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BACKGROUND: Patient safety is a fundamental aspect of health care practice across global health systems. Safe practices, which include incident reporting systems, have proven valuable in preventing the recurrence of safety incidents. However, the accessibility of this tool for health care discipline students is not consistent, limiting their acquisition of competencies. In addition, there is no tools to familiarize students with analyzing safety incidents. Gamification has emerged as an effective strategy in health care education. OBJECTIVE: This study aims to develop an incident reporting system tailored to the specific needs of health care discipline students, named Safety Incident Report System for Students. Secondary objectives included studying the performance of different groups of students in the use of the platform and training them on the correct procedures for reporting. METHODS: This was an observational study carried out in 3 phases. Phase 1 consisted of the development of the web-based platform and the incident registration form. For this purpose, systems already developed and in use in Spain were taken as a basis. During phase 2, a total of 223 students in medicine and nursing with clinical internships from universities in Argentina, Brazil, Colombia, Ecuador, and Spain received an introductory seminar and were given access to the platform. Phase 3 ran in parallel and involved evaluation and feedback of the reports received as well as the opportunity to submit the students' opinion on the process. Descriptive statistics were obtained to gain information about the incidents, and mean comparisons by groups were performed to analyze the scores obtained. RESULTS: The final form was divided into 9 sections and consisted of 48 questions that allowed for introducing data about the incident, its causes, and proposals for an improvement plan. The platform included a personal dashboard displaying submitted reports, average scores, progression, and score rankings. A total of 105 students participated, submitting 147 reports. Incidents were mainly reported in the hospital setting, with complications of care (87/346, 25.1%) and effects of medication or medical products (82/346, 23.7%) being predominant. The most repeated causes were related confusion, oversight, or distractions (49/147, 33.3%) and absence of process verification (44/147, 29.9%). Statistically significant differences were observed between the mean final scores received by country (P<.001) and sex (P=.006) but not by studies (P=.47). Overall, participants rated the experience of using the Safety Incident Report System for Students positively. CONCLUSIONS: This study presents an initial adaptation of reporting systems to suit the needs of students, introducing a guided and inspiring framework that has garnered positive acceptance among students. Through this endeavor, a pathway toward a safety culture within the faculty is established. A long-term follow-up would be desirable to check the real benefits of using the tool during education. TRIAL REGISTRATION: Trial Registration: ClinicalTrials.gov NCT05350345; https://clinicaltrials.gov/study/NCT05350345.
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Segurança do Paciente , Gestão de Riscos , Humanos , Gestão de Riscos/métodos , Internato e Residência , Espanha , Brasil , Argentina , Equador , Masculino , Colômbia , Feminino , Estudantes de Medicina/estatística & dados numéricosRESUMO
Introduction: The role of the type, stage and status of cancer in the outcome of COVID-19 remains unclear. Moreover, the characteristic pathological changes of severe COVID-19 reveled by laboratory and radiological findings are similar to those due to the development of cancer itself and antineoplastic therapies. Objective: To identify potential predictors of mortality of COVID-19 in cancer patients. Materials and methods: A retrospective and cross-sectional study was carried out in patients with clinical suspicion of COVID-19 who were confirmed for COVID-19 diagnosis by RT-PCR testing at the National Institute of Neoplastic Diseases between April and December 2020. Demographic, clinical, laboratory and radiological data were analyzed. Statistical analyses included area under the curve and univariate and multivariate logistic regression analyses. Results: A total of 226 patients had clinical suspicion of COVID-19, the diagnosis was confirmed in 177 (78.3%), and 70/177 (39.5%) died. Age, active cancer, leukocyte count ≥12.8 × 109/L, urea ≥7.4 mmol/L, ferritin ≥1,640, lactate ≥2.0 mmol/L, and lung involvement ≥35% were found to be independent predictors of COVID-19 mortality. Conclusion: Active cancer represents the main prognosis factor of death, while the role of cancer stage and type is unclear. Chest CT is a useful tool in the prognosis of death from COVID-19 in cancer patients. It is a challenge to establish the prognostic utility of laboratory markers as their altered values it could have either oncological or pandemic origins.
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COVID-19 , Neoplasias , Humanos , Teste para COVID-19 , Estudos Transversais , Estudos Retrospectivos , Ácido LácticoRESUMO
BACKGROUND: The COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience. OBJECTIVE: This study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations. METHODS: The study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises. RESULTS: The findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used. CONCLUSIONS: Ensuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams.
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COVID-19 , Humanos , Equador , Pandemias , Pessoal de Saúde , Adaptação PsicológicaRESUMO
Surveillance of antimicrobial resistance among gram-negative bacteria (GNB) is of critical importance, but data for Peru are not available. To fill this gap, a non-interventional hospital-based surveillance study was conducted in 15 hospitals across Peru from July 2017 to October 2019. Consecutive unique blood culture isolates of key GNB (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp.) recovered from hospitalized patients were collected for centralized antimicrobial susceptibility testing, along with linked epidemiological and clinical data. A total of 449 isolates were included in the analysis. Resistance to third-generation cephalosporins (3GCs) was present in 266 (59.2%) GNB isolates. Among E. coli (n = 199), 68.3% showed 3GC resistance (i.e., above the median ratio for low- and middle-income countries in 2020 for this sustainable development goal indicator). Carbapenem resistance was present in 74 (16.5%) GNB isolates, with wide variation among species (0% in E. coli, 11.0% in K. pneumoniae, 37.0% in P. aeruginosa, and 60.8% in Acinetobacter spp. isolates). Co-resistance to carbapenems and colistin was found in seven (1.6%) GNB isolates. Empiric treatment covered the causative GNB in 63.3% of 215 cases. The in-hospital case fatality ratio was 33.3% (92/276). Pseudomonas aeruginosa species and carbapenem resistance were associated with higher risk of in-hospital death. In conclusion, an important proportion of bloodstream infections in Peru are caused by highly resistant GNB and are associated with high in-hospital mortality.
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Infecções por Bactérias Gram-Negativas , Sepse , Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Escherichia coli , Prevalência , Peru/epidemiologia , Mortalidade Hospitalar , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Carbapenêmicos , Bactérias Gram-Negativas , Klebsiella pneumoniae , Pseudomonas aeruginosa , Sepse/tratamento farmacológico , Testes de Sensibilidade MicrobianaRESUMO
This study analyzed the frequency and intensity of acute stress among health professionals caring for COVID-19 patients in four Latin American Spanish-speaking countries during the outbreak. A cross-sectional study involved a non-probability sample of healthcare professionals in four Latin American countries. Participants from each country were invited using a platform and mobile application designed for this study. Hospital and primary care workers from different services caring for COVID-19 patients were included. The EASE Scale (SARS-CoV-2 Emotional Overload Scale, in Spanish named Escala Auto-aplicada de Sobrecarga Emocional) was a previously validated measure of acute stress. EASE scores were described overall by age, sex, work area, and experience of being ill with COVID-19. Using the Mann-Whitney U test, the EASE scores were compared according to the most critical moments of the pandemic. Univariate and multivariate analysis was performed to investigate associations between these factors and the outcome 'acute stress'. Finally, the Kruskal-Wallis was used to compare EASE scores and the experience of being ill. A total of 1372 professionals responded to all the items in the EASE scale: 375 (27.3%) Argentines, 365 (26.6%) Colombians, 345 (25.1%) Chileans, 209 (15.2%) Ecuadorians, and 78 (5.7%) from other countries. 27% of providers suffered middle-higher acute stress due to the outbreak. Worse results were observed in moments of peak incidence of cases (14.3 ± 5.3 vs. 6.9 ± 1.7, p < 0.05). Higher scores were found in professionals in COVID-19 critical care (13 ± 1.2) than those in non-COVID-19 areas (10.7 ± 1.9) (p = 0.03). Distress was higher among professionals who were COVID-19 patients (11.7 ± 1) or had doubts about their potential infection (12 ± 1.2) compared to those not infected (9.5 ± 0.7) (p = 0.001). Around one-third of the professionals experienced acute stress, increasing in intensity as the incidence of COVID-19 increased and as they became infected or in doubt whether they were infected. EASE scale could be a valuable asset for monitoring acute stress levels among health professionals in Latin America.ClinicalTrials: NCT04486404.
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COVID-19 , Pessoal de Saúde , Estresse Ocupacional , Argentina/epidemiologia , COVID-19/epidemiologia , COVID-19/terapia , Chile , Colômbia/epidemiologia , Estudos Transversais , Equador/epidemiologia , Pessoal de Saúde/psicologia , Humanos , Estresse Ocupacional/epidemiologia , Fatores de RiscoRESUMO
Abstract Introduction: High Andean flamingos also known as parihuanas, are species of recurrent presence in the high Andean areas which find this area as an important resting, feeding and in some cases breeding area The species recorded here correspond to Phoenicoparrus jamesi, Phoenicoparrus andinus and Phoenicopterus chilensis, the latter being the most abundant and common. During the censuses performed during 2018 and 2019, in the high Andean lake of Salinas, Ramsar site, located within the Reserva Nacional Salinas y Aguada Blanca in Southern Peru, atypical behaviors of these birds were recorded in a sector of the lake, observing reproductive courtship and the settlement of colonies of P. chilensis. Objective: The study aimed to confirm and evaluate reproductive events of P. chilenesis (Chilean flamingo) through the use of an unmanned aerial vehicle (UAV) and image processing tools using geographic information systems. Methodology: Monitoring was conducted during 2018 and 2019 to breeding colonies of P. chilensis, we used a UAV Phantom 4 testing different flight altitudes to avoid disturbing the birds and performed records of aerial photographs and GIS post-processing with the creation of panchromatic images for the identification and counting of individuals and eggs automated, and manual verification. Results: During 2018 were identified nests and presence of six eggs, this occurred between March and June where the event was interrupted not observing chicks or juveniles during this period, for 2019 the breeding was more successful, where a higher number of eggs were counted (40-66) and with the formation of three reproductive colonies with 4 185 adult individuals, also verified the presence of chicks and juveniles that reached a maximum of 1 491 individuals. Conclusions: We confirmed two continuous reproductive events of P. chilensis in the Salinas lake, where during 2019 was the most successful incorporating several new individuals to the initial population, likewise the methodology applied in the image processing allowed differentiating between adult individuals and eggs but did not allow differentiating juveniles, however, the images directly acquired by the UAV allow distinguishing the types of individuals to perform a manual count.
Resumen Introducción: Los flamencos altoandinos también conocidos como parihuanas, son especies con presencia recurrente en las zonas altoandinas, principalmente en humedales salinos donde suelen arribar para descanso, alimentación y en algunos casos reproducción. Las especies que se registran aquí corresponden a Phoenicoparrus jamesi, Phoenicoparrus andinus y Phoenicopterus chilenesis, siendo esta última la más abundante y común. Durante los censos desarrollados en 2018 y 2019, en la laguna de Salinas, ubicada en la Reserva Nacional de Salinas y Aguada Blanca en el sur del Perú, se registraron comportamientos atípicos de estas aves en un sector del humedal, se observaron cortejos reproductivos y el asentamiento de colonias de flamencos chilenos. Objetivo: Confirmar y evaluar eventos reproductivos de Phoenicopterus chilenesis mediante la incorporación de un vehículo aéreo no tripulado (UAV) y herramientas de procesamiento de imágenes mediante sistemas de información geográfica. Metodología: Se realizaron censos aéreos durante 2018 y 2019 a colonias reproductivas del P. chilensis, utilizando un UAV Phantom 4 a diferentes alturas de vuelo para evitar la perturbación de las colonias de flamencos. Se realizaron registros de fotografías aéreas y post procesamiento SIG con la creación de imágenes pancromáticas para la identificación y conteo de individuos y huevos automatizada, así como la verificación manual. Resultados: En 2018 se identificaron nidos y la presencia de seis huevos, entre marzo y junio donde el evento fue interrumpido, no se observaron pollos o juveniles durante este periodo. En 2019 la nidificación tuvo éxito, se contabilizó un mayor número de huevos (40-66) con la formación de tres colonias reproductivas de 4 185 individuos adultos, se verificó la presencia de pollos y juveniles que alcanzaron un máximo de 1 491 individuos. Conclusiones: Se confirman dos eventos reproductivos continuos de P. chilensis en la laguna Salinas, durante el 2019 incorporando varios nuevos individuos a la población inicial. La metodología aplicada en el tratamiento de imágenes permitió diferenciar entre individuos adultos y huevos, pero no permitió diferenciar juveniles, aunque las imágenes directamente adquiridas por el UAV permiten diferenciar los tipos de individuos para realizar un conteo manual.
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Animais , Aves , Dispositivos Aéreos não Tripulados , Peru , Comportamento de NidaçãoRESUMO
RESUMEN El objetivo de este artículo es analizar de manera crítica los procesos históricos que ha tenido la idea de bienestar en el campo de la salud, principalmente en Colombia. Desde la definición de salud propuesta por la Organización Mundial de la Salud a mediados del siglo XX, surgieron compromisos estatales que vincularon los modelos económicos en Latinoamérica, orientados a la garantía de mejores condiciones de bienestar social. Sin embargo, al examinar el proceso histórico de la idea de bienestar, es posible identificar los giros discursivos que han permitido el surgimiento, aplicación y reproducción de prácticas de poder institucional, justificadas en la búsqueda de mejores condiciones para el bienestar social. Ejemplo de ello son las reformas neoliberales a los servicios de salud, lo cual ha contribuido a la reconfiguración de los Estados y las relaciones sociales y a la naturalización de las desigualdades, como un asunto vinculado con la poca gestión de las personas para competir económicamente dentro de las reglas de juego del mercado. Para esto, se analizarán fuentes secundarias de índole política y normativa, así como algunos referentes teóricos que han contribuido a la discusión en torno a temas como el neoliberalismo, el bienestar y los sistemas de salud.
ABSTRACT The objective of this article is to critically analyze the historical processes that social well-being has had in the field of health, mainly in Colombia. Since the definition of health proposed by the World Health Organization in the mid-twentieth century, State commitments have emerged that link economic models in Latin America to policies aimed at guaranteeing better social welfare conditions. However, when examining the historical process of well-being, it is possible to identify the discursive turns that have allowed the emergence, application, and reproduction of justified practices of institutional power in the search for better social welfare conditions. An example of this are neoliberal reforms to healthcare, which have contributed to the reconfiguration of States, social relations, and naturalization of inequalities as a matter of poor management of people to compete economically within the rules of the market. As it relates to welfare policies in Colombia, a secondary source of political and normative nature will be analyzed, as well as theoretical references that have contributed to the discussion around issues such as neoliberalism, well-being, and health systems.
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Abstract Several species of the genus Anastrepha Schiner are associated to different hosts and have a great economic importance in fruit crops of the Neotropical region. Ripe and unripe fruits of six passion flowers species were sampled in Oxapampa during 2016 and 2018. Larvae of Anastrepha pseudoparallela Loew (Diptera: Tephritidae) were detected infesting fruits of Passiflora ambigua Hemsl and Passiflora quadrangularis L. For the first time, this fruit fly species is recorded attacking fruits of passion flowers in Peru.
Resumen Diversas especies del género Anastrepha Schiner están asociadas a diferentes hospederos y tienen gran importancia económica en la fruticultura de la región Neotropical. Frutos maduros e inmaduros de seis especies de Passiflora L. fueron colectados en Oxapampa durante el 2016 y 2018. Larvas de Anastrepha pseudoparallela Loew (Diptera: Tephritidae) fueron encontradas infestando frutos de Passiflora ambigua Hemsl y Passiflora quadrangularis L. Por primera vez, esta especie de mosca es registrada atacando frutos de pasifloras en el Perú.
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El género Liolaemus presenta una gran diversidad entre los tetrápodos actuales, al punto de corresponder al segundo género con mayor número de especies válidas descritas del infraorden Iguania. En este trabajo, se describe una nueva especie de lagartija arenícola perteneciente al subgénero Eulaemus, grupo de Liolaemusmontanus, procedente de las lomas costeras de Quilca, La Chira y Ocoña, todos en la provincia de Camaná, departamento de Arequipa, Perú. Para determinar el estatus taxonómico de esta nueva especie, analizamos los caracteres morfológicos, moleculares y geográficos. Los caracteres morfológicos permitieron la caracterización y diagnóstico de la nueva especie, los moleculares fueron utilizados para realizar una inferencia bayesiana y los geográficos para determinar potenciales áreas de distribución. Este reptil se diferencia de las otras especies del grupo Liolaemusmontanus en su tamaño pequeño a mediano, su conjunto de caracteres morfológicos, folidosis y patrón de coloración: es la única especie del género donde los machos tienen un patrón de manchas laterales de forma redondeada con borde oscuro e interior verde desde las axilas hasta la mitad del cuerpo. Del mismo modo, los resultados filogenéticos moleculares realizados con el gen Cyt-b indican que no tiene relación directa con las especies fenéticamente similares descritas para el grupo. Sin embargo, existe una relación con poblaciones geográficamente cercanas que permanecen taxonómicamente innominadas. Finalmente, se determinó que esta lagartija tiene un endemismo muy marcado y sus poblaciones son poco abundantes.
The genus Liolaemus presents great diversity among the current tetrapods. It is the second genus with the highest number of valid species described of the Iguana infraorder. In this study, we described a new species of sand lizard from the coastal lomas of Quilca, La Chira and Ocoña that belongs to the subgenus Eulaemus and group of Liolaemus montanus, all in the province of Camaná, department of Arequipa, Peru. To determine the taxonomic status of this new organism, we analyzed morphological, molecular and geographical characters. The morphological characters allowed the characterization and diagnosis of the new species, the molecular data was used to make a Bayesian inference, and the geographic data served to determine potential distribution areas. This lizard diverges from the other species of the Liolaemus montanus group for its small to medium size, several sets of morphological characters, folidosis and color pattern. It is also the only species of the genus where the males have a pattern of lateral spots of rounded shape with dark border and green interior, from the armpits to the middle of the body. Additionally, the molecular phylogenetic results made with the Cyt-b gene indicate that it has no direct relationship with the phenetically similar species described for the group; nevertheless, there is a relationship with geographically close populations, which has not been properly described. Finally, it was determined that this lizard has a very marked endemism and its populations are not abundant.
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The present study documented for the first time data on plastic ingestion by Prionace glauca in the South Pacific Ocean, south of the Peruvian Sea. In total, 136 individuals were studied between 2015 and 2016. Their size ranged from 61.5 to 255.0â¯cm TL. Pieces of plastic bags were found in the stomach contents, corresponding to the 2.2% of the individuals. The mean number of ingested plastics was 0.02. The polymer type identified by FT-IR for the pieces of plastics bags was polyethylene.
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Ingestão de Alimentos , Conteúdo Gastrointestinal/química , Polietileno/análise , Tubarões/metabolismo , Poluentes Químicos da Água/análise , Animais , Oceano Pacífico , Peru , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
Soil microbial communities are an important component of biological diversity and terrestrial ecosystems which is responsible for processes such as decomposition, mineralization of nutrients, and accumulation of organic matter. One of the factors that provide information on the mechanisms regulating biodiversity is spatial scaling. We characterized the microbial communities using 16S rRNA gene sequences from DNA isolated from halite at various locations and correlated these to geographic distance in the Uyuni salt flat (Bolivia). Sequences from each site were analyzed to determine any spatial patterns of diversity, as well as to describe the microbial communities. Results suggest that different taxa are able to disperse over Uyuni's surface crust regardless of distance. As expected, ubiquitous taxa included members of Halobacteriaceae such as Haloarcula, Halorubrum, Halorhabdus, Halolamina, and halophilic bacteria Salinibacter, Halorhodospira, and unclassified members of the Gammaproteobacteria. Archaeal communities were homogeneous across the salt flat. In contrast, bacterial communities present strong local variations which could be attributed to external factors. Likely sources for these variations are the Rio Grande river influent in the south shore and the Tunupa volcano influencing the northern area.
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Archaea/classificação , Bactérias/classificação , Biota , Microbiologia do Solo , Archaea/genética , Bactérias/genética , Bolívia , Análise por Conglomerados , DNA Arqueal/química , DNA Arqueal/genética , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Metagenômica , Filogenia , RNA Ribossômico 16S/genética , Análise de Sequência de DNARESUMO
El nivel de preparación de los estudiantes de la carrera de medicina y los factores que lo determinan son objeto de debate y preocupación en las reuniones de los departamentos docentes. Con el objetivo de identificar los principales factores que están influyendo en la calidad del egresado se realizó una investigación de desarrollo en el Hospital Clínico- Quirúrgico "Celia Sánchez Manduley" de Manzanillo, Granma, Cuba en el que se utilizaron como técnicas y métodos de pesquisa la revisión documental de las actas de reuniones metodológicas departamentales, de las tarjetas de habilidades de los estudiantes y de los registros de control de asistencia y evaluaciones (C-1). También se trabajó con un grupo nominal conformado por los jefes de cátedras y una consulta a expertos que fueron profesores del área básica y clínica con categoría docente superior. Como principales conclusiones se señalan los incumplimientos del Plan de trabajo metodológico, la inadecuada preparación pedagógica del claustro y la carencia de métodos y hábitos de estudio en los educandos(AU)
The level of preparation of the students of the medical career and the factors that determine it are the object of debate and concern in the meetings of the teaching departments. In order to identify the main factors that are influencing the quality of the graduate, a development research was carried out at the "Celia Sánchez Manduley" Clinical and Surgical Hospital of Manzanillo, Granma, Cuba, where they were used as research techniques and methods. the documentary review of the minutes of departmental methodological meetings, of the students' skill cards and of attendance control and evaluation records (C-1). We also worked with a nominal group formed by the chairs of chairs and a consultation with experts who were professors of the basic and clinical area with higher teaching category. The main conclusions are the breaches of the Methodological Work Plan, the inadequate pedagogical preparation of the faculty and the lack of methods and study habits in the students(AU)
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Humanos , Competência Profissional , Estudantes de Medicina , Desempenho AcadêmicoRESUMO
The gut contents of 292 planktivorous fish, from four families (Atherinopsidae, Clupeidae, Engraulidae and Scombridae) and seven species, captured along the coast of the southeast Pacific, were examined for microplastic contamination. Only a small fraction of all studied fish (2.1%; 6 individuals) contained microplastic particles in their digestive tract. Microplastics found were degraded hard fragments and threads, ranging from 1.1 to 4.9 (3.8±SD 2.4) mm in length, and of various colours, which suggests that the planktivorous fish species examined herein did not capture microplastics on the basis of their colour. The low prevalence of microplastic contamination in planktivorous fishes found in this study suggests that the risk of accidental ingestion by these species might be limited in the coastal upwelled waters of the southeast Pacific, perhaps due to small human population and highly dynamic oceanographic processes.
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Peixes , Plásticos/análise , Poluentes Químicos da Água/análise , Animais , Monitoramento Ambiental , Oceano PacíficoRESUMO
Lipid-lowering response to statin therapy shows large interindividual variability. At a genome-wide significance level, single nucleotide polymorphisms (SNPs) in PCSK9 and HMGCR have been implicated in this differential response. However, the influence of these variants is uncertain in the Chilean population. Hence, we aimed to evaluate the contribution of PCSK9 rs7552841 and HMGCR rs17671591 SNPs as genetic determinants of atorvastatin response in Chilean hypercholesterolaemic individuals. One hundred and one hypercholesterolaemic patients received atorvastatin 10 mg/day for 4 weeks. Plasma lipid profile (TC, HDL-C, LDL-C and TG) was determined before and after statin treatment, and SNPs were identified by allelic discrimination using TaqMan(®) SNP Genotyping Assays. Adjusted univariate and multivariate analyses' models were used for statistical analyses, and a p-value <0.05 was considered significant. From baseline (week 0) to the study end-point (week 4), significant reductions were observed in plasma TC, LDL-C and TG (p < 0.001), while HDL-C levels were increased (p < 0.001). Multivariate analysis showed no association between lipid levels and atorvastatin therapy for the PCSK9 variant. However, the HMGCR rs17671591 T allele contributed to basal HDL-C concentration variability along with a higher increase in this lipid fraction after statin medication. In addition, this allele determined greater plasma LDL-C reductions after therapy with atorvastatin. Our data suggest that the HMGCR rs17671591 polymorphism can constitute a genetic marker of lower plasma LDL-C and enhanced HDL-C concentration after atorvastatin therapy in the Chilean population.
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Anticolesterolemiantes/uso terapêutico , Atorvastatina/uso terapêutico , LDL-Colesterol/sangue , Hidroximetilglutaril-CoA Redutases/genética , Hipercolesterolemia/tratamento farmacológico , Polimorfismo de Nucleotídeo Único , Anticolesterolemiantes/administração & dosagem , Anticolesterolemiantes/farmacocinética , Atorvastatina/administração & dosagem , Atorvastatina/farmacocinética , Chile , Feminino , Estudo de Associação Genômica Ampla , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/genética , Masculino , Pessoa de Meia-Idade , Pró-Proteína Convertase 9/genética , Resultado do TratamentoRESUMO
BACKGROUND: Low grade fibromyxoid sarcoma or tumor Evans is a variety of soft tissue sarcoma that represents 1% of all malignancies. More common in limbs and trunk (50%), we present 3 new cases of retroperitoneal reviewing their characteristics and performing a literature review. CLINICAL CASE: In the retroperitoneal location highlights the poor specificity of clinical symptoms, demonstrating, according to their growth and size, as an abdominal tumor, usually painless, or by compression and/or invasion of nearby structures. In cases that present the most important finding was the presence of a palpable abdominal tumor without other symptoms despite remarkable infiltration of other organs that should be included in surgical resection. CONCLUSIONS: We emphasize the difficulty of correct diagnosis preoperatively because preoperative studies are inconclusive and only the histological and immuno-histo-typing chemistry allow precise identification.
Antecedentes: el sarcoma fibromixoide de bajo grado o tumor de Evans es una variedad de sarcoma de partes blandas que representa el 1% de todos los tumores malignos. Más frecuente en extremidades y tronco (50%), presentamos tres nuevos casos de localización retroperitoneal. Se revisan sus características y se realiza actualización bibliográfica. Casos clínicos: en su localización retroperitoneal destaca lo inespecífico de su sintomatología clínica, se manifiesta en función de su crecimiento y tamaño, como una tumoración abdominal, habitualmente indolora, o por la compresión y/o invasión de estructuras próximas. Los casos presentados se manifestaron, por la presencia de tumoración abdominal, sin otra sintomatología; a pesar de infiltrar a otros órganos. Conclusiones: el diagnóstico preoperatorio es difícil, y debe tenerse la presunción clínica para solicitar el estudio histológico, con tipificación inmuno-histo-química para su dentificación precisa.
Assuntos
Fibrossarcoma/patologia , Neoplasias Retroperitoneais/patologia , Adulto , Biomarcadores Tumorais/análise , Terapia Combinada , Diagnóstico Diferencial , Evolução Fatal , Feminino , Fibrossarcoma/diagnóstico , Fibrossarcoma/terapia , Humanos , Leiomiossarcoma/secundário , Leiomiossarcoma/cirurgia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Miofibroblastos/patologia , Recidiva Local de Neoplasia/cirurgia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/terapia , Sarcoma/classificação , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgiaRESUMO
During the last decade we have assisted in the development of new therapeutic strategies for the treatment of ovarian cancer, based on the best knowledge of molecular biology. One of the most promising strategies under investigation is antiangiogenic therapy. Bevacizumab is a monoclonal humanised antibody targeting vascular endothelial growth factor (VEGF), which has shown antitumour activity in ovarian cancer in preclinical models as well as in clinical trials, both in monotherapy and in combination with other therapies. Currently, ongoing phase III trials are testing bevacizumab as a front-line therapy with carboplatin and paclitaxel. Bevacizumab has been generally well tolerated with mild frequent toxicities (proteinuria, hypertension and bleeding). However, the drug may result in other uncommon, but potentially life-threatening side effects, such as arterial thromboembolism, wound healing complications, and gastrointestinal perforation or fistulae, which should be considered when the drug is administered. Other new therapeutic antiangiogenic strategies that include small-molecule tyrosine kinase inhibitors, antibodies neutralising the VEGF receptor (VEGFR) and soluble VEGFR hybrids (VEGF Trap) are being investigated with promising early results.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Carcinoma/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Algoritmos , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Bevacizumab , Carcinoma/irrigação sanguínea , Carcinoma/patologia , Quimioterapia Adjuvante , Dissidências e Disputas , Feminino , Humanos , Neovascularização Patológica/tratamento farmacológico , Neoplasias Ovarianas/irrigação sanguínea , Neoplasias Ovarianas/patologia , RecidivaRESUMO
BACKGROUND: Mexico has had the Advanced Trauma Life Support (ATLS) program since 1986. We assessed the attrition of ATLS skills among ATLS providers and instructors in this country. STUDY DESIGN: Three groups (S, 16 students [new medical graduates enrolled for an ATLS course]; P, 33 providers; and I, 26 instructors [who had completed courses previously]) were evaluated. Group S read the manual before pretesting. Groups P and I were subdivided based on the length of time since the course had been completed: P1, less than 2 years (n = 22); P2, more than 2 years (n = 11); I1, less than 2 years (n = 16); and I2, more than 2 years (n = 10). Multiple-choice and psychomotor testing using ATLS scoring criteria were used. Affect was assessed post-ATLS for motivational factors, interactivity, and attitude toward trauma care. RESULTS: Multiple-choice test scores (means +/- SD) out of a maximum of 40 were as follows: S, 24.3 +/- 2.6; P1, 24.0 +/- 5.7; P2, 21.3 +/- 8.0; I1, 23.2 +/- 8.2; and I2, 24.0 +/- 7.2. Group S all passed the post-ATLS multiple-choice test (with correct answer percentages of 60.3% +/- 6.6% pre-ATLS versus 88.8% +/- 5.6% post-ATLS). An ATLS passing score of 80% correct answers was achieved in 2 of 33 for group P and 8 of 26 for group I (p < 0.05), with no statistically significant differences between groups P1 and P2 or between groups I1 and I2. For the psychomotor skills testing component, 5 of 16 in the S group passed, 15 of 22 in P1 passed, 9 of 11 in P2 passed, 14 of 16 in I1 passed, and 6 of 10 in I2 passed. The pass rate was significantly lower in the S pre-ATLS group than in the P and I groups (p < 0.05, Fisher's exact test). More than 60% preferred interactive components and enrolled for professional improvement, and more than 90% reported improved post-ATLS attitude to trauma care. CONCLUSIONS: Reading the manual alone yields similar cognitive but inferior psychomotor performance compared with subjects who completed the course previously. The majority of previous providers and instructors did not obtain a passing score (80%) in the multiple-choice test, but all the new providers passed the post-ATLS multiple-choice test, suggesting major attrition of cognitive skills but maintenance of psychomotor skills. Instructors had superior cognitive performance versus providers with worsening performance over time, but clinical skills performance was maintained at an equally high level by all groups. A very positive attitude toward ATLS prevailed among all participants.
Assuntos
Educação Médica Continuada/normas , Avaliação Educacional/normas , Cuidados para Prolongar a Vida/normas , Traumatologia/educação , Ferimentos e Lesões/terapia , Suporte Vital Cardíaco Avançado/educação , Competência Clínica/normas , Cognição , Humanos , Memória , México , Desempenho PsicomotorRESUMO
Se hizo un estudio descriptivo-retrospectivo y se abordó el comportamiento epidemiológico de las formas de presentación intraparenquimatosa y subaracnoidea en el Hospital "Celia Sánchez Manduley" de Manzanillo, durante el año 1998, para establecer los indicadores de morbilidad, mortalidad, letalidad, variables biológicas y distributivas del ictus hemorrágico. Se halló que la morbilidad por hemorragia intraparenquimatosa triplicó las formas de hemorragia subaracnoidea, dentro de una tasa de 4,1 x 1 000 egresos para ambas; a su vez, la tasa de mortalidad general por éstas fue casi 14 veces superior a la de los procesos de hemorragia subaracnoidea y 4 veces preponderantes en términos de letalidad. La edad superior a los 60 años y el sexo masculino prevalecieron para ambas formas de presentación. La hipertensión arterial y las edades superiores a 60 años representaron los factores de riesgo de mayor frecuencia