RESUMO
The use of mixed microbial cultures (MMCs) is seen as an attractive strategy for polyhydroxyalkanoate (PHA) production. In order to optimize the MMC-PHA production process, tools are required to improve our understanding of the physiological state of the PHA-storing microorganisms within the MMC. In the present study, we explored the use of flow cytometry to analyse the metabolic state and polyhydroxybutyrate (PHB) content of the microorganisms from an MMC-PHA production process. A sequencing batch reactor under a feast and famine regime was used to enrich an MMC with PHB-storing microorganisms. Interestingly, once the PHB-storing microorganisms are selected, the level of PHB accumulation depends largely on the metabolic state of these microorganisms and not exclusively on the consortium composition. These results demonstrate that flow cytometry is a powerful tool to help to understand the PHA storage response of an MMC-PHA production process. KEY POINTS: ⢠Flow cytometry allows to measure PHB content and metabolic activity over time. ⢠Microorganisms showing high PHB content also have high metabolic activity. ⢠PHB producers with low metabolic activity show low PHB content.
Assuntos
Reatores Biológicos , Poli-Hidroxialcanoatos , Poli-Hidroxialcanoatos/metabolismo , Citometria de Fluxo , FermentaçãoRESUMO
RESUMEN Introducción: el afrontamiento a la muerte constituye una de las situaciones más difíciles y estresantes a las que se tienen que enfrentar los estudiantes de medicina por el contacto cercano a pacientes en riesgo vital. Objetivos: determinar el nivel de afrontamiento a la muerte en estudiantes de medicina. Metodología: se aplicó diseño con enfoque cuantitativo, de tipo observacional, transversal, multicéntrico. Se incluyó a estudiantes de medicina del Paraguay, de ambos sexos, en agosto 2021, que aceptaban participar del estudio. Se utilizó un cuestionario telemático. Se midieron variables sociodemográficas. El nivel de afrontamiento se determinó con la escala de Bugen. La investigación fue aprobada por Comité de Ética de la Universidad Privada del Este, Asunción. Resultados: se incluyeron 504 estudiantes, siendo del sexo femenino en 74 % y con edad media 22 ± 4 años. El 88 % de los encuestados eran de nacionalidad paraguaya (88 %) y 73 % de religión católica. La mayoría nació en Paraguay (88 %), era católica (73 %), se hallaba inscripta como donante de órganos (60 %) y tenía antecedente reciente de muerte de un familiar o amigo (76 %). La escala de Bugen detectó bajo nivel de afrontamiento a la muerte en 50 %, siendo 52 % en las mujeres y 42 % en los varones (p <0,05). Conclusión: el afrontamiento a la muerte en estudiantes de medicina fue bajo. Se sugiere incluir cursos, talleres y planes formativos dentro de las asignaturas o como actividades de extensión para mejorar ese aspecto en el currículo de las facultades de medicina del Paraguay.
ABSTRACT Introduction: coping with death is one of the most difficult tasks that medical students have to face. Objectives: to determine the level of coping with death in medical students. Methodology: we conducted an observational, cross-sectional, multicenter study. We included men and women, medical students from public and private universities from Paraguay in 2021, who agreed to participate in the study. A telematic questionnaire was used. Sociodemographic variables were measured. The level of coping was determined with the Bugen scale. The research was approved by the Comité de Ética of the Universidad Privada del Este, Asunción. Results: 504 students were included, 74 % being female and with a mean age of 22 ± 4 years. Most were born in Paraguay (88 %), were Catholic (73 %), registered as an organ donor (60 %), and had a recent history of the death of a family member or friend (76 %). The Bugen scale detected a low level of coping with death in 52 % of the women and 42 % of the men (p <0.05). Conclusion: coping with death in medical students was low. It is suggested to include courses or workshops to improve this aspect in the curriculum of the medical schools of Paraguay.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Estudantes de Medicina , Adaptação Psicológica , Atitude Frente a Morte , Medo , Paraguai , Faculdades de Medicina , Inquéritos e Questionários , Pandemias , COVID-19/psicologiaRESUMO
The pandemic has challenged countries to develop stringent measures to reduce infections and keep the population healthy. However, the greatest challenge is understanding the process of adopting self-care measures by individuals in different countries. In this research, we sought to understand the behavior of individuals who take self-protective action. We selected the risk homeostasis approach to identify relevant variables associated with the risk of contagion and the Protective Action Decision Model to understand protective decision-making in the pandemic. Subsequently, we conducted an exploratory survey to identify whether the same factors, as indicated in the literature, impact Chile's adoption of prevention measures. The variables gender, age, and trust in authority behave similarly to those found in the literature. However, socioeconomic level, education, and media do not impact the protection behaviors adopted to avoid contagion. Furthermore, the application of the Protective Action Decision Model is adequate to understand the protective measures in the case of a pandemic. Finally, women have a higher risk perception and adopt more protective measures, and in contrast, young people between 18 and 30 years of age are the least concerned about COVID-19 infection.
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COVID-19 , Adolescente , Chile , Feminino , Humanos , Pandemias , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
Neotropical montane forests are considered biodiversity hotspots, where epiphytic bryophytes are an important component of the diversity, biomass and functioning of these ecosystems. We evaluated the richness and composition of bryophytes in secondary successional forests and mixed plantations of Juglans neotropica. In each forest type, the presence and cover of epiphytic bryophytes was registered in 400 quadrats of 20 cm × 30 cm. We analyzed the effects of canopy openness, diameter at breast height (DBH) and forest type on bryophyte richness, using a generalized linear model (GLM), as well as the changes in species composition using multivariate analysis. Fifty-five bryophyte species were recorded, of which 42 species were in secondary forests and 40 were in mixed plantations. Bryophyte richness did not change at forest level; however, at tree level, richness was higher in the mixed plantation of J. neotropica compared to the secondary forests, due to the presence of species adapted to high light conditions. On the other hand, bryophyte communities were negatively affected by the more open canopy in the mixed plantation of J. neotropica, species adapted to more humid conditions being less abundant. We conclude that species with narrow microclimatic niches are threatened by deforestation, and J. neotropica plantations do not act as refuge for drought-sensitive forest species present in secondary forests.
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Reference materials (RM) are tools used in the comparability and traceability of measurements. They are widely used by laboratories for method validation and quality control of assay. Chile must evaluate theperformance of laboratories that analyzing metals in fishery products, despite RM have high prices and are scarce. For that reason, a RM in a hydrobiological product was developed. Reference values for arsenic and cadmium elements for a fishmeal were assigned. The measurement methods for characterization of the material were Inductively Coupled Plasma Mass Spectrometry, Atomic Absorption Spectrometry and Neutron Activation Analysis. Reference values with their expanded uncertainty (U) were established for arsenic 2.64 ± 0.42 mg/kg (U; k = 2) and for cadmium 0.86 ± 0.16 mg/kg (U; k = 2). Homogeneity and stability of the RM allowed its use in a proficiency test for eleven food control laboratories. Results for median were 2.114 mg/kg for arsenic, and 0.863 mg/kg for cadmium. The performance values of the participants were evaluated with a z score obtaining 60% satisfaction for arsenic and 73% for cadmium.The material demonstrated to be suitable for use in interlaboratory proficiency assay. (AU)
Materiales de referencia (MR) son herramientas utilizadas en la comparabilidad y trazabilidad entre mediciones. Laboratorios los utilizan ampliamente en validación de métodos y control de calidad. Chile debe evaluar el desempeño de los laboratorios que analizan metales en productos pesqueros, a pesar de los altos precios y escasez del MR. Por esa razón, se desarrolló un MR en producto hidrobiológico. Se asignaron valores de referencia para arsénico y cadmio en harina de pescado. Los métodos de medición para la caracterización del material fueron Espectrometría de Masas de Plasma Acoplado Inductivamente, Espectrometría de Absorción Atómica y Análisis de Activación de Neutrones. Se establecieron valores de referencia con su incertidumbre (U) para arsénico 2.64 ± 0.42 mg/kg (U; k = 2) y para cadmio 0.86 ± 0.16 mg/kg (U; k = 2). La homogeneidad y estabilidad del MR permitieron su uso en una prueba de aptitud para once laboratorios de control de alimentos. Las medianas fueron 2,114 mg/kg para arsénico y 0,863 mg/kg para cadmio. Se evaluaron los rendimientos de los participantes con un estadístico de puntaje z satisfactorio del 60% para el arsénico y 73% para el cadmio. El material demostró ser adecuado para uso en ensayo de aptitud de intercomparación. (AU)
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Arsênio , Cádmio , Ensaio de Proficiência Laboratorial , Farinha de Peixe , LaboratóriosRESUMO
Our aim was to analyze the prevalence of high-risk human papillomavirus (HR-HPV) and its association with risk factors related to cervical lesions. We used 362 cervical samples from a transversal study to detect nineteen types from the high-risk HPV clade by highly sensitive PCR. Unexpectedly, we found a very high prevalence of HPV type 66 (32.8%), particularly in low-grade squamous intraepithelial lesions. A significant association of HPV66 with previously sexually transmitted disease was observed (p < 0.05). Our results strongly suggest that HPV66 might be indicative of cervical lesions that will not progress to cancer. HPV genotyping by methods that grouped type 66 with other HR-HPV clade types should be interpreted with caution.
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Colo do Útero/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Displasia do Colo do Útero/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer , Feminino , Genótipo , Técnicas de Genotipagem , Humanos , Modelos Logísticos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/classificação , Fatores de Risco , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal , Adulto Jovem , Displasia do Colo do Útero/patologiaRESUMO
Keratinocytes and neutrophils are the main cellular components in wound healing during re-epithelization and inflammation. Free fatty acids such as linoleic acid (LA) present beneficial properties for wound healing by modulating the inflammatory response. LA is a natural ligand of free fatty acids receptor 1 (FFA1), a G protein-coupled receptor (GPCR), able to modulate inflammatory process; however, the role of FFA1 in keratinocytes and wound healing remains poorly understood. In this study, we investigated the role of FFA1 signaling in migration, matrix metalloproteinase-9 (MMP-9) activity, and IL-8 expression induced by LA in keratinocytes. We confirmed that HaCaT cells, a human keratinocyte cell line, expresses the FFA1 receptor and GW1100, a selective antagonist of FFA1, decreased LA-induced migration of HaCaT cells. Also, GW9508, a synthetic agonist of FFA1, increased migration of these cells. Furthermore, ERK1/2 and p38 MAPK inhibitors abolished the LA-induced increase in cell migration. Besides, HaCaT cells stimulated with LA or GW9508 increased the activity of MMP-9 and the expression of IL-8. GW1100 partially inhibited both responses. We further evaluated the effects of HaCaT cells conditioned media stimulated with LA or GW9508 on neutrophil chemotaxis. Conditioned media induced neutrophil chemotaxis. Furthermore, IL-8 secreted by HaCaT cells stimulated with LA or GW9508, contributed to neutrophil chemotaxis. In conclusion, LA increased migration, MMP-9 activity, and expression of IL-8 from HaCaT cells via FFA1. Hence, these results showed that the effects induced by LA in keratinocytes can be mediated through FFA1, thus explaining a possible mechanism by which this fatty acid could accelerate wound healing.
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The expansion of the habitat of mosquitoes belonging to the Aedes genus puts nearly half of the world's population at risk of contracting dengue fever, and a significant fraction will develop its serious hemorrhagic complication, which can be fatal if not diagnosed properly and treated in a timely fashion. Although several diagnostic methods have been approved for dengue diagnostics, their applicability is limited in rural areas of developing countries by sample preparation costs and methodological requirements, as well as cross-reactivity among the different serotypes of the Dengue virus and other flavivirus, such as the Zika virus. For these reasons, it is necessary to generate more specific antigens to improve serological methods that could be cheaper and used in field operations. Here, we describe a strategy for the inactivation of cross-reacting epitopes on the surface of the Dengue virus envelope protein through the synthetic generation of recombinant peptide sequences, where key amino acid residues from Dengue virus serotype 1 (DENV-1) and 2 (DENV-2) are substituted by alanine residues. The proteins thus generated are recognized by 88% of sera from Dengue NS1+ patients and show improved serotype specificity because they do not react with the antibodies present in seroconverted, PCR-serotyped DEN-4 infected patients.
Assuntos
Alanina/imunologia , Vírus da Dengue/genética , Vírus da Dengue/imunologia , Epitopos/genética , Epitopos/imunologia , Proteínas do Envelope Viral/imunologia , Substituição de Aminoácidos , Anticorpos Antivirais/sangue , Reações Cruzadas , Dengue/imunologia , Dengue/virologia , Vírus da Dengue/classificação , Mapeamento de Epitopos , Humanos , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Sorogrupo , Proteínas do Envelope Viral/genéticaRESUMO
BACKGROUND: High risk human papillomavirus (hrHPV) infection is associated with the development of cervical cancer (CC) in 99.7%. The prevalence of HPV varies according to the geographic region, lesion degree, method of detection, among other variables. OBJECTIVE: To determine the prevalence of hrHPV and identify some risk factors in a group of women with cervical lesions from Mexico City. MATERIAL AND METHODS: Of 421 women, 310 were included. Questionnaires of risk factors were administered, and cervical samples which included the entire spectrum of cervical lesions according to the Bethesda system were obtained. HPV genotyping was made with INNO-LiPA system. Population characteristics were analyzed with descriptive statistics. Risk factors' odds ratio (OR) was calculated with chi squared using SPSS software, version 24.0. RESULTS: 91.6% of the samples were positive for hrHPV. The prevalent types were 16, 66, 52 and 51. By age group there were not statistically significant differences in the risk of HPV infection. Having had three or more sexual partners increased the risk of infection by hrHPV (OR: 2.99; 95% confidence interval [95% CI]: 1.247.24). Sexually transmitted diseases increased the probability of infection by hrHPV different to types 16, and 18 (OR: 2.47; 95% CI, 1.24-7.24 and 1.50-4.06). CONCLUSIONS: The high prevalence of types 66, 52 and 51 is a finding that has not been described previously in our population. We hope that this study will help to improve health services in order to decrease the incidence of cervical cancer.
INTRODUCCIÓN: La infección por el virus del papiloma humano (VPH) de alto riesgo oncogénico (VPHar) se asocia al cáncer cervicouterino en el 99.7% de los casos. La prevalencia de VPH varía según la región geográfica, el grado de lesión y el método de detección, entre otras variables. OBJETIVO: Determinar la prevalencia de VPHar e identificar factores de riesgo en mujeres con lesión cervical de la Ciudad de Mexico. MATERIAL Y MÉTODOS: De 421 mujeres, se incluyeron 310. Se aplicaron cuestionarios y se obtuvieron muestras que incluyeron todo el espectro de las lesiones cervicales según el sistema Bethesda. La tipificación del VPH se hizo mediante el sistema INNO-LiPA. Las características de la población se analizaron con estadística descriptiva. Con la prueba de chi cuadrada se calculó la razón de momios (RM) de los factores de riesgo con el programa SPSS, versión 24.0. RESULTADOS: El 91.6% de las muestras fueron positivas para VPHar. Los VPH prevalentes fueron los tipos 16, 66, 52 y 51. Por edad no hubo significación estadística para riesgo de infección por VPHar. Haber tenido tres o más parejas sexuales elevó el riesgo de infección por HPVar (RM: 2.99; intervalo de confianza del 95 [IC 95%]: 1.247.24). Las infecciones de transmisión sexual favorecieron el riesgo de infección por otros VPHar distintos de los tipos 16 y 18 (RM: 2.47; IC 95%: 1.24-7.24 y 1.50-4.06). CONCLUSIÓN: La elevada prevalencia de VPH 66, 52 y 51 es un hallazgo que no ha sido descrito previamente en nuestra población. Esperamos que este estudio contribuya a mejorar los programas de los servicios de salud dirigidos a disminuir la incidencia de cáncer cervicouterino.
Assuntos
Alphapapillomavirus , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Feminino , Genótipo , Humanos , México/epidemiologia , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Prevalência , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologiaRESUMO
BACKGROUND: Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention that aims to improve existential and spiritual well-being in patients with advanced cancer. To validate it, several efficacy studies with predominantly non-Hispanic white patients have been done. Puerto Ricans residing on the island are a largely overlooked segment of the US Latinx population. They have a strong national identity and are embedded in a collectivist culture which shares the Spanish language, cultural traditions, and an emphasis on familism, a cultural factor that values the role of the family in ensuring the well-being of its members. OBJECTIVE: The purpose of this study is to present a case study focused on a Puerto Rican advanced cancer patient who underwent MCP to assess the comprehension and acceptance of the MCP intervention. METHOD: We used a mixed-methods study design that included the taking of ethnographic notes, and pre- and post-test assessments of the scores the patient received on all the measures (using validated scales). The ethnographic notes were analyzed to determine the participant's comprehension and acceptance of the MCP intervention. Content analysis was performed on the ethnographic notes by three independent coders using a deductive coding approach. Pre- and post-interview assessments were conducted to explore changes in distress, spiritual well-being, and self-perceived quality of life. RESULTS: A Latino patient with stage III cancer, low income, and low literacy skills showed low comprehension of the concepts of meaning, the finite, legacy, and moderate comprehension and acceptance of the concepts of the search for hope, purpose in life, connecting with life, courage, life's limitations, and sources of meaning. However, the patient showed high comprehension of death and dying (i.e., meaningful death). The patient showed low acceptance of death and dying concepts and high acceptance of the integration of family members into the therapy. SIGNIFICANCE OF RESULTS: Additional studies are needed to address cultural themes and to improve the comprehensibility and acceptance of the manual's content and the central MCP concepts. The findings suggest that MCP has the potential of being a feasible form of psychotherapy for Latinx patients suffering from distress, low spiritual well-being, and low self-perceived QOL.
Assuntos
Neoplasias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Psicoterapia/normas , Adaptação Psicológica , Idoso , Compreensão , Humanos , Masculino , Neoplasias/complicações , Cuidados Paliativos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Psicoterapia/métodos , Porto Rico/etnologia , Pesquisa QualitativaRESUMO
Bacteria under stress increase the proportion of dormant cells to ensure their survival. Cold and osmotic stress are similar, because in both the availability of water is reduced. Glycine betaine (GB) is one of the most common osmoprotectants in bacteria and possesses cryoprotectant properties. Our aim was to determine whether GB modifies the proportion of dormant Deinococcus sp. UDEC-P1 and Psychrobacter sp. UDEC-A5 cells exposed to osmotic stress. Both bacterial strains were incubated in the presence of up to 1 M NaCl with or without GB. Active and dormant cells were evaluated by both spectrophotometric and flow cytometry analysis. Without GB, Deinococcus sp. UDEC-P1 grew in the presence of 0.05 M NaCl, but with 5 mM GB grew at 0.1 M NaCl. Psychrobacter sp. UDEC-A5 grew in the presence of up to 0.25 M NaCl, but with 5 mM GB grew at 0.5 M NaCl. Under osmotic stress, the proportion of dormant cells of Deinococcus sp. UDEC-P1 and Psychrobacter sp. UDEC-A5 increased significantly (about eightfold and fivefold, respectively). The addition of GB (5 mM) exerted a different effect on the two strains, since it avoided the entrance into the dormancy of Psychrobacter sp. UDEC-A5 cells, but not of Deinococcus sp. UDEC-P1 cells. Our results suggest that the effect of GB on bacterial metabolism is strain dependent. For bacteria in which GB avoids dormancy, such as Psychrobacter sp. UDEC-A5, it could be a "double-edged sword" by reducing the "seed bank" available to recover the active population when favorable conditions return.
Assuntos
Betaína/metabolismo , Deinococcus/crescimento & desenvolvimento , Psychrobacter/crescimento & desenvolvimento , Proteínas de Bactérias/metabolismo , Deinococcus/fisiologia , Pressão Osmótica , Psychrobacter/fisiologia , Cloreto de Sódio/metabolismo , Estresse FisiológicoRESUMO
RESUMEN La presencia de metástasis hepática es frecuente en el momento del diagnóstico del tumor primario, o bien puede aparecer tiempo después de haber resecado el cáncer. La enfermedad metastásica anteriormente era considerada como inoperable, sin embargo, los adelantos en la cirugía, terapias adyuvantes y medicamentos quimioterapéuticos, han ofrecido nuevas esperanzas a estos pacientes. El diseño de protocolos, guías de atención y esquemas de seguimiento en estos enfermos ha sido un tema importante en los centros especializados, por lo que se propone plantear las principales pautas de actuación diagnóstica y terapéutica frente a enfermos portadores de un hígado metastásico, que de forma simplificada y orientativa pueda interpretarse y adecuarse a los pacientes afectos por esta dolencia, además, de ser factibles de interpretar y aplicar por profesionales de la salud pertenecientes a varias especialidades(AU)
ABSTRACT The presence of liver metastases is frequent at the time of diagnosis of the primary tumor, or it may appear sometime after the cancer has been resected. Metastatic disease was previously considered inoperable, however, advances in surgery, adjuvant therapies, and chemotherapeutic drugs have offered new hope for these patients. The design of protocols, care guides and monitoring schemes in these patients has been an important topic in specialized centers, so it is proposed to propose the main guidelines for diagnostic and therapeutic action against patients with metastatic liver, which in In a simplified and guiding way, it can be interpreted and adapted to the patients affected by this ailment, as well as being feasible to interpret and apply by health professionals belonging to various specialtiesAU)
Assuntos
Humanos , Guias de Prática Clínica como Assunto , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgiaRESUMO
U.S.-Mexico border communities are uniquely vulnerable to sexually transmitted infection (STI) transmission given the economic and social challenges these communities face. This study examines how marginalized statuses of U.S. border residents are associated with STI awareness and sexual behaviors. We surveyed low-income residents receiving STI testing and/or HIV/AIDS care in the lower Rio Grande Valley of southernmost Texas. Respondents aged 18+ took a self-administered survey available in English or Spanish in a clinic waiting room (N = 282). Approximately 52% of respondents reported being HIV+, and 32% of respondents reported having a prior STI other than HIV. Although most respondents had heard of HPV (72%), awareness of the HPV vaccine was low across all subgroups (28%), including women (< 35%), reflecting previous findings that border residents are less knowledgeable about the HPV vaccine. Almost half of respondents reported always using a condom (45%), which is higher than elsewhere in the U.S. Male and non-Hispanic respondents had higher estimated prevalence ratios (PR) of lifetime partners [PR 1.39 (95% confidence interval 1.43-3.68), PR 1.88 (1.04-3.41), respectively] and sexual partners met online [PR 3.73 (1.00-14.06), PR 19.98 (5.70-70.10), respectively]. Sexual minority, non-Hispanic, and male respondents had higher adjusted odds ratios (AOR) of utilizing the internet to find sexual partners than their peers [AOR 2.45 (1.60-3.87), AOR 1.52 (1.11-2.07), AOR 1.97 (1.20-3.24), respectively], placing them at greater STI-transmission risk. We found diversity in dimensions of STI awareness and sexual behaviors in our sample. Results can help tailor public health interventions to the unique STI risks of marginalized groups in border communities.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , México , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Texas , Adulto JovemRESUMO
Resumen: La oxigenoterapia de alto flujo mediante cánula nasal (CNAF) es un método de apoyo respiratorio no invasivo que se ha desarrollado con excelentes resultados en servicios pediátricos de emergencia y cuidados moderados, para el tratamiento de infecciones respiratorias bajas de etiología viral. Objetivo: describir y analizar las características clínicas y evolución de los menores de 2 años con infecciones respiratorias bajas de probable etiología viral que recibieron tratamiento con CNAF en el servicio de cuidados moderados pediátricos de la ciudad de Florida, Uruguay. Método: estudio observacional, descriptivo, retrospectivo. Se incluyeron todos los menores de 2 años con la patología respiratoria mencionada que fueron asistidos con CNAF desde el 1º de junio hasta el 31 de octubre de 2017: n=10. Criterios de inclusión: score de Tal modificado mayor o igual a 7 mantenido, score de Tal mayor o igual a 9 desde el inicio, o saturación de oxígeno menor o igual a 90% con oxigenoterapia convencional. Los criterios de éxito o fracaso se definieron de acuerdo a la respuesta y evolución clínica. En los casos en que se consideró el fracaso de la técnica, los pacientes fueron derivados a centro de terapia intensiva para realizar otras modalidades de soporte ventilatorio. En todos los casos se realizó gasometría preconexión, que no se repitió si la técnica fue exitosa. Se registraron diferentes variables: edad, procedencia, sexo, institución prestadora, comorbilidades, motivo de conexión, aspirado nasofaríngeo, tiempo de aplicación de la técnica y resultado de su aplicación. Resultados: se incluyeron 10 pacientes, con edad promedio de 8,1 meses, 6 de sexo femenino; en nueve casos el motivo de la conexión fue un score de Tal mayor o igual 7 mantenido pese al tratamiento; siete pacientes tuvieron aspirado nasofaríngeo diagnóstico negativo y tres fueron reactivos para virus respiratorio sincicial. El promedio de aplicación fue de 54,9 horas y la técnica resultó exitosa en 7/10 casos. En los tres casos en que se consideró fracaso, los pacientes fueron trasladados en ambulancia especializada pediátrica, sin suspender la técnica, y en la evolución requirieron asistencia respiratoria invasiva. Conclusiones: la utilización de la CNAF en el servicio asistencial pediátrico de Florida permitió la resolución de 7/10 casos de lactantes con insuficiencia respiratoria hipoxémica en el contexto de infección respiratoria baja.
Summary: High Flow Nasal Cannula (HFNC) Oxygen Therapy is a non-invasive respiratory support method that has had excellent results for the treatment of low viral respiratory infections in pediatric emergency centers and moderate care units. Objective: analyze and describe the clinical characteristics and evolution of children under 2 years of age, treated with HFNC for low viral respiratory infections at moderate care pediatric units in Florida Department, Uruguay. Method: observational, descriptive, and retrospective study. We included all children under 2 years of age with low viral respiratory infections treated with HFNC between June 1st. and October 31st, 2017: n=10. Inclusion criteria: Tal Score modified more or equal 7, maintained despite treatment, Tal Score more or equal 9 from the beginning, or oxygen saturation less or equal 90% conventional oxygenation. The success or failure criteria were defined by clinical response and evolution. Failure cases were referred to Intensive Therapy for alternative ventilatory support. Gasometry was performed in all cases before the treatment, and it was not repeated if the technique was successful. We recorded age, place of birth, gender, institution, comorbidities, reason for cannula insertion, nasopharyngeal aspiration, application time and treatment results. Results: 10 patients were included, average age 8.1 months, 6 female; the connection reason was Tal Score more or equal 7 maintained despite treatment; 7 had negative nasopharyngeal aspiration and 3 were reactive to respiratory syncytial virus. The average application time was 54.9 hours and the technique was successful in 7/10 cases. The three failed cases were transferred by pediatric ambulance and the treatment was not discontinued. These children required invasive respiratory assistance. Conclusions: the use of HFNC in the Florida Pediatric Center enabled us to successfully treat 7/10 lactating children with hypoxemic respiratory failure due to low respiratory infection.
Resumo: A oxigenoterapia de alto fluxo por cânula nasal (CNAF) é um método não invasivo de suporte respiratório, desenvolvido com excelentes resultados em serviços pediátricos de emergência e cuidados moderados, para o tratamento das infecções respiratórias baixas de etiologia viral. Objetivo: descrever e analisar as características clínicas e a evolução de crianças menores de 2 anos de idade com infecções respiratórias de provável etiologia viral, que receberam tratamento com CNAF, no Serviço de Atendimento Pediátrico Moderado do Departamento de Flórida, Uruguai. Método: estudo observacional, descritivo, retrospectivo. n = 10. Critérios de inclusão: todas as crianças com menos de 2 anos de idade com as doenças respiratórias mencionadas, que foram atendidos utilizando CNAF de 1 Junho a 31 de outubro de 2017. Critérios de inclusão: Score de Tal modificado o mais ou igual 7 mantido, Score de Tal mais ou igual 9 desde o início, ou saturação de O2 menor ou igual 90% com oxigenoterapia convencional. Os critérios para sucesso foram definidos de acordo com a resposta e a evolução clínica. Nos casos de falha da técnica, os pacientes foram encaminhados ao Centro de Terapia Intensiva (CTI), para realizar outras modalidades de suporte ventilatório. Em todos os casos, foi realizada a gasometria de pré-conexão, que não foi repetida se a técnica teve sucesso. Registramos diferentes variáveis, como: idade, origem, sexo, instituição médica, comorbidades, motivo para a conexão, aspirado nasofaríngeo, tempo de aplicação da técnica e resultados. Resultados: foram incluídos 10 pacientes, com média de idade de 8,1 meses, 6 do sexo feminino; em 9 casos a razão para a conexão foi um Score de Tal mais ou igual 7 mantido desde o início do tratamento; 7 tiveram diagnóstico negativo e aspirado nasofaríngeo e 3 foram reativos para o vírus sincicial respiratório. A aplicação média foi de 54,9 horas e a técnica obteve sucesso em 7/10 casos. Nos 3 casos em que houve falha, os pacientes foram transferidos por ambulância especializada pediátrica, sem suspender a técnica, e na evolução necessitaram de assistência respiratória invasiva. Conclusões: o uso do CNAF no serviço de pediatria do Departamento de Florida, Uruguai, resolveu com sucesso 7/10 casos de lactentes com insuficiência respiratória hipoxêmica no contexto de infecção respiratória baixa.
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[RESUMEN]. Objetivo. Determinar la asociación entre el embarazo en adolescentes y los factores socioeconómicos, así como calcular las desigualdades sociales presentes en las adolescentes de México durante 2015. Métodos. Se realizó un estudio a partir de registros de nacimientos del año 2015 en mujeres de 15 a 19 años. Se determinó la tasa de fecundidad y se desagregó en quintiles por cada variable socioeconómica. Se calcularon medidas absolutas y relativas de desigualdad, regresión binomial negativa para razón de riesgo e intervalos de confianza del 95%. Resultados. La tasa de fecundidad fue 73,21 nacimientos por 1 000 mujeres de 15 a 19 años en México. Coahuila fue el estado con la mayor tasa de nacimientos (99,3 por 1 000 adolescentes). Se encontró una asociación estadísticamente significativa entre la tasa de fecundidad y el rezago al acceso a servicios de salud, en especial en el quintil 5 (riesgo relativo [RR] = 45,68), mientras que para el rezago educativo fue mayor en el quintil 4 (RR = 27,36). No existieron diferencias significativas respecto al rezago en el acceso a la seguridad social. Conclusiones. Las condiciones de marginación y pobreza tienen una asociación importante con el embarazo y la tasa de fecundidad en las adolescentes. Sin embargo, existen grandes brechas de desigualdad entre los grupos sociales, por lo que resulta necesario implementar acciones enfocadas la promoción de la mejora de los entornos sociales, políticos y económicos.
[ABSTRACT]. Objective. To determine the association between teenage pregnancy and socioeconomic factors and to estimate social inequalities among adolescents in Mexico in 2015. Methods. A study involving women from 15 to 19 years of age was conducted using data from birth records for 2015. The fertility rate was determined and disaggregated by quintiles for each socioeconomic variable. Absolute and relative measures of inequality were estimated; negative binomial regression analysis was used to obtain risk ratios and 95% confidence intervals. Results. The fertility rate was 73.21 births per 1000 women between the ages of 15 and 19 years in Mexico. Coahuila was the state with the highest birth rate (99.3 per 1000 adolescents). A statistically significant association was found between fertility rate and the gap in access to health services, especially in quintile 5 (risk ratio [RR] = 45.68), whereas a greater association with the gap in education was found in quintile 4 (RR = 27.36). No significant differences were found in terms of the gap in access to social security. Conclusions. Marginalization and poverty are significantly associated with teenage pregnancy and fertility rate. However, wide inequalities exist among the different social groups, making it necessary to implement actions geared towards promoting measures to improve the social, political, and economic environment.
[RESUMO]. Objetivo. Determinar a associação entre gravidez na adolescência e fatores socioeconômicos e estimar as desigualdades sociais nas adolescentes do México em 2015. Material e métodos. Um estudo foi realizado a partir dos registros de nascimentos de 2015 em adolescentes do sexo feminino com idade de 15 a 19 anos. Foi determinada a taxa de fecundidade desagregada por quintis para cada variável socioeconômica. Foram calculadas medidas absolutas e relativas de desigualdade e analisado um modelo de regressão binomial negativa para as razões de risco e intervalos de confiança de 95%. Resultados. A taxa de fecundidade encontrada foi de 73,21 nascimentos por 1.000 mulheres com idade de 15 a 19 anos no México. O Estado de Coahuila teve a maior taxa de nascimento (99,3 por 1.000 adolescentes). Observou-se uma associação estatisticamente significativa entre a taxa de fecundidade e defasagem no acesso aos serviços de saúde, sobretudo no quintil 5 (risco relativo [RR] 45,68), enquanto que o atraso educacional foi maior no quintil 4 (RR 27,36). Não houve diferença significativa na defasagem no acesso à previdência social. Conclusões. O estado de marginalização e pobreza têm uma importante associação com gravidez e taxa de fecundidade em adolescentes. Existem, no entanto, grandes lacunas de desigualdade entre os grupos sociais, sendo necessário implementar ações direcionadas a promover a melhoria dos entornos sociais, políticos e econômicos.
Assuntos
Gravidez na Adolescência , Disparidades nos Níveis de Saúde , Taxa de Fecundidade , México , Gravidez na Adolescência , Disparidades nos Níveis de Saúde , Determinantes Sociais da Saúde , Taxa de Fecundidade , México , Gravidez na Adolescência , Taxa de Fecundidade , Determinantes Sociais da Saúde , Disparidades nos Níveis de Saúde , Determinantes Sociais da SaúdeRESUMO
OBJECTIVE: To determine the association between teenage pregnancy and socioeconomic factors and to estimate social inequalities among adolescents in Mexico in 2015. METHODS: A study involving women from 15 to 19 years of age was conducted using data from birth records for 2015. The fertility rate was determined and disaggregated by quintiles for each socioeconomic variable. Absolute and relative measures of inequality were estimated; negative binomial regression analysis was used to obtain risk ratios and 95% confidence intervals. RESULTS: The fertility rate was 73.21 births per 1000 women between the ages of 15 and 19 years in Mexico. Coahuila was the state with the highest birth rate (99.3 per 1000 adolescents). A statistically significant association was found between fertility rate and the gap in access to health services, especially in quintile 5 (risk ratio [RR] = 45.68), whereas a greater association with the gap in education was found in quintile 4 (RR = 27.36). No significant differences were found in terms of the gap in access to social security. CONCLUSIONS: Marginalization and poverty are significantly associated with teenage pregnancy and fertility rate. However, wide inequalities exist among the different social groups, making it necessary to implement actions geared towards promoting measures to improve the social, political, and economic environment.
OBJETIVO: Determinar a associação entre gravidez na adolescência e fatores socioeconômicos e estimar as desigualdades sociais nas adolescentes do México em 2015. MATERIAL E MÉTODOS: Um estudo foi realizado a partir dos registros de nascimentos de 2015 em adolescentes do sexo feminino com idade de 15 a 19 anos. Foi determinada a taxa de fecundidade desagregada por quintis para cada variável socioeconômica. Foram calculadas medidas absolutas e relativas de desigualdade e analisado um modelo de regressão binomial negativa para as razões de risco e intervalos de confiança de 95%. RESULTADOS: A taxa de fecundidade encontrada foi de 73,21 nascimentos por 1.000 mulheres com idade de 15 a 19 anos no México. O Estado de Coahuila teve a maior taxa de nascimento (99,3 por 1.000 adolescentes). Observou-se uma associação estatisticamente significativa entre a taxa de fecundidade e defasagem no acesso aos serviços de saúde, sobretudo no quintil 5 (risco relativo [RR] 45,68), enquanto que o atraso educacional foi maior no quintil 4 (RR 27,36). Não houve diferença significativa na defasagem no acesso à previdência social. CONCLUSÕES: O estado de marginalização e pobreza têm uma importante associação com gravidez e taxa de fecundidade em adolescentes. Existem, no entanto, grandes lacunas de desigualdade entre os grupos sociais, sendo necessário implementar ações direcionadas a promover a melhoria dos entornos sociais, políticos e econômicos.
RESUMO
RESUMEN Objetivo Determinar la asociación entre el embarazo en adolescentes y los factores socioeconómicos, así como calcular las desigualdades sociales presentes en las adolescentes de México durante 2015. Métodos Se realizó un estudio a partir de registros de nacimientos del año 2015 en mujeres de 15 a 19 años. Se determinó la tasa de fecundidad y se desagregó en quintiles por cada variable socioeconómica. Se calcularon medidas absolutas y relativas de desigualdad, regresión binomial negativa para razón de riesgo e intervalos de confianza del 95%. Resultados La tasa de fecundidad fue 73,21 nacimientos por 1 000 mujeres de 15 a 19 años en México. Coahuila fue el estado con la mayor tasa de nacimientos (99,3 por 1 000 adolescentes). Se encontró una asociación estadísticamente significativa entre la tasa de fecundidad y el rezago al acceso a servicios de salud, en especial en el quintil 5 (riesgo relativo [RR] = 45,68), mientras que para el rezago educativo fue mayor en el quintil 4 (RR = 27,36). No existieron diferencias significativas respecto al rezago en el acceso a la seguridad social. Conclusiones Las condiciones de marginación y pobreza tienen una asociación importante con el embarazo y la tasa de fecundidad en las adolescentes. Sin embargo, existen grandes brechas de desigualdad entre los grupos sociales, por lo que resulta necesario implementar acciones enfocadas la promoción de la mejora de los entornos sociales, políticos y económicos.
ABSTRACT Objective To determine the association between teenage pregnancy and socioeconomic factors and to estimate social inequalities among adolescents in Mexico in 2015. Methods A study involving women from 15 to 19 years of age was conducted using data from birth records for 2015. The fertility rate was determined and disaggregated by quintiles for each socioeconomic variable. Absolute and relative measures of inequality were estimated; negative binomial regression analysis was used to obtain risk ratios and 95% confidence intervals. Results The fertility rate was 73.21 births per 1000 women between the ages of 15 and 19 years in Mexico. Coahuila was the state with the highest birth rate (99.3 per 1000 adolescents). A statistically significant association was found between fertility rate and the gap in access to health services, especially in quintile 5 (risk ratio [RR] = 45.68), whereas a greater association with the gap in education was found in quintile 4 (RR = 27.36). No significant differences were found in terms of the gap in access to social security. Conclusions Marginalization and poverty are significantly associated with teenage pregnancy and fertility rate. However, wide inequalities exist among the different social groups, making it necessary to implement actions geared towards promoting measures to improve the social, political, and economic environment.
RESUMO Objetivo Determinar a associação entre gravidez na adolescência e fatores socioeconômicos e estimar as desigualdades sociais nas adolescentes do México em 2015. Material e métodos Um estudo foi realizado a partir dos registros de nascimentos de 2015 em adolescentes do sexo feminino com idade de 15 a 19 anos. Foi determinada a taxa de fecundidade desagregada por quintis para cada variável socioeconômica. Foram calculadas medidas absolutas e relativas de desigualdade e analisado um modelo de regressão binomial negativa para as razões de risco e intervalos de confiança de 95%. Resultados A taxa de fecundidade encontrada foi de 73,21 nascimentos por 1.000 mulheres com idade de 15 a 19 anos no México. O Estado de Coahuila teve a maior taxa de nascimento (99,3 por 1.000 adolescentes). Observou-se uma associação estatisticamente significativa entre a taxa de fecundidade e defasagem no acesso aos serviços de saúde, sobretudo no quintil 5 (risco relativo [RR] 45,68), enquanto que o atraso educacional foi maior no quintil 4 (RR 27,36). Não houve diferença significativa na defasagem no acesso à previdência social. Conclusões O estado de marginalização e pobreza têm uma importante associação com gravidez e taxa de fecundidade em adolescentes. Existem, no entanto, grandes lacunas de desigualdade entre os grupos sociais, sendo necessário implementar ações direcionadas a promover a melhoria dos entornos sociais, políticos e econômicos.
Assuntos
Humanos , Disparidades nos Níveis de Saúde , Taxa de Fecundidade , Determinantes Sociais da Saúde , Gravidez na Adolescência , MéxicoRESUMO
Resumen Introducción: en Uruguay se ha notificado un aumento en el número de casos de tuberculosis en niños con formas pulmonares y extrapulmonares. La infección osteoarticular representa 10%-15% de las formas extrapulmonares. Objetivo: alertar sobre una etiología poco habitual de osteomielitis cuya forma de presentación genera dificultades diagnósticas. Caso clínico: niña de 18 meses, previamente sana. Consulta por edema e impotencia funcional de tobillo derecho de tres meses de evolución, en apirexia. La radiografía muestra múltiples imágenes geódicas en el sector distal de la diáfisis con secuestro en peroné derecho. Se realiza punción ósea obteniéndose líquido serohemático. El cultivo de dicha muestra y el hemocultivo fueron negativos. Luego de recibir clindamicina 21 días más gentamicina 10 días por via intravenosa y dos limpiezas quirúrgicas, se otorga alta con cefuroxime acetil vía oral. El cultivo de la muestra ósea desarrolló Mycobacterium tuberculosis. Se inició tratamiento con isoniacida, rifampicina y piracinamida. No fue identificado el caso índice. Discusión: la presentación clínica de la tuberculosis ósea es generalmente insidiosa lo que generando dificultades y retraso en el diagnóstico. Sólo la biopsia permite confirmar el diagnóstico. La situación epidemiológica actual obliga a descartar posible etiología tuberculosa ante un proceso inflamatorio osteoarticular de evolución tórpida. El tratamiento oportuno y adecuado requiere alto índice de sospecha y realización sistemática de punción ósea y/o articular.
Summary Introduction: in Uruguay, an increase in the number of cases of TB with pulmonary and extra-pulmonary involvement in children has been reported. Osteoarticular infections represent 10%-15% of extra-pulmonary involvement. Objective: to warn about an uncommon etiology of osteomyelitis whose presentation results in diagnostic difficulties. Clinical case: 18 month-old girl, previously healthy. Consultation was due to edema and right ankle functional insuficiency with three-month evolution, under apyrexia. X-ray imaging revealed multiple geodesic images in the distal portion of diaphysis, as well as a small sequestrum in right fibula. Through a bone puncture, serohematic fluid was extracted. Culture and hemoculture were negative. Treatment consisted of 21 days of intravenous clindamycin and 10 days of gentamicin. Two surgical debridements were performed. Progressive recovery followed. The child was discharged under cefuroxime axetil oral suspension and later a bone culture showed positive results for Mycobacterium TB. Treatment with isoniazid, rifampin and pyrazinamide was started. Index case could not be identified. Discussion: clinical presentation of bone tuberculosis is generally insidious. This explains difficulties and delays in diagnosis. It is remarkable that only biopsy allows the confirmation of diagnosis. The present epimediologic condition forces us to rule out possible TB etiology in the presence of an inflammatory osteoarticular process of lethargic evolution. Timely and accurate treatment requires a high degree of suspicion, as well as the performance of systematic bone and/or joint puncture.
Assuntos
Humanos , Osteomielite , Osteomielite/diagnóstico , Osteomielite/etiologia , Tuberculose/complicações , Tuberculose/diagnóstico , Pirazinamida/uso terapêutico , Tuberculose , Espectroscopia de Ressonância Magnética , Traumatismos do Tornozelo , Doenças Transmissíveis Emergentes , Diagnóstico Diferencial , Isoniazida/uso terapêuticoRESUMO
Introducción: en Uruguay se ha notificado un aumento en el número de casos de tuberculosis en niños con formas pulmonares y extrapulmonares. La infección osteoarticular representa 10%-15% de las formas extrapulmonares. Objetivo: alertar sobre una etiología poco habitual de osteomielitis cuya forma de presentación genera dificultades diagnósticas.Caso clínico:niña de 18 meses, previamente sana. Consulta por edema e impotencia funcional de tobillo derecho de tres meses de evolución, en apirexia. La radiografía muestra múltiples imágenes geódicas en el sector distal de la diáfisis con secuestro en peroné derecho. Se realiza punción ósea obteniéndose líquido serohemático. El cultivo de dicha muestra y el hemocultivo fueron negativos. Luego de recibir clindamicina 21 días más gentamicina 10 días por via intravenosa y dos limpiezas quirúrgicas, se otorga alta con cefuroxime acetil vía oral. El cultivo de la muestra ósea desarrolló Mycobacterium tuberculosis. Se inició tratamiento con isoniacida, rifampicina y piracinamida. No fue identificado el caso índice. Discusión: la presentación clínica de la tuberculosis ósea es generalmente insidiosa lo que generando dificultades y retraso en el diagnóstico. Sólo la biopsia permite confirmar el diagnóstico. La situación epidemiológica actual obliga a descartar posible etiología tuberculosa ante un proceso inflamatorio osteoarticular de evolución tórpida. El tratamiento oportuno y adecuado requiere alto índice de sospecha y realización sistemática de punción ósea y/o articular.
Assuntos
Humanos , Feminino , Lactente , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite , Tuberculose/complicações , Tuberculose/diagnóstico , Doenças Transmissíveis Emergentes , Diagnóstico Diferencial , Tuberculose/tratamento farmacológico , Espectroscopia de Ressonância Magnética , Traumatismos do Tornozelo , Pirazinamida/uso terapêutico , Isoniazida/uso terapêutico , Antituberculosos/uso terapêutico , Antibióticos Antituberculose/uso terapêutico , Rifampina/uso terapêuticoRESUMO
Dormancy is characterized by low metabolism and absence of protein synthesis and cellular division enabling bacterial cells to survive under stress. The aim was to determine if carbon starvation and low temperature are factors that modify the proportion of dormant/active cells in Deinococcus sp. UDEC-P1. By flow cytometry, RedoxSensor Green (RSG) was used to quantify metabolic activity and Propidium Iodide (PI) to evaluate membrane integrity in order to determine the percentage of dormant cells. Cell size and morphology were determined using scanning electronic microscopy. Under carbon starvation at 30°C, Deinococcus sp. UDEC-P1 increased its proportion of dormant cells from 0.1% to 20%, decreased the count of culturable cells and average cell volume decreased 7.1 times. At 4°C, however, the proportion of dormant cells increased only to 6%, without a change in the count of culturable cells and an average cellular volume decrease of 4.1 times and 3% of the dormant cells were able to be awakened. Results indicate a greater proportion of dormant Deinococcus sp. UDEC-P1 cells at 30ºC and it suggests that carbon starvation is more deleterious condition at 30ºC than 4ºC. For this reason Deinococcus sp. UDEC-P1 cells are more likely to enter into dormancy at higher temperature as a strategy to survive.