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The Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) causes reproductive failure and respiratory symptoms, leading to huge economic losses for the pig farming industry. Although several vaccines against PRRSV are available in the market; they show an overall low efficacy, and several countries have the need for vaccines covering the local, circulating variants. This project aims at developing a new chimeric antigen targeting specific epitopes from PRRSV and evaluating two test adjuvants to formulate a vaccine candidate. The test antigen was called LTB-PRRSV, which was produced recombinantly in Escherichia coli and consisted of the heat labile enterotoxin B subunit from E. coli (LTB) and four epitopes from PRRSV. LTB-PRRSV was rescued as inclusion bodies and methods for its solubilization, IMAC-based purification, and refolding were standardized, leading to mean yields of 18 mg of pure protein per liter culture. Layered double hydroxides (LDH) have been used as vaccine adjuvants given their biocompatibility, low cost, and positive surface charge that allows an efficient adsorption of negatively charged biomolecules. Therefore, LDH were selected as delivery vehicles of LTB-PRRSV. Pure LTB-PRRSV was adsorbed onto LDH by incubation at different LDH:LTB-PRRSV mass ratios (1:0.25, 1:0.5, 1:1, and 1:2) and at pH 9.5. The best adsorption occurred with a 1:2 mass ratio, and in a sucrose-tween solution. The conjugates obtained had a polydispersity index of 0.26, a hydrodynamic diameter of 192 nm, and a final antigen concentration of 64.2 µg/mL. An immunogenicity assessment was performed by injecting mice with LDH:LTB-PRRSV, Alum/LTB-PRRSV, or LTB-PRRSV in a scheme comprising three immunizations at two-week intervals and two dose levels (1 and 5 µg). LTB-PRRSV was capable of inducing strong humoral responses, which lasted for a longer period when LDH was used as the delivery vehicle/adjuvant. The potential of LDH to serve as an attractive carrier for veterinary vaccines is discussed.
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This overview assessed the available body of published peer-reviewed systematic reviews and meta-analyses related to the effects of active exergames compared with active/passive control on physical performance outcomes in older people. The methodological quality and certainty of evidence were assessed using PRISMA, AMSTAR 2, and GRADE. The protocol was registered in PROSPERO (code: CRD42023391694). The main outcomes indicate that 4,477 records, five systematic reviews, and 10 meta-analyses were included. The AMSTAR-2 reported six meta-analyses with high methodological quality, four moderate quality, two systematic reviews with low quality, and three very-low quality. Meta-analysis was performed on balance using the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG) tests, on cardiorespiratory fitness using the 6-min walk test, and on upper and lower limbs muscle strength using the handgrip strength, knee extension, and 30-s chair stand tests. Significant differences in favor of the active exergames groups concerning active/passive groups were reported in BBS (SMD = 0.85; 95% CI = 0.12-1.58; I2 = 96%; p = 0.02), TUG (SMD = 1.44; 95% CI = 0.71-2.16; I2 = 97%; p < 0.0001), and 30-s chair stand test (SMD = 0.79; 95% CI = 0.33-1.25; I2 = 88%; p = 0.0008). However, no significant differences were reported in favor of the active exergames groups in 6-min walk (SMD = 0.93; 95% CI = -0.64 to 2.50; I2 = 95%; p = 0.24), handgrip strength (SMD = 0.67; 95% CI = -0.04 to 1.38; I2 = 84%; p = 0.06), and knee extension tests (SMD = 0.20; 95% CI = -0.05 to 0.44; I2 = 95%; p = 0.12) compared to active/passive control. However, it was impossible to perform a meta-analysis for the variables of walking speed as a fall risk due to the diversity of instruments and the small number of systematic reviews with meta-analysis. In conclusion, interventions utilizing active exergames have shown significant improvements in the static and dynamic balance and lower limb muscle strength of apparently healthy older people, compared to control groups of active/inactive participants, as measured by BBS, TUG, and 30-s chair stand tests. However, no significant differences were found in the 6-min walk, HGS, and knee extension tests. Systematic review registration: PROSPERO, CRD42023391694.
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Desempenho Físico Funcional , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Humanos , Aptidão Cardiorrespiratória/fisiologia , Exercício Físico/fisiologia , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Revisões Sistemáticas como Assunto , Jogos de Vídeo , Metanálise como AssuntoRESUMO
BACKGROUND: Internal redistribution of gas, referred to as pendelluft, is a new potential mechanism of effort-dependent lung injury. Neurally-adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV +) follow the patient's respiratory effort and improve synchrony compared with pressure support ventilation (PSV). Whether these modes could prevent the development of pendelluft compared with PSV is unknown. We aimed to compare pendelluft magnitude during PAV + and NAVA versus PSV in patients with resolving acute respiratory distress syndrome (ARDS). METHODS: Patients received either NAVA, PAV + , or PSV in a crossover trial for 20-min using comparable assistance levels after controlled ventilation (> 72 h). We assessed pendelluft (the percentage of lost volume from the non-dependent lung region displaced to the dependent region during inspiration), drive (as the delta esophageal swing of the first 100 ms [ΔPes 100 ms]) and inspiratory effort (as the esophageal pressure-time product per minute [PTPmin]). We performed repeated measures analysis with post-hoc tests and mixed-effects models. RESULTS: Twenty patients mechanically ventilated for 9 [5-14] days were monitored. Despite matching for a similar tidal volume, respiratory drive and inspiratory effort were slightly higher with NAVA and PAV + compared with PSV (ΔPes 100 ms of -2.8 [-3.8--1.9] cm H2O, -3.6 [-3.9--2.4] cm H2O and -2.1 [-2.5--1.1] cm H2O, respectively, p < 0.001 for both comparisons; PTPmin of 155 [118-209] cm H2O s/min, 197 [145-269] cm H2O s/min, and 134 [93-169] cm H2O s/min, respectively, p < 0.001 for both comparisons). Pendelluft magnitude was higher in NAVA (12 ± 7%) and PAV + (13 ± 7%) compared with PSV (8 ± 6%), p < 0.001. Pendelluft magnitude was strongly associated with respiratory drive (ß = -2.771, p-value < 0.001) and inspiratory effort (ß = 0.026, p < 0.001), independent of the ventilatory mode. A higher magnitude of pendelluft in proportional modes compared with PSV existed after adjusting for PTPmin (ß = 2.606, p = 0.010 for NAVA, and ß = 3.360, p = 0.004 for PAV +), and only for PAV + when adjusted for respiratory drive (ß = 2.643, p = 0.009 for PAV +). CONCLUSIONS: Pendelluft magnitude is associated with respiratory drive and inspiratory effort. Proportional modes do not prevent its occurrence in resolving ARDS compared with PSV.
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[This corrects the article DOI: 10.3389/fphys.2023.1127669.].
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This study aims to compare the effects of standard warm-up versus warm-up using stretching exercises on the physical performance of male youth soccer players. Eighty-five male soccer players (age: 10.3 ± 4.3 years; body mass index: 19.8 ± 4.3 kg/m2) were assessed for countermovement jump height (CMJ, cm), 10 m, 20 m and 30 m running sprint speed (s) and ball kicking speed (km/h) for the dominant and non-dominant leg under five (randomized) warm-up conditions. Using 72 h of recovery between conditions, the participants completed a control condition (CC) and four experimental conditions, including static stretching (SSC), dynamic stretching (DSC), ballistic stretching (BSC), and proprioceptive neuromuscular facilitation (PNFC) exercises. All warm-up conditions had a duration of 10 minutes. The main results indicate that no significant differences (p > 0.05) were found between warm-up conditions compared to CC in CMJ (CC = 28.1 ± 4.9; SSC = 28.4 ± 4.9; DSC = 30.9 ± 4.8; BSC = 30.9 ± 5.2; PNFC = 28.4 ± 5.0), 10 m sprint (CC = 2.42 ± 0.4; SSC = 2.50 ± 0.4; DSC = 2.30 ± 0.3; BSC = 2.27 ± 0.3; PNFC = 2.53 ± 0.4), 20 m sprint (CC = 5.42 ± 0.9; SSC = 5.59 ± 0.9; DSC = 5.37 ± 0.9; BSC = 5.40 ± 0.9; PNFC = 5.44 ± 0.9), 30 m sprint (CC = 8.05 ± 1.3; SSC = 8.27 ± 1.3; DSC = 8.01 ± 1.3; BSC = 8.00 ± 1.3; PNFC = 8.12 ± 1.3), ball kicking speed for dominant (CC = 56.2 ± 4.9; SSC = 55.3 ± 5.2; DSC = 56.9 ± 5.8; BSC = 57.3 ± 5.8; PNFC = 55.7 ± 5.2) and non-dominant leg (CC = 52.8 ± 3.4; SSC = 51.8 ± 4.6; DSC = 53.5 ± 5.4; BSC = 53.6 ± 4.9; PNFC = 52.5 ± 4.0). In conclusion, compared to standard warm-up, stretching-based warm-up exerts no effect on male youth soccer players jump height, sprint speed and ball kicking speed.
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The transition from controlled to partial support ventilation is a challenge in acute respiratory distress syndrome (ARDS) patients due to the risks of patient-self-inflicted lung injury. The magnitude of tidal volume (VT) and intrapulmonary dyssynchrony (pendelluft) are suggested mechanisms of lung injury. We conducted a prospective, observational, physiological study in a tertiary academic intensive care unit. ARDS patients transitioning from controlled to partial support ventilation were included. On these, we evaluated the association between changes in inflammatory biomarkers and esophageal pressure swing (ΔPes), transpulmonary driving pressure (ΔPL), VT, and pendelluft. Pendelluft was defined as the percentage of the tidal volume that moves from the non-dependent to the dependent lung region during inspiration, and its frequency at different thresholds (- 15, - 20 and - 25%) was also registered. Blood concentrations of inflammatory biomarkers (IL-6, IL-8, TNF-α, ANGPT2, RAGE, IL-18, Caspase-1) were measured before (T0) and after 4-h (T4) of partial support ventilation. Pendelluft, ΔPes, ΔPL and VT were recorded. Nine out of twenty-four patients (37.5%) showed a pendelluft mean ≥ 10%. The mean values of ΔPes, ΔPL, and VT were - 8.4 [- 6.7; - 10.2] cmH2O, 15.2 [12.3-16.5] cmH2O and 8.1 [7.3-8.9] m/kg PBW, respectively. Significant associations were observed between the frequency of high-magnitude pendelluft and IL-8, IL-18, and Caspase-1 changes (T0/T4 ratio). These results suggest that the frequency of high magnitude pendelluft may be a potential determinant of inflammatory response related to inspiratory efforts in ARDS patients transitioning to partial support ventilation. Future studies are needed to confirm these results.
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Lesão Pulmonar , Síndrome do Desconforto Respiratório , Humanos , Interleucina-18 , Estudos Prospectivos , Interleucina-8 , Respiração , Síndrome do Desconforto Respiratório/terapia , Biomarcadores , Caspase 1 , PulmãoRESUMO
This study aims to analyze the effect of different types of warm-ups on handgrip strength (HGS) in physically inactive older females. Secondarily, it aims to compare HGS according to their baseline nutritional status. A randomized crossover trial study was conducted with 44 physically inactive older females distributed into normal weight (n = 12, BMI = 23.9 ± 3.2 kg/m2), overweight (n =16, BMI = 27 ± 4.7 kg/m2) and obese (n = 16, BMI = 31.6 ± 5.3 kg/m2), who participated in three warm-up conditions (static stretching condition, SSC; elastic band condition, EBC; and therapeutic compression ball condition, TCBC) and one control condition (CC, no warm-up). All participants performed the four randomized conditions with recovery within 72 h. A significant decrease (p < 0.05) in HGS for the dominant and non-dominant hands was observed when comparing SSC vs. CC. In contrast, comparing the warm-up conditions according to the baseline nutritional status, statistically significant differences (p < 0.05) were only reported in the obese group in the dominant and non-dominant hand in favor of CC concerning SSC. In conclusion, warm-up with static flexibility led to a decrease in HGS in physically inactive older females. Only the obese group exhibited this result when analyzed by nutritional status.
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Força da Mão , Estado Nutricional , Humanos , Feminino , Chile , Sobrepeso/epidemiologia , Obesidade/epidemiologiaRESUMO
BACKGROUND: Medical students are especially prone to anxiety and depression. AIM: To characterize the presence of anxiety and depression and their association with gender and academic year among medical students. MATERIAL AND METHODS: Standardized electronic surveys about anxiety and depression symptoms were sent to 498 medical students with a response rate of 78%. Results: We analyzed 359 surveys. A mean of 11.4 points out of 27 was observed in the depression symptoms scale. Also, 23 and 10% of respondents had moderately severe or symptoms of depression, respectively. A mean of 8.9 out of 21 points in the anxiety symptoms scale was observed. Moderate or severe anxiety symptoms were present in 26 and 15% of respondents, respectively. Women and preclinical students had higher depression and anxiety scores. CONCLUSIONS: A high presence of anxiety and depression symptoms was characterized among medical students during the pandemic. Preclinical students and women had higher scores in both scales.
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Humanos , Feminino , Estudantes de Medicina , COVID-19/epidemiologia , Ansiedade/epidemiologia , Prevalência , Depressão/epidemiologia , PandemiasRESUMO
BACKGROUND: Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. AIMS: To evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. METHODS: Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcome were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and the type of support needed. Etiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death. RESULTS: A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6%, p=0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3% vs. 24.8%, p= 0.056). CONCLUSIONS: Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of etiology of GIB.
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Anticoagulantes , Hemorragia Gastrointestinal , Doença Aguda , Administração Oral , Anticoagulantes/uso terapêutico , Fibrinolíticos/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/terapia , Mortalidade Hospitalar , Humanos , Vitamina KRESUMO
BACKGROUND: Medical students are especially prone to anxiety and depression. AIM: To characterize the presence of anxiety and depression and their association with gender and academic year among medical students. MATERIAL AND METHODS: Standardized electronic surveys about anxiety and depression symptoms were sent to 498 medical students with a response rate of 78%. RESULTS: We analyzed 359 surveys. A mean of 11.4 points out of 27 was observed in the depression symptoms scale. Also, 23 and 10% of respondents had moderately severe or symptoms of depression, respectively. A mean of 8.9 out of 21 points in the anxiety symptoms scale was observed. Moderate or severe anxiety symptoms were present in 26 and 15% of respondents, respectively. Women and preclinical students had higher depression and anxiety scores. CONCLUSIONS: A high presence of anxiety and depression symptoms was characterized among medical students during the pandemic. Preclinical students and women had higher scores in both scales.
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COVID-19 , Estudantes de Medicina , Humanos , Feminino , COVID-19/epidemiologia , Pandemias , Depressão/epidemiologia , Prevalência , Ansiedade/epidemiologiaRESUMO
Es importante el estudio de variables del comportamiento organizacional, ya que ayudan a la empresa a tener una mejor gestión de los recursos humanos, debido a que la satisfacción laboral tiene relaciones positivas y estadísticamente significativas con el desempeño laboral. El objetivo de este estudio fue medir los niveles de percepción laboral de empleados del sector sanitario del área pública y privada, con respecto a las variables satisfacción laboral y compromiso organizacional. El estudio es de tipo transversal y descriptivo, el instrumento de medición es una encuesta que consta de 3 partes y la muestra estuvo conformada por 271 administrativos. Se presentaron análisis univariados principales, luego un análisis de conglomerados para segmentar a los participantes, y finalmente se efectúan modelos de regresión. Se determinó que existen tres segmentos de trabajadores que son claramente definidos, compuestos por aquellos administrativos con una baja percepción en general (21% y 42%, respectivamente), aquellos con una percepción media (54% y 38%, respectivamente) y aquellos con una percepción alta (25% y 20%, respectivamente). Se confirma que el compromiso organizacional afecta significativamente y de forma positiva a la satisfacción laboral(AU)
The study of variables of organizational behavior is important, since they help the company better manage its human resources, as job satisfaction has been positively and significantly correlated with job performance. The objective of this study was to measure the levels of job perception of employees in the public and private healthcare sector, with respect to job satisfaction and organizational commitment. The study was cross-sectional and descriptive, and the measurement instrument was a survey consisting of three sections. The study sample consisted of 271 administrative staff. We present the main univariate analysis results, followed by a cluster analysis to segment the participants, and then regression analysis. We identified three clearly defined segments of workers, consisting of administrative staff with a low overall perception of hob satisfaction and organizational commitment (21% and 42%, respectively), those with a medium perception (54% and 38%, respectively) and those with a high perception (25% and 20%, respectively). The results confirm that organizational commitment significantly and positively affects job satisfaction(AU)
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Humanos , Adulto , Pessoa de Meia-Idade , Percepção , Satisfação Pessoal , Pessoal de Saúde , Setor de Assistência à Saúde , Desempenho Profissional , Engajamento no Trabalho , Satisfação no Emprego , Estudos Transversais , Inquéritos e Questionários , Categorias de TrabalhadoresRESUMO
AIMS OF THIS STUDY: To describe the Latin American population affected by COVID-19, and to determine relevant risk factors for in-hospital mortality. METHODS: We prospectively registered relevant clinical, laboratory, and radiological data of adult patients with COVID-19, admitted within the first 100 days of the pandemic from a single teaching hospital in Santiago, Chile. The primary outcome was in-hospital mortality. Secondary outcomes included the need for respiratory support and pharmacological treatment, among others. We combined the chronic disease burden and the severity of illness at admission with predefined clinically relevant risk factors. Cox regression models were used to identify risk factors for in-hospital mortality. RESULTS: We enrolled 395 adult patients, their median age was 61 years; 62.8% of patients were male and 40.1% had a Modified Charlson Comorbidity Index (MCCI) ≥5. Their median Sequential Organ Failure Assessment (SOFA) score was 3; 34.9% used a high-flow nasal cannula and 17.5% required invasive mechanical ventilation. The in-hospital mortality rate was 14.7%. In the multivariate analysis, were significant risk factors for in-hospital mortality: MCCI ≥5 (HR 4.39, P < .001), PaO2 /FiO2 ratio ≤200 (HR 1.92, P = .037), and advanced chronic respiratory disease (HR 3.24, P = .001); pre-specified combinations of these risk factors in four categories was associated with the outcome in a graded manner. CONCLUSIONS AND CLINICAL IMPLICATIONS: The relationship between multiple prognostic factors has been scarcely reported in Latin American patients with COVID-19. By combining different clinically relevant risk factors, we can identify COVID-19 patients with high-, medium- and low-risk of in-hospital mortality.
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COVID-19 , Adulto , Chile/epidemiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , SARS-CoV-2RESUMO
RATIONALE: Cyclic strain may be a determinant of ventilator-induced lung injury. The standard for strain assessment is the computed tomography (CT), which does not allow continuous monitoring and exposes to radiation. Electrical impedance tomography (EIT) is able to monitor changes in regional lung ventilation. In addition, there is a correlation between mechanical deformation of materials and detectable changes in its electrical impedance, making EIT a potential surrogate for cyclic lung strain measured by CT (StrainCT ). OBJECTIVES: To compare the global StrainCT with the change in electrical impedance (ΔZ). METHODS: Acute respiratory distress syndrome patients under mechanical ventilation (VT 6 mL/kg ideal body weight with positive end-expiratory pressure 5 [PEEP 5] and best PEEP according to EIT) underwent whole-lung CT at end-inspiration and end-expiration. Biomechanical analysis was used to construct 3D maps and determine StrainCT at different levels of PEEP. CT and EIT acquisitions were performed simultaneously. Multilevel analysis was employed to determine the causal association between StrainCT and ΔZ. Linear regression models were used to predict the change in lung StrainCT between different PEEP levels based on the change in ΔZ. MAIN RESULTS: StrainCT was positively and independently associated with ΔZ at global level (P < .01). Furthermore, the change in StrainCT (between PEEP 5 and Best PEEP) was accurately predicted by the change in ΔZ (R2 0.855, P < .001 at global level) with a high agreement between predicted and measured StrainCT . CONCLUSIONS: The change in electrical impedance may provide a noninvasive assessment of global cyclic strain, without radiation at bedside.
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Pulmão , Tomografia , Impedância Elétrica , Humanos , Pulmão/diagnóstico por imagem , Respiração com Pressão Positiva , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Continuing education is essential for health professions and online courses can be a good way for professional development. AIM: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. MATERIAL AND METHODS: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. RESULTS: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. CONCLUSIONS: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.
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Educação a Distância/métodos , Educação Médica Continuada/métodos , Gastroenterologia/educação , Chile , Avaliação Educacional , Feminino , Geografia , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Reprodutibilidade dos Testes , Sociedades Médicas , Fatores de TempoRESUMO
BACKGROUND: Male EBP disorder with neurologic defects (MEND) syndrome is an X-linked disease caused by hypomorphic mutations in the EBP (emopamil-binding protein) gene. Modifier genes may explain the clinical variability among individuals who share a primary mutation. METHODS: We studied four males (Patient 1 to Patient 4) exhibiting a descending degree of phenotypic severity from a family with MEND syndrome. To identify candidate modifier genes that explain the phenotypic variability, variants of homeostasis cholesterol genes identified by whole-exome sequencing (WES) were ranked according to the predicted magnitude of their effect through an in-house scoring system. RESULTS: Twenty-seven from 105 missense variants found in 45 genes of the four exomes were considered significant (-5 to -9 scores). We found a direct genotype-phenotype association based on the differential accumulation of potentially functional gene variants among males. Patient 1 exhibited 17 variants, both Patients 2 and 3 exhibited nine variants, and Patient 4 exhibited only five variants. CONCLUSION: We conclude that APOA5 (rs3135506), ABCA1 (rs9282541), and APOB (rs679899 and rs12714225) are the most relevant candidate modifier genes in this family. Relative accumulation of the deficiencies associated with variants of these genes along with other lesser deficiencies in other genes appears to explain the variable expressivity in MEND syndrome.
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Transportador 1 de Cassete de Ligação de ATP , Apolipoproteína A-V , Apolipoproteína B-100 , Colesterol , Exoma , Polimorfismo Genético , Síndrome de Waardenburg , Transportador 1 de Cassete de Ligação de ATP/genética , Transportador 1 de Cassete de Ligação de ATP/metabolismo , Apolipoproteína A-V/genética , Apolipoproteína A-V/metabolismo , Apolipoproteína B-100/genética , Apolipoproteína B-100/metabolismo , Colesterol/genética , Colesterol/metabolismo , Feminino , Estudos de Associação Genética , Homeostase/genética , Humanos , Masculino , Fenótipo , Índice de Gravidade de Doença , Síndrome de Waardenburg/genética , Síndrome de Waardenburg/metabolismo , Síndrome de Waardenburg/patologiaRESUMO
Background: Continuing education is essential for health professions and online courses can be a good way for professional development. Aim: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. Material and Methods: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. Results: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. Conclusions: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.
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Humanos , Masculino , Feminino , Educação a Distância/métodos , Educação Médica Continuada/métodos , Gastroenterologia/educação , Sociedades Médicas , Fatores de Tempo , Avaliação de Programas e Projetos de Saúde , Chile , Reprodutibilidade dos Testes , Avaliação Educacional , GeografiaRESUMO
Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress. He was managed with vasoactive drugs and prone positioning ventilation for 48 hours. Chest radiography showed a right superior lobe condensation. The electrocardiogram and echocardiogram suggested septic myocarditis. Blood cultures demonstrated the presence of serogroup W135-NM. A lumbar puncture ruled out meningitis, and a 10-day ceftriaxone therapy was completed favorably.
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Neisseria meningitidis/isolamento & purificação , Pneumonia Bacteriana/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Chile , Humanos , Masculino , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológicoRESUMO
Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress. He was managed with vasoactive drugs and prone positioning ventilation for 48 hours. Chest radiography showed a right superior lobe condensation. The electrocardiogram and echocardiogram suggested septic myocarditis. Blood cultures demonstrated the presence of serogroup W135-NM. A lumbar puncture ruled out meningitis, and a 10-day ceftriaxone therapy was completed favorably.
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Humanos , Masculino , Adolescente , Pneumonia Bacteriana/microbiologia , Neisseria meningitidis/isolamento & purificação , Ceftriaxona/uso terapêutico , Chile , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
OBJECTIVE: To investigate clinical outcomes and 3-year persistence of human papillomavirus (HPV) infections among women in Mexico. METHODS: A prospective study enrolled sexually active women attending primary healthcare clinics in metropolitan Monterrey, Mexico, between June 3 and August 30, 2002. Baseline data were collected and participants underwent HPV screening. Patients with HPV infections were asked to attend a repeat screening appointment after 3 years, when the same screening data were gathered. Descriptive analyses were performed and the prevalence of cervical lesions and viral infections were examined. RESULTS: In total, 1188 patients who underwent initial HPV screening were included. Cervical lesions were detected in 5 (0.4%) patients and 239 (20.1%) patients had HPV infections; 129 (54.0%) of these patients attended 3-year follow-up. Among the 357 HPV serotypes identified, the most prevalent serotypes were HPV-59, HPV-52, HPV-16, and HPV-56, detected 62 (17.4%), 38 (10.6%), 27 (7.6%), and 18 (5.0%) times, respectively. Of the 129 patients attending 3-year follow-up, 104 (80.6%) were clear from HPV infections, 13 (10.1%) patients had persistent HPV infections, and 12 (9.3%) had HPV infections with different HPV types. CONCLUSIONS: The HPV prevalence was 20.1% in the present study; the most prevalent infections were HPV-59, HPV-52, HPV-16, and HPV-56. At 3-year follow-up, 25 (19.4%) patients had HPV infections.