário por telefone em adultos de 65 ou mais anos, um ano após da intervenção cirúrgica por fraturas de quadril em Méderi - Hospital Universitário Mayor, de Bogotá D.C. Descrevem-se variáveis avaliativas de satisfação e atenção em saúde, assim como outras relacionadas. Resultados: de 287 pacientes, 116 cumprem os critérios de inclusão e aceitam participar. O rango de idade oscila entre 65 e 99 anos, média de 81,3 ± 8,17. As mulheres e os homens representam respetivamente 76% e 24% da amostra. Mortalidade anual 28%, por gênero: 23% mulheres e 3% homens. 29,3% apresenta reingressos hospitalários, 50% recupera a sua habilidade para a marcha. 81% considera boa a atenção intra-hospitalar por ortopedia. 64% não qualifica o serviço intra-hospitalar por fisioterapia já que não o recebe. 70% expressa satisfação com os serviços ambulatórios de ortopedia e reabilitação. Conclusões: estudo novo e único que dá voz como sujeito ativo ao paciente para avaliar o sistema de saúde, sugere o grau de dor como elemento traçador de qualidade de vida e obriga a implementar programas e serviços para idosos com fraturas de quadril.

Assuntos

RESUMO

Relato de experiência da equipe de Saúde Mental, composta por fonoaudióloga e psicóloga, da Unidade Básica de Saúde Vila Pirituba da Prefeitura do Município de São Paulo, na organização da demanda e construção de fluxo de atendimento, criando formas de atuação fundamentadas no paradigma atual de saúde em que se possibilitou dentro dos recursos disponíveis otimizar os atendimentos com a significativa redução do tempo de espera para os referidos especialistas, uma vez que todos os interessados são acolhidos através de uma escuta qualificada e direcionados para os atendimentos necessários (AU)

Assuntos

RESUMO

O diabetes mellitus é uma síndrome de etiologia múltipla e um dos principais agravos de saúde pública no Brasil. O controle desse agravo nos serviços básicos é fundamental, em virtude de sua magnitude crescente, transcendência e complexa vulnerabilidade. O objetivo deste estudo foi avaliar o tratamento e acompanhamento de pacientes diabéticos, segundo as recomendações da Sociedade Brasileira de Diabetes (SBD), em duas unidades básicas de saúde do município de Goiânia ? GO. Os dados foram obtidos por meio da revisão de prontuários médicos referentes ao período de janeiro de 2007 a dezembro de 2009, totalizando 250 prontuários, consolidados no software Epi InfoTM . Houve maior frequência de diabetes mellitus tipo 2 (96,65%) em relação ao tipo 1. Em 78% dos prontuários, havia descrição de hipertensão arterial e, destes, 77,4% tinham prescrição de IECA, e em 30,4% dos prontuários havia prescrição de AAS. Em média, pequena porcentagem de prontuários atendeu às recomendações da SBD: quase 50% dos pacientes estavam com pressão arterial controlada na unidade UBESF ?A? e 35%, na unidade UBESF ?B?; cerca de 25% estavam com LDL inferior a 100mg/dL em ambas as unidades e aproximadamente 25% dos prontuários da unidade UBESF ?B? tinham HbA1c inferior a 7%, e 18%, na UBESF ?A?. Quanto ao estudo de utilização de medicamentos, 41,1% dos prontu- ários tinham prescrição de metformina e um secretagogo, e apenas 20,4% dos pacientes com HbA1c>9% tinham prescrição de insulina.

Diabetes mellitus is a syndrome of multiple etiology and a major public health problem in Brazil. The control of this disease in basic services is crucial because of its growing magnitude, transcendence, and complex vulnerability. This retrospective study aimed to evaluate the treatment and monitoring of diabetic patients according to the Brazilian Diabetes Society guidelines in two basic health units (UBESFs) in the city of Goiânia/GO. Data were collected by review of medical records from January 2007 to December 2009, resulting in 250 records, consolidated in the Epi InfoTM software. There was a higher frequency of diabetes mellitus type 2 (96.65%) compared to type 1. In 78% of the records, arterial hypertension had been detected and of these, 77.4% had a prescription for ACE inhibitors. In 30.4% of the records, aspirin had been prescribed. On average, a small percentage of the medical records met the recommendations of the Brazilian Diabetes Society: almost 50% of the patients had controlled blood pressure in UBESF unit ?A? and over 35% in UBESF unit ?B?; about 25% had LDL less than 100mg/dL in both units, and approximately 25% had HbA1c below 7% in UBESF unit ?B? and 18% in UBESF unit ?A?. As to the study of medication use, 41.1% of the records had prescriptions for metformin and a secretagogue, and only 20.4% of the patients with HbA1c >9% had an insulin prescription.

Assuntos

RESUMO

En México, el paro cardiaco que ocurre fuera de las instalaciones hospitalarias representa un problema de salud pública debido a que se estima que es responsable de 33,000 a 150,000 muertes al año. La mortalidad que se informa, en las escasas publicaciones que existen en México, son tan elevadas que incluso llegan al 100% de los eventos, cifras mucho más altas que las informadas en otros países. En la ciudad de Querétaro no se tenían documentados casos de reanimación exitosa en los últimos 5 años, sin embargo, en el 2012 se informaron varios casos en los que la reanimación logró obtener el retorno de la circulación espontánea. Se presentan3 casos con retorno de la circulación espontánea en la escena y pulso a la llegada al hospital. De ellos, 2 egresaron con vida del hospital; pero uno de estos con pobre actividad cerebral. Factores como reanimación cardiopulmonar comunitaria, desfibrilación en los primeros minutos y mejores tiempos de respuesta del sistema de urgencia se relacionan con la supervivencia de las víctimas. Podrían mejorarse los resultados de este poco explorado problema de salud en el contexto mexicano con la mejora de la calidad del servicio de manera continua, con la difusión de estrategias de educación pública en reanimación cardiopulmonar asistida por la persona que está en ese momento, la participación de la policía en la reanimación cardiopulmonar y la desfibrilación, con los programas de acceso público a la desfibrilación y la determinación de indicadores de retroalimentación.

In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results.

Assuntos

RESUMO

In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results.

Assuntos

RESUMO

We evaluate the effects of strontium ranelate on the composition and crystal structure of the biological bone-like apatite produced in osteoblast cell cultures, a system that gave us the advantage of obtaining mineral samples produced exclusively during treatment. Cells were treated with strontium ranelate at concentrations of 0.05 and 0.5 mM Sr(2+). Mineral substances were isolated and analyzed by using a combination of methods: Fourier transform infrared spectroscopy, solid-state (1)H nuclear magnetic resonance, X-ray diffraction, micro-Raman spectroscopy and energy dispersive X-ray spectroscopy. The minerals produced in all cell cultures were typical bone-like apatites. No changes occurred in the local structural order or crystal size of the minerals. However, we noticed several relevant changes in the mineral produced under 0.5 mM Sr(2+): (1) increase in type-B CO3 (2-) substitutions, which often lead to the creation of vacancies in Ca(2+) and OH(-) sites; (2) incorporation of Sr(2+) by substituting slightly less than 10 % of Ca(2+) in the apatite crystal lattice, resulting in an increase in both lattice parameters a and c; (3) change in the PO4 (3-) environments, possibly because of the expansion of the lattice; (4) the Ca/P ratio of this mineral was reduced, but its (Ca+Sr)/P ratio was the same as that of the control, indicating that its overall cation/P ratio was preserved. Thus, strontium ranelate changes the composition and crystal structure of the biological bone-like apatite produced in osteoblast cell cultures.

Assuntos