RESUMO

(analítico) Con la finalidad de conocer la experiencia de ser joven hoy en la educación superior en Argentina, Chile o Uruguay, se realiza un análisis temático a 54 artículos de los últimos tres años en WoS, Scopus y Scielo. Por intermedio de un trabajo inductivo y reflexivo, se identifican patrones comunes en las fuentes de análisis, que permiten identificar siete temas que dan cuenta de una transición: ampliación de cobertura, pero sin inclusión; facilidad al ingreso, pero con incertidumbre al egreso; cambios en los roles de género, pero manteniéndose el machismo; valoración de la salud, pero con conductas de riesgo; preocupación por los otros, pero con individualismo; valoración del movimiento estudiantil, pero con cambios en sus manifestaciones y tránsito de lo presencial a lo virtual, acelerado por covid-19.

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(analytical) In order to know the experience of being young today in higher education in Argentina, Chile or Uruguay, a Thematic Analysis is carried out on 54 articles from the last three years in WoS, Scopus and Scielo. Through inductive and reflective work, common patterns are identified in the sources of analysis, which allow the identification of seven themes that account for a transition: expansion of coverage, but without inclusion; ease upon admission, but with uncertainty upon discharge; changes in gender roles, but maintaining machismo; health assessment, but with risk behaviors; concern for others, but with individualism; appreciation of the student movement, but with changes in its manifestations and transition from face-to-face to virtual, accelerated by COVID-19.

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(analítico) Para conhecer a experiência de ser jovem hoje na educação superior na Argentina, Chile ou Uruguai, realiza-se uma Análise Temática de 54 artigos dos últimos três anos em WoS, Scopus e Scielo. Através de um trabalho indutivo e reflexivo, identificam-se padrões comuns nas fontes de análise, que permitem identificar sete temas que dão conta de uma transição: ampliação da cobertura, mas sem inclusão; facilidade na admissão, mas com incerteza na alta; mudanças nos papéis de gênero, mas mantendo o machismo; avaliação de saúde, mas com comportamentos de risco; preocupação com os outros, mas com individualismo; valorização do movimento estudantil, mas com mudanças em suas manifestações e transição do presencial para o virtual, acelerada pela Covid-19.

Assuntos

Glomerulonefrite Membranoproliferativa , Glomerulonefrite , Mieloma Múltiplo , Humanos , Filgrastim/efeitos adversos , Mieloma Múltiplo/tratamento farmacológico , Recidiva Local de Neoplasia , Anticorpos Monoclonais , Imunoglobulina G

RESUMO

A study was undertaken in which the handgrip strength in three arm positions above the shoulder was measured to compare handgrip strength when arm support is used and when it is not used. Grip forces were generated in pairs of flexion angles, corresponding to shoulder and elbow at 90°-90°, 135°-45° and 160°-20°. Thirty-two participants completed the present study; 23 men and nine women with a median age of 23.1 (SD ±3.6) years. A manual handgrip dynamometer (0-90 kg) and an adjustable angle arm support (AAAS) were used during the data collection. Two-way analysis of variance (ANOVA) for repeated measurements indicates a significant effect of the AAAS factor on the handgrip strength, as well as on the AAAS × angle interaction. However, there is no significant effect of the angle factor on the AAAS × angle interaction.

Assuntos

Força da Mão , Ombro , Masculino , Humanos , Feminino , Adulto Jovem , Adulto , Extremidade Superior , Cotovelo , Postura

Assuntos

Falência Renal Crônica , Insuficiência Renal , Humanos , Idoso , Diálise Renal , Qualidade de Vida , Insuficiência Renal/terapia , Atenção à Saúde

RESUMO

Introducción: a partir del año 2000, los médicos han asistido a un retorno de la sífilis vinculado a prácticas sexuales no protegidas y con parejas múltiples, en especial entre hombres que tienen sexo con hombres. La coinfección Treponema pallidum/virus de la inmunodeficiencia humana (VIH) modifica tanto la historia natural de la sífilis, incrementando la incidencia de neurosífilis temprana, como la respuesta al tratamiento con penicilina. Métodos: un paciente varón, peruano, de 36 años, seropositivo para VIH, consulta por dis-minución de la agudeza visual en ojo derecho, pérdida de la audición, tinnitus, mareos y vértigo. Refería antecedentes de sífilis en los 2 años previos. Resultados: el examen oftalmológico efectuado al paciente mostró células en el segmento anterior del ojo derecho. El fondo de ojo reveló la existencia de inflamación del nervio óptico asociada con panuveítis. En base a los hallazgos clínicos, los valores de VDRL en suero y líquido cefalorraquídeo (LCR) se diagnosticó neurosífilis (NS) con neuritis óptica, panuveítis y otosífilis en un paciente coinfectado por VIH. El paciente fue tratado con penicilina G sódica intravenosa, 4 millones de UI cada 4 horas, durante 2 semanas con buena respuesta clínica. Discusión: el compromiso de los pares craneales óptico y auditivo puede representar la manifestación de una NS temprana, en especial, en el contexto de un paciente VIH positivo. De acuerdo con nuestro conocimiento, este sería el segundo caso publicado de compromiso simultáneo del nervio óptico y del aparato vestíbulo-coclear en un paciente con NS.

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Introduction: from the 2000s, the physicians experienced a return of syphilis, which may be related to unrestricted sexual behaviour with unprotected contact between multiple partners, especially in men who have sex with men. Concurrent infection with human immunodeficiency virus (HIV) alters the natural history of syphilis by increasing the frequency of early neurosyphilis and the response to penicillin. Methods: a 36-year-old Peruvian man, seropositive for HIV infection, was admitted to the hospital with decreased visual acuity in his right eye, hearing loss, tinnitus, buzzing, and vertigo. He referred history of syphilis in the previous two years. Results: oph-thalmological examination was performed. Ocular anterior segment examination of the right eye showed cells. Fundoscopy revealed swelling of the right optic disc with panuveitis. Diagnosis of neurosyphilis (NS) with optic and ear neuritis, and concurrent HIV infection was made, based on the clinical manifestations and serum and cerebrospinal VDRL titers. The patient was treated with intravenous penicillin (four million units every four hours for two weeks) with an excellent clinical response. Discussion: simultaneous optic and auditive cranial nerve involvement can manifest early neurosyphilis (NS) and HIV coinfection. This is the second report to describe the simultaneous occurrence of syphilitic optic neuritis with vestibulocochlear nerve involvement.

RESUMO

Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

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Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

Assuntos

Encefalite , Paralisia Facial , Herpes Zoster da Orelha Externa , Herpes Zoster , Idoso , Paralisia Facial/etiologia , Herpes Zoster da Orelha Externa/diagnóstico , Herpesvirus Humano 3/genética , Humanos , Hospedeiro Imunocomprometido

RESUMO

Resumen | Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

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Abstract | Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

Assuntos

Paralisia Facial , Herpes Zoster , Líquido Cefalorraquidiano , Síndrome da Imunodeficiência Adquirida , HIV

RESUMO

Las infecciones osteoarticulares y musculoesqueléticas son patologías infecciosas relativamente infrecuentes en la infancia, afectando generalmente a varones y menores de 5 años. Países desarrollados reportan una incidencia anual de osteomielitis de 10 a 80/100.000 niños y de 4 casos/100.000 niños para artritis séptica. En países tropicales, la piomiositis tiene una incidencia de un caso por cada 2.000 habitantes. El Staphylococcus aureus es el principal agente causal. En la infancia la vía más común del legada del germen a la articulación es la hematógena. Hasta en un 30% de niños coexisten osteomielitis aguda y artritis séptica. Se presenta el caso de preescolar masculino de 3años, quien posterior a aplastamiento de miembro inferior izquierdo, presenta aumento de volumen, dolor y limitación para la marcha, asociándose 9 días después fiebre de 39.5°C,acudiendo al Hospital Universitario de Caracas. La anamnesis, evaluación clínica y estudios paraclínicos fueron sugestivos depiomiositis de muslo izquierdo, osteomielitis de fémur izquierdo y artritis séptica de rodilla izquierda. Se indica antibioticoterapiacon cobertura para Staphylococcus aureus (ciprofloxacina y clindamicina). Se realizó artrotomía evacuadora y limpieza quirúrgica de estructuras afectadas. El cultivo reportó Staphylococcus aureus sensible a ciprofloxacina, gentamicina, linezolid, rifampicina, trimetropin/sulfametoxazol; resistentea clindamicina, eritromicina, oxacilina, por lo que se omitióclindamicina y se indicó trimetropin/sulfametoxazol. Cumplió21 días de tratamiento intravenoso, observándose evolución satisfactoria por lo que se decidió egreso, dando continuidad con tratamiento vía oral por cuatro semanas y seguimiento interdisciplinario. El abordaje oportuno y adecuado de estas patologías disminuye el riesgo de desarrollar complicaciones(AU)

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Osteoarticular and musculoskeletal infections are relatively rare infectious diseases in childhood, generally affecting men and children under 5 years of age. Developed countries report an annual incidence of osteomyelitis of 10 to 80 / 100,000 children and 4 cases / 100,000 children for septicarthritis. In tropical countries, pyomyositis has an incidence of one case for every 2,000 inhabitants. Staphylococcus aureusis the main causative agent. In childhood the most commonroute of arrival of the germ to the joint is hematogenous.Up to 30% of children coexist acute osteomyelitis and septic arthritis. We present the case of a 3-year-old male preschoolerwho, after crushing his left lower limb, presented an increasein volume, pain, and limited gait, and was associated witha fever of 39.5 ° C 9 days later, going to the University Hospital of Caracas. the anamnesis, clinical evaluation and paraclinical studies were suggestive of pyomyositis of the leftthigh, osteomyelitis of the left femur and septic arthritis of the left knee. Antibiotic therapy with coverage for Staphylococcus aureus (ciprofloxacin and clindamycin) is indicated. Evacuating arthrotomy and surgical cleaning of affected structures were performed. The culture reported Staphylococcus aureus sensitiveto ciprofloxacin, gentamicin, linezolid, rifampin, trimetropin /sulfamethoxazole; resistant to clindamycin, erythromycin,oxacillin, therefore clindamycin was omitted and trimetropin /sulfamethoxazole was indicated. He completed 21 days ofintravenous treatment, observing satisfactory evolution so hisdis charge was decided, continuing with oral treatment for four weeks and interdisciplinary follow-up. The timely and adequate approach to these pathologies reduces the risk of developing complications(AU)

Assuntos

Humanos , Masculino , Pré-Escolar , Osteomielite , Staphylococcus aureus , Artrite Infecciosa , Piomiosite , Meticilina , Oxacilina , Terapêutica , Gentamicinas , Infecções , Articulações , Antibacterianos , Sistema Musculoesquelético

RESUMO

Introduction The endoscopic endonasal transsphenoidal approach (EETA) is routinely used to treat sellar and suprasellar tumors. It provides safe and direct access to tumors in these locations, with wide visualization of anatomical landmarks and great surgical results. With the COVID-19 pandemic, despite the high risk of transmission involved, various surgical procedures cannot be postponed due to their emergency. Case Report A 62-year-old female presented in the previous two months with headaches, followed by bilateral severe visual loss. In 2016, she was submitted to subtotal resection of a non-secretorymacroadenoma. Because of the progressive visual deficits, the EETA was used to the resect the pituitary adenoma. Technical Note We developed a low-cost adaptation to the surgical fields, covering the patient's head and superior trunk with a regular surgicalmicroscope bag with a tiny slit to enable the endoscope and surgical instruments to enter the nose, thus protecting the personnel in the operating room from the aerosolization of particles. This makes surgery safer for the surgical team and for the patient. Conclusion In view of the lack of literature on this subject, except for some reports of experiences from some services around the world, we describe the way we have adjusted the EETA in the context of the COVID-19 pandemic.

Assuntos

Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Adenoma/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , COVID-19/transmissão , Hipófise/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , COVID-19/prevenção & controle

RESUMO

Background and aims: Oxidative stress (OS) induces the production of fibroblast growth factor 21 (FGF21). Previous data have revealed that FGF21 protects cells from OS injury and death, making it a potential therapeutic option for many diseases with increased OS. However, the association of this growth factor with OS markers in humans with chronic kidney disease (CKD) remains unknown. This study aims to evaluate the association of serum FGF21 with serum total antioxidant capacity (TAC) and oxidized low-density lipoproteins (OxLDL) in subjects in different stages of kidney disease. Methods: This is a cross-sectional study that included 382 subjects with different stages of CKD, irrespective of type 2 diabetes (T2D) diagnosis. Associations of serum FGF21 with OxLDL, TAC, sex, age, body mass index (BMI), fasting plasma glucose, estimated glomerular filtration rate (eGFR), T2D, and smoking, were evaluated through bivariate and partial correlation analyses. Independent associations of these variables with serum FGF21 were evaluated using multiple linear regression analysis. Results: Serum FGF21 was significantly and positively correlated with age (r = 0.236), TAC (lnTAC) (r = 0.217), and negatively correlated with eGFR (r = -0.429) and male sex (r = -0.102). After controlling by age, sex, BMI, T2D, smoking, and eGFR; both TAC and OxLDL were positively correlated with FGF21 (r = 0.117 and 0.158 respectively, p < 0.05). Using multiple linear regression analysis, eGFR, male sex, T2D, OxLDL, and TAC were independently associated with serum FGF21 (STDß = -0.475, 0.162, -0.153, 0.142 and 0.136 respectively; p < 0.05 for all) adjusted for age, BMI, smoking, and fasting plasma glucose. Conclusion: A positive association between serum FGF21 and OS has been found independently of renal function in humans. Results from the present study provide novel information for deeper understanding of the role of FGF21 in OS in humans with CKD and T2D; mechanistic studies to explain the association of serum FGF21 with oxidative stress in CKD are needed.

RESUMO

AIM: Severe hypocalcaemia following parathyroidectomy for secondary or tertiary hyperparathyroidism (SHPT/THPT) is scarcely studied. We aimed to describe and identify risk factors for early and persistent hypocalcaemia after parathyroidectomy. METHODS: Retrospective pair-matched cohort study. We assessed 87 dialysis patients with SHPT (n = 73) or THPT (n = 14) paired with 146 subjects with primary hyperparathyroidism (PHPT) who underwent parathyroidectomy and were followed for 12 months. Early severe hypocalcaemia was defined as a free Ca ≤0.8 mmol/L [3.2 mg/dl] or corrected Ca ≤1.87 mmol/L [7.5 mg/dl] within 48 h. After parathyroidectomy and persistent hypocalcaemia, as an elemental Ca intake >3.0 g/day to achieve corrected Ca >2 mmol/L [8.0 mg/dl]. RESULTS: Early severe hypocalcaemia occurred in 77% (67/87) versus 6.8% (10/146) of subjects with SHPT/THPT and PHPT, respectively (p < .001). In SHPT/THPT cases, persistent hypocalcaemia occurred in 77% (49/64) and 64% (35/54) after 6 and 12 months of parathyroidectomy, respectively. In PHPT cases, persistent hypocalcaemia occurred in 6.8% (10/146) after 4-12 months of parathyroidectomy. Preoperative serum alkaline phosphatase (ALP) was the only risk factor associated to early severe hypocalcaemia (OR 7.3, 95% C.I. 1.7-10.9, p = .006) and persistent hypocalcaemia (OR 7.1, 95% C.I: 2.1-14.2, p = .011). Subjects with persistently low intact parathormone (iPTH) (<5.3 pmol/L [50 ng/ml]), suggestive of adynamic bone disease) showed higher Ca increases and less oral calcium requirements compared to those who progressively increased iPTH after parathyroidectomy. CONCLUSION: Early and persistent hypocalcaemia after parathyroidectomy in severe HPT were a common event associated directly to preoperative ALP levels. Subjects with persistently low postoperative iPTH normalized serum Ca more frequently after 1 year of follow up.

Assuntos

Hiperparatireoidismo/cirurgia , Hipocalcemia/epidemiologia , Paratireoidectomia , Complicações Pós-Operatórias/epidemiologia , Diálise Renal , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo

RESUMO

Sodium-Glucose Cotransporter 2 inhibitors (SGLT2i), or gliflozins, are a group of antidiabetic drugs that have shown improvement in renal and cardiovascular outcomes in patients with kidney disease, with and without diabetes. In this review, we will describe the different proposed mechanisms of action of SGLT2i. Gliflozins inhibit renal glucose reabsorption by blocking the SGLT2 cotransporters in the proximal tubules and causing glucosuria. This reduces glycemia and lowers HbA1c by ~1.0%. The accompanying sodium excretion reverts the tubuloglomerular feedback and reduces intraglomerular pressure, which is central to the nephroprotective effects of SGLT2i. The caloric loss reduces weight, increases insulin sensitivity, lipid metabolism, and likely reduces lipotoxicity. Metabolism shifts toward gluconeogenesis and ketogenesis, thought to be protective for the heart and kidneys. Additionally, there is evidence of a reduction in tubular cell glucotoxicity through reduced mitochondrial dysfunction and inflammation. SGLT2i likely reduce kidney hypoxia by reducing tubular energy and oxygen demand. SGLT2i improve blood pressure through a negative sodium and water balance and possibly by inhibiting the sympathetic nervous system. These changes contribute to the improvement of cardiovascular function and are thought to be central in the cardiovascular benefits of SGLT2i. Gliflozins also reduce hepcidin levels, improving erythropoiesis and anemia. Finally, other possible mechanisms include a reduction in inflammatory markers, fibrosis, podocyte injury, and other related mechanisms. SGLT2i have shown significant and highly consistent benefits in renal and cardiovascular protection. The complexity and interconnectedness of the primary and secondary mechanisms of action make them a most interesting and exciting pharmacologic group.

RESUMO

BACKGROUND: Interhemispheric approach is widely used to surgical management of midline tumors and vascular lesion in and around the third ventricle. Complete exposure of the superior sagittal sinus to obtain adequate working space of midline lesion is difficult, because of the risk to inadvertent injury to the sinus and bridging veins, which may cause several neurological deficits. Understanding the SSS neuroanatomy and its relationships with external surgical landmarks avoid such complications. The objective of this study is to accurately describe the position of SSS and its displacement in relation with sagittal midline by magnetic resonance imaging. METHODS: A retrospective cross-sectional, observational study was performed. Magnetic resonance image of 76 adult patients with no pathological imaging was analyzed. The position of the halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was performed. The width and the displacement of the superior sagittal sinus accordingly to the sagittal midline were assessed in those landmarks. RESULTS: The mean width of superior sagittal sinus at halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was 5.62 ± 2.5, 6.5 ± 2.8, 7.4 ± 3.2, and 8.5 ± 2.1 mm, respectively, without gender discrepancy. The mean displacement according to the midline at those landmarks showed a statistically significant difference to the right side among sexes. CONCLUSION: In this study, we demonstrate that sagittal midline may approximate external location of the superior sagittal sinus. Our data showed that in the majority of the cases, the superior sagittal sinus is displaced to the right side of sagittal midline as far as 16.3 mm. The data we obtained provide useful information that suggest that neurosurgeons should use safety margin to perform burr holes and drillings at the sagittal midline.

RESUMO

INTRODUCTION: The prevalence of Clostridium difficile infection is rapidly increasing worldwide, but prevalence is difficult to estimate in developing countries where awareness, diagnostic resources, and surveillance protocols are limited. As diarrhea is the hallmark symptom, we conducted a systematic review and meta-analysis to determine the prevalence and incidence of C. difficile infection in patients in these regions who presented with diarrhea. METHODS: We conducted a systematic literature search of MEDLINE/PubMed, Scopus, and Latin-American and Caribbean Health Sciences Literature databases to identify and analyze data from recent studies providing prevalence or incidence rates of C. difficile-associated diarrhea in developing countries within four regions: Africa-Middle East, developing Asia, Latin America, and China. Our objectives were to determine the current prevalence and incidence density rates of first episodes of C. difficile-associated diarrhea in developing countries. RESULTS: Within the regions included in our analysis, prevalence of C. difficile infection in patients with diarrhea was 15% (95% CI 13-17%) (including community and hospitalized patients), with no significant difference across regions. The incidence of C. difficile infection in 17 studies including this information was 8.5 per 10,000 patient-days (95% CI 5.83-12.46). Prevalence was significantly higher in hospitalized patients versus community patients (p  = 0.0227). CONCLUSION: Our prevalence estimate of 15% is concerning; however, low awareness and inconsistent diagnostic and surveillance protocols suggest this is markedly underestimated. Enhanced awareness and management of C. difficile infection in patients with diarrhea, along with improvements in infection control and surveillance practices, should be implemented to reduce prevalence of C. difficile-associated diarrhea in developing countries. FUNDING: Pfizer Inc.

RESUMO

The new American College of Cardiology/American Heart Association 2017 Hypertension Guidelines lower the threshold to define hypertension, thus increasing its prevalence. The impact on populations and health systems is poorly understood. We included data from 990 subjects aged 20 to 64 years from the SALMEX cohort (Salt in Mexico; Mexico City) and determined the prevalence of hypertension and requirement for pharmacological treatment according to both Joint National Committee on the Prevention, Detection, and Treatment of High Blood Pressure 7 and American College of Cardiology/American Heart Association 2017 guidelines. The data obtained were extrapolated to sex- and age-adjusted Mexico City population, and annual costs of medical follow-up were calculated. The new definition increased the prevalence of hypertension among SALMEX cohort from 16.2% to 37.4% (18%-39.3% after adjusting to Mexico City population). The proportion of subjects that require pharmacological and nonpharmacological treatment increased from 17.7% to 19.0% and from 17.7% to 37.4%, respectively (19.4%-21.8% for pharmacological and 19.4%-39.3% for nonpharmacological treatment, after adjusting to Mexico City population). Annual costs of medical follow-up for subjects with hypertension in Mexico City would increase an estimated $59 278 928. The requirement to initiate pharmacological treatment was similar when assessed by Framingham risk score with lipids or with body mass index compared with the Atherosclerotic Cardiovascular Disease score, with correlation κ indexes of 0.981 and 0.972, respectively. On the basis of these results, Framingham body mass index represents an attractive and potentially cost-effective alternative to assess cardiovascular risk. In conclusion, the adoption of the new guidelines in Mexican population has implications not only on its prevalence but also on medical follow-up costs. A pharmacoeconomic model is required to assess the actual financial impact.

Assuntos

Anti-Hipertensivos , Cardiologia , Hipertensão , Guias de Prática Clínica como Assunto/normas , Anti-Hipertensivos/economia , Anti-Hipertensivos/uso terapêutico , Cardiologia/métodos , Cardiologia/normas , Cardiologia/tendências , Estudos de Coortes , Custos e Análise de Custo , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , México/epidemiologia , Avaliação das Necessidades , Prevalência , Fatores de Risco

RESUMO

Initiatives to reduce sodium intake are encouraged globally, yet there is concern about compromised iodine intake supplied through salt. The aim of the present study was to determine baseline sodium, potassium, and iodine intake in a sample of workers from our Institution in Mexico City (SALMEX Cohort). Methods. From a cohort of 1009 workers, appropriate 24-h urine and three-day dietary recall was collected in a sample of 727 adult subjects for assessment of urinary sodium, potassium, and iodine concentrations. Median urinary iodine excretion (UIE) was compared across categories of sodium intake of <2, 2⁻3.6, and ≥3.6 g/day. Results. Average sodium intake was 3.49 ± 1.38 g/day; higher in men than women (4.14 vs. 3.11 g/day, p ≤0.001). Only 10.6% of the population had sodium intake within the recommended range (<2 g/day); 45.4% had high (2⁻3.6 g/day) and 44% had excessive intake (>3.6 g/day). Average urinary Na/K ratio was 3.15 ± 1.22 (ideal < 1), higher in men (3.42 vs. 3.0, p ≤ 0.001). The multivariate analysis showed that sodium intake was associated with age (p = 0.03), male sex (p < 0.001), caloric intake (p = 0.002), UKE (p < 0.001) and BMI (p < 0.001). Median iodine intake was 286.7 µg/day (IQR 215⁻370 µg/day). Less than 2% of subjects had iodine intake lower than recommended for adults (95 µg/day); 1.3% of subjects in the recommended range of salt intake had low iodine intake. There is a direct relationship between iodine and sodium urinary excretion (r = 0.57, p < 0.0001). Conclusions. In the studied population, there was an excessive sodium intake and an imbalance between sodium and potassium intake. Only 10.6% of the population had sodium intake within the recommended values, but iodine intake in this group appears to be adequate.

Assuntos

Iodo/administração & dosagem , Deficiência de Potássio/epidemiologia , Potássio na Dieta/administração & dosagem , Sódio na Dieta/administração & dosagem , Adulto , Distribuição de Qui-Quadrado , Estudos Transversais , Inquéritos sobre Dietas , Feminino , Humanos , Iodo/urina , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Doenças não Transmissíveis/epidemiologia , Estado Nutricional , Valor Nutritivo , Deficiência de Potássio/diagnóstico , Deficiência de Potássio/urina , Potássio na Dieta/urina , Prevalência , Recomendações Nutricionais , Sódio na Dieta/efeitos adversos , Sódio na Dieta/urina , Saúde da População Urbana , Urinálise

RESUMO

Unplanned pregnancy and sexually transmitted infections (STIs) in adolescents continue to be major health problems around the world. They are associated with sex that occurs without contraceptive protection. We determined the relationship of family, personal, and social factors with the non-use of any contraceptive method during the first sexual experience in 1409 adolescent women. The most significant risk factors were being less than 15 years of age and lacking knowledge and awareness about contraceptive methods. In the family environment, the risk factors were living in an incomplete family and the existence of a poor relationship among the father, the mother, and the adolescents. Socialization with friends who became sexually active at an early age was also associated with having sex for the first time without protection. This information should be used in sexual and reproductive education programmes to prevent unplanned pregnancy and STIs in adolescent women.

Assuntos

Anticoncepção/estatística & dados numéricos , Comportamento Sexual/psicologia , Adolescente , Fatores Etários , Família/psicologia , Feminino , Amigos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Fatores de Risco , Comportamento Social , Meio Social

RESUMO

Having an accurate model of the power curve of a wind turbine allows us to better monitor its operation and planning of storage capacity. Since wind speed and direction is of a highly stochastic nature, the forecasting of the power generated by the wind turbine is of the same nature as well. In this paper, a method for obtaining a robust confidence band containing the power curve of a wind turbine under test conditions is presented. Here, the confidence band is bound by two curves which are estimated using parametric statistical inference techniques. However, the observations that are used for carrying out the statistical analysis are obtained by using the binning method, and in each bin, the outliers are eliminated by using a censorship process based on robust statistical techniques. Then, the observations that are not outliers are divided into observation sets. Finally, both the power curve of the wind turbine and the two curves that define the robust confidence band are estimated using each of the previously mentioned observation sets.

RESUMO

BACKGROUND: Omalizumab is a monoclonal antibody that is prescribed in a stepwise addition regimen for the treatment of severe asthma. OBJECTIVE: To report the experience of patients with severe asthma who were given omalizumab in accordance with international guides, in a context of real-world data. METHODS: Open, analytical, cross-sectional, retrospective, observational clinical study with real-world data. GINA 2006 Asthma Control Scheme was used to evaluate patients, and a questionnaire was used to evaluate patient characteristics, effectiveness, safety, and tolerance to omalizumab. RESULTS: 48 patients were studied, 34 women and 14 men with an average age of 39 years. The average disease duration was 26 years. Average serum IgE was 522 IU. At the beginning of treatment, all patients had uncontrolled asthma; at the end, 69% asthma control was obtained, 19% was partially controlled and 12% unchanged. The changes were observed at seven months on average. CONCLUSION: Omalizumab is effective and safe for treating severe asthma when applied in accordance with international guidelines for the management of bronchial asthma.

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Antecedentes: El omalizumab es un anticuerpo monoclonal que se prescribe en esquema de adición por pasos para el tratamiento del asma severa. Objetivos: Informar la experiencia en pacientes con asma severa a quienes se aplicó omalizumab conforme a las guías internaciones, en un contexto de datos de mundo real. Métodos: Estudio retrospectivo, clínico, observacional, abierto, analítico y transversal a partir de datos de la vida real. Se utilizó el esquema de Control del Asma de GINA 2006 para evaluar a los pacientes y con un cuestionario se calificaron las características del paciente, efectividad, seguridad y tolerancia al omalizumab. Resultados: Se estudiaron 48 pacientes, 34 mujeres y 14 hombres, con edad promedio de 39 años. La duración promedio de la enfermedad fue de 26 años. La concentración sérica promedio de la IgE fue de 522 UI. Al inicio del tratamiento, todos los pacientes estaban sin control del asma; al final, en 69% se obtuvo control del asma, 19% estaba parcialmente controlado y 12% sin modificaciones. Los cambios se observaron en promedio a los siete meses. Conclusión: El omalizumab es efectivo y seguro para tratar el asma severa cuando se aplica conforme las guías internacionales para el manejo del asma bronquial.

Assuntos

Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Omalizumab/uso terapêutico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento

RESUMO

In this paper, a method of verification of the power performance of a wind farm is presented. This method is based on the Friedman's test, which is a nonparametric statistical inference technique, and it uses the information that is collected by the SCADA system from the sensors embedded in the wind turbines in order to carry out the power performance verification of a wind farm. Here, the guaranteed power curve of the wind turbines is used as one more wind turbine of the wind farm under assessment, and a multiple comparison method is used to investigate differences between pairs of wind turbines with respect to their power performance. The proposed method says whether the power performance of the specific wind farm under assessment differs significantly from what would be expected, and it also allows wind farm owners to know whether their wind farm has either a perfect power performance or an acceptable power performance. Finally, the power performance verification of an actual wind farm is carried out. The results of the application of the proposed method showed that the power performance of the specific wind farm under assessment was acceptable.