RESUMO

Background: Heart failure (HF) and atrial fibrillation (AF) represent conditions that commonly coexist. The impact of AF in HF has yet to be well studied in Latin America. This study aimed to characterize the sociodemographic and clinical features, along with patients' outcomes with AF and HF from the Colombian Heart Failure Registry (RECOLFACA). Methods: Patients with ambulatory HF and AF were included in RECOLFACA, mainly with persistent or permanent AF. A 6-month follow-up was performed. Primary outcome was all-cause mortality. To assess the impact of AF on mortality, we used a logistic regression model. A P value of < 0.05 was considered significant. All statistical tests were two-tailed. Results: Of 2,528 patients with HF in the registry, 2,514 records included information regarding AF diagnosis. Five hundred sixty (22.3%) were in AF (mean age 73 ± 11, 56% men), while 1,954 had no AF (mean age 66 ± 14 years, 58% men). Patients with AF were significantly older and had a different profile of comorbidities and implanted devices compared to non-AF patients. Moreover, AF diagnosis was associated with lower quality of life score (EuroQol-5D), mainly in mobility, personal care, and daily activity. AF was prevalent in patients with preserved ejection fraction (EF), while no significant differences in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were observed. Although higher mortality was observed in the AF group compared to individuals without AF (8.9% vs. 6.1%, respectively; P = 0.016), this association lost statistical significance after adjusting by age in a multivariate regression model (odds ratio (OR): 1.35; 95% confidence interval (CI): 0.95 - 1.92). Conclusions: AF is more prevalent in HF patients with higher EF, lower quality of life and different clinical profiles. Similar HF severity and non-independent association with mortality were observed in our cohort. These results emphasize the need for an improved understanding of the AF and HF coexistence phenomenon.

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) represents one of the most frequent comorbidities observed in heart failure (HF) patients and has been observed to increase this population's risk of adverse outcomes. Nevertheless, evidence analyzing kidney dysfunction in HF is scarce in Latin American populations. We aimed to analyze the prevalence of kidney dysfunction and assess its association with mortality in patients diagnosed with HF enrolled in the Colombian Heart Failure Registry (RECOLFACA). METHODS: RECOLFACA enrolled adult patients with HF diagnosis from 60 centers in Colombia during the period 2017-2019. The primary outcome was all-cause mortality. A Cox proportional-hazards regression model was used to assess the impact of the different categories of eGFR in mortality risk. A p value of <0.05 was considered significant. All statistical tests were two-tailed. RESULTS: From the total 2,514 evaluated patients, 1,501 (59.7%) patients had moderate kidney dysfunction (eGFR <60 mL/min/1.73 m2), while 221 (8.8%) patients were classified as having a severe kidney dysfunction (eGFR <30 mL/min/1.73 m2). Patients with lower kidney function were most commonly males, had higher median age, and reported a higher prevalence of cardiovascular comorbidities. Moreover, different patterns of medications prescription were observed when comparing CKD versus non-CKD patients. Finally, eGFR <30 mL/min/1.73 m2 was significantly associated with a higher mortality risk compared to eGFR >90 mL/min/1.73 m2 status (HR: 1.87; 95% CI, 1.10-3.18), even after an extensive adjustment by relevant covariates. CONCLUSION: CKD represents a prevalent condition in the setting of HF. Patients with CKD and HF present with multiple sociodemographic, clinical, and laboratory differences compared with those only diagnosed with HF and present a significantly higher risk of mortality. A timely diagnosis and optimal treatment and follow-up of CKD in the setting of HF may improve the prognosis of these patients and prevent adverse outcomes.

Assuntos

RESUMO

We aimed to describe and compare characteristics and outcomes of patients with a worsening heart failure episode included in the RECOLFACA registry during 2017-2019 vs population from VICTORIA trial. 2528 patients were included, 1890 (74.8%) had an ejection fraction <45% and a worsening episode. VICTORIA population was similar to RECOLFACA patients in mean age (67.3 vs 66.9 years), ejection fraction (28.9% vs 28.4%), the prevalence of COPD (17.1% vs 15.7%), and the median eGFR (61.5 vs 61.4 mL/min/1.73m2). RECOLFACA patients were mostly women, with a lower prevalence of atrial fibrillation, diabetes mellitus, and coronary artery disease. The 1-year heart failure hospitalization rate was 29.6% in the placebo group of VICTORIA, compared to 26.9% in RECOLFACA. Patients enrolled in the RECOLFACA that met the VICTORIA definition had more similar characteristics and outcomes compared to the VICTORIA population. There is an opportunity to improve this unmet need with the use of vericiguat.

Assuntos

RESUMO

Numerous reports describe the antioxidant and antimicrobial activity of polyphenols-rich plant extracts. The aim of this study was to determine the total polyphenols content (TPC), and the in vitro (DPPH, FRAP and TEAC) antioxidant and antibacterial activity of leaves and wood of six native woody species (Aspidosperma quebracho-blanct, Sarcomphalus mistol, Geoffroea decorticans, Prosopis chilensis, Larrea divaricata and Larrea cuneifolia) from Catamarca. Also, the phenolic profile was determined in the species with higher activity. L. cuneifolia leaf extracts showed the highest antioxidant activity followed by L. divaricata and S. mistol, while S. mistol wood extracts showed the highest. Furthermore, Larrea species showed antibacterial activity against S. aureus and E. faecalis strains showing cidal effects mainly against S. aureus. Fifty-nine polyphenols were identified in leaves and wood of Larrea and S. mistol species, which are likely to be responsible for the different activities observed.

Assuntos

RESUMO

Non-alcoholic fatty liver disease (NAFLD) has a high prevalence and risk of progression to cirrhosis and other complications in patients with type 2 diabetes mellitus (T2DM). Likewise, the presence of NAFLD implies a high risk of developing T2DM, determining a bidirectional relationship between them. The diabetology and hepatology societies, developed a joint initiative aiming to unify criteria, reviewing the definitions, diagnostic criteria, risk stratification, treatment, and follow-up of patients with NAFLD and T2DM. The key questions to be discussed were defined by a panel of specialists in diabetology and hepatology. The Delphi methodology was used to reach consensus on the respective recommendations. Based on the discussion generated among the experts, diagnostic and treatment algorithms were proposed, as well as an indication for referral and the role of the different specialists involved in the management of these patients. Strengthening multidisciplinary work with patients with NAFLD and T2DM will allow the early recognition of the disease, the prevention of the progression to cirrhosis, and reducing the associated complications.

Assuntos

RESUMO

Aflatoxin B1 (AFB1), ochratoxin A (OTA), zearalenone (ZEN), and deoxynivalenol (DON) are frequent mycotoxins that may cause carcinogenic, mutagenic, estrogenic, or gastrointestinal effects. The aim of this study was to assess the exposure to and risk from AFB1, OTA, ZEN, and DON in 172 participants of the Maule Cohort (MAUCO) by a biomarker analysis in urine and to associate their exposure with food consumption and occupation. Mycotoxins in the first morning urine were analyzed by solid-phase extraction and quantified by Ultra-High-Performance Liquid Chromatography with a mass-mass detector. Participants' information regarding food consumption, occupation, and other characteristics was obtained from a baseline and 2-year follow-up survey of the cohort. The prevalence and mean levels of mycotoxins in the urine were as follows: DON 63%, 60.7 (±78.7) ng/mL; AFB1 8%, 0.3 (±0.3) ng/mL; α-zearalenol (α-ZEL) 4.1%, 41.8 (±115) ng/mL; ß-ZEL 3.5%, 17.4 (±16.1) ng/mL; AFM1 2%, 1.8 (±1.0) ng/mL; OTA 0.6% (1/172), 1.3 ng/mL; and ZEN 0.6%, 1.1 ng/mL. These results were translated into exposures of DON, ZEN, and aflatoxins of public health concern. Participants who consumed coffee and pepper the day before had a significantly greater presence of DON (OR: 2.3, CI95 1.17-4.96) and total ZEL (OR: 14.7, CI95 3.1-81.0), respectively, in their urine. Additionally, we observed associations between the habitual consumption of beer and DON (OR: 2.89, CI95 1.39-6.42). Regarding the levels of mycotoxins and the amount of food consumed, we found correlations between DON and nuts (p = 0.003), total ZEL and cereals (p = 0.01), and aflatoxins with capsicum powder (p = 0.03) and walnuts (p = 0.03). Occupation did not show an association with the presence of mycotoxins in urine.

Assuntos

RESUMO

Introducción: El estudio de las percepciones de los estudiantes de Medicina sobre la salud mental es un tema de investigación significativo, puesto que su conocimiento puede ayudar a comprender las principales barreras a vencer para acceder a servicios de salud mental. Objetivos: Describir la percepción de los estudiantes de Medicina (campus de Sajonia y de San Lorenzo) de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción sobre los problemas de salud mental y sobre las barreras para acceder a los servicios de atención a la salud mental ofrecidos por la institución. Materiales y métodos: Estudio observacional descriptivo, de corte transversal y temporalmente prospectivo, con muestreo no probabilístico. A través de una encuesta en línea, se examinaron una serie de variables con el fin de describir las percepciones, tales como estigma, actitudes de la Facultad hacia la salud mental y barreras para acceder a los servicios de salud mental. Resultados: 243 estudiantes fueron encuestados. El 24,7 % mencionó haber sido tratado por un problema de salud mental. El 83,13% refirió conocer a algún estudiante con problemas de salud mental en la Facultad. 81,07% indicó que el estigma/vergüenza es la barrera más importante en el acceso a los servicios de salud mental ofrecidos por la institución. El 89,71% sostuvo que la Facultad tiene la responsabilidad de brindar mejor atención a los estudiantes con problemas de salud mental, mientras que el 37,04% estuvo de acuerdo con que la Facultad es amigable con estudiantes con problemas de salud mental. Conclusión: estos hallazgos servirán de base para futuras investigaciones sobre problemas prevalentes de salud mental en los estudiantes de Medicina, incluyendo las maneras de abordarlos y tratarlos, y sobre qué debe hacer la Facultad para mejorar el cuidado de la salud mental de sus estudiantes.

Introduction: The study of the medical students' perceptions on mental health is a significant research topic, since its knowledge can help to understand the main barriers to overcome to access mental healthcare services. Objectives: To describe the perceptions of medical students (Sajonia and San Lorenzo campuses) of the Faculty of Medical Sciences of the National University of Asunción about mental health problems and about the barriers to accessing mental healthcare services offered by the institution. Materials and methods: Descriptive, cross-sectional and temporally prospective observational study, with non-probabilistic sampling. Through an online survey, a series of variables were examined to describe perceptions, such as stigma, Faculty attitudes towards mental health, and barriers to accessing mental healthcare services. Results: 243 students were surveyed. 24.7% mentioned having been treated for a mental health problem. 83.13% reported knowing a student with mental health problems at the Faculty. 81.07% indicated that stigma/shame is the most important barrier in accessing mental healthcare services offered by the institution. 89.71% said that the Faculty has the responsibility to provide better care to students with mental health problems, while 37.04% agreed that the Faculty is friendly with students with mental health problems. Conclusion: These findings will serve as the basis for future research on prevalent mental health problems in medical students, including ways to approach and treat them, and on what the Faculty should do to improve mental healthcare for its students.

Assuntos

Assuntos

RESUMO

INTRODUCCIÓN: La percepción que tienen los pacientes oncológicos hospitalizados del cuidado de enfermería puede ayudar a mejorar su calidad, fortaleciendo el rol del enfermero, buscando articular teoría, investigación y práctica, desde un enfoque holístico del paciente y su familia. OBJETIVO: Analizar la percepción del paciente hospitalizado sobre los cuidados de enfermería en una institución privada. METODOLOGÍA: Fue un estudio cuantitativo, descriptivo, transversal; como instrumento se utilizó el cuestionario de CARE-Q que posee 46 preguntas divididas en seis subescalas. RESULTADOS: La percepción de los pacientes oncológicos en relación con las subescalas accesibilidad, monitoreo y seguimiento: 86,7% responde siempre en "la enfermera le solicita al paciente que la llame cuando la necesite y supervisa para garantizar la atención", y en la subescala "se anticipa" con un 75,6% responden que siempre "la enfermera tiene conductas para prevenir complicaciones". CONCLUSIONES: Mostraron que las sub escalas con mayor porcentaje fueron accesibilidad, monitoreo y seguimiento y la de menor puntuación fue "se anticipa".

INTRODUCTION: The perception that hospitalized cancer patients have of nursing care can help to improve its quality, strengthening the role of the nurse, seeking to articulate theory, research, and practice, from a holistic approach to the patient and their family. OBJECTIVE: Analyze the perception of the hospitalized patient about nursing care in a private institution. METHODOLOGY: This was a quantitative, descriptive, cross-sectional study; as an instrument, the CARE-Q questionnaire was used, with46questions divided into six sub-scales. RESULTS: The perception of cancer patients aboutthe accessibility, monitoring,and follow-up subscales:86.7% always respond in "the nurse asking the patient to call her when she needs it and supervise to guarantee care,"and in the "anticipates"subscale with 75.6%, they answered that "the nurse always has behaviors to prevent complications." CONCLUSIONS:The subscales with the highest percentage were Accessibility, Monitoring,and Follow-up,and the one with the lowest score was Anticipated.

INTRODUÇÃO: A percepção que o paciente oncológico hospitalizado tem da assistência de enfermagem pode contribuir para a melhoria de sua qualidade, fortalecendo o papel do enfermeiro, buscando articular teoria, pesquisa e prática, a partir de uma abordagem holística aopaciente e sua família. OBJETIVO: Analisar a percepção do paciente hospitalizado sobre o cuidado de enfermagem em uma instituição privada. METODOLOGIA: Foi um estudo quantitativo, descritivo e transversal. Como instrumento, foi utilizado o questionário CareQ, que possui 46 questões divididas em seis subescalas. RESULTADOS: A percepção dos pacientes oncológicos em relação às subescalas de acessibilidade, monitoramento e seguimento:86,7% sempre respondem no "enfermeiro pedir ao paciente para ligar quando ela precisar e supervisionar para garantir o atendimento", e na subescala "antecipado"com 75,6%, responderam que "o enfermeiro sempre tem condutas para prevenir complicações".CONCLUSÕES: Mostraram que as subescalas com maior percentual foram Acessibilidade, Monitoramento e Acompanhamento e a de menor pontuação foi "antecipada"

Assuntos

RESUMO

Introducción. Los procesos de rehabilitación funcional pueden verse bastante favorecidos con el uso de la tecnología, ya que mediante diferentes dispositivos es posible estimular la independencia funcional de los pacientes, tal es el caso del Kinect, que en su modalidad semiinmersiva de realidad virtual puede ser muy útil para el tratamiento de diferentes pacientes, incluidos los adultos mayores. El objetivo del presente reporte de caso es determinar la utilidad de una intervención mediante el uso de Kinect para Xbox 360 para mejorar el equilibrio en un adulto mayor con enfermedad renal crónica. Presentación del caso. Paciente masculino de 81 años de edad con insuficiencia renal crónica (IRC), quien durante 6 semanas recibió intervención con Kinect (3 sesiones semanales de 45 minutos). Cada sesión se hizo en tres fases: calentamiento, práctica de juegos con el Kinect y estiramientos musculares. Se hicieron 3 evaluaciones (antes de la intervención, a la tercera semana y a la sexta semana) mediante las pruebas de alcance funcional, velocidad de la marcha, Tinetti marcha y equilibrio, Mini mental Examination de Folstein (MMSE), estabilometría, podometría y Test Modificado de Integración Sensorial. Con la intervención el usuario no mostró cambios en la prueba de Tinetti marcha ni en podometria, pero en la prueba de alcance funcional mejoró 8,5 puntos; en la Tinetti equilibrio, 7, y en la MMSE, 3; la velocidad de la marcha se incrementó a 1,5 m/segundo y el índice de Romberg a 0,77. Conclusión. El uso de del Kinect en el tratamiento de pacientes mayores, a través de un entorno recreativo, favorece el proceso de intervención fisioterapéutica, el acondicionamiento muscular general y los procesos cognitivos, además mejora el equilibrio.

Introduction: The functional rehabilitation processes require the adoption of technology in rehabilitation; it results in the stimulation of the functional independence in the elderly through the use of the Xbox-360 Kinect® as a semi- immersive mode of virtual reality. General Objective: To determine the effect of the Xbox-360 Kinect® to improve balance in the elderly with chronic kidney disease. Methodology: A case report of using videogames with the Xbox-360 Kinect® with elderly people who have chronic kidney disease. The intervention was six weeks of three weekly sessions, each lasting 45 minutes. Three assessments were performed: the first, before the intervention; the second, on the third week; and last one, on the sixth week. Each session comprised of three phases: warming up, use of the X-BOX 360 kinect®, and the muscle stretching. Functional Test scope, gait velocity, Tinetti Gait and Balance, Mini-Mental State Examination, stabilometry test, podiatry exam, and Modified Clinical Test of Sensory Integration were the instruments used. Results: The patient improved in all tests, except for in Tinetti Gait and in podiatry tests, where no change had been observed. The functional test scope showed an improvement score of 8.5 points, Tinetti balance of 7 points and Mini- mental state examination of 3 points. Gait speed increased to 1.5m/sec and the Romberg index to 0.77. Conclusion: The use of the Xbox-360 Kinect® in elderly people, through a recreational environment, favors the process of physiotherapeutic intervention, general muscle conditioning, and improvement of balance, as well as, favoring cognitive processes.

Introdução. Os processos de reabilitação funcional podem ser bastante favorecidos com o uso da tecnologia, pois por meio de diferentes dispositivos é possível estimular a independência funcional dos pacientes, como é o caso do Kinect, que em sua modalidade de realidade virtual semi-imersiva pode ser muito útil para o tratamento de diferentes pacientes, incluindo idosos. O objetivo deste relato de caso é determinar a utilidade de uma intervenção usando o Kinect para Xbox 360 para melhorar o equilíbrio em um adulto idoso com doença renal crônica. Apresentação do caso. Paciente do sexo masculino, 81 anos, com insuficiência renal crônica (IRC), que recebeu intervenção do Kinect por 6 semanas (3 sessões semanais de 45 minutos). Cada sessão foi realizada em três fases: aquecimento, prática de jogos com o Kinect e alongamento muscular. Foram feitas 3 avaliações (antes da intervenção, na terceira semana e na sexta semana) utilizando os testes de amplitude funcional, velocidade da marcha, marcha e equilíbrio de Tinetti, Mini Exame Mental de Folstein (MEEM), estabilometria, podometria e Teste Modificado de Integração Sensorial. Com a intervenção, o usuário não apresentou alterações no teste de marcha de Tinetti ou na pedometria, mas no teste de amplitude funcional melhorou 8,5 pontos; no equilíbrio de Tinetti, 7, e no MMSE, 3; a velocidade da marcha aumentou para 1,5 m / segundo e o índice de Romberg para 0,77. Conclusão. A utilização do Kinect no tratamento de pacientes idosos, por meio de um ambiente lúdico, favorece o processo de intervenção fisioterapêutica, condicionamento muscular geral e processos cognitivos, além de melhorar o equilíbrio.

Assuntos

RESUMO

Porifera has been relatively well studied from underwater caves worldwide. However, sponges in Mexico are only known from two anchialine caves: La Quebrada and El Aerolito, both in Cozumel Island. An ecological study found that sponges have the second highest species richness and density in La Quebrada. The aim of the present work is to describe the sponge biodiversity inhabiting the dark zone of La Quebrada anchialine cave. A total of ten species were found and are described herein, six are new species to science vis. Calyx maya n. sp. a thinly branched sponge; Haliclona (Reniera) stygobia n. sp. globe-shaped with the thinnest diameter of oxeas in its group; Haliclona (Halichoclona) chankanaabiis n. sp. tubular habit with the smallest oxeas in its group; Neosiphonia microtriaeneae n. sp. characterized by very small dichotriaenes; Svenzea germanyanezi n. sp. a lone conical shape; and Diplastrella cozumella n. sp. for its tri to multilobed tylostyles. The other four species are previously known from open reefs or deep-sea: Discodermia adhaerens, Siphonidium ramosum, Cinachyrella kuekenthali, and Plakinastrella onkodes. This is the only inventory of Porifera in Mexican caves up to now, thus the species here described are the first stygobiont sponges from Mexico with an endemism rate of Porifera in this anchialine cave of 60%. Conservation programs are needed to preserve this unique and special ecosystem.

Assuntos

RESUMO

A total of 51 sponges (Porifera) and 13 ascidians (Chordata) were collected on the coast of the Yucatan Peninsula (Mexico) and extracted with organic solvents. The resulting extracts were screened for antibacterial activity against four multidrug-resistant (MDR) bacterial pathogens: the Gram-negative Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa and the Gram-positive Staphylococcus aureus. The minimum inhibitory concentrations (MICs) of the organic extracts of each marine organism were determined using a broth microdilution assay. Extracts of eight of the species, in particular the Agelas citrina and Haliclona (Rhizoniera) curacaoensis, displayed activity against some of the pathogens tested. Some of the extracts showed similar MIC values to known antibiotics such as penicillins and aminoglycosides. This study is the first to carry out antimicrobial screening of extracts of marine sponges and ascidians collected from the Yucatan Peninsula. Bioassay-guided fractionation of the active extracts from the sponges Amphimedon compressa and A. citrina displayed, as a preliminary result, that an inseparable mixture of halitoxins and amphitoxins and (-)-agelasine B, respectively, are the major compounds responsible for their corresponding antibacterial activities. This is the first report of the antimicrobial activity of halitoxins and amphitoxins against major multidrug-resistant human pathogens. The promising antibacterial activities detected in this study indicate the coast of Yucatan Peninsula as a potential source of a great variety of marine organisms worthy of further research.

Assuntos

RESUMO

La Diabetes Mellitus tipo 2 (DM2) y las enfermedades crónicas del hígado(ECH), definida para esta revisión como cualquier alteración funcional o estructural de este órgano, desde inflamación hasta fibrosis, son patologías que frecuentemente se asocian, y su coexistencia se relaciona con peor pronóstico y mayores complicaciones de ambas entidades. El objetivo de este artículo es describir la relación entre hiperglicemia y enfermedades del hígado, sus procesos fisiopatológicos comunes y tratamiento, distinguiendo las patologías más relevantes, entre ellas la Diabetes Hepatogénica (DH), la enfermedad hepática por Virus Hepatitis C (VHC) y la Enfermedad Hepática Grasa No Alcohólica (EHGNA). La DH es aquella diagnosticada en pacientes con cirrosis asociada a insuficiencia hepática, sin antecedentes previos de alteración de la glicemia. En la actualidad el diagnóstico se realiza en etapas tardías de la enfermedad. El VHC tiene un efecto diabetogénico conocido. Algunas terapias antivirales usadas para VHC evidencian mejoría de las alteraciones metabólicas al lograr respuestas virológicas sostenidas. En DM2, la EHGNA es frecuente, con mayor incidencia de fibrosis, hepatocarcinoma (HCC) y riesgo cardiovascular (RCV). Es necesario realizar una pesquisa e intervención precoz de EHGNA a los pacientes con DM2. En el manejo de éstos, la baja de peso ha demostrado ser efectiva en el control glicémico y en la mejoría histológica. Dentro de las terapias antidiabéticas, además del uso de metformina, debería considerarse aquellas que han demostrado a la fecha beneficios en EHGNA, como son tiazolidinedionas (pioglitazona) y/o análogos de GLP-1 (liraglutide) y optimizar el control de otros factores de RCV.

Type 2 Diabetes Mellitus (DM2) and chronic liver diseases (CLD) defined in this revision as any functional or structural alteration in the organ, covering from inflammation to fibrosis, are pathologies that are frequently associated, and when found together are related to worse prognosis and higher complications in both conditions. The objective of this article is to describe the relationship between hyperglycemia and liver diseases, their common physio-pathological processes and treatments, identifying the most important pathologies, including Hepatogenic Diabetes (HD), Hepatitis C Virus (HCV) liver disease and Non-Alcoholic Fatty Liver Disease (NAFLD). Hepatogenic diabetes (HD) is diagnosed in patients with liver failure associated to cirrhosis with no previous record of impaired glycemia. Currently, diagnosis is made during the late stages of the disease. Hepatitis C virus (HCV) has a known diabetogenic effect. Some antiviral therapies used for HCV show improvement in metabolic alterations by achieving sustained virological responses. Non-alcoholic fatty liver disease (NAFLD) in DM2 patients is common, presenting higher risk for fibrosis, hepatocellular carcinoma (HCC) and increased cardiovascular risk (CVR). Early screening and interventions for NAFLD in DM patients are necessary. Weight loss has been shown to be effective in glycemic control and histological improvement. Anti-diabetic therapies, in addition to the use of metformin, should consider therapies that have shown benefits for managing NAFLD, such as thiazolidinedione (pioglitazones) and/or aGLP-1 (Liraglutide), and optimally controlling other cardiovascular risk (CVR) factors.

Assuntos

RESUMO

Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.

Assuntos

RESUMO

Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.

Assuntos

RESUMO

La sistematización permite el devenir permanente de pensar, reconstruir e innovar la práctica de la enfermería. La Red de Enfermería en Cuidados Críticos en conjunto con Red Enfermería de Seguridad de los Pacientes, de Enfermería Basada en Evidencia, Enfermería en Salud Mental y la Sociedad de Pediatría Argentina, construyeron a lo largo de cuatro añosun espaciode aprendizaje: ateneos clínicos. Objetivo: Sistematizar la experiencia de los ateneos clínicos. Metodología: Sistematización de la práctica. Contexto: realizado en Córdoba, Argentina. Resultados: Etapa 1 Iniciación: se elaboró un formato de presentación de casos, participaron enfermeros de instituciones de salud de ámbitos públicos y privados, aportando a la discusión teórica conocimientos de seguridad de los pacientes, la mejor evidencia y salud mental. Etapa 2 Consolidación: se desarrollaron una vez al mes a lo largo de cuatro años y se incorporaron en esta etapa la consulta a expertos. Etapa 3 Análisis de la experiencia: se presentaron tres casos clínicos en cada encuentro, logrando la participación de los asistentes en la discusión de la temática presentada, se identificaron vacíos de conocimiento, conflictos y beneficios. Se logró visualizar la producción científica que en la actualidad posee la disciplina en el mundo. Conclusiones: Etapa 4 Re conceptualización de la práctica: los cambios ocurridos promovieron en el grupo repensar su práctica con una visión crítica y aumentar la capacidad de producciones sistemáticas de cuidado seguro y de calidad. Etapa 5 Propuesta de transformación: continuar y profundizar los ateneos clínicos, motivar y sensibilizar a más enfermeros, involucrar otras instituciones de salud

Systematization allows the permanent evolution of thinking, reconstructing and innovating the practice of nursing. The Critical Care Nursing Network in conjunction with Network Patient Safety Nursing, Evidence-Based Nursing, Mental Health Nursing and the Argentine Pediatric Society, built a four-year learning space: clinical athenaeums. Objective: To systematize the experience of the clinical athenaeums. Methodology: Critical, Systematization of the practice. Context: Developed in Cordoba, Argentina. Results: Stage 1 Initiation: a case presentation format was developed, nurses from public and private health institutions participated, contributing to the theoretical discussion knowledge of patient safety, best evidence and mental health. Stage 2 Consolidation: they were developed once a month over four years and the expert consultation was incorporated at this stage. Stage 3 Analysis of the experience: three clinical cases were presented at each meeting, with participation of the participants in the discussion of the theme presented, knowledge gaps, conflicts and benefits were identified. It was possible to visualize the scientific production that currently has discipline in the world. Conclusions: Stage 4 Re conceptualization of the practice: the changes occurred in the group to rethink their practice with a critical vision and increase the capacity of systematic productions of safe care and quality. Stage 5 Transformation proposal: continue and deepen the clinical ateneos, motivate and sensitize more nurses, involve other health institutions. Key words: Nursing, Networks, Teaching Rounds, Critical Care, Patient Safety, Argentina.

Sistematização permite constante evolução do pensamento, reconstruir e inovar a prática de enfermagem. Rede de Enfermeiros Cuidados Críticos em conjunto com Segurança Red Paciente Enfermagem, Enfermagem Baseada em Evidências, Enfermagem de Saúde Mental e Pediátrica da Sociedade Argentina, construído ao longo de quatro anos, um espaço de aprendizagem: ateneus clínicos. Objetivo: sistematizar a experiência de ateneus clínicos. Metodologia: Critical, sistematização da prática. Contexto: Desenvolvido em Córdoba, Argentina. Resultados: Fase 1 Iniciação: Um formato de apresentação de caso foi desenvolvido, enfermeiros participaram instituições de saúde nas esferas públicas e privadas, contribuindo para o conhecimento da teórica segurança discussão paciente, a melhor evidência e saúde mental. Consolidação Passo 2: eles desenvolveram uma vez por mês ao longo de quatro anos e consulta de peritos incorporados nesta fase. Fase 3 Análise da experiência: três casos clínicos foram apresentados em cada reunião, envolvendo os participantes na discussão da questão apresentada, foram identificados conhecimento lacunas, conflitos e benefícios. Foi possível visualizar produção científica que atualmente tem a disciplina no mundo. Conclusões: Passo 4 Re conceituação de prática: as mudanças promovidas no grupo a repensar a sua prática com uma visão crítica e aumentar a capacidade de produção segura sistemática, cuidados de qualidade. Passo 5 transformação proposta: continuar e aprofundar as clínicas de discussão, motivar e educar mais enfermeiros, envolver outras instituições de saúde

Assuntos

RESUMO

Es importante señalar que los sistemas de incentivos y sus contradicciones, requieren ser analizados, con especial atención a los de la práctica en salud a fi n de poder mediar los efectos posibles en el sistema. Objetivo: Analizar las normas de remuneración e incentivos existentes en las instituciones de salud y su relación con la calidad de la prestación de los servicios, en Córdoba, Argentina. Método: Observacional, analítico y correlacional. Universo instituciones polivalentes de salud, público y privado. Muestra bietápico aleatorio. Instrumento, análisis documental, dos encuestas auto administradas, e índices estandarizados de calidad. Fuente primaria y secundaria. Resultados: Mayor proporción de personal de enfermería y medicina con respecto a psicología y trabajo social. Predominan mujeres 2 a 1, población joven entre los 20 y 39 años, la antigüedad 5 a 15 años. La planta permanente en las públicas es mayor que en las privadas (p=0,002), mientras que en los contratados la situación se presenta inversa (p=0,0001), en cambio la proporción se muestran similares en el interior y en capital. En la composición de la remuneración los tres ítems más reconocidos fueron: monto básico, antigüedad y título de grado. El sector público tiene un salario mayor que el privado (p< 0.0001).

It is important to note that incentive systems and its contradictions, need to be analyzed, with particular attention to the practice of health in order to mediate the possible effects on the system. Objective: To analyze existing remuneration standards and incentives in health institutions and their relationship to the quality of service delivery, in Córdoba, Argentina. Method: Observational, analytic and correlationa. Universe multipurpose health institutions, public and private. Two-stage random sample. Instrument, documentary analysis, two self-administered survey, and standardized quality indices. Primary and secondary source. Results: A higher proportion of nursing and medicine with respect to psychology and social work. Women prevail 2-1 , young people between 20 and 39 years , age 5-15 years. The permanent public plant is greater than private (p = 0.002) , whereas the reverse situation is employed the (p = 0.0001 ) arises, however the ratio is similar in the interior and in capital. In the composition of the remuneration the three items were recognize: basic amount, age and title of degree. The public sector has a salary greater than the private (p < 0.0001). The incentives they receive, concentrate on training and awards. A correlation between the IACC , and IMRA Iaçu variables regarding the antiquity (p < 0.01) , the amount of wages ( p < 0.0001 ), economic incentives (p < 0.0001 ) , nature legal (p < 0.05 ) and the status of magazine (p < 0.01).

É importante notar que os sistemas de incentivos e suas contradições, precisam ser analisados, com especial atenção para a prática da saúde, a fi m de ter condições de mediar nos possíveis efeitos sobre o sistema. Objetivo: Analisar normas de compensação existentes e incentivos nas instituições de saúde e sua relação com a qualidade da prestação de serviços, em Córdoba, Argentina. Método: observacional, analítico e correlacional.. Universo: instituições de saúde polivalentes, públicas e privativas. Amostra: bietápicaaleatória. Instrumento: análise documental das enquetes, auto-administradas e índices de qualidade padronizados. Fonte primária e secundária. Resultados: Aumento da proporção do pessoal de enfermagem e medicina em relação com o de psicologia e serviço social. As mulheres predominam 2-a 1, população jovem entre 20 e 39 anos, antiguidade de 5 a 15 anos. A quantidade de cargos permanentes públicos é maior do que a privativa (p = 0,002), enquanto que com os contratados apresenta-se a situação oposta (p = 0,0001) apresenta, no entanto, a proporção é semelhante no interior e na capital. Na composição dos salários, os três itens mais reconhecidos foram: o básico, antiguidade e titulação de grau. O salário do setor público é maior do que o privativo (p <0,01).

Assuntos

RESUMO

En este texto se confronta una discusión disciplinar pedagógica -epistemológica- con una no disciplinar -ontológica- relacionada con procesos formativos que explicitan diferentes experiencias organizativas en Colombia. En su primera parte se presenta la relación entre las nociones de pedagogía, formación, educación y movimientos sociales; en la segunda, se exponen algunas narrativas colectivas acerca de las prácticas formativas construidas en comunidades y movimientos sociales en contextos de guerra. Las comunidades vinculadas a movimientos sociales, además de traer una lucha política, aportan formas alternativas de formación política y nuevas epistemologías desde la diversidad, y una crítica no sólo cognitiva o ideológica sino, principalmente, existencial, que re-crea los procesos de enseñanza-aprendizaje y la construcción de poderes subalternos anclados a los contextos culturales y territorios de vida capaces de cambiar las formas de relación inter-humanas y entre mundos, cruzando fronteras civilizatorias y con la tierra entre nos...

Assuntos

RESUMO

El objetivo del trabajo fue comprender las actitudes de afrontamiento de los enfermeros-as profesionales del servicio de Perinatologia del turno noche frente a la muerte de un paciente neonato. El estudio cualitativo de tipo fenomenologico, cuyo escenario es el servicio de perinatologia, Unidad de cuidados intensivos neonatales. Los sujetos fueron las enfermeras profesionales del turno noche de una institucion polivalente de la ciudad de Cordoba, Argentina. Tecnicas utilizadas: observación participante y entrevista en profundidad. Los hallazgos encontrados se organizaron en cuatro patrones teoricos: Primer patrón: interpretacion subjetiva y/o sensacion de muerte. Segundo patron: manejo y reacciones emocionales. Tercer patrón: cambio de actitud ante la situacion del paciente. Cuarto patron: Agotamiento en la relacion enfermería-paciente.

Assuntos

RESUMO

Resumen:

Objetivo: el progreso de la investigación contribuye al desarrollo profesional del formador y promueve el aprendizaje funcional de los futuros docentes, potencia el trabajo en equipo, permite conformar un currículum integrado, basado en el diagnóstico y estudio de los problemas que son vitales para la comunidad educativa y generan conocimientos basados en evidencias para la mejora de la práctica. El objetivo del estudio es caracterizar las competencias investigativas de los docentes de enfermería en las universidades públicas de la provincia de Córdoba, Argentina. Método: observacional, descriptivo y transversal. El universo: todos los docentes de las universidades nacionales públicas de las carreras de Licenciatura en Enfermería de Córdoba, la muestra aleatoria (n: 44). Fuente primaria. Resultados/discusión: el 38% cree que hay carencia de políticas de investigación dentro de las instituciones. El 50% expresa que existen incentivos institucionales para investigar. El 70% ha participado en investigaciones multidisciplinarias. El método de investigación más elegido el cuantitativo.

Abstract:

Purpose: research progress contributes to teacher's professional development and promotes functional learning in future teachers, enhances team work, allows an integrated curriculum to be developed, based on the diagnosis and problem analysis that are critical for the educational community and create evidence-based knowledge to improve practice. The study aimed at characterizing research competences in nursing teachers at public universities in Córdoba province, Argentine.

Method: an observational, cross-sectional, descriptive study. Universe: All teachers in public national universities for Nursing Degree in Córdoba, with a randomly selected sample (n: 44). Primary source. Results/discussion: 38% of participants reported a lack of research policies within institutions. 50% of participants reported the availability of institutional incentives to promote research. 70% of participants had been involved in multidisciplinary investigations. The most commonly selected method for investigations was quantitative.

Objetivo: o progresso da pesquisa contribui para o desenvolvimento profissional do treinador e promove a aprendizagem funcional dos futuros docentes, melhora o trabalho em equipe, ajuda a construir um currículo integrado, com base no diagnóstico e estudo de problemas que são vitais para a comunidade educativa e gerado com base em evidências para a melhoria do conhecimento prático. Caracterizar as habilidades de investigação de docentes de enfermagem nas universidades públicas da província de Córdoba, Argentina. Método: estudo transversal observacional, descritivo. O universo foram todos os professores de universidades públicas Nacionais de Licenciatura em Enfermagem de Córdoba, a amostra aleatória (n= 44). Fonte primária. Resultados/discussão: 38% percebe que há uma falta de políticas de investigação dentro das instituições. Estado 50% que há incentivos institucionais para investigar. 70% participara de pesquisa multidisciplinar. O método de pesquisa escolhido mais quantitativa.

Assuntos