RESUMO
Introduction: HIV disease was transformed from a fatal condition to one with metabolic complications. In Mexico City, the associated factors for prediabetes in this population are unknown; investigating it is relevant to improve their quality of life. Objective: To determine the risk association factors for prediabetes in people living with HIV. Material and methods: Cross-analytical, retrospective study. Records of patients living with HIV were reviewed, exposure factors and fasting glucose concentration were recorded. Patients from 18 to 65 years of age were included, on co-formulated antiretroviral treatment, without adjustment of antiretroviral treatment in the last two years, with a BMI of 18.5-40 kg/m2. Results: 148 patients were included, 68 presented prediabetes. The factors with risk association that were identified are: age over 60 years (OR 9.48, 95% CI 1.68-40.13), treatment with Efavirenz/Tenofovir/Emtricitabine (OR 9.28, 95% CI 2.55-33.74) and treatment time antiretroviral older than 12 months (OR 2.53, 95% CI .912-7.041). Conclusion: The prevalence of prediabetes in people living with HIV is 46%. The main associated factor was the consumption of Atripla. This study has clinical relevance since it will allow the implementation of prevention, diagnosis and treatment strategies for prediabetes in order to reduce associated morbidity and mortality.
Introducción: la enfermedad por VIH ha pasado de ser un padecimiento mortal a uno con complicaciones metabólicas. En la Ciudad de México se desconocen los factores asociados para prediabetes en esta población, investigarlo es relevante para mejorar su calidad de vida. Objetivo: determinar los factores con asociación de riesgo para prediabetes en personas que viven con VIH. Material y métodos: estudio transversal-analítico, retrospectivo. Se revisaron expedientes de pacientes que viven con VIH, registrándose los factores de exposición y la concentración de glucosa en ayuno. Se incluyeron pacientes de 18 a 65 años, en tratamiento antirretroviral coformulado, sin ajuste de tratamiento antirretroviral en los últimos dos años, con IMC de 18.5-40 kg/m2. Resultados: se incluyeron 148 pacientes, 68 presentaron prediabetes. Los factores con asociación de riesgo que se identificaron son: edad mayor de 60 años (OR: 9.48, IC95%: 1.68-40.13), tratamiento con Efavirenz/Tenofovir/Emtricitabina (OR: 9.28, IC95%: 2.55-33.74) y tiempo de tratamiento antirretroviral mayor de 12 meses (OR: 2.53, IC95%: 0.912-7.041). Conclusión: la prevalencia de prediabetes en personas que viven con VIH es del 46%. El principal factor asociado fue el consumo de Atripla. Este estudio tiene relevancia clínica ya que permitirá implementar estrategias de prevención, diagnóstico y tratamiento de prediabetes con la finalidad de reducir la morbimortalidad asociada.
Assuntos
Infecções por HIV , Estado Pré-Diabético , Humanos , Pré-Escolar , Pessoa de Meia-Idade , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etiologia , HIV , Qualidade de Vida , Estudos Retrospectivos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologiaRESUMO
Chitin is a natural biopolymer obtained from the exoskeleton of crustaceans. Chitosan is a derivative of chitin, which has antimicrobial properties and potential applications in several industries. Moreover, the composites of chitosan with other biodegradable polymers, such as polylactide (PLA) as packaging film, have shown promising results. In this study, chitosan was obtained and characterized from shrimp shells. Then, polylactide-chitosan composite films were prepared by a solvent casting technique using various amounts of chitosan (0.5-2% w/w) and polyethylene glycol as plasticizer (10% w/w). Thermal, mechanical properties, Fourier-transform infrared, scanning electron microscopy, as well as antibacterial properties of composite films were determined. It was found that adding chitosan (CH) into PLA films has a significant effect on tensile strength and no effect on thermal properties. The results showed a reduction on average of 1 log of colony-forming units against Staphylococcus aureus, while there is no antibacterial effect against Salmonella typhimurium. The study proved the antibacterial effect of CH in films of PLA against Gram-positive bacteria and appropriate mechanical properties. These films could be used for the development of biodegradable/eco-friendly food packaging prototypes, as a potential solution to replace conventional non-degradable packaging materials.
RESUMO
INTRODUCTION: In the care of patients with medically unexplained physical symptoms (MUPS) it is important what they think about their symptoms. OBJECTIVE: To validate the psychometric properties of a symptom attribution scale in patients with MUPS and to verify its reliability. METHODS: A non-probabilistic sample of 400 male and female adult patients were interviewed in the outpatient services of a family medicine hospital, 200 with MUPS and 200 with a defined organic pathology. Each group was diagnosed with defined criteria, and a scale with content and construct validity was applied by means of principal component analysis with varimax rotation. RESULTS: The scale was made up of 12 items with two factors, one of symptom psychosocial attribution and other with organic attribution. The psychosocial-origin factor showed a variance of 49.7%. The goodness-of-fit test demonstrated that the correlation matrix was adequate, and Bartlett's sphericity test indicated statistical significance (p < 0.0001); Cronbach's alpha was 0.841. CONCLUSION: The scale showed acceptable construct validity and good reliability and stability. The implications of these results for future measurement research are discussed.
INTRODUCCIÓN: En la atención de pacientes con síntomas físicos médicamente no explicables (SFMNE) es importante lo que el paciente piensa de sus síntomas. OBJETIVO: Validar propiedades psicométricas de una escala de atribución del síntoma en pacientes con SFMNE y verificar su confiabilidad. MÉTODOS: Se entrevistó a una muestra no probabilística de 400 pacientes adultos, hombres y mujeres, en la consulta de un hospital con medicina familiar, 200 con SFMNE y 200 con patología orgánica concreta. Se diagnosticó a cada grupo con criterios definidos y se aplicó una escala con validez de contenido y de constructo por medio de análisis de componentes principales con rotación varimax. RESULTADOS: La escala quedó integrada por 12 reactivos con dos factores, uno de atribución psicosocial y otro de atribución orgánica del síntoma. El factor de origen psicosocial tuvo una varianza de 49.7 %. La prueba de bondad de ajuste mostró que la matriz de correlaciones fue adecuada y la prueba de esfericidad de Bartlett indicó significación estadística (p < 0.0001); el alfa de Cronbach fue de 0.841. CONCLUSIÓN: La escala mostró una validez de constructo aceptable y buena confiabilidad y estabilidad. Se discuten las implicaciones de estos resultados para la investigación de mediciones futuras.
Assuntos
Sintomas Inexplicáveis , Adulto , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Resumen Introducción: En la atención de pacientes con síntomas físicos médicamente no explicables (SFMNE) es importante lo que el paciente piensa de sus síntomas. Objetivo: Validar propiedades psicométricas de una escala de atribución del síntoma en pacientes con SFMNE y verificar su confiabilidad. Métodos: Se entrevistó a una muestra no probabilística de 400 pacientes adultos, hombres y mujeres, en la consulta de un hospital con medicina familiar, 200 con SFMNE y 200 con patología orgánica concreta. Se diagnosticó a cada grupo con criterios definidos y se aplicó una escala con validez de contenido y de constructo por medio de análisis de componentes principales con rotación varimax. Resultados: La escala quedó integrada por 12 reactivos con dos factores, uno de atribución psicosocial y otro de atribución orgánica del síntoma. El factor de origen psicosocial tuvo una varianza de 49.7 %. La prueba de bondad de ajuste mostró que la matriz de correlaciones fue adecuada y la prueba de esfericidad de Bartlett indicó significación estadística (p < 0.0001); el alfa de Cronbach fue de 0.841. Conclusión.: La escala mostró una validez de constructo aceptable y buena confiabilidad y estabilidad. Se discuten las implicaciones de estos resultados para la investigación de mediciones futuras.
Abstract Introduction: In the care of patients with medically unexplained physical symptoms (MUPS) it is important what they think about their symptoms. Objective: To validate the psychometric properties of a symptom attribution scale in patients with MUPS and to verify its reliability. Methods: A non-probabilistic sample of 400 male and female adult patients were interviewed in the outpatient services of a family medicine hospital, 200 with MUPS and 200 with a defined organic pathology. Each group was diagnosed with defined criteria, and a scale with content and construct validity was applied by means of principal component analysis with varimax rotation. Results: The scale was made up of 12 items with two factors, one of symptom psychosocial attribution and others with organic attribution. The psychosocial-origin factor showed a variance of 49.7%. The goodness-of-fit test demostrated that the correlation matrix was adequate, and Bartlett's sphericity test indicated statistical significance (p < 0.0001); Cronbach's alpha was 0.841. Conclusion: The scale showed acceptable construct validity and good reliability and stability. The implications of these results for future measurement research are discussed.
RESUMO
RESUMEN Introducción: En marzo de 2020 la Organización Mundial de la Salud (OMS) declaró a la enfermedad SARS-CoV-2 coronavirus una pandemia; desde ese momento se lleva a cabo un experimento psicológico notablemente grande en el mundo: el aislamiento social. Objetivos: Analizar los aspectos psicosociales del confinamiento y las restricciones impuestas por la pandemia en la ciudad de Mendoza (Argentina). Material y métodos: Mediante la utilización de las redes sociales (WhatsApp, Instagram, Facebook, e-Mail) se realizó de manera anónima por medio de un formulario, una encuesta diseñada para valorar los aspectos psicosociales y conductuales del confinamiento obligatorio por la situación de pandemia, y cómo afectó a la población. Fue realizada en la ciudad de Mendoza capital y gran Mendoza utilizando la población que asiste al instituto de cardiología y medicina del deporte. Resultados: Contestaron la encuesta 915 personas en 10 días de enviado el link; el 49% de los participantes se encontraba entre los 20 y 40 años y la mayoría eran mujeres. El 80,7% de la población encuestada realizó ejercicio durante el tiempo de confinamiento, pero solo el 3,8% mantuvo la cantidad de horas previas de ejercicio semanal. El 44% de las personas aumentó el tiempo que pasaba frente a una pantalla y el 61% alteró sus hábitos alimentarios saludables. Al menos el 60% de la población encuestada refirió síntomas compatibles con depresión, ansiedad, tristeza, falta de voluntad o desesperanza. Conclusiones: El tiempo de confinamiento sin permitir actividades al aire libre, a pesar de la prohibición de contacto social, se asocia con cambios en el estilo de vida saludable.
ABSTRACT Background: In March 2020 the World Health Organization (WHO) declared SARS-CoV-2 coronavirus disease a pandemic, and since then the largest psychological experiment in the world is being carried out: social isolation. Objectives: The aim of this study was to analyze the psychosocial aspects of confinement and the restrictions imposed by the pandemic in the city of Mendoza, Argentina Methods: An anonymous survey using social networks (WhatsApp, Instagram, Facebook and e-mail) was designed to assess the psychosocial and behavioral aspects of mandatory confinement due to the pandemic and its impact in the population that attends the Institute of Cardiology and Sports in the city of Mendoza and Greater Mendoza. Results: The survey was answered by 915 persons within 10 days of sending the link; 49% of participants were between 20 and 40 years old with a majority of female gender. In 80.7% of cases they performed physical exercise during the confinement, but only 3.8% maintained the previous number of hours of weekly activity, 44% increased their time in front of a screen and 61% altered their healthy eating habits. At least 60% of the surveyed population reported symptoms compatible with depression: anxiety, sadness, unwillingness or hopelessness. Conclusions: Confinement without allowing outdoor activities, notwithstanding the proscription of social contact, is associated with changes in healthy lifestyle.
RESUMO
Resumen Introducción: Este artículo presenta avances de la medicina regenerativa y la ingeniería de tejidos orientados a la regeneración de neuronas, de axones y nervios. Revisamos las técnicas que existen actualmente, las más utilizas o prometedoras, en la búsqueda de avances para regenerar este tipo de tejidos. Objetivo: Con esta revisión queremos describir el conocimiento actual sobre la medicina regenerativa y la ingeniería de tejidos orientados a la reparación de tejidos nerviosos. Metodología: Para desarrollar esta revisión se realizó una búsqueda de artículos entre los años 2007 y el 2018, la búsqueda se restringió a los artículos que incluyeran dentro de sus palabras clave; Ingeniería tisular, Enfermedades Neurodegenerativas, Medicina regenerativa, Regeneración axonal, Regeneración neuronal, Regeneración tisular. Con el fin de seleccionar los artículos más adecuados, se realizó una búsqueda exhaustiva en bases de datos como Springer, Medline Ebsco y Science direct. Conclusiones: Se mencionan técnicas como implantación de injertos, terapia celular y terapia molecular e implantación de andamios 3D para regeneración de neuronas, axones y nervios; a partir de esta revisión pudimos observar que estas técnicas en su mayoría funcionan mejor cuando se combinan, aprovechando las ventajas de cada una para promover la regeneración de los diferentes tejidos nerviosos.
Introduction: This article presents advances in regenerative medicine aimed at the regeneration of nervous and neuronal tissue, focusing on regeneration of neurons, axons and nerve regeneration. We will review the techniques that currently exist, the most used or promising, in the search of advances to regenerate this type of tissues. Objective: With this review we want to describe the current knowledge about regenerative medicine and tissue engineering oriented to nerve tissue repair. Methodology: To carry out this review, a search of articles was carried out between 2007 and 2018, the search was restricted to the articles that they included within their keywords; Tissue Engineering, Neurodegenerative Diseases, Regenerative Medicine, Axonal Regeneration, Neuronal Regeneration, Tissue Regeneration. We will mention about techniques such as implantation. Conclusions: with this review we could observe that most of the mentioned techniques work better when combined, taking advantage of each one to promote a greater regeneration of the different tissues.
Assuntos
Axônios , Doenças Neurodegenerativas , Engenharia Tecidual , Terapia Baseada em Transplante de Células e Tecidos , Tecido Nervoso , NeurôniosRESUMO
Antioxidants are molecules that delay or inhibit the oxidation of other molecules. Its use significantly increased in recent years in the diet of people. Natural antioxidants are replacing the use of synthetic antioxidant ingredients due to their safety, nutritional, and therapeutic values. Hydrolyzed collagen (HC) is a popular ingredient considered to be an antioxidant. This low molecular weight protein has been widely utilized due to its excellent biocompatibility, easy biodegradability, and weak antigenicity. It is a safe cosmetic biomaterial with good moisturizing properties on the skin. The antioxidant properties of HC are conditioned to the size of the molecule: the lower the molecular weight of peptides, the greater the ability to donate an electron or hydrogen to stabilize radicals. The antioxidant capacity of HC is mostly due to the presence of hydrophobic amino acids in the peptide. The exact mechanism of peptides acting as antioxidants is not clearly known but some aromatic amino acids and histidine are reported to play an important role in the antioxidant activity. Oral ingestion of HC increases the levels of collagen-derived peptides in the blood torrent and improves the skin properties such as elasticity, skin moisture, and transepidermal water loss. Additionally, daily intakes of HC protect the skin against UV melasma, enhances the fibroblast production and extracellular matrix of the skin. HC has been identified as a safe cosmetic ingredient for topical formulations with good moisturizing properties at the stratum corneum layer of the skin. It reduces the effects of skin aging (dryness, laxity, and wrinkles). The use of HC as a principal ingredient in safe formulations for skin protection was reviewed and compared when it is used by topical and/or oral administration.
RESUMO
Colombia es un país afectado por los fenómenos de violencia; con ello, la primera infancia como población vulnerable se ha visto perjudicada por diversas situaciones que han amenazado el bienestar y desarrollo integral de esta. Hoy en día, existen leyes enfocadas en garantizar los derechos de los niños y niñas que buscan proteger integralmente esta población. Gracias a esto, la atención desde el área de la psicología viene tomando fuerza, en aspectos como la restitución y garantía de los derechos. El psicólogo tiene un lugar importante cuando de protección hacia la primera infancia se refiere, puesto que es el mediador entre la institución y las familias, y ofrece acompañamiento y asesorías en los casos que sea necesario.
Colombia is an affected country by violence phenomenus, and early childhood is a vulnerable population that has been harmed by numerous situations threatening it welfare and the correct development of it. Nowadays, there are laws focused on guarantee children's rights, protecting them in an integral way within this population. Tanks to this, the attention from psychology is getting strong in aspects like restitution and guarantee of rights. The psychologist has very important place in regard to the protection of early childhood, as he is the mediator between the institution and the families, and he also provides accompaniment and counseling in the needed cases.
Assuntos
Humanos , Maus-Tratos Infantis , Equipe de Assistência ao Paciente , Maus-Tratos Infantis/prevenção & controle , Defesa da Criança e do Adolescente/psicologia , Psicologia , Serviços de Proteção InfantilRESUMO
INTRODUCTION: Multi-drug resistant (MDR-TB) and extensively drug-resistant (XDR-TB) tuberculoses are a global public health problem. Their timely detection might reduce the burden of the disease and the economic impact on health systems worldwide. OBJECTIVE: To conduct a literature review of the diagnostic accuracy of three molecular tests to detect multi-drug resistant and extensively drug-resistant tuberculoses. MATERIALS AND METHODS: A systematic literature review following Cochrane methodology was carried out to study the diagnostic accuracy of three molecular tests to detect MDR-TB and XDR-TB in previous studies among immunocompetent population. Articles indexed in Medline and Embase were reviewed starting in 2007. Diagnostic accuracy was reported by sensitivity, specificity, and positive and negative predictive values of each test. RESULTS: In total, 8, 12 and 13 studies were included to assess the diagnostic accuracy of GeneXpert MTB/RIF®, GenoType MTBDRplus® and GenoType MTBDRsl®, respectively. The specificity of GeneXpert MTB/RIF® ranged between 91 and 100%, and its sensitivity between 33.3 and 100%. The sensitivity of GenoType® MTBDRplus® ranged between 88 and 100%. The sensitivity and specificity of GenoType MTBDRsl® to evaluate drug resistance ranged between 56 and 100% and 21 and 100%, respectively. CONCLUSION: The three diagnostic tests evaluated have shown an adequate diagnostic accuracy to detect MDR and XDR tuberculoses.
Assuntos
Reação em Cadeia da Polimerase Multiplex/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , DNA Bacteriano/genética , Farmacorresistência Bacteriana Múltipla/genética , Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico , Genes Bacterianos , Humanos , Imunocompetência , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
Resumen Introducción. La tuberculosis multirresistente (TB-MDR) y la extremadamente resistente (TB-XDR) constituyen un problema de salud pública a nivel mundial. Su detección oportuna permitiría reducir la carga de la enfermedad y su impacto económico en los sistemas de salud. Objetivo. Revisar sistemáticamente la información relacionada con la precisión diagnóstica de tres pruebas moleculares para detectar la tuberculosis multirresistente y la extremadamente resistente. Materiales y métodos. Se hizo una revisión sistemática de la literatura, según los lineamientos de Cochrane, de los estudios en población inmunocompetente relacionados con la precisión diagnóstica de tres pruebas moleculares para detectar la tuberculosis multirresistente y la extremadamente resistente. La búsqueda de los estudios publicados a partir del 2007 se hizo en Medline y Embase. La precisión diagnóstica de las pruebas se estableció con base en los valores máximos y mínimos de sensibilidad y especificidad, y en los valores predictivos positivos y negativos. Resultados. Se detectaron ocho estudios sobre la precisión diagnóstica de la prueba GeneXpert MTB/RIF(r), 12 sobre la de GenoType MTBDRplus(r) y 13 sobre la de GenoType MTBDRsl(r). La especificidad de GeneXpert MTB/RIF(r) osciló entre 91 y 100 % y su sensibilidad, entre 33,3 y 100 %. La sensibilidad de GenoType MTBDRplus(r) varió entre 82 y 100 %, en tanto que la sensibilidad y la especificidad de GenoType(r) MTBDRsl fluctuaron entre 56 y 100 % y 21 y 100 %, respectivamente. Conclusión. Según los estudios consultados, los tres métodos de diagnóstico evaluados presentabanuna adecuada eficacia diagnóstica para detectar la tuberculosis multirresistente y la extremadamente resistente.
Abstract Introduction: Multi-drug resistant (MDR-TB) and extensively drug-resistant (XDR-TB) tuberculoses are a global public health problem. Their timely detection might reduce the burden of the disease and the economic impact on health systems worldwide. Objective: To conduct a literature review of the diagnostic accuracy of three molecular tests to detect multi-drug resistant and extensively drug-resistant tuberculoses. Materials and methods: A systematic literature review following Cochrane methodology was carried out to study the diagnostic accuracy of three molecular tests to detect MDR-TB and XDR-TB in previous studies among immunocompetent population. Articles indexed in Medline and Embase were reviewed starting in 2007. Diagnostic accuracy was reported by sensitivity, specificity, and positive and negative predictive values of each test. Results: In total, 8, 12 and 13 studies were included to assess the diagnostic accuracy of GeneXpert MTB/RIF(r), GenoType MTBDRplus (r) and GenoType MTBDRsl (r), respectively. The specificity of GeneXpert MTB/RIF(r) ranged between 91 and 100%, and its sensitivity between 33.3 and 100%. The sensitivity of GenoType(r) MTBDRplus (r) ranged between 88 and 100%. The sensitivity and specificity of GenoType MTBDRsl (r) to evaluate drug resistance ranged between 56 and 100% and 21 and 100%, respectively. Conclusion: The three diagnostic tests evaluated have shown an adequate diagnostic accuracy to detect MDR and XDR tuberculoses.
Assuntos
Humanos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Reação em Cadeia da Polimerase Multiplex/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , DNA Bacteriano/genética , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico , Genes Bacterianos , Imunocompetência , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/genéticaRESUMO
Resumen La fenestración apical sucede cuando el ápice de un diente está totalmente expuesto al medio ambiente oral; se considera una variación del rango normal periodontal por múltiples factores. Aunque sin síntomas, la presencia de fenestraciones puede complicar el tratamiento de endodoncia o poner en peligro un resultado funcional y estético de la cirugía periodontal. Esta condición no patológica debe tratarse con precaución ya que representa un desafío para el clínico; pues a menudo es mal diagnosticada y maltratada, por lo tanto, es necesario un enfoque multidisciplinar. Varios procedimientos quirúrgicos y no quirúrgicos se documentan para el tratamiento; incluso, cuando se diagnostica correctamente, su manejo con una sencilla intervención quirúrgica es suficiente. Se presenta el caso de una mujer de 42 años de edad que consulta al odontólogo por presentar raíz dental expuesta en encía del sector anterosuperior generando inconformidad estética. Se diagnosticó fenestración apical en la raíz del órgano dentario 23 debido a placas corticales delgadas y biotipo periodontal fino, la cual se trató de manera exitosa con tratamiento endodóntico convencional, en conjunto con cirugía apical. El control posoperatorio reveló la cobertura completa de la fenestración. Se describe el protocolo quirúrgico de la fenestración apical con resultados estéticos y funcionales satisfactorios, mostrando el procedimiento como una opción de tratamiento seguro y eficaz en estos casos inusuales.
Apical fenestration describes the situation where the apex of a tooth is exposed to the oral environment following breakdown of the overlying bone and alveolar mucosa; it is considered a variation within the range of periodontal normality. Although symptom free, the presence of fenestrations may complicate endodontic treatment or jeopardize the functional and aesthetic outcome of periodontal surgery. This non-pathological condition should be treated with caution because it represents a challenge to the clinician, because it is often misdiagnosed and mistreated and therefore, requires a multidisciplinary approach. Several surgical and nonsurgical procedures were documented for treatment, even when diagnosed properly, the management with a simple surgical procedure is sufficient. We report an unusual case of a 42 year old woman who consulted the dentist and referred an exposed tooth root in anterior gingival area with an aesthetic compromise. A diagnosis was made of an apical fenestration of the maxillary canine root at the apex with very thin buccal cortical plate and thin periodontal biotype, which was treated successfully by a combination of nonsurgical root canal treatment and apical surgery. Postoperative control revealed complete coverage of the fenestration. We describe The surgical protocol to correct the apical fenestration with satisfactory aesthetic and functional results is described, showing the procedure as a safe treatment option which is effective in these unusual cases.
RESUMO
BACKGROUND: Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. PRINCIPAL FINDINGS: A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1). CONCLUSIONS: This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this sublineage.
Assuntos
Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colômbia/epidemiologia , Feminino , Técnicas de Genotipagem , Humanos , Masculino , Pessoa de Meia-Idade , Filogeografia , Sequências de Repetição em Tandem/genética , Adulto JovemRESUMO
Morbidity and mortality caused by tuberculosis are increased in most of the Latin-American indigenous communities. Factors that could explain this situation are poverty and limited health services access due to social conflicts and geographical isolation. We determined the frequency of tuberculosis in Colombian indigenous communities and described their knowledge related to transmission and control. We developed a descriptive study and health survey. Interviews were performed to find ancestral knowledge about tuberculosis. Sputum samples from patients with respiratory symptoms were analyzed. 10 indigenous communities were studied, which tuberculosis incidence was 291/100,000. Communities believe that tuberculosis is a body and spirit disease, which transmission is by direct contact or by witchcraft. Tuberculosis incidence in the studied communities was ninefold higher than that of the general population from Antioquia Department. Knowledge exchange could facilitate the community empowerment and implementation of educational activities which might improve the control of the disease.
Assuntos
Cultura , Indígenas Sul-Americanos/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Adulto , Colômbia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Indígenas Sul-Americanos/etnologia , Entrevistas como Assunto , MasculinoRESUMO
Several genomes of different Mycobacterium tuberculosis isolates have been completely sequenced around the world. The genomic information obtained have shown higher diversity than originally thought and specific adaptations to different human populations. Within this work, we sequenced the genome of one Colombian M. tuberculosis virulent isolate. Genomic comparison against the reference genome of H37Rv and other strains showed multiple deletion and insertions that ranged between a few bases to thousands. Excluding PPE and PG-PGRS genes, 430 proteins present changes in at least 1 amino acid. Also, novel positions of the IS6110 mobile element were identified. This isolate is also characterized by a large genomic deletion of 3.6 kb, leading to the loss and modification of the dosR regulon genes, Rv1996 and Rv1997. To our knowledge, this is the first report of the genome sequence of a Latin American M. tuberculosis clinical isolate.
Assuntos
Proteínas de Bactérias/genética , Deleção de Genes , Genes Bacterianos , Genoma Bacteriano , Mycobacterium tuberculosis/genética , Proteínas Quinases/genética , Regulon , Tuberculose/microbiologia , Adulto , Colômbia , Proteínas de Ligação a DNA , Humanos , Masculino , Dados de Sequência Molecular , Mycobacterium tuberculosis/isolamento & purificação , Análise de Sequência de DNARESUMO
The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient. Therefore it is necessary to develop a practical tool that allows the family physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow the design of strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly.
Assuntos
Avaliação Geriátrica/métodos , Idoso , Algoritmos , HumanosRESUMO
BACKGROUND: In critically ill children, Candida species and other yeasts appear as an important nosocomial pathogen. The emerging fungal pathogens are usually less susceptible to azole compounds, and the management of such infections could be problematic. METHODS: 6,065 bloodstream cultures and 627 catheters from intensive care units and hospitalized oncology pediatric patients were studied. Antifungal susceptibility testing of isolates was performed according to the reference broth microdilution method describedby the National Committee for Clinical Laboratory Standards (M27-A). RESULTS: We found a low activity of fluconazole (FCZ) and itraconazole (ITZ) against Candida glabrata, C. albicans, C. tropicalis and C. haemulonii. Resistant strains to FCZ and ITZ were detected. CONCLUSION: Results reveal the emergence of antifungal-resistant species and a change in the predominant role of C. albicans as a cause of candidemia in hospitalized children.
Assuntos
Antifúngicos/farmacologia , Candida/isolamento & purificação , Cateteres de Demora/microbiologia , Farmacorresistência Fúngica , Fluconazol/farmacologia , Fungemia/microbiologia , Itraconazol/farmacologia , Adolescente , Candida/efeitos dos fármacos , Criança , Pré-Escolar , Humanos , Lactente , Testes de Sensibilidade Microbiana , Neoplasias/complicaçõesRESUMO
Yeast strains obtained from blood cultures and catheters from intensive care units (ICU) and hospitalised oncology paediatrics were studied. Yeast were the first cause of catheter colonisation (51/627), and the third cause of bloodstream infection (44/6065). In catheter, the most frequent species were Candida albicans (34%), C. parapsilosis (27.7%) and C. tropicalis (15%). In blood, C. albicans (40.8%), C. parapsilosis (26.6%), C. tropicalis (15%). Malassezia furfur and Malassezia sympodialis were isolated from catheters from ICU patients. All isolates were susceptible to amphotericin B, 88.8% to itraconazole and 91.9% to fluconazole. Candida albicans and C. tropicalis strains resistant to fluconazole and itraconazol were detected. These results reveal a change in the predominant role of C. albicans as cause of candidemia in hospitalised children and the emergence of antifungal resistant species. These variations emphasise the importance of performing a permanent surveillance to observe and assess them.
Assuntos
Candida/isolamento & purificação , Cateterismo , Fungemia/epidemiologia , Malassezia/isolamento & purificação , Adolescente , Anfotericina B/farmacologia , Antifúngicos/farmacologia , Argentina/epidemiologia , Candida/efeitos dos fármacos , Criança , Pré-Escolar , Farmacorresistência Fúngica , Fluconazol/farmacologia , Fungemia/microbiologia , Inquéritos Epidemiológicos , Humanos , Incidência , Lactente , Unidades de Terapia Intensiva Pediátrica , Itraconazol/farmacologia , Malassezia/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Especificidade da EspécieRESUMO
Se analiza la evolución temporal de la concentración de ozono (O3) y de óxidos de nitrógeno (NO) en dos ciudades con características diferenciadas. Se observa diferencia en los valores de concentración de los contaminantes, pero es posible detectar importantes similitudes en la evolución temporal de los mismos
Assuntos
Argentina , Poluição do Ar , Ozônio , Óxidos de Nitrogênio , EspanhaRESUMO
Se analiza la evolución temporal de la concentración de ozono (O3) y de óxidos de nitrógeno (NO) en dos ciudades con características diferenciadas. Se observa diferencia en los valores de concentración de los contaminantes, pero es posible detectar importantes similitudes en la evolución temporal de los mismos