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High-saturated fat (HF) or high-fructose (HFr) consumption in children predispose them to metabolic syndrome (MetS). In rodent models of MetS, diets containing individually HF or HFr lead to a variable degree of MetS. Nevertheless, simultaneous intake of HF plus HFr have synergistic effects, worsening MetS outcomes. In children, the effects of HF or HFr intake usually have been addressed individually. Therefore, we have reviewed the outcomes of HF or HFr diets in children, and we compare them with the effects reported in rodents. In humans, HFr intake causes increased lipogenesis, hypertriglyceridemia, obesity and insulin resistance. On the other hand, HF diets promote low grade-inflammation, obesity, insulin resistance. Despite the deleterious effects of simultaneous HF plus HFr intake on MetS development in rodents, there is little information about the combined effects of HF plus HFr intake in children. The aim of this review is to warn about this issue, as individually addressing the effects produced by HF or HFr may underestimate the severity of the outcomes of Western diet intake in the pediatric population. We consider that this is an alarming issue that needs to be assessed, as the simultaneous intake of HF plus HFr is common on fast food menus.
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BACKGROUND AND OBJECTIVES: Laser ablation is increasingly used to treat atrial fibrillation (AF). However, atrioesophageal injury remains a potentially serious complication. While proactive esophageal cooling (PEC) reduces esophageal injury during radiofrequency ablation, the effects of PEC during laser ablation have not previously been determined. We aimed to evaluate the protective effects of PEC during laser ablation of AF by means of a theoretical study based on computer modeling. METHODS: Three-dimensional mathematical models were built for 20 different cases including a fragment of atrial wall (myocardium), epicardial fat (adipose tissue), connective tissue, and esophageal wall. The esophagus was considered with and without PEC. Laser-tissue interaction was modeled using Beer-Lambert's law, Pennes' Bioheat equation was used to compute the resultant heating, and the Arrhenius equation was used to estimate the fraction of tissue damage (FOD), assuming a threshold of 63% to assess induced necrosis. We modeled laser irradiation power of 8.5 W over 20 s. Thermal simulations extended up to 250 s to account for thermal latency. RESULTS: PEC significantly altered the temperature distribution around the cooling device, resulting in lower temperatures (around 22°C less in the esophagus and 9°C in the atrial wall) compared to the case without PEC. This thermal reduction translated into the absence of transmural lesions in the esophagus. The esophagus was thermally damaged only in the cases without PEC and with a distance equal to or shorter than 3.5 mm between the esophagus and endocardium (inner boundary of the atrial wall). Furthermore, PEC demonstrated minimal impact on the lesion created across the atrial wall, either in terms of maximum temperature or FOD. CONCLUSIONS: PEC reduces the potential for esophageal injury without degrading the intended cardiac lesions for a variety of different tissue thicknesses. Thermal latency may influence lesion formation during laser ablation and may play a part in any collateral damage.
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Fibrilação Atrial , Ablação por Cateter , Terapia a Laser , Humanos , Esôfago/cirurgia , Esôfago/lesões , Esôfago/patologia , Átrios do Coração/cirurgia , Fibrilação Atrial/cirurgia , Lasers , Computadores , Ablação por Cateter/métodosRESUMO
The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences (p < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.
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Solidão , Transtornos Mentais , Testes Psicológicos , Humanos , Solidão/psicologia , Autorrelato , Transtornos Mentais/terapia , Continuidade da Assistência ao PacienteRESUMO
BACKGROUND: For mental disorders Mutual Aid Groups (MAG) have been proposed, however, these have lack of methodologies that approach the needs of young people. The aim of the present study was to determine the impact of MAG in rural and semi-urban environments, developed through poetry, on the improvement of mental health. METHODS: A quasi-experimental study was carried out in Caldas, Colombia. 171 adolescents participated, divided into 10 MAG. Child Behavior Checklist 4-18 (CBCL/4-18) was used and the nuclear components of the MAG were applied, adding elements of introduction to poetry, creation and group rituals. RESULTS: Statistically significant associations (P < .001) were found between the number of sessions and the reduction of symptoms, as well as a decrease in Internalizing Problems and Social problems, after participating in the groups. CONCLUSION: Poetry applied to the core components of the MAG can improve psychiatric symptoms in adolescents.
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BACKGROUND: Proactive cooling with a novel cooling device has been shown to reduce endoscopically identified thermal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation using medium power settings. We aimed to evaluate the effects of proactive cooling during high-power short-duration (HPSD) ablation. METHODS: A computer model accounting for the left atrium (1.5 mm thickness) and esophagus including the active cooling device was created. We used the Arrhenius equation to estimate the esophageal thermal damage during 50 W/ 10 s and 90 W/ 4 s RF ablations. RESULTS: With proactive esophageal cooling in place, temperatures in the esophageal tissue were significantly reduced from control conditions without cooling, and the resulting percentage of damage to the esophageal wall was reduced around 50%, restricting damage to the epi-esophageal region and consequently sparing the remainder of the esophageal tissue, including the mucosal surface. Lesions in the atrial wall remained transmural despite cooling, and maximum width barely changed (<0.8 mm). CONCLUSIONS: Proactive esophageal cooling significantly reduces temperatures and the resulting fraction of damage in the esophagus during HPSD ablation. These findings offer a mechanistic rationale explaining the high degree of safety encountered to date using proactive esophageal cooling, and further underscore the fact that temperature monitoring is inadequate to avoid thermal damage to the esophagus.
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Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Temperatura Corporal , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Esôfago/lesões , Esôfago/cirurgia , Átrios do Coração/cirurgia , HumanosRESUMO
OBJECTIVE: To evaluate the association between depressive symptoms in the caregiver and the presen ce of affective and behavioral problems in children and adolescents. SUBJECTS AND METHOD: Descripti ve correlational cross-sectional research. SAMPLE: 1100 children and adolescents with their respective parents or caregivers from public schools in Caldas, Colombia. Instruments used: Child Behavior Checklist (CBCL) and Patient Health Questionnaire (PHQ-9). RESULTS: The mean age was 12.1 years. According to the CBCL, up to 20% of the children and adolescents showed alteration in one of the syndromes for affective or behavioral difficulties. 34% of mothers and 14% of fathers showed for at least two weeks sadness, discouragement, depression, and loss of interest. When applying the PHQ- 9, 32.4% of the parents/caregivers were classified with depression. Parents/caregivers with such di sorders tend to perceive greater difficulty in coping with their daily lives compared with parents/ caregivers of children and adolescents who are not at risk (p < 0.003). CONCLUSIONS: The presence of depressive symptoms in the parents/caregivers is related to an increase in internalizing and externali zing symptoms in children and adolescents.
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Depressão , Comportamento Problema , Feminino , Humanos , Criança , Adolescente , Depressão/epidemiologia , Depressão/psicologia , Comportamento Problema/psicologia , Cuidadores/psicologia , Estudos Transversais , MãesRESUMO
The conjugation of biomolecules to magnetic nanoparticles has emerged as promising approach in biomedicine as the treatment of several diseases, such as cancer. In this study, conjugation of bioactive peptide fractions from germinated soybeans to magnetite nanoparticles was achieved. Different fractions of germinated soybean peptides (>10 kDa and 5-10 kDa) were for the first time conjugated to previously coated magnetite nanoparticles (with 3-aminopropyltriethoxysilane (APTES) and sodium citrate) by the Ugi four-component reaction. The crystallinity of the nanoparticles was corroborated by X-ray diffraction, while the particle size was determined by scanning transmission electron microscopy. The analyses were carried out using infrared and ultraviolet-visible spectroscopy, dynamic light scattering, and thermogravimetry, which confirmed the coating and functionalization of the magnetite nanoparticles and conjugation of different peptide fractions on their surfaces. The antioxidant activity of the conjugates was determined by the reducing power and hydroxyl radical scavenging activity. The nanoparticles synthesized represent promising materials, as they have found applications in bionanotechnology for enhanced treatment of diseases, such as cancer, due to a higher antioxidant capacity than that of fractions without conjugation. The highest antioxidant capacity was observed for a >10 kDa peptide fraction conjugated to the magnetite nanoparticles coated with APTES.
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Antioxidantes/farmacologia , Glycine max/química , Nanopartículas de Magnetita/química , Peptídeos/farmacologia , Antioxidantes/química , Sequestradores de Radicais Livres/química , Germinação , Tamanho da Partícula , Peptídeos/química , Propilaminas/química , Silanos/química , Citrato de Sódio/química , Espectroscopia de Infravermelho com Transformada de Fourier , Termogravimetria , Difração de Raios XRESUMO
El soporte nutricional que se brinda a los pacientes críticos, constituye para la mayoría la única vía de acceso a través de la cual es posible cubrir sus requerimientos nutricionales diarios. Sin embargo, se ha identificado que la presencia de deuda calórica impide cubrir dichos requerimientos. Este estudio determinó la deuda calórica y su potencial efecto clínico a través de una cohorte prospectiva que incluyó 191 pacientes que recibieron soporte nutricional en unidades de cuidado intensivo (UCI). Se evaluó la magnitud de la deuda calórica, los principales factores que la favorecen y se exploraron diferencias en desenlaces clínicos relacionados con mortalidad, complicaciones infecciosas y tiempo de estancia en UCI. Los resultados evidenciaron que la deuda calórica estuvo presente en el 73,8%(IC 95% = 67%-80%) de los pacientes evaluados; la principal causa estuvo relacionada con la interrupción de la nutrición enteral y no se encontró asociación entre el porcentaje de adecuación calórico y los desenlaces evaluados. Esta evaluación permitió establecer que la mayoría de los pacientes, a pesar de recibir soporte nutricional, se encuentran expuestos a deuda calórica siendo necesario generar estrategias de atención que permitan disminuir la exposición de esta población a dicha condición.
The nutritional support offered to critically ill patients is, for most of them, the only means to fulfill their daily nutritional requirements. However, it has been documented that nutritional support is not enough to cover such needs, due to the presence of caloric debt. We seek to determine the caloric debt and its potential to clinical affect critically ill patients that receive nutritional support in the Intensive Care Unit (ICU). We conducted a prospective cohort study with 191 patients. We assessed the magnitude of caloric debt and its related factors. We also explored variations in clinical outcomes related to mortality, infectious complications and ICU stay length. Caloric debt was found in 73.8% (95% CI = 67-80%) of patients who received less than 80% of their daily caloric requirements. Main causes were related to enteral nutrition interruption. We found no association between caloric debt and the evaluated outcomes. This evaluation made it possible to establish that the majority of patients, despite receiving nutritional support, were exposed to caloric debt, and it is necessary to generate care strategies to reduce the patients' exposure to this condition.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Nutrição Enteral , Nutrição Parenteral , Restrição Calórica/efeitos adversos , Unidades de Terapia Intensiva , Estudos Prospectivos , Fatores de Risco , Seguimentos , Estado Terminal , Apoio Nutricional , Ingestão de Alimentos , HospitalizaçãoRESUMO
PURPOSE: We sought to quantify the capabilities of a commercially available cooling device to protect the esophagus from RF injury in an animal model and develop a mathematical model to describe the system and provide a framework from which to advance this technology. METHODS: A series of ablations (10 W, duration 30-45 seconds) were performed directly on exposed swine esophagus. Control ablations were performed with static 37°C water, and treatment ablations were performed with water (range 5°C-37°C) circulating within the device. Mucosal lesions were evaluated visually and with target tissue histology. A mathematical model was then developed and compared against the experimental data. RESULTS: All 23 ablations (100%) performed under control conditions produced visible external esophageal lesions; 12 of these (52%) were transmural. Under treatment conditions, only 5 of 23 ablations (22%) produced visible external lesions; none (0%) were transmural. Transmurality of lesions decreased as circulating water temperature decreased, with absolute reduction ranging from 5.1% with the use of 37°C water (p=0.7) to 44.5% with the use of 5°C water (p<0.001). Comparison to the mathematical model showed an R^2 of 0.75, representing good agreement. CONCLUSION: Under worst-case conditions, with RF energy applied directly to the adventitial side of the esophagus, internal esophageal cooling with an esophageal cooling device provides significant protective effect from thermal injury. A mathematical model of the process provides a means to further investigate this approach to preventing esophageal injury during RF ablation and can serve to guide ongoing clinical investigations currently in progress.
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Intestinal parasitosis (IP) is a public health problem in developing countries affecting one fourth of the global population. IP are common studied in children, ne glecting the adults that are also at high risk and source of transmission. A screening study was performed with a convenience sample in three Colombian regions: Guachené (Cauca), Quibdó (Chocó), and Urabá (Antioquia). Feces samples from 284 volunteers (older than 18 years old) were tested by microscopy to identify para site ova and cysts. The IP frequency was 14.5%, and 52.1% were males. 63.2% of the parasitized patients exhibited diarrhea, and/or abdominal pain with significant association. 39.5% had single parasitic infection and 60.5% had multiple parasites: Blastocystis hominis (63.9%), Entamoeba hystolitica/dispar (39.4%), Endolimax nana (33.3%), Ascaris lumbricoides (22.2%), Giardia lamblia (19.4%), Entamoeba coli (13.9%), Trichuris trichiura (11.1%), hookworm species (11.1%), Strongyloides stercolaris (5.6%), and Iodamoeba butschlii (2.8%). A multivariate approach was used to determine predictor factors for IP: male gender, rainwater as drinking sour ce, and feces disposal different to toilet, latrine or septic tank were positively associated with infection. This study evidences that adult population, not only children from vulnerable areas of Colombia, must have to include as a risk for intestinal parasitism.
La parasitosis intestinal (PI) es un problema de salud pública en países en desarrollo que afecta un cuarto de la población mundial. Las PI son comúnmente estudia das en niños, olvidando que los adultos están también en riesgo y a su vez pueden ser fuentes de transmisión. Se realizó un estudio de tamizaje con una muestra escogida por conveniencia en tres regiones de Colombia: Guachené (Cauca), Quibdó (Chocó) y Urabá (Antioquia). Las muestras de materia fecal de 284 voluntarios mayores de 18 años, fueron estudiadas por microscopía para identificar parásitos, huevos y quistes. La frecuencia de las PI fue del 14.5%, 52.1% de los positivos fueron hombres. 63.2% de los individuos parasitados tenían asociación significativa con diarrea, y/o dolor abdominal. 39.5% tuvieron infección por un solo parásito y 60.5% fueron positivos para varios parásitos: Blastocystis hominis (63.9%), Entamoeba hystolitica/dispar (39.4%), Endolimax nana (33.3%), Ascaris lumbricoides (22.2%), Giardia lamblia (19.4%), Entamoeba coli (13.9%), Trichuris trichiura (11.1%), Strongyloides stercolaris (5.6%), y Iodamoeba butschlii (2.8%). Se realizó un aná lisis multivariado para determinar factores predictores para PI: el género masculino, el agua lluvia para consumo, y la disposición de excretas diferente a sanitario, letrina o pozo séptico, están asociados positivamente a la PI. Este estudio evidencia que la población adulta, no solo la infantil, residentes en áreas vulnerables de Colombia, deben incluirse como población de riesgo al parasitismo intestinal.
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Humanos , Masculino , Feminino , Parasitos , Doenças Parasitárias , Programas de Rastreamento , Helmintíase , Banheiros , Ancylostomatoidea , Água , Dor Abdominal , Fossas Sépticas , Giardia lamblia , Blastocystis hominis , Ascaris lumbricoides , Colômbia , Diarreia , Ingestão de Líquidos , ColiformesRESUMO
Functional foods containing peptides offer the possibility to modulate the absorption of sugars and insulin levels to prevent diabetes. This study investigates the potential of germinated soybean peptides to modulate postprandial glycaemic response through inhibition of dipeptidyl peptidase IV (DPP-IV), salivary α-amylase, and intestinal α-glucosidases. A protein isolate from soybean sprouts was digested by pepsin and pancreatin. Protein digest and peptide fractions obtained by ultrafiltration (<5, 5â»10 and >10 kDa) and subsequent semipreparative reverse phase liquid chromatography (F1, F2, F3, and F4) were screened for in vitro inhibition of DPP-IV, α-amylase, maltase, and sucrase activities. Protein digest inhibited DPP-IV (IC50 = 1.49 mg/mL), α-amylase (IC50 = 1.70 mg/mL), maltase, and sucrase activities of α-glucosidases (IC50 = 3.73 and 2.90 mg/mL, respectively). Peptides of 5â»10 and >10 kDa were more effective at inhibiting DPP-IV (IC50 = 0.91 and 1.18 mg/mL, respectively), while peptides of 5â»10 and <5 kDa showed a higher potency to inhibit α-amylase and α-glucosidases. Peptides in F1, F2, and F3 were mainly fragments from ß-conglycinin, glycinin, and P34 thiol protease. The analysis of structural features of peptides in F1â»F3 allowed the tentative identification of potential antidiabetic peptides. Germinated soybean protein showed a promising potential to be used as a nutraceutical or functional ingredient for diabetes prevention.
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Dipeptidil Peptidase 4/química , Germinação , Glycine max/química , Hipoglicemiantes/farmacologia , Fragmentos de Peptídeos/farmacologia , alfa-Amilases/antagonistas & inibidores , alfa-Glucosidases/química , Inibidores da Dipeptidil Peptidase IV/farmacologia , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Humanos , Extratos Vegetais/farmacologiaRESUMO
The aim was to investigate the potential of germinated soybean proteins asa source of peptides with anticancer and anti-inflammatory activities produced after simulated gastrointestinal digestion. Protein concentrate from germinated soybean was hydrolysed with pepsin/pancreatin and fractionated by ultrafiltration. Whole digest and fractions>10, 5-10, and<5kDa caused cytotoxicity to Caco-2, HT-29, HCT-116 human colon cancer cells, and reduced inflammatory response caused by lipopolysaccharide in macrophages RAW 264.7. Antiproliferative and anti-inflammatory effects were generally higher in 5-10kDa fractions. This fraction was further purified by semi-preparative chromatography and characterised by HPLC-MS/MS. The most potent fraction was mainly composed of ß-conglycinin and glycinin fragments rich in glutamine. This is the first report on the anti-cancer and anti-inflammatory effects of newly isolated and identified peptides from germinated soybean released during gastrointestinal digestion. These findings highlight the potential of germination as a process to obtain functional foods or nutraceuticals for colon cancer prevention.
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Neoplasias do Colo/metabolismo , Glycine max/metabolismo , Peptídeos/metabolismo , Proteínas de Soja/metabolismo , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/metabolismo , Células CACO-2 , Linhagem Celular Tumoral , Proliferação de Células , Cromatografia Líquida de Alta Pressão , Neoplasias do Colo/genética , Neoplasias do Colo/imunologia , Neoplasias do Colo/fisiopatologia , Digestão , Germinação/efeitos dos fármacos , Humanos , Hidrólise , Camundongos , Pancreatina/química , Pancreatina/metabolismo , Pepsina A/química , Pepsina A/metabolismo , Peptídeos/química , Células RAW 264.7 , Proteínas de Soja/química , Glycine max/química , Glycine max/crescimento & desenvolvimento , Espectrometria de Massas em TandemRESUMO
Leprosy in Colombia is in a stage of post elimination-since 1997, prevalence of the disease is less than 1/10000. However, the incidence of leprosy has remained stable, with 400-500 new cases reported annually, with MB leprosy representing 70% of these case and 10% having grade 2 disability. Thus, leprosy transmission is still occurring, and household contacts (HHCs) of leprosy patients are a population at high risk of contracting and suffering from the effects of the disease during their lifetime. We performed a cross-sectional study with the aim of evaluating leprosy transmission within Family Groups (FGs) from four Colombian departments: Antioquia, Bolívar, Córdoba and Sucre. This study included 159 FGs formed by 543 HHCs; 45 FGs were monitored twice, first in 2003 and again in 2012. Migration, forced displacement by violence, loss of contact with the health center and the lack of an agreement to participate in the second monitoring were the primary reasons not all FGs were tested a second time. In each HHC, a clinical examination was performed, epidemiological data recorded, the bacillary index determined, DNA was isolated for M. leprae detection by nested PCR and IgM anti-phenolic glycolipid-I (PGL-I) titers were inspected. Further, DNA from M. leprae isolates were typed and compared among FGs. Twenty-two (4.1%) of the 543 HHCs had IgM anti-PGL-I positive antibody titers, indicating infection. Nasal swabs (NS) taken from 113 HHCs were tested by RLEP PCR; 18 (16%) were positive for M. leprae DNA and two new leprosy cases were detected among the HHCs. Of the confirmed HHCs with leprosy, it was possible to genotype the bacterial strains from both the index case and their HHCs. We found that the genotype of these two strains agreed at 9 markers, showing the individuals to be infected by the same strain, indicating familiar transmission. HHCs of leprosy patients not only are a high-risk population for M. leprae infection, they can act as M. leprae carriers and therefore serve as sources for transmission and infection. Our results confirm familiar leprosy transmission and suggest that follow-up of HHCs is a good strategy for early diagnosis of leprosy and to monitor its transmission.
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Hanseníase/microbiologia , Hanseníase/transmissão , Mycobacterium leprae/fisiologia , Adolescente , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Características da Família , Feminino , Humanos , Lactente , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/genética , Mycobacterium leprae/isolamento & purificação , Adulto JovemRESUMO
An active search for Mycobacterium leprae drug resistance was carried out, 243 multibacillary patients from endemic regions of Colombia were included from 2004 to 2013 in a surveillance program. This program was a World Health Organization initiative for drug resistance surveillance in leprosy, where Colombia is a sentinel country. M. leprae DNA from slit skin smear and/or skin biopsy samples was amplified and sequenced to identify mutations in the drug resistance determining region (DRDR) in rpoB, folP1, gyrA, and gyrB, the genes responsible for rifampicin, dapsone and ofloxacin drug-resistance, respectively. Three isolates exhibited mutations in the DRDR rpoB gene (Asp441Tyr, Ser456Leu, Ser458Met), two in the DRDR folP1 gene (Thr53Ala, Pro55Leu), and one isolate exhibited mutations in both DRDR rpoB (Ser456Met) and DRDR folP1 (Pro55Leu), suggesting multidrug resistance. One isolate had a double mutation in folP1 (Thr53Ala and Thr88Pro). Also, we detected mutations outside of DRDR that required in vivo evaluation of their association or not with drug resistance: rpoB Arg505Trp, folP1 Asp91His, Arg94Trp, and Thr88Pro, and gyrA Ala107Leu. Seventy percent of M. leprae mutations were related to drug resistance and were isolated from relapsed patients; the likelihood of relapse was significantly associated with the presence of confirmed resistance mutations (OR range 20.1-88.7, p < 0.05). Five of these relapsed patients received dapsone monotherapy as a primary treatment. In summary, the current study calls attention to M. leprae resistance in Colombia, especially the significant association between confirmed resistance mutations and relapse in leprosy patients. A high frequency of DRDR mutations for rifampicin was seen in a region where dapsone monotherapy was used extensively.
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Proteínas de Bactérias/genética , Farmacorresistência Bacteriana , Hansenostáticos/farmacologia , Hanseníase/microbiologia , Mycobacterium leprae/efeitos dos fármacos , Vigilância de Evento Sentinela , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colômbia/epidemiologia , DNA Bacteriano/genética , Dapsona/farmacologia , Dapsona/uso terapêutico , Farmacorresistência Bacteriana/genética , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação , Mycobacterium leprae/genética , Mycobacterium leprae/isolamento & purificação , Ofloxacino/farmacologia , Ofloxacino/uso terapêutico , Reação em Cadeia da Polimerase , Recidiva , Rifampina/farmacologia , Rifampina/uso terapêutico , Pele/microbiologia , Adulto JovemRESUMO
Objective. To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome. Methods. Participants in this quasi-experimental intervention study included acute coronary syndrome patients 30–70 years old. The intervention group (n = 165) received care under the CACM, guided by an interdisciplinary team. The CACM included transitional care, risk stratification by severity, physiological profiling (impedance cardiography), and a treatment plan in accordance with current guidelines. The control group (n = 277) received conventional, recommended care in an ambulatory cardiac rehabilitation program. During one year of follow-up, the use of emergency and hospital services related to new cardiovascular and coronary events was evaluated. Results. Differences in the numbers of cardiovascular events (P = 0.003) and coronary events (P = 0.006) experienced by patients were found between the control group and the intervention group. The instantaneous risk of a cardiovascular event (hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.17–2.75; P = 0.007) and of a coronary event (HR = 1.81; 95% CI: 1.13–2.90; P = 0.013), after adjusting for age, sex, smoking, and compromised coronary arteries, was higher in the control group than the intervention group. Conclusions. Provision of care under the CACM to patients who had experienced an acute coronary event reduced emergency room visits and rehospitalizations related to new cardiovascular and coronary events by 40%. The average “number needed to treat” (NNT) under the CACM to have an impact on one person (in this case, the prevention of one cardiovascular or coronary event), was 9 and 11 respectively, indicating it is cost-effective.
Objetivo. Evaluar el efecto de un programa de atención diseñado según un modelo integral de atención ambulatoria (MIAA) en la aparición de nuevos episodios cardiovasculares o coronarios en pacientes con síndrome coronario agudo. Métodos. Como participantes en este estudio de intervención cuasiexperimental se incluyó a pacientes con síndrome coronario agudo de 30 a 70 años de edad. El grupo de intervención (n = 165) recibió atención mediante el MIAA, guiada por un equipo interdisciplinario. El MIAA incluyó la atención transitoria, la estratificación del riesgo según la gravedad, la realización de pruebas fisiológicas (cardiografía de impedancia) y un plan de tratamiento conforme con las directrices actuales. El grupo de referencia (n = 277) recibió la atención convencional recomendada en un programa ambulatorio de rehabilitación cardíaca. Durante el año en que se llevó a cabo el seguimiento, se evaluó el uso de los servicios de urgencia y hospitalarios relacionados con nuevos episodios cardiovasculares y coronarios. Resultados. Se observaron diferencias en el número de episodios cardiovasculares (P = 0,003) y episodios coronarios (P = 0,006) experimentados por los pacientes del grupo de referencia y el grupo de intervención. El cociente de riesgo instantáneo de un episodio cardiovascular (HR = 1,80; IC de 95%: 1,17–2,75; P = 0,007) y de un episodio coronario (HR = 1,81; IC de 95%: 1,13–2,90; P = 0,013), tras ajustar para la edad, el sexo, el tabaquismo y las arterias coronarias afectadas, fue mayor en el grupo de referencia que en el grupo de intervención. Conclusiones. La prestación de atención mediante el MIAA a los pacientes que habían experimentado un episodio coronario agudo redujo en 40% las visitas a servicios de urgencia y las rehospitalizaciones relacionadas con nuevos episodios cardiovasculares y coronarios. El número promedio de pacientes “que es necesario tratar” mediante el MIAA para que tenga repercusión en uno de ellos (en este caso, la prevención de un episodio cardiovascular o coronario), fue de 9 y 11 respectivamente, lo que indica que la intervención es eficaz en función de los costos.
Assuntos
Doença das Coronárias , Doenças Cardiovasculares , Assistência Ambulatorial , Readmissão do Paciente , Cardiografia de Impedância , Colômbia , Doença das Coronárias , Doenças Cardiovasculares , Assistência Ambulatorial , Readmissão do Paciente , Cardiografia de ImpedânciaRESUMO
OBJECTIVE: To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome. METHODS: Participants in this quasi-experimental intervention study included acute coronary syndrome patients 30-70 years old. The intervention group (n = 165) received care under the CACM, guided by an interdisciplinary team. The CACM included transitional care, risk stratification by severity, physiological profiling (impedance cardiography), and a treatment plan in accordance with current guidelines. The control group (n = 277) received conventional, recommended care in an ambulatory cardiac rehabilitation program. During one year of follow-up, the use of emergency and hospital services related to new cardiovascular and coronary events was evaluated. RESULTS: Differences in the numbers of cardiovascular events (P = 0.003) and coronary events (P = 0.006) experienced by patients were found between the control group and the intervention group. The instantaneous risk of a cardiovascular event (hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.17-2.75; P = 0.007) and of a coronary event (HR = 1.81; 95% CI: 1.13-2.90; P = 0.013), after adjusting for age, sex, smoking, and compromised coronary arteries, was higher in the control group than the intervention group. CONCLUSIONS: Provision of care under the CACM to patients who had experienced an acute coronary event reduced emergency room visits and rehospitalizations related to new cardiovascular and coronary events by 40%. The average "number needed to treat" (NNT) under the CACM to have an impact on one person (in this case, the prevention of one cardiovascular or coronary event), was 9 and 11 respectively, indicating it is cost-effective.
OBJETIVO:Evaluar el efecto de un programa de atención diseñado según un modelo integral de atención ambulatoria (MIAA) en la aparición de nuevos episodios cardiovasculares o coronarios en pacientes con síndrome coronario agudo. MÉTODOS: Como participantes en este estudio de intervención cuasiexperimental se incluyó a pacientes con síndrome coronario agudo de 30 a 70 años de edad. El grupo de intervención (n = 165) recibió atención mediante el MIAA, guiada por un equipo interdisciplinario. El MIAA incluyó la atención transitoria, la estratificación del riesgo según la gravedad, la realización de pruebas fisiológicas (cardiografía de impedancia) y un plan de tratamiento conforme con las directrices actuales. El grupo de referencia (n = 277) recibió la atención convencional recomendada en un programa ambulatorio de rehabilitación cardíaca. Durante el año en que se llevó a cabo el seguimiento, se evaluó el uso de los servicios de urgencia y hospitalarios relacionados con nuevos episodios cardiovasculares y coronarios. RESULTADOS: Se observaron diferencias en el número de episodios cardiovasculares (P = 0,003) y episodios coronarios (P = 0,006) experimentados por los pacientes del grupo de referencia y el grupo de intervención. El cociente de riesgo instantáneo de un episodio cardiovascular (HR = 1,80; IC de 95%: 1,17-2,75; P = 0,007) y de un episodio coronario (HR = 1,81; IC de 95%: 1,13-2,90; P = 0,013), tras ajustar para la edad, el sexo, el tabaquismo y las arterias coronarias afectadas, fue mayor en el grupo de referencia que en el grupo de intervención. CONCLUSIONES: La prestación de atención mediante el MIAA a los pacientes que habían experimentado un episodio coronario agudo redujo en 40% las visitas a servicios de urgencia y las rehospitalizaciones relacionadas con nuevos episodios cardiovasculares y coronarios. El número promedio de pacientes "que es necesario tratar" mediante el MIAA para que tenga repercusión en uno de ellos (en este caso, la prevención de un episodio cardiovascular o coronario), fue de 9 y 11 respectivamente, lo que indica que la intervención es eficaz en función de los costos.
Assuntos
Humanos , Psicologia do Esquizofrênico , Percepção Social , Sinais (Psicologia) , Emoções , Empatia , Esquizofrenia/fisiopatologia , Meio Social , Teoria da MenteRESUMO
OBJECTIVE: To evaluate the effect of a care program designed according to a comprehensive ambulatory care model (CACM) on the appearance of new cardiovascular/coronary events in patients with acute coronary syndrome. METHODS: Participants in this quasi-experimental intervention study included acute coronary syndrome patients 30-70 years old. The intervention group (n = 165) received care under the CACM, guided by an interdisciplinary team. The CACM included transitional care, risk stratification by severity, physiological profiling (impedance cardiography), and a treatment plan in accordance with current guidelines. The control group (n = 277) received conventional, recommended care in an ambulatory cardiac rehabilitation program. During one year of follow-up, the use of emergency and hospital services related to new cardiovascular and coronary events was evaluated. RESULTS: Differences in the numbers of cardiovascular events (P = 0.003) and coronary events (P = 0.006) experienced by patients were found between the control group and the intervention group. The instantaneous risk of a cardiovascular event (hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.17-2.75; P = 0.007) and of a coronary event (HR = 1.81; 95% CI: 1.13-2.90; P = 0.013), after adjusting for age, sex, smoking, and compromised coronary arteries, was higher in the control group than the intervention group. CONCLUSIONS: Provision of care under the CACM to patients who had experienced an acute coronary event reduced emergency room visits and rehospitalizations related to new cardiovascular and coronary events by 40%. The average "number needed to treat" (NNT) under the CACM to have an impact on one person (in this case, the prevention of one cardiovascular or coronary event), was 9 and 11 respectively, indicating it is cost-effective.
Assuntos
Síndrome Coronariana Aguda , Adulto , Idoso , Assistência Ambulatorial , Colômbia , Humanos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , FumarRESUMO
Objetivo: Demostrar la seguridad de la inyección mecánica de contraste a través de catéteres centrales, excluyendo catéteres de hemodiálisis y puertos de quimioterapia, a velocidades > 3 ml/seg. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en pacientes hospitalizados, quienes tenían como única vía de acceso una línea central y en quienes se les realizó inyección mecánica de medio de contraste a una velocidad de 3 y 4 cm3/ seg. Se evaluaron las complicaciones hemodinámicas y relacionadas con la integridad de los catéteres. Resultados: Se inyectaron 20 pacientes a través de catéteres venosos centrales (CVC) y 35 pacientes a través de catéteres centrales de inserción periférica (CCIP). No se presentaron complicaciones hemodinámicas ni se observaron complicaciones relacionadas con la integridad del catéter. Conclusión: La inyección mecánica de medio de contraste a través de CVC y CCIP, utilizando velocidades entre 3 y 4,5 ml/seg es una alternativa segura y viable para tomografías contrastadas.
Objective: The objective is to demonstrate the safety of medium contrast mechanical injection through central lines, not through a hemotherapy port or a hemodialysis catherer, at rates > 3 ml/sec. Methods: We performed a descriptive, longitudinal and prospective injection in patients who had a central line as the only venous access, and who underwent a mechanical injection with medium contrast at a rate 3-4 cc / sec. We evaluated complications in hemodynamics and complications related to the integrity of catherers. Results: 20 patients were injected via central venous catheters (CVC) and 35 patients via peripherally inserted central catheters (PICC). No complications were observed related to the integrity of the catherer. Conclusion: Medium contrast mechanical injection, performed through CVC and PICC at rates between 3 and 4.5 ml / sec, is considered a safe and viable alternative to contrast-enhanced CT
Assuntos
Humanos , Injeções , Cateterismo Venoso Central , Tomografia , Meios de Contraste , CatéteresRESUMO
Objetivo. Describir el curso clínico de los pacientes con pancreatitis aguda en un centro hospitalario de cuarto nivel y explorar los factores de riesgo asociados con la mortalidad. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de cohortes de 71episodios de pacientes que cumplieron los criterios de pancreatitis aguda grave según el consenso internacional de Atlanta de 1992. Se evaluó la información demográfica, los factores de gravedad, el manejo quirúrgico y médico, las complicaciones y la mortalidad. Resultados. La pancreatitis aguda grave corresponde al 42.7 % de los diagnósticos de pancreatitis aguda, una de las mayores reportadas en la literatura científica mundial. Al ingreso, los pacientes presentaron un puntaje de Ranson de 1,9 (desviación estándar, DE, 1,7), un APACHE II de 12,1 (DE, 5,8) y un promedio del índice tomográfico de gravedad (Tomography Severity Index, IST) de 3,5. El 29 % de los pacientes requirió estancia en la unidad de cuidados intensivos y, el 50 %, asistencia respiratoria mecánica; el 52% requirió soporte vasopresor, el 82 % recibió nutrición entérica y el 46,5 % se sometió a cirugía. La mortalidad fue de 32,4 %. Los factores de riesgo relacionados con la muerte fueron falla orgánica al ingreso, necesidad de asistencia respiratoria mecánica, necesidad de hemodiálisis, uso de vasopresores e ingreso a la unidad de cuidado intensivo en las primeras 48 horas. En el análisis multivariado, el uso de vasopresores fue un factor de riesgo independiente para la muerte. Conclusión. Los pacientes con pancreatitis aguda grave requieren un diagnóstico temprano para recibir un manejo precoz e integral que incluya la nutrición entérica. La mortalidad está relacionada con la necesidad de soporte avanzado por falla orgánica.
Objective. To describe the clinical course of patients with acute pancreatitis at a four level of care medical center and to explore mortality-associated factors. Material and methods. Retrospective study of cohorts of 71 episodes of pancreatitis fulfilling the Atlanta 1992 international consensus severe acute pancreatitis criteria. Demographic information, severity factors, surgical and medical management, complications and mortality rate were evaluated. Results. Severe acute pancreatitis represented 42.7% of the diagnoses of acute pancreatitis, one of the highest figures in the world literature. Upon admission, patients presented Ranson criteria of 1.9 (standard deviation, SD, 1.7), APACHE II index of 2.1 (SD, 5.8), and Tomography Severity Index of 3.5. Intensive care unit care was required by 29% of patients, and 50% demanded mechanical respiratory support; 52% required vasopressor hemodynamic support; 82% received enteral nutrition; 45% were submitted to surgery. Mortality rate was 32.4%, a value higher than the reported world scientific literature. Related mortality risk factors were organ failure upon admission, hemodialysis requirement, mechanical ventilatory support requirement, and use of vasopressor agents on admission to the ICU and during the first 48 hours. In the multivariate analysis, the use of vasopressor agents appeared as an independent mortality risk factor. Conclusion. Patients with severe acute pancreatitis demand an early diagnosis in oprder to receive prompt and efficient care, which includes enteral nutrition. Mortality is related with the early requirement of advanced vital support for their organ failure.
Assuntos
Pâncreas , Pancreatite , Fatores de Risco , MortalidadeRESUMO
Objetivo: determinar la prevalencia de las alteraciones de la visión al color y visomotoras en un grupo de niños en edades entre cinco y quince años, en las localidades de Fontibón, Puente Aranda y Usaquén en Bogotá. Metodología: se realizó un estudio observacional descriptivo en 243 pacientes que estudiaban en colegios representativos de cada localidad. A cada niño se le aplicaron los test de integración visomotora (vmi), Ishihara y Farnsworth. El análisis estadístico se realizó por medio de tablas de contingencia y ji2 (c2). Resultados: la prevalencia de las alteraciones en la visión al color fue de 6,7 % (6/89 test de Ishihara) y 14,6 % (13/89 test de Farnsworth) para el colegio España de Puente Aranda; 2,4 % (2/84 test de Ishihara), y 4,8 % (4/84 test de Farnsworth) para el colegio Pablo Neruda de Fontibón, y 2,9 % (2/70 test de Ishihara) y 10 % (7/70 test de Farnsworth) para el colegio de La Salle de Usaquén. La prevalencia de disfunciones visomotoras fue de 55,1 % (49/89) para el colegio España de Puent Aranda, 28,6 % (24/84) para el colegio Pablo Neruda de Fontibón y 18,6 % (13/70) para el colegio de La Salle de Usaquén. Conclusiones: la prevalenciade alteraciones en la visión al color y las disfunciones visomotoras fue mayor en las localidades de Fontibón y Puente Aranda que en la localidad de Usaquén.
Objective: To determine the prevalence of impaired color vision and visual motor dysfunction in a group of children aged between five and fifteen years in the localities of Fontibon, Puente Aranda and Usaquén in Bogota. Methodology: We conducted a descriptive study in 243 patients who were studying in schools representing each locality. Each child was subjected to the Ishihara and Farnsworth tests of visual-motor integration (vmi). Statistical analysis was performed using contingency tables and ji2 (c2). Results: The prevalence of impairments in color vision was 6.7% (6/89 Ishihara test) and 14.6% (13/89 Farnsworth test) for the Spanish school in Puente Aranda, 2.4 % (2/84 Ishihara test) and 4.8% (4/84 Farnsworth test) for the Pablo Neruda school in Fontibón, and 2.9% (2/70 Ishihara test) and 10% (7 / 70 Farnsworth test) for the La Salle School in Usaquén. The prevalence of visual-motor dysfunction was 55.1% (49/89) for the Spanish school in Puente Aranda, 28.6% (24/84) for the Pablo Neruda school in Fontibón and 18.6% (13/70) for the La Salle School in Usaquén. Conclusions: The prevalence of impaired color vision and visual motor dysfunction was higher in the villages of Puente Aranda and Fontibon than in the town of Usaquén.