RESUMO
INTRODUCTION: Major orthopedic surgery such as total hip arthroplasty (THA) is associated with an increased risk of postoperative complications. Candidates for THA are often older adults, with comorbidities that increase the risk of major bleeding, the IMPROVE scale has independent actors on the risk of bleeding according to the characteristics of the patients at hospital admission. It foresees the possibility of hemorrhage and the need for blood transfusion, being support in decision-making in the planning of a safe THA with the provision of the necessary resources. OBJECTIVE: To evaluate the sensitivity, validity and reliability of the modified IMPROVE scale in patients undergoing primary total hip arthroplasty. MATERIAL AND METHODS: Study of processes with a sample of 131 patients undergoing primary THA, in the period from January 01, 2018 to July 01, 2018. RESULTS: The scale presents good reliability, as for the performance of the scale, a good sensitivity was obtained, classifying 96.9% of the patients correctly; which is suitable for the type of scale. CONCLUSIONS: The modified IMPROVE scale is a discretely adequate and useful tool for the prognosis of bleeding risk in patients who undergo THA, compared with other assessment scales developed in other geographical areas. It is recommended to continue with the study of risk factors for major bleeding in this specific population.
INTRODUCCIÓN: La cirugía ortopédica mayor, como la artroplastía total de cadera (ATC), se asocia con mayor riesgo de complicaciones postoperatorias. Los candidatos a ATC con frecuencia son adultos mayores, con comorbilidades que aumentan el riesgo de hemorragia mayor. La escala IMPROVE tiene factores independientes sobre el riesgo de sangrado según las características de los pacientes al ingreso hospitalario, prevé la posibilidad de hemorragia y la necesidad de transfusión sanguínea, siendo apoyo en la toma de decisiones en la planeación de ATC seguras con la probabilidad de prever los recursos necesarios. OBJETIVO: Evaluar la sensibilidad, validez y confiabilidad de la escala IMPROVE modificada en los pacientes sometidos a artroplastía total de cadera primaria. MATERIAL Y MÉTODOS: Estudio de procesos con una muestra de 131 pacientes sometidos a ATC primaria, en el período del 01 de Enero al 01 de Julio de 2018. RESULTADOS: La escala presenta una buena confiabilidad, en cuanto al rendimiento se obtuvo una buena sensibilidad, clasificando al 96.9% de los pacientes correctamente, lo cual es adecuado para el tipo de escala. CONCLUSIONES: La escala IMPROVE modificada es una herramienta discretamente adecuada y útil para el pronóstico del riesgo hemorrágico en pacientes que se someten a una ATC primaria comparada con otras escalas de valoración desarrolladas en otras zonas geográficas. Se recomienda seguir con el estudio de los factores de riesgo de sangrado mayor en esta población en específico.
Assuntos
Artroplastia de Quadril , Idoso , Artroplastia de Quadril/efeitos adversos , Transfusão de Sangue , Humanos , Complicações Pós-Operatórias/etiologia , Reprodutibilidade dos Testes , Fatores de RiscoRESUMO
Itolizumab is a humanized anti-CD6 monoclonal antibody (mAb) that has previously shown encouraging results, in terms of safety and positive clinical effects, in a 6-week monotherapy clinical trial conducted in rheumatoid arthritis (RA) patients. The current Phase I study evaluated the safety and clinical response for a longer treatment of 12 itolizumab intravenous doses in subjects with active RA despite previous disease-modifying anti-rheumatic drug (DMARD) therapy. Twenty-one subjects were enrolled into four dosage groups (0·1, 0·2, 0·4 and 0·8 mg/kg). Efficacy end-points including American College of Rheumatology (ACR)20, ACR50 and ACR70 response rates and disease activity score in 28 joints (DAS28) were monitored at baseline and at specific time-points during a 10-week follow-up period. Itolizumab was well tolerated up to the highest tested dose. No related serious adverse events were reported and most adverse events were mild. Remarkably, itolizumab treatment did not produce lymphopenia and, therefore, was not associated with infections. All patients achieved a clinical response (ACR20) at least once during the study. Eleven subjects (55%) achieved at least a 20% improvement in ACR just 1 week after the first itolizumab administration. The clinical response was observed from the beginning of the treatment and was sustained during 24 weeks. The efficacy profile of this 12-week treatment was similar to that of the previous study (6-week treatment). These results reinforce the safety profile of itolizumab and provide further evidence on the clinical benefit from the use of this anti-CD6 mAb in RA patients.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Adolescente , Adulto , Idoso , Antígenos CD/imunologia , Antígenos de Diferenciação de Linfócitos T/imunologia , Cuba , Progressão da Doença , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Seguimentos , Humanos , Linfopenia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Pancreatic ductal adenocarcinoma (PDAC) is a tumor with a very poor prognosis. Most of the patients are diagnosed in advanced stages of the disease, and 5-year survival rates in these patients remains <10%. Surgery still remains the only radical treatment option, although only 15-20% of patients are candidates for surgical resection at the time of the diagnosis. Patients who undergo radical surgery still have a limited survival rate, being the average of 23 months. Three clinical trials have shown that adjuvant chemotherapy therapy after surgery may improve survival: CONKO-1, ESPAC-3, and ESPAC-4. Adjuvant therapy is recommended in patients with R0/R1, T1-4/N1-0 tumors and with ECOG 0-1. In patients with ECOG-2, the decision needs to be individualized. Treatment schemes that have demonstrated efficacy include gemcitabine alone, 5-fluorouracil, or the combination of gemcitabine and capecitabine for six months. Prior to adjuvant treatment, the following test are recommended: Complete blood tests, including CA19.9 biomarker; imaging studies to rule out early disease relapse (preferable thorax-abdomen-pelvic CT). Studies that have evaluated the efficacy of radiation therapy in the adjuvant setting have presented conflicting results. Its use should be considered in patients with R1 or R2 tumors or in those with lymph nodes involved.
Assuntos
Carcinoma Ductal Pancreático/terapia , Terapia Neoadjuvante , Neoplasias Pancreáticas/terapia , Quimiorradioterapia Adjuvante , Humanos , PrognósticoRESUMO
In this study we demonstrated that the vaccine candidate against avian influenza virus H5N1 based on the hemagglutinin H5 (HA) fused to the chicken CD154 (HACD) can also be used for differentiating infected from vaccinated animals (DIVA). As the strategy of DIVA requires at least two proteins, we obtained a variant of the nucleoprotein (NP49-375) in E. coli. After its purification by IMAC, the competence of the proteins NP49-375 and HACD as coating antigens in indirect ELISA assays were tested by using the sera of chickens immunized with the proteins HA and HACD and the reference sera from several avian influenza subtypes. Together with these sera, the sera from different species of birds and the sera of chickens infected with other avian viral diseases were analyzed by competition ELISA assays coated with the proteins NP49-375 and HACD. The results showed that the segment CD154 in the chimeric protein HACD did not interfere with the recognition of the molecule HA by its specific antibodies. Also, we observed variable detection levels when the reference sera were analyzed in the ELISA plates coated with the protein NP49-375. Moreover, only the antibodies of the reference serum subtype H5 were detected in the ELISA plates coated with the protein HACD. The competition ELISA assays showed percentages of inhibition of 88-91% for the positives sera and less than 20% for the negative sera. We fixed the cut-off value of these assays at 25%. No antibody detection was observed in the sera from different species of birds or the sera of chickens infected with other avian viral diseases. This study supported the fact that the ELISA assays using the proteins NP49-375 and HACD could be valuable tools for avian influenza surveillance and as a strategy of DIVA for counteracting the highly pathogenic avian influenza virus H5N1 outbreaks.
RESUMO
The genus Colletotrichum, comprised of pathogenic fungi that affect plants grown worldwide, causes the disease known as anthracnose in several fruit and vegetable species. Several studies conducted on plants have shown that the disease is characterized by the presence of one or several species of the fungus attacking the fruit or other organs of the same host. To develop and implement effective control strategies, it is vital to understand the genetic structure of the fungus in agricultural systems, identify associated Colletotrichum species, and define the subpopulations responsible for the disease. Molecular tools were accordingly developed to characterize genotypic populations of Colletotrichum spp, causal agent of anthracnose in commercial crops of Andean blackberry (Rubus glaucus Benth.). A microsatellite-enriched library for Colletotrichum gloeosporioides was developed to identify and characterize microsatellite loci among isolates collected in R. glaucus plantations. Thirty microsatellites were developed and tested in 36 isolates gathered from eight different blackberry-production areas of Colombia. Ten pairs of microsatellites were polymorphic.
Assuntos
Colletotrichum/isolamento & purificação , Repetições de Microssatélites/genética , Micoses/microbiologia , Rubus/microbiologia , Sequência de Bases , Colletotrichum/genética , Primers do DNA , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
OBJECTIVE: To identify the frequency of geriatric syndromes in patients with a non- recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. MATERIAL AND METHODS: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. RESULTS: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 +/- 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. CONCLUSION: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.
Assuntos
Fraturas do Quadril/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Atenção Primária à Saúde , Síndrome , Fatores de TempoRESUMO
OBJECTIVE: To assess the quality of life of patients with functional knee impairment at a primary health care unit. MATERIAL AND METHODS: Descriptive study of 317 primary health care patients with functional impairment due to gonarthrosis. The WOMAC and SF-36 questionnaires were used to assess functional impairment and quality of life, respectively. We used chi2 and Kendall's Tau-b to prove the hypothesis. RESULTS: 317 patients, 137 (43%) males, 180 (57%) females, mean age 72.46, standard deviation +/- 6.76 with a range of 65-95. Mild functional impairment occurred in 222 (70%) patients; 52.37% of patients had a fair quality of life. When the association between functional impairment and quality of life was studied, chi2 was 106.78, with p = 0.00, the application of Kendall's Tau-b to show a relation was -0.502 with a significant p = 0.00, thus showing the relation between both variables. Both variables were dichotomized and the degree of dependence of quality of life from functional impairment was assessed; 120 (37.85%) patients had poor quality of life and mild functional impairment with chi2 = 75.50, p = 0.00, Kendall's Tau-b = -0.428, p = 0.00. CONCLUSION: The quality of life of patients with gonarthrosis ranges from fair to poor and is directly dependent on the degree of functional impairment.
Assuntos
Artropatias , Articulação do Joelho , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Artropatias/fisiopatologia , Masculino , Atenção Primária à Saúde , Estudos ProspectivosRESUMO
Researchers have classified the Heliconia genus as a group of highly variable and diverse plants. Species and cultivars are visually differentiated primarily on the basis of the color and size of inflorescence bracts. At taxonomic level, flower type (parabolic, sigmoid, or erect) and size are taken into account. The vast morphological diversity of heliconias at intra-specific, intra-population, and varietal levels in central-west Colombia prompted the present study. We characterized the genetic variability of 67 genotypes of cultivated heliconias belonging to Heliconia caribaea Lamarck, H. bihai (L.) L., H. orthotricha L. Andersson, H. stricta Huber, H. wagneriana Petersen, and H. psittacorum L. f., as well as that of several interspecific hybrids such as H. psittacorum L. f. x H. spathocircinata Aristeguieta and H. caribaea Lamarck x H. bihai (L.) L. We also created an approximation to their phylogenetic analysis. Molecular analysis using amplified fragment length polymorphism (AFLP) markers revealed a total of 170 bands. Two large, well-defined groups resulted: the first grouped cultivars of the very closely related H. caribaea and H. bihai species with those of H. orthotricha and H. psittacorum, and the second grouped H. stricta and H. wagneriana cultivars. The lowest percentage of polymorphism was found in H. psittacorum (17.65%) and the highest was in H. stricta (55.88%). Using AFLP, phylogenetic analysis of the species studied revealed the monophyletic origin of the Heliconiaceae family, and identified the Heliconia subgenus as monophyletic while providing evidence of the polyphyletic origin of several representatives of the Stenochlamys subgenus.
Assuntos
Flores/genética , Heliconiaceae/genética , Alelos , Quimera/anatomia & histologia , Quimera/genética , Colômbia , Flores/anatomia & histologia , Genes de Plantas , Marcadores Genéticos , Variação Genética , Heliconiaceae/anatomia & histologia , Filogenia , Polimorfismo de Fragmento de RestriçãoRESUMO
The species Rubus glaucus, also known as the Andean or "Castilla" blackberry, is one of nine edible species of this genus that grow naturally in Central and South America. In Colombia, this species is the most important of all Rubus species for agricultural and commercial purposes. We used 20 SSRs developed for other Rubus species to characterize 44 Colombian R. glaucus genotypes, collected from eight different departments, and to look for molecular differences between thornless and thorny cultivated blackberries. Eighty-two bands were obtained from 28 loci. The genotypes were classified into eight populations, corresponding to collection sites. The mean number of polymorphic alleles per locus in all populations and genotypes ranged from 1.857 to 2.393. Samples collected from Valle del Cauca, Quindío, Caldas, and Risaralda departments had the highest heterozygosity values. The finding of exclusive bands from R. glaucus genotypes from Valle del Cauca, Quindío, and Caldas demonstrates genetic and molecular differentiation between thorny and thornless Andean blackberries.
Assuntos
DNA de Plantas/genética , Repetições de Microssatélites/genética , Rosaceae/genética , Agricultura , Alelos , Cromossomos de Plantas/genética , Genótipo , Polimorfismo de Nucleotídeo ÚnicoRESUMO
INTRODUCTION: Breast cancer is one of the most frequent diseases in women today, and its social impact is devastating. The risk factors focused on in recent research are mainly hormonal, genetic, and environmental though toxic habits, overweight, and obesity have also been studied. In contrast, protective factors against breast cancer include breastfeeding and daily exercise. OBJECTIVE: To ascertain the risk factors for the women with breast cancer in our study sample. MATERIAL AND METHODS: A study of cases and controls was performed on 115 women diagnosed with breast cancer and on 115 healthy women, who had been patients at the National Cancer Institute ISSEMYM in Mexico from January to December 2011. Information was collected from the women in the sample pertaining to their family history of cancer, personal background, life style, and body mass index (BMI). Breast cancer risk was estimated with multivariate logistic regression models and the chi-square test. RESULTS: It was found that there was a greater risk of breast cancer in overweight or obese women who did not do any physical exercise and either who had breastfed their children for a very short time or who had not breastfed them at all. No significant differences were found between breast cancer and toxic habits. CONCLUSIONS: The results of our study found a direct relation between breast cancer and overweight, obesity, and physical inactivity. Breastfeeding during the first months of the baby's life was found to be a protective factor against breast cancer.
Assuntos
Neoplasias da Mama/epidemiologia , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Aleitamento Materno , Criança , Exercício Físico/fisiologia , Feminino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Puberdade Precoce/epidemiologia , Fatores de Risco , Adulto JovemRESUMO
Helicobacter pylori successfully colonizes the gastric niche. These bacteria produce a vacuolating cytotoxin known as VacA, which is codified by the vacA gene. This protein represents an important virulence factor. H. pylori strains have different vacA alleles, which show a variety of phenotypes that have been associated with gastrointestinal diseases. The aim of this study was to generate data about the prevalence of H. pylori and the vacA genotype in Tolima (Colombia) residents, and to evaluate if there exists a relationship between these data and the development of different gastrointestinal pathologies. Seventy three patients with different pathologies were included. The DNA extracted from biopsy specimens was analyzed and the presence of bacteria was determined by amplifying a fragment of the 16 rDNA gene. The vacA genotype was also determined by PCR. Fifty-two percent out of the 50 genotyped samples showed vacA s1m1 allele, 42% vacA s2m2, 4% s1m2, and 2% s1,s2,m1,m2. A higher sensitivity for the detection of H. pylori was evidenced by amplifying the vacA gene rather than the 16S rDNA gene. No association was found between the vacA genotype and the gastrointestinal diseases included in the study.
Assuntos
Proteínas de Bactérias/genética , Gastrite/microbiologia , Genes Bacterianos , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Estômago/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Colômbia/epidemiologia , DNA Bacteriano/genética , DNA Ribossômico/genética , Feminino , Gastrite/epidemiologia , Gastrite/patologia , Genótipo , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/patogenicidade , Humanos , Masculino , Pessoa de Meia-Idade , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Sensibilidade e Especificidade , Estômago/patologia , Virulência/genética , Adulto JovemRESUMO
Helicobacter pylori es una bacteria que coloniza la mucosa gástrica de los humanos. Este microorganismo produce una citotoxina vacuolizante conocida como VacA y codificada por el gen vacA, el que se considera un factor de virulencia importante. Las cepas de H. pylori con diferentes alelos de vacA exhiben una gran variedad de fenotipos, algunos de los cuales han sido asociados con enfermedades gastroduodenales. El presente estudio pretende aportar datos sobre la prevalencia de H. pylori y de los genotipos de vacA en pacientes residentes en Tolima (Colombia), así como determinar la relación entre estos datos y el desarrollo de diferentes patologías gastroduodenales. Se incluyeron en este análisis 73 pacientes con diferentes patologías gástricas. Con el ADN total extraído de cada biopsia, se determinó la presencia de la bacteria mediante la amplificación de un fragmento específico del gen 16S ADNr. También se realizó la genotipificación del gen vacA por PCR. De las 50 muestras genotipificadas, el 52% mostró el alelo vacA s1m1, el 42% el alelo vacA s2m2, el 4% el s1m2 y el 2% los alelos s1,s2,m1,m2. Se evidenció una mayor sensibilidad en la detección de H. pylori por medio del gen vacA que por el gen 16S ADNr. En la población evaluada no se encontró asociación entre el genotipo de vacA y la presencia de las distintas patologías incluidas en este estudio.
Helicobacter pylori successfully colonizes the gastric niche. These bacteria produce a vacuolating cytotoxin known as VacA, which is codified by the vacA gene. This protein represents an important virulence factor. H. pylori strains have different vacA alleles, which show a variety of phenotypes that have been associated with gastrointestinal diseases. The aim of this study was to generate data about the prevalence of H. pylori and the vacA genotype in Tolima (Colombia) residents, and to evaluate if there exists a relationship between these data and the development of different gastrointestinal pathologies. Seventy three patients with different pathologies were included. The DNA extracted from biopsy specimens was analyzed and the presence of bacteria was determined by amplifying a fragment of the 16 rDNA gene. The vacA genotype was also determined by PCR. Fifty-two percent out of the 50 genotyped samples showed vacA s1m1 allele, 42% vacA s2m2, 4% s1m2, and 2% s1,s2,m1,m2. A higher sensitivity for the detection of H. pylori was evidenced by amplifying the vacA gene rather than the 16S rDNA gene. No association was found between the vacA genotype and the gastrointestinal diseases included in the study.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Proteínas de Bactérias/genética , Genes Bacterianos , Gastrite/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Estômago/microbiologia , Biópsia , Colômbia/epidemiologia , DNA Bacteriano/genética , DNA Ribossômico/genética , Genótipo , Gastrite/epidemiologia , Gastrite/patologia , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/patogenicidade , RNA Bacteriano/genética , /genética , Sensibilidade e Especificidade , Estômago/patologia , Virulência/genéticaRESUMO
Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.
La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro delas complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientesque presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria.También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y elequipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A).Su beneficio es aún incierto en pacientes con IRA secundaria a síndrome de dificultad respiratoria aguda, salvoen el subgrupo de pacientes inmunosuprimidos (Recomendación B). Los resultados son también favorablesen la desvinculación de la asistencia respiratoria mecánica (ARM), especialmente en pacientes ventilados por exacerbación de EPOC (Recomendación A). En la insuficiencia respiratoria crónica se ha hallado mejoría en la calidad de vida y mayor sobrevida en pacientes con enfermedades restrictivas (Recomendación B), mientrasque existe aún controversia sobre su utilidad en pacientes con EPOC estable (Recomendación C). La VNI debeser aplicada con estándares de cuidados que son establecidos. Se revisan las eventuales complicaciones derivadasde su uso y el beneficio costo-efectividad ahorrando recursos de mayor complejidad y disminuyendolos riesgos que implica la ARM invasiva.
Assuntos
Humanos , Insuficiência Respiratória/terapia , Respiração Artificial/métodos , Ventiladores Mecânicos , Doença Aguda , Argentina , Doença Crônica , Análise Custo-Benefício , Desmame do Respirador/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/fisiopatologia , Respiração Artificial/efeitos adversos , Respiração Artificial/normas , Ventiladores Mecânicos/normasRESUMO
Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.(AU)
La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro delas complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientesque presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria.También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y elequipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A).Su beneficio es aún incierto en pacientes con IRA secundaria a síndrome de dificultad respiratoria aguda, salvoen el subgrupo de pacientes inmunosuprimidos (Recomendación B). Los resultados son también favorablesen la desvinculación de la asistencia respiratoria mecánica (ARM), especialmente en pacientes ventilados por exacerbación de EPOC (Recomendación A). En la insuficiencia respiratoria crónica se ha hallado mejoría en la calidad de vida y mayor sobrevida en pacientes con enfermedades restrictivas (Recomendación B), mientrasque existe aún controversia sobre su utilidad en pacientes con EPOC estable (Recomendación C). La VNI debeser aplicada con estándares de cuidados que son establecidos. Se revisan las eventuales complicaciones derivadasde su uso y el beneficio costo-efectividad ahorrando recursos de mayor complejidad y disminuyendolos riesgos que implica la ARM invasiva.(AU)
Assuntos
Humanos , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Ventiladores Mecânicos , Doença Aguda , Argentina , Doença Crônica , Análise Custo-Benefício , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/efeitos adversos , Respiração Artificial/normas , Insuficiência Respiratória/fisiopatologia , Desmame do Respirador/normas , Ventiladores Mecânicos/normasRESUMO
Thiopurine methyltransferase (TPMT) catalyzes the inactivation of thiopurine drugs (mercaptopurine, thioguanine and azathioprine) used to treat acute lymphoblastic leukemia, autoimmune diseases and recipients of transplanted organs. No endogenous substrates for this enzyme are known. The TPMT polymorphism is a major determinant of individual differences in the toxicity or therapeutic efficacy of these drugs. The molecular basis of this polymorphism has been established in Caucasians, Africans, African-Americans and Asians, but not yet in the heterogeneous Latin American groups, including the Colombian population. The frequency of the four allelic variants of the TPMT gene, TPMT*2 (G238C), TPMT*3A (G460A and A719G), TPMT*3B (G460A) and TPMT*3C (A719G), were determined in 140 Colombian volunteers of Mestizo origin, using allele-specific PCR and PCR-RFLP assays. The *3A allele was found in 10 samples and the *2 allele in one, all heterozygotes; neither homozygous mutant genotypes nor the *3B and *3C alleles were detected. In agreement with these results, 92.1% and 7.9% of the Colombian population correspond to the phenotypes high and intermediate methylators, respectively. These results show that the frequency of mutations and the allelic distribution of the TPMT gene in the Colombian population are similar to the genetic profile found among US and European Caucasian populations, where the *3A allele is prevalent and the *2 allele is currently present.
Assuntos
Metiltransferases/genética , Adulto , Alelos , Colômbia , Eletroforese em Gel de Ágar , Éxons , Feminino , Frequência do Gene , Genótipo , Humanos , Masculino , Reação em Cadeia da Polimerase , Polimorfismo Genético , Polimorfismo de Fragmento de RestriçãoRESUMO
Calcium (Ca) is important in bone formation and as aging progresses, bone loss gradually occurs. With the onset of menopause, reduced estrogen levels and insufficient Ca in the diet often create serious problems with fractures. Since little is known about the diet and other factors related to risk factors in postmenopausal women in northern Mexico, it was the objective of this study to determine the effects of dietary Ca and phosphorus (P) and their excretion, anthropometric measurements, and blood serum estradiol on bone density in women aged 45-63 years. No studies are available on the dietary intake of Ca and P and the effects on bone mineral density (BMD) in postmenopausal women in northern Mexico, so this study reports some of the first data on this population. Women with an average age of 55 years showed a positive relation of Ca intake and Ca excretion, however, dietary intake of Ca and P had no relation to bone density. Age, urinary Ca, Ca/creatinine and years of postmenopause had the highest negative correlation. Weight and body mass index had a positive correlation with BMD in the forearm and heel. Only 15% of the women met the recommendation of 1,500 mg/day of Ca. A high Ca/creatinine ratio has been proposed to indicate excess Ca excretion and subsequent bone density loss. Thirty-five percent of the women exceed the Ca/creatinine indicator of >0.16. In this study, 1% of the subjects were classified as osteoporotic and 37% as osteopenic.
Assuntos
Densidade Óssea/efeitos dos fármacos , Cálcio da Dieta/administração & dosagem , Osteoporose Pós-Menopausa/prevenção & controle , Fósforo na Dieta/administração & dosagem , Absorciometria de Fóton , Envelhecimento/fisiologia , Cálcio da Dieta/urina , Creatinina/urina , Proteínas Alimentares/administração & dosagem , Estradiol/sangue , Feminino , Humanos , Rememoração Mental , México , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/patologia , Fósforo na Dieta/urina , Pós-MenopausaRESUMO
INTRODUCTION: Duchenne/Becker muscular dystrophy (DMD/B) is one of the commonest myopathies, with an incidence of 1/3,500 male live births. It is characterized by the slow degeneration of muscle fibres, so that the patient has become an invalid by the age of 10 years, followed by death from respiratory or cardiac failure. It has a sex linked recessive mode of inheritance. DEVELOPMENT: The gene causing this disorder is the DMD gene and is found on the short arm of the X chromosome. The commonest mutations of this gene are deletions. Many molecular techniques for study of the disorder have been developed over the years. These include the Southern Blot, polymerase chain reaction (PCR), use of the Short Tandem Repeat (STR), polymorphic length restriction fragments (RFLP), Western Blot for the study of the protein and others. CONCLUSIONS: In this paper we review the diagnostic tests most widely used in this disease. These have permitted improved study of the various families affected and thus improved the quality of life of the families at risk.
Assuntos
Biologia Molecular/instrumentação , Distrofia Muscular de Duchenne/diagnóstico , Western Blotting , Enzimas de Restrição do DNA/genética , Distrofina/genética , Eletromiografia/instrumentação , Eletrorretinografia/instrumentação , Marcadores Genéticos , Humanos , Fibras Musculares Esqueléticas/patologia , Distrofia Muscular de Duchenne/genética , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de RestriçãoRESUMO
In this study the effect of calcium absorption on some physical properties and composition of rat femurs was evaluated, comparing rats fed with raw whole corn (RC), tortillas made from extruded masa with 0.25% lime content (TEWL) and without lime (TE), and nixtamal tortillas (NT). The diets were formulated to contain the same amount of protein, oil, fiber, vitamins and minerals other than calcium. In all diets 0.20% calcium was added. At the end of the trials, the femurs were extracted, weighed and measured for ash, calcium and phosphorus content, some physical dimensions, and the crystallinity percentage. The femurs of rats fed with TEWL and NT were heavier, thicker, longer and had higher calcium content. On the other hand, the force required to break the femur of rats fed on ETWL and NT was 1.25 kg greater than that required to break the femurs of rats fed with RC. Higher crystallinity percentage values were observed in the femurs of the rats fed with NT (37.66%) and TEWL (36.98%) as compared to a 30.31% value obtained with the RC.