RESUMO
Resumen El síndrome metabólico (SM) se asocia con alteraciones metabólicas e inflamatorias que imprimen un mayor riesgo de desarrollar diabetes y enfermedades cardiovasculares y tiene como base la resistencia insulínica. La alimentación, sedentarismo, educación y distribución del ingreso pueden influir en la aparición del SM. El objetivo del estudio fue conocer la prevalencia del SM y los factores de riesgo cardiovascular asociados en una población vulnerable, adulta y urbana, que acudió voluntariamente luego de una campaña de difusión, a un hospital de atención primaria en la ciudad de San Luis, Argentina. En 451 sujetos, 205 hombres y 246 mujeres (45,5±12,4 años) se analizaron datos personales, antropométricos y biomarcadores: colesterol total, colesterol HDL (c-HDL), colesterol LDL, triglicéridos, glucosa, insulina, proteína C reactiva ultrasensible (PCRus), apolipoproteínas A y B, ácido úrico e índices subrogados de insulina. El SM se estableció empleando la definición armonizada de SM (2009). El 80% de la población no completó la educación formal. Los hombres estaban desempleados o con trabajo informal (70%). El 51,4% de la población cumplía con el criterio de SM (50,0% mujeres y 53,1% hombres). Entre los componentes del SM, la tríada más frecuente en mujeres y hombres, fue: c-HDL disminuido, circunferencia de cintura elevada e hipertrigliceridemia. El SM aumentó con la edad en los hombres. Las mujeres con SM presentaron niveles altos de PCRus. El conocimiento de la prevalencia local, tanto de la obesidad como del SM, permite valorar la magnitud del problema en cada comunidad, establecer medidas de prevención, control y compararlo con otras realidades epidemiológicas.
Abstract Metabolic syndrome (MS) is associated with metabolic and inflammatory alterations that increase the risk of developing diabetes and cardiovascular diseases, based on insulin resistance. Diet, sedentary lifestyle, education and income distribution can influence the appearance of MS. The objective of the study was to know the prevalence of MS and associated cardiovascular risk factors in a vulnerable, adult and urban population, that voluntarily attends after diffusion campaign, to a primary care hospital in the city of San Luis, Argentina. In 451 subjects, 205 men and 246 women (45.5±12.4 years), personal, anthropometric and biomarker data were analysed: total cholesterol HDL cholesterol (HDL-c), LDL cholesterol, triglycerides, glucose, insulin, ultrasensitive C-reactive protein (usCRP), apolipoproteins A and B, uric acid and insulin surrogate indices. The MS was established using the harmonised definition of MS (2009). Eighty percent of the population did not complete formal education. Men were unemployed or in informal work (70%). A total of 51.4% of the population had the MS criteria (50.0% women and 53.1% men). Among the components of MS, the most frequent triad in women and men, were: decreased HDL-c, elevated waist circumference and hypertriglyceridemia. The prevalence of MS increased with age in men. Women with MS presented high levels of usCRP. Knowledge of the local prevalence of both obesity and MS would allow enable the assessment of the magnitude of the problem in each community, establish prevention and control measures, and compare it with other epidemiological realities.
Resumo A síndrome metabólica (SM) está associada a alterações metabólicas e inflamatórias que aumentam o risco de desenvolvimento de diabetes e doenças cardiovasculares, considerando a resistência à insulina. A alimentação, o sedentarismo, a escolaridade e a distribuição de renda podem influenciar o aparecimento da SM. O objetivo do estudo foi conhecer a prevalência da SM e os fatores de risco cardiovascular associados em uma população vulnerável, adulta e urbana, que compareceu voluntariamente a um hospital de atenção primária na cidade de San Luis, Argentina, após uma campanha de divulgação. Em 451 indivíduos, 205 homens e 246 mulheres (45,5±12,4 anos), foram analisados dados pessoais, antropométricos e de biomarcadores: colesterol total, colesterol HDL (c-HDL), colesterol LDL, triglicerídeos, glicose, insulina, proteína C reativa ultrassensível (PCRus), apolipoproteínas A e B, ácido úrico e índices substitutos de insulina. A SM foi estabelecida utilizando a definição harmonizada de SM (2009). Oitenta por cento da população não concluiu a educação formal. Os homens estavam desempregados ou em trabalho informal (70%). 51,4% da população atendia os critérios da SM (50,0% mulheres e 53,1% homens). Dentre os componentes da SM, a tríade mais frequente em mulheres e homens: c-HDL diminuído, circunferência abdominal elevada e hipertrigliceridemia. SM aumentou com a idade nos homens. Mulheres com SM apresentaram níveis elevados de PCRus. O conhecimento da prevalência local da obesidade quanto da SM permite avaliar a magnitude do problema em cada comunidade, estabelecer medidas de prevenção e controle e compará-lo com outras realidades epidemiológicas.
RESUMO
Se presenta el caso de un lactante de 2 meses que fue llevado a consulta varias veces por llanto problemático, inicialmente interpretado como de causa gastrointestinal. Dado que el síntoma persistía, se sospechó de una fractura debido a su asociación con la movilización de los miembros y la palpación de una tumoración en la cara anterior de la tibia derecha. Las radiografías mostraron compromiso poliostótico diafisario y lesiones compatibles con compromiso cortical de huesos largos. Se realizó el diagnóstico operativo de síndrome de Caffey-De Toni-Silverman y se inició el tratamiento con antiinflamatorios no esteroideos, lo que resultó en una remisión sintomática. Posteriormente, se confirmó el diagnóstico mediante la identificación de la variante patogénica COL1A1 en estado heterocigota. Se trata de una patología rara de la cual se estima una incidencia de 48/100 000 y hay menos de 150 casos descritos al momento.
Here we describe the case of a 2-month-old infant who consulted several times due to excessive crying, initially interpreted as having a gastrointestinal cause. Since the symptom persisted, a fracture was suspected due to its association with mobilization of the limbs and palpation of a mass on the anterior aspect of the right tibia. X-rays showed diaphyseal polyostotic involvement and lesions compatible with cortical involvement of long bones. Caffey-De Toni-Silverman syndrome was diagnosed and treatment with nonsteroidal anti-inflammatory drugs was initiated, resulting in symptom remission. Subsequently, the diagnosis was confirmed by the identification of the pathogenic heterozygous variant COL1A1. This is a rare condition with an estimated incidence of 48/100 000 individuals, and less than 150 cases have been described to date.
Assuntos
Humanos , Masculino , Lactente , Choro , Hiperostose Cortical Congênita/diagnóstico , Colágeno Tipo I/genética , Cadeia alfa 1 do Colágeno Tipo IRESUMO
Introducción. La pandemia por COVID-19 ha tenido un impacto profundo en la salud de la población joven de todo el mundo y especialmente en personas con trastornos de la conducta alimentaria (TCA) por situaciones de estrés, ansiedad y cambios en el acceso a la atención médica. Objetivo. Explorar las percepciones de adolescentes sobre los cambios en sus vínculos sociales y modalidades de atención en pacientes con TCA. Población y métodos. Se realizó un estudio cualitativo a través de entrevistas en profundidad a adolescentes con TCA en un hospital universitario durante la pandemia por COVID-19. Resultados. Se entrevistó a 15 adolescentes; el 93 % fueron mujeres y la mediana de edad fue 18 años. El 86,6 % tuvo anorexia nerviosa. Los aspectos negativos percibidos más importantes fueron los malestares en la convivencia familiar (80 %) y la disconformidad con los contenidos de las redes sociales sobre la imagen corporal y dietas (73 %). Los aspectos percibidos positivos fueron la ayuda de los pares (66 %) y mejoras en relación con la alimentación (66 %). El principal cambio identificado en comparación con el tratamiento recibido previo a la pandemia por COVID-19 fue el seguimiento virtual por salud mental (73 %). Conclusión. La población adolescente con TCA durante el ASPO manifestó malestar en la convivencia familiar y disconformidad en los contenidos en redes sociales sobre imagen corporal y dietas. Aunque resaltaron como aspectos positivos la ayuda de los pares y mejoras en su alimentación
Introduction. The COVID-19 pandemic has had a profound impact on the health of young people worldwide, especially on people with eating disorders (EDs) due to the stress, anxiety, and changes experienced in access to health care. Objective. To explore adolescents' perceptions on changes in their social ties and the modalities of health care for patients with EDs. Population and methods. Qualitative study using in-depth interviews with adolescents with EDs seen at a teaching hospital during the COVID-19 pandemic. Results. Fifteen adolescents were interviewed; their mean age was 18 years; 93% were girls. Anorexia nervosa was observed in 86.6%. The most relevant negative aspects perceived were discomfort with family life (80%) and dissatisfaction with social media content regarding body image and dieting (73%). The aspects perceived as positive were peer support (66%) and improvements in eating habits (66%). The main change identified regarding the management before the COVID-19 pandemic was online followup by the mental healthcare team (73%). Conclusion. The adolescent population with EDs during the mandatory social isolation period reported discomfort with family life and dissatisfaction with social media content regarding body image and dieting. Notwithstanding this, adolescents highlighted peer support and improvements in their eating habits as positive aspects.
Assuntos
Humanos , Feminino , Adolescente , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , COVID-19/psicologia , COVID-19/epidemiologia , Isolamento Social/psicologia , Apoio Social , Imagem Corporal/psicologia , Pesquisa Qualitativa , Pandemias , Mídias SociaisRESUMO
This pilot cross-sectional study was designed to determine the profile of obstetric violence in Ecuador in recent years. An online survey was conducted between March 2022 and April 2022, including women over 18 years who granted their informed consent to participate (n = 1598). We used non-probabilistic sampling to obtain our sample. Fisher's exact test was performed to assess the association between violence and type of birth, healthcare facility, and education level. Out of the women who participated in the study, 89.2% (n = 1426) identified themselves as Mestiza. Additionally, 88.3% (n = 1411) had completed university-level education. The majority of the participants, specifically 63.6% (n = 1017), received their care in public institutions, and 98.2% (n = 1569) reported structural negligence, while 74.5% (n = 1190) reported violation of their right to information. The entire sample affirmed to have experienced violation of the right of presence. This report shows that obstetric violence is present in Ecuador in different ways and that women experience negligence and violation of their right to receive ethical healthcare during childbirth.
RESUMO
Catalases are essential enzymes for removal of hydrogen peroxide, enabling aerobic and anaerobic metabolism in an oxygenated atmosphere. Monofunctional heme catalases, catalase-peroxidases, and manganese catalases, evolved independently more than two billion years ago, constituting a classic example of convergent evolution. Herein, the diversity of catalase sequences is analyzed through sequence similarity networks, providing the context for sequence distribution of major catalase families, and showing that many divergent catalase families remain to be experimentally studied.
Assuntos
Catalase , Evolução Molecular , Catalase/química , Catalase/genética , Catalase/metabolismo , Humanos , Animais , Peróxido de Hidrogênio/metabolismo , Peróxido de Hidrogênio/química , Heme/química , Heme/metabolismoRESUMO
The genomic characteristics of Peruvian patients with gastric adenocarcinoma from diverse socioeconomic backgrounds were examined in consideration of the possibility that patients from different socioeconomic backgrounds may be exposed to different risk factors. We conducted a prospective pilot study in two Peruvian cities (Lima and Ica). This study enrolled 15 patients from low socioeconomic status (LSES) and 15 patients from medium/high socioeconomic status (MHSES). The genomic profiling of gastric adenocarcinoma samples was done through the FoundationOne CDx platform. We compared the genomic characteristics and the need for targeted therapy and immunotherapy between LSES and MHSES. The genes with higher rates of alterations were TP53 (73.3% vs. 50.0%, P = 0.2635); CDH1 (26.7% vs. 28.6%, P = 1); CDKN2A (20.0% vs. 28.6%, P = 1); KRAS (33.3% vs. 7.1%, P = 0.1686); ARID1A (20.0% vs. 14.3%, P = 1); MLL2 (13.3% vs. 21.4%, P = 1) and SOX9 (33.3% vs. 0.0%, P = 0.0421) in LSES versus HMSES, respectively. There was no significant difference in tumor mutational burden (P = 0.377) or microsatellite status (P = 1). The LSES group had a higher need for targeted therapy or immunotherapy according to gene involvement and alterations. A significant genomic difference exists among patients with gastric adenocarcinoma of different socioeconomic status, which may result in a different need for targeted therapy and immunotherapy.
Assuntos
Neoplasias Gástricas , Humanos , Neoplasias Gástricas/genética , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adenocarcinoma/genética , Estudos Prospectivos , Genômica/métodos , Peru/epidemiologia , Projetos Piloto , Adulto , Fatores Socioeconômicos , Mutação , Classe Social , Disparidades Socioeconômicas em SaúdeRESUMO
BACKGROUND: The description of local seasonality patterns in respiratory syncytial virus (RSV) incidence is important to guide the timing of administration of RSV immunization products. METHODS: We characterized RSV seasonality in Guatemala using the moving epidemic method (MEM) with absolute counts of RSV-associated acute respiratory infections (ARI) from hospital surveillance in Santa Rosa and Quetzaltenango departments of Guatemala. RESULTS: From Week 17 of 2008 through Week 16 of 2018, 8487 ARI cases tested positive for RSV by rRT-PCR. Season onsets varied up to 5 months; early seasons starting in late May to early August and finishing in September to November were most common, but late seasons starting in October to November and finishing in March to April were also observed. Both epidemic patterns had similar durations ranging from 4 to 6 months. Epidemic thresholds (the levels of virus activity that signal the onset and end of a seasonal epidemic) calculated prospectively using previous seasons' data captured between 70% and 99% of annual RSV detections. Onset weeks differed by 2-10 weeks, and offset weeks differed by 2-16 weeks between the two surveillance sites. CONCLUSIONS: Variability in the timing of seasonal RSV epidemics in Guatemala demonstrates the difficulty in precisely predicting the timing of seasonal RSV epidemics based on onset weeks from past seasons and suggests that maximal reduction in RSV disease burden would be achieved through year-round vaccination and immunoprophylaxis administration to at-risk infants.
Assuntos
Epidemias , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Estações do Ano , Guatemala/epidemiologia , Humanos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Vírus Sincicial Respiratório Humano/isolamento & purificação , Lactente , Pré-Escolar , Incidência , Feminino , Masculino , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , CriançaRESUMO
Chronic kidney disease (CKD) is a growing global public health challenge worldwide. In Mexico, CKD prevalence is alarmingly high and remains a leading cause of morbidity and mortality. Diabetic kidney disease (DKD), a severe complication of diabetes, is a leading determinant of CKD. The escalating diabetes prevalence and the complex regional landscape in Mexico underscore the pressing need for tailored strategies to reduce the burden of CKD. This narrative review, endorsed by the Mexican College of Nephrologists, aims to provide a brief overview and specific strategies for healthcare providers regarding preventing, screening, and treating CKD in patients living with diabetes in all care settings. The key topics covered in this review include the main cardiometabolic contributors of DKD (overweight/obesity, hyperglycemia, arterial hypertension, and dyslipidemia), the identification of kidney-related damage markers, and the benefit of novel pharmacological approaches based on Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA). We also address the potential use of novel therapies based on Mineralocorticoid Receptor Antagonists (MRAs) and their future implications. Emphasizing the importance of multidisciplinary treatment, this narrative review aims to promote strategies that may be useful to alleviate the burden of DKD and its associated complications. It underscores the critical role of healthcare providers and advocates for collaborative efforts to enhance the quality of life for millions of patients affected by DKD.
RESUMO
Crops contamination with aflatoxins (AFs) and zearalenone (ZEA) threaten human and animal health; these mycotoxins are produced by several species of Aspergillus and Fusarium. The objective was to evaluate under field conditions the influence of the wet season on the dissemination of AF- and ZEA-producing fungi via houseflies collected from dairy farms. Ten dairy farms distributed in the semi-arid Central Mexican Plateau were selected. Flies were collected in wet and dry seasons at seven points on each farm using entomological traps. Fungi were isolated from fly carcasses via direct seeding with serial dilutions and wet chamber methods. The production of AFs and ZEA from pure isolates was quantified using indirect competitive ELISA. A total of 693 Aspergillus spp. and 1274 Fusarium spp. isolates were obtained, of which 58.6% produced AFs and 50.0% produced ZEA (491 ± 122; 2521 ± 1295 µg/kg). Houseflies and both fungal genera were invariably present, but compared to the dry season, there was a higher abundance of flies as well as AF- and ZEA-producing fungi in the wet season (p < 0.001; 45.3/231 flies/trap; 8.6/29.6% contaminated flies). These results suggest that rainy-weather conditions on dairy farms increase the spread of AF- and ZEA-producing Aspergillus spp. and Fusarium spp. through houseflies and the incorporation of their mycotoxins into the food chain.
Assuntos
Aflatoxinas , Aspergillus , Indústria de Laticínios , Fusarium , Moscas Domésticas , Estações do Ano , Zearalenona , Animais , Fusarium/metabolismo , México , Aspergillus/metabolismo , Aspergillus/isolamento & purificação , Aflatoxinas/biossíntese , Moscas Domésticas/microbiologia , Contaminação de Alimentos/análise , FazendasRESUMO
Cellulose modified hydrogels can be produced directly from raw biopolymers in novel cellulose solvents such as NaOH/urea aqueous solution. The effect of cellulose characteristics on the synthesis of a cellulose-graft-(net-poly(acrylamide-co-acrylic acid)) and its performance as water absorbent/methylene blue dye removal material is analyzed. Three cellulose samples, one analytical grade and two obtained from teak wood sawdust with different pretreatments (one alkaline and the other, a novel one known as (gas phase) acid pretreatment) were compared. The starting raw celluloses were characterized by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), X-ray diffraction (XRD) and viscosity in cupri ethylenediamine hydroxide (CED) solution, whereas the chemically modified materials were characterized by SEM, FTIR, and TGA. The pretreatment used influences composition, crystallinity index and degree of polymerization (DP) of the cellulose obtained. The modified material produced with cellulose from alkaline pretreatment showed the highest swelling ratio in water absorption tests at room temperature (12,714 %); in contrast, the one with cellulose from acid pretreatment showed the lowest swelling ratio (7,470 %). However, this difference is not so significative in dye removal tests, where absorption capacity is 139 and 140 mg/g, respectively. The results indicate that cellulose composition, particularly structures with significant hemicellulose and lignin remaining content, has a major effect on the performance of modified materials for water absorption, and degree of polymerization has a major effect on adsorption capacity of methylene blue.
Assuntos
Celulose , Corantes , Lignina , Água , Madeira , Lignina/química , Celulose/química , Água/química , Madeira/química , Corantes/química , Resinas Acrílicas/química , Azul de Metileno/química , Espectroscopia de Infravermelho com Transformada de Fourier , Difração de Raios X , Purificação da Água/métodos , Poluentes Químicos da Água/química , Acrilamidas/químicaRESUMO
Ataxia-telangiectasia (AT) is a rare genetic disorder leading to neurological defects, telangiectasias, and immunodeficiency. We aimed to study the clinical and immunological features of Latin American patients with AT and analyze factors associated with mortality. Referral centers from 9 Latin American countries participated in this retrospective cohort study, and 218 patients were included. Median (IQR) ages at symptom onset and diagnosis were 1.0 (1.0-2.0) and 5.0 (3.0-8.0) years, respectively. Most patients presented recurrent airway infections, which was significantly associated with IgA deficiency. IgA deficiency was observed in 60.8% of patients and IgG deficiency in 28.6%. T- and B-lymphopenias were also present in most cases. Mean survival was 24.2 years, and Kaplan-Meier 20-year-survival rate was 52.6%, with higher mortality associated with female gender and low IgG levels. These findings suggest that immunologic status should be investigated in all patients with AT.
Assuntos
Ataxia Telangiectasia , Humanos , Feminino , Masculino , América Latina/epidemiologia , Ataxia Telangiectasia/mortalidade , Ataxia Telangiectasia/imunologia , Ataxia Telangiectasia/diagnóstico , Estudos Retrospectivos , Criança , Pré-Escolar , Adulto , Adolescente , Lactente , Síndromes de Imunodeficiência/mortalidade , Síndromes de Imunodeficiência/epidemiologia , Síndromes de Imunodeficiência/imunologia , Adulto JovemRESUMO
[This corrects the article DOI: 10.1371/journal.pone.0280528.].
RESUMO
Introduction: Surgical campaigns for thyroid surgery in low-income environments are very efficient, but there is little literature reporting results. These campaigns are complex due to multiple particularities: highly evolved cases, the need for professionals to travel or an obvious socio-cultural barrier influence towards the surgical act. We describe a surgical campaign in Cameroon to treat patients with goiter and issue some medical and sociocultural recommendations in view of our experience for its implementation with guarantees. Material and methods: An experienced group carried out an 11-day campaign at the Saint Martin de Porres Dominican Hospital, Yaounde, Cameroon. Demographic data, TSH values, surgery and complications after a 12-month follow-up were analyzed. Results: Thirty-eight patients with goiter were selected for the campaign and 32 patients (mean age, 40-years-old; 30 females) were operated. Bilateral goiter, as assessed with echography, was diagnosed in 13 patients (41%). Ten patients (31%) had a WHO grade II goiter (visible with the neck in a normal position). The surgical procedures were 18 unilateral thyroidectomy with isthmectomie, 13 total thyroidectomy, and 1 totalizing thyroidectomy, due to previous unilateral thyroidectomy (cancer recurrence). A pathological study in 13 patients (40%, extra cost 60 ) showed benign multinodular goiter/thyroid nodule (12 patients) and an extensive papillary carcinoma (one patient). Six months postoperatively, 3 patients had a slight dysphonia and one patient had persistent hypocalcemia. Follow-up was completed in all patients, either face to face (75%, 24 patients) or by phone (25%, 8 patients who failed to have a TSH test because of its cost, 23 ). Conclusions: Surgical campaigns to treat thyroid pathology can be carried out with guarantees if a series of important steps are followed: active participation of the patient's environment, thyroid ultrasound by the surgical team to decide which technique, intense awareness about monitoring and hormone replacement therapy, and the participation of local personnel for long-term follow-up.
Assuntos
Tireoidectomia , Humanos , Feminino , Camarões , Masculino , Adulto , Pessoa de Meia-Idade , Bócio/cirurgia , Recursos em Saúde , Adulto Jovem , HospitaisRESUMO
Physical inactivity represents a global challenge in public health, being the second most significant factor contributing to mortality. In Latin America, the prevalence of physical inactivity and sedentary behaviour is notable, affecting medical students as well, who play a crucial role as behavioural role models for the population. This study addresses the prevalence of physical activity and sedentary behaviour among medical students in Latin America during the year 2023. A total of 864 participants from 12 institutions across eight countries were surveyed using the Global Physical Activity Questionnaire. Significant variations in physical activity and sedentary behaviour were observed according to sex, age, body mass index, academic year, and country. Notably, Costa Rica exhibited the highest levels of moderate physical activity in leisure time (90 min/day). Strength training was more common among men (60 min/day) and in Argentina (60 min/day). Sedentary behaviour was higher in women (420 min/day) and during the first academic year (485 min/day). Uruguay stood out with high levels of sedentary behaviour (600 min/day). Correlations indicated positive moderate associations between academic year and moderate leisure-time PA (r:0,128, p:0,007). In conclusion, there are associations between the level of physical activity and sedentary behaviour with the variables studied in this research, with the main findings being that the female sex has more time spent in sedentary behaviour (minutes/day) and less time spent in strength training (minutes/day). Additionally, there are higher levels of sedentary behaviour in the early years of medical study compared to the later years of the program.
Assuntos
Índice de Massa Corporal , Comportamento Sedentário , Estudantes de Medicina , Humanos , Masculino , Feminino , Estudantes de Medicina/estatística & dados numéricos , Estudantes de Medicina/psicologia , América Latina , Adulto Jovem , Adulto , Inquéritos e Questionários , Exercício Físico , Fatores Sexuais , Fatores Etários , AdolescenteRESUMO
BACKGROUND: The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. OBJECTIVE: The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). METHODS: We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. RESULTS: We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. CONCLUSION: A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.
Assuntos
COVID-19 , Unidades de Terapia Intensiva , Melhoria de Qualidade , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Argentina , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Feminino , Equipamento de Proteção Individual/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Atenção à Saúde/normas , Adulto , Saúde Pública/métodos , Pessoal de Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Análise de Séries Temporais Interrompida/métodosRESUMO
INTRODUCTION: Venous thromboembolism (VTE) is a serious, frequent, and preventable medical complication in hospitalized patients. Although the efficacy of prophylaxis (pharmacological and/or mechanical) has been demonstrated, compliance with prophylaxis is poor at international and national levels. AIM: To determine the indication and use of pharmacological thromboprophylaxis in hospitalized patients in Uruguay. METHODS: An observational, descriptive, cross-sectional, multicentre study involving 31 nationwide healthcare facilities was conducted. Baseline characteristics associated with hospital admission, the percentage of the population with an indication for thromboprophylaxis, and the percentage of patients receiving pharmacological thromboprophylaxis were assessed. The VTE risk was determined using the Padua score for medical patients; the Caprini score for surgical patients; the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for pregnant-postpartum patients. RESULTS: 1925 patients were included, representing 26% of hospitalized patients in Uruguay. 71.9% of all patients were at risk of VTE. Of all patients at risk of VTE, 58.6% received pharmacological thromboprophylaxis. The reasons for not receiving thromboprophylaxis were prescribing omissions in 16.1% of cases, contraindication in 15.9% and 9.4% of patients were already anticoagulated for other reasons. Overall, just 68% of patients were "protected" against VTE. Recommendations of major thromboprophylaxis guidelines were followed in 70.1% of patients at risk. CONCLUSIONS: Despite the progress made in adherence to thromboprophylaxis indications, nonadherence remains a problem, affecting one in six patients at risk of VTE in Uruguay.
Assuntos
Hospitalização , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Uruguai , Feminino , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Adulto , Fatores de Risco , Idoso , Fidelidade a Diretrizes/estatística & dados numéricos , Gravidez , Anticoagulantes/uso terapêuticoRESUMO
Three-dimensional cell cultures have improved the evaluation of drugs for cancer therapy, due to their high similarity to solid tumors. In melanoma, autophagy appears to show a dual role depending on the progression of the disease. p62 protein has been proposed for the evaluation of autophagic flux since its expression is an indicator of the state of autophagy. Pentoxifylline (PTX) and Norcantharidin (NCTD) are drugs that have been shown to possess anticancer effects. In this work, we used B16F1 mouse melanoma cells in two-dimensional (2D) monolayer cultures and three-dimensional (3D) spheroids to test the effect of PTX and NCTD over the p62 expression. We analyzed the effect on p62 expression through Western blot and immunofluorescence assays. Our results indicate that PTX decreases p62 expression in both cell culture models, while Norcantharidin increases its expression in 3D cultures at 24 h. Therefore, these drugs could have a potential therapeutic use for the regulation of autophagy in melanoma, depending on the state of evolution of the disease.
Assuntos
Autofagia , Compostos Bicíclicos Heterocíclicos com Pontes , Pentoxifilina , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , Animais , Camundongos , Pentoxifilina/farmacologia , Autofagia/efeitos dos fármacos , Linhagem Celular Tumoral , Melanoma Experimental/metabolismo , Melanoma Experimental/tratamento farmacológico , Melanoma Experimental/patologia , Técnicas de Cultura de Células , Proteína Sequestossoma-1/metabolismo , Proteína Sequestossoma-1/genética , Antineoplásicos/farmacologia , Esferoides Celulares/efeitos dos fármacos , Esferoides Celulares/metabolismoRESUMO
Ticks are obligate hematophagous ectoparasites of vertebrates and are relevant worldwide due to the number of bacterial and other pathogens they can transmit. To date, the knowledge about the microorganisms that ticks harbor and transmit to their hosts is incipient. In this study, 24 samples of mammals belonging to four taxonomic orders and ticks of the genera Amblyomma and Rhipicephalus from the Orinoco region of Colombia were analyzed to described and compare the bacterial microbiome. Genetic extraction was performed, and the V3-V4 region of the 16S rRNA gene was amplified by PCR. Libraries were created, and those samples with adequate quality indices were sequenced using Illumina MiSeq technology. Bacterial taxonomic assignment analyses were conducted through Amplicon Sequence Variants (ASVs) and Operational Taxonomic Units (OTUs). The results correspond to 16 samples that passed the quality filters, with 3218 OTUs (415 families). Although a considerable number of unknown bacteria was found, Enterobacteriaceae, Beijerinckiaceae, Moraxellaceae, and Burkholderiaceae are the most prevalent families, and the presence of the genera Coxiella, Escherichia-Shigella, Enterobacter, which can harbor pathogenic species was confirmed. In individuals of Amblyomma mixtum found actively feeding on Hydrochoerus hydrochaeris, bacteria of the genera Escherichia-Shigella and Enterobacter were documented. Similarly, Rhipicephalus microplus found actively feeding on Odocoileus virginianus cariacou shared Escherichia-Shigella. Ralstonia was shared among the blood samples of H. hydrochaeris, while Anaplasma and Eubacterium were shared in blood and liver samples of O. v. cariacou. Shared bacteria between A. mixtum and R. microplus included Bacillus, Coxiella, and Escherichia-Shigella. The results highlight the need of additional studies in other natural regions of Colombia and other American countries where tick-borne diseases have been detected. Likewise, the recorded data are the first at the level of bacterial communities in ticks of the family Ixodidae and provide valuable knowledge for the understanding host-tick and pathogen interactions.
RESUMO
Ventricular septal defect (VSD) is one of the most common congenital defects. It has a wide variety of clinical spectrum of presentation depending on the location and size of the defect. Generally, small restrictive VSDs present spontaneous closure during follow-up. A clinical case is presented with suspected persistent perimembranous VSD, with described intraoperative anatomical findings of aneurysmal cribriform membrane, ruling out VSD.
La comunicación interventricular (CIV) es uno de los defectos congénitos más comunes. Tiene una amplia variedad de espectro clínico de presentación dependiendo de la localización y tamaño del defecto. Por lo general, en los CIV restrictivos pequeños presentan un cierre espontáneo durante el seguimiento. Se presenta un caso clínico con sospecha de CIV perimembranosa persistente, con hallazgos anatómicos intraoperatorios descritos de membrana cribiforme aneurismática descartandose CIV.