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Continuous O(d,d) global symmetries emerge in Kaluza-Klein reductions of D-dimensional string supergravities to D-d dimensions. We show that the nongeometric elements of this group effectively act in the D-dimensional parent theory as a hidden bosonic symmetry that fixes its couplings: the ß symmetry. We give the explicit ß transformations to first order in α^{'} and verify the invariance of the action as well as the closure of the transformation rules.
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Abstract Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions to assess reproducibility. Methods: We performed A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia. The information was collected from the initial year of implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs. We observed an increase in the number of patients. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7%), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3%. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.
Resumen Antecedentes: las fracturas de cadera son una causa importante de morbilidad y mortalidad. Los programas de fracturas geriátricas prometen mejorar la calidad de la atención, los desenlaces clínicos y reducir costos, Objetivos: Describir los resultados relacionados con la implementación de un programa de fracturas geriátricas en dos instituciones en Colombia para evaluar la reproducibilidad Métodos: Realizamos un estudio retrospectivo descriptivo de los pacientes atendidos en el programa de fracturas geriátricas en dos instituciones en Colombia. Se obtuvo información desde el año de implementación hasta 2018. Se describió información demográfica, de estancia hospitalaria, de complicaciones, de rehospitalizaciones y de mortalidad. Se determinó un caso base de consumo de recursos con expertos y se costeó usando métodos estandarizados. Resultados: Se incluyeron 475 pacientes. Se observó un aumento en la cantidad de pacientes. La duración de estancia disminuyó entre 8.5% y 26.1%, así como la frecuencia de complicaciones. Se encontraron reducciones en mortalidad en el primer año (entre 10.9% y 4.7%), muertes hospitalarias y rehospitalizaciones. Los costos estimados mostraron reducciones entre 22% y 68.3%. Conclusiones: El presente estudio muestra la experiencia de implementación de programa de fracturas geriátricas en dos instituciones en Colombia, mostrando aumento en cantidades de pacientes y reducciones en estancia hospitalaria, frecuencia de complicaciones, rehospitalizaciones, mortalidad y costos estimados. Los resultados fueron similares en las dos instituciones y comparables con otros descritos en literatura. Esto sugiero que los programas de fracturas geriátricas se pueden implementar con resultados reproducibles.
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Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions to assess reproducibility. Methods: We performed A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia. The information was collected from the initial year of implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs. We observed an increase in the number of patients. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7%), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3%. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.
Antecedentes: las fracturas de cadera son una causa importante de morbilidad y mortalidad. Los programas de fracturas geriátricas prometen mejorar la calidad de la atención, los desenlaces clínicos y reducir costos. Objetivos: Describir los resultados relacionados con la implementación de un programa de fracturas geriátricas en dos instituciones en Colombia para evaluar la reproducibilidad. Métodos: Realizamos un estudio retrospectivo descriptivo de los pacientes atendidos en el programa de fracturas geriátricas en dos instituciones en Colombia. Se obtuvo información desde el año de implementación hasta 2018. Se describió información demográfica, de estancia hospitalaria, de complicaciones, de rehospitalizaciones y de mortalidad. Se determinó un caso base de consumo de recursos con expertos y se costeó usando métodos estandarizados. Resultados: Se incluyeron 475 pacientes. Se observó un aumento en la cantidad de pacientes. La duración de estancia disminuyó entre 8.5% y 26.1%, así como la frecuencia de complicaciones. Se encontraron reducciones en mortalidad en el primer año (entre 10.9% y 4.7%), muertes hospitalarias y rehospitalizaciones. Los costos estimados mostraron reducciones entre 22% y 68.3%. Conclusiones: El presente estudio muestra la experiencia de implementación de programa de fracturas geriátricas en dos instituciones en Colombia, mostrando aumento en cantidades de pacientes y reducciones en estancia hospitalaria, frecuencia de complicaciones, rehospitalizaciones, mortalidad y costos estimados. Los resultados fueron similares en las dos instituciones y comparables con otros descritos en literatura. Esto sugiero que los programas de fracturas geriátricas se pueden implementar con resultados reproducibles.
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Fraturas do Quadril , Idoso , Colômbia/epidemiologia , Fraturas do Quadril/terapia , Humanos , Tempo de Internação , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
INTRODUCCIÓN. El cáncer de ovario es uno de los principales diagnósticos de malignidad en mujeres en nuestro país. La Tomografía por Emisión de Positrones -Tomografía Computarizada es importante porque puede establecer de manera correcta el estadio de la enfermedad así como puede determinar la recurrencia, incluso mejor que métodos diagnósticos como la Tomografía Simple o la Resonancia Magnética. OBJETIVO. Establecer los principales aspectos demográficos de los pacientes diagnosticados con cáncer de ovario que fueron evaluados en la Unidad Tomografía por Emisión de Positrones Ciclotrón del Hospital de Especialidades Carlos Andrade Marín de Quito-Ecuador. MATERIALES Y MÉTODOS. Estudio descriptivo retrospectivo. El número total de la población fue de 166 pacientes, y una muestra de 103 pacientes con criterios de inclusión y exclusión en la Unidad PET Ciclotrón del Hospital de Especialidades Carlos Andrade Marín de la ciudad de Quito, desde 2013 al 2018, obtenidas de bases estadísticas de la Unidad PET Ciclotrón y en la base de datos del sistema AS400 del Hospital. RESULTADOS. La mediana de edad de las pacientes con cáncer de ovario fue de 56 años (IQR 48 64; mínima: 13 y máxima 85). Al momento del estudio estuvieron casadas el 58,3% (60;103). El 43,7% (45;103) tuvieron un hijo. El 47,6% (49;103) tuvieron estudios de tercer nivel. El 64,0% (66;103) residieron en Quito. CONCLUSIÓN. Este perfil demográfico resaltó el poco acceso de este tipo de tecnología diagnóstica en pacientes con bajo nivel educativo y en lugares geográficamente alejados de Quito.
INTRODUCTION. Ovarian cancer is one of the main diagnoses of malignancy in women in our country. Positron Emission Tomography - Computed Tomography is important because it can correctly establish the stage of the disease as well as determine recurrence, even better than diagnostic methods such as Simple Tomography or Magnetic Resonance. OBJECTIVE. To establish the main demographic aspects of the patients diagnosed with ovarian cancer that were evaluated in the Cyclotron Positron Emission Tomography Unit of the Carlos Andrade Marín Specialty Hospital of Quito-Ecuador. MATERIALS AND METHODS. Retrospective descriptive study. The total number of the population was 166 patients, and a sample of 103 patients with inclusion and exclusion criteria in the PET Cyclotron Unit of the Carlos Andrade Marín Specialty Hospital of the city of Quito, from 2013 to 2018, obtained from statistical bases PET Cyclotron Unit and in the database of the AS400 system of the Hospital. RESULTS Hospital. The median age of ovarian cancer patients was 56 years (IQR 48-64; minimum: 13 and maximum 85). At the time of the study, 58,3% were married (60; 103). 43,7% (45; 103) had a child. 47,6% (49; 103) had third level studies. 64,0% (66; 103) resided in Quito. CONCLUSION. This demographic profile highlighted the little access of this type of diagnostic technology in patients with low educational level and in geographically remote places of Quito.
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Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Ovarianas , Ovário , Mulheres , Demografia , Tomografia por Emissão de Pósitrons , Mortalidade , Cônjuges , Consentimento Livre e EsclarecidoRESUMO
INTRODUCCIÓN. La Tomografía por Emisión de Positrones Tomografía Computarizada, 18 Flúor-Deoxiglucosa, es utilizado para estadiaje, re-estadiaje, seguimiento y respuesta a tratamiento del melanoma cutáneo. OBJETIVO. Valorar la utilidad de la Tomografía por Emisión de Positrones Tomografía Computarizada, en la detección de metástasis en los pacientes con melanoma cutáneo. MATERIALES Y MÉTODOS. Estudio observacional, retrospectivo. Información obtenida de la base estadística de la Unidad de Tomografía por Emisión de PositronesTomografía Computarizada del Hospital Carlos Andrade Marín, de Quito-Ecuador, desde enero de 2016 hasta junio de 2018. RESULTADOS. Se recopiló la información de 100 pacientes, 48 pacientes cumplieron los criterios de inclusión. La media de edad general fue 64 años (SD 12,5 años). El 35,4% de los pacientes tuvieron ganglio centinela positivo con una frecuencia de secundarismo en el 29,4% (p=0,43). El 60% de pacientes acudió por re-estadiaje. Pacientes con y sin melanoma ulcerado tuvieron un promedio de edad de 67,8 años y 59,8 años, respectivamente. La presencia de metástasis a distancia presenta una estimación de riesgo calculada de 1,57 (IC 95% 1,005 a 2,45) (p = 0,001). DISCUSIÓN. A mayor edad de los pacientes, mayor porcentaje de melanomas ulcerados, siendo estadísticamente significativo. Sin embargo, ninguna de las dos variables tuvo relación estadística con la presencia de metástasis a distancia. No se encontró relación con el espesor de Breslow y presencia de metástasis a distancia. CONCLUSIÓN. El estudio por Tomografía por Emisión de Positrones Tomografía Computarizada es el más sensible para la detección de metástasis a distancia, su presencia representa un mayor riesgo de mortalidad.
INTRODUCTION. Positron-Emission Tomography- Computerized Tomography, is used for staging, re-staging, follow-up and response to treatment in patients with cutaneous melanoma. OBJECTIVE. To evaluate the usefulness of Positron-Emission Tomography-Computer Tomography in the detection of metastasis in patients with cutaneous melanoma. MATERIALS AND METHODS. Observational retrospective study. Information obtained from the statistical base of Positron-Emission Tomography- Computerized Tomography Unit of the Carlos Andrade Marin, Hospital Specialty in Quito-Ecuador, from January 2016 to June 2018. RESULTS. Information was collected from 100 patients, 48 met the inclusion criteria. The general average age was 64,19 years (SD 12,5 years). 35,4% of the patients had a positive sentinel lymph node and 64,6% with a secondary frequency in 29,4% (p = 0,43). In 60% of patients, the reason for the request was re-staging. Patients with and without ulcerated melanoma had an average age of 67,8 years and 59,8 years, respectively. The presence of distant metastasis presents a calculated risk estimate of 1,57 (95% CI 1,005 to 2,45) (p = 0,001). DISCUSSION. The higher percentage of ulcerated melanomas was found in older people, being statistically significant; however, none of the two variables had a statistical relationship with the presence of distant metastases. No relationship was found with the Breslow thickness and the presence of distant metastasis. CONCLUSION. The study by Positron-Emission Tomography- Computerized Tomography, is the most sensitive for the detection of distant metastasis; they represent a higher risk of mortality.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias de Anexos e de Apêndices Cutâneos , Tomografia por Emissão de Pósitrons , Diagnóstico , Melanoma , Metástase Neoplásica , Linfonodo SentinelaRESUMO
BACKGROUND AND RATIONAL: Telaprevir-based therapy (TBT) has been extensively evaluated in clinical trials. So we designed a study to compare the efficacy and safety of TBT between patients with moderate fibrosis and those suffering from advanced fibrosis in clinical practice. A multicenter observational and ambispective study was conducted. It included 582 patients with chronic hepatitis C genotype 1, 214 with fibrosis F2, and 368 with F3/F4 (F3: 148; F4: 220). RESULTS: The mean patient age was 55 years, 67% male. Type of prior response was 22% naïve, 57% relapsers, and 21% partial/null responders, 69% had high viral load (> 800,000 IU/mL). HCV genotypes were 1a (19%), 1b (69%), and 1 (12%), respectively. Sixty-five percent were non-CC IL28B genotype. Week-12 sustained virologic response (SVR12) was significantly higher among F2-naïve patients (78%) compared with F3/F4-naïve patients (60%; p = 0.039) and among F2 non-responders (67%) compared with F3/F4 non-responders (42%; p = 0.014). SVR12 among relapsers was remarkably high in both groups (F2:89% vs. F3/F4:78%). Severe anemia and thrombocytopenia were more frequent among patients with F3/F4 than those with F2 (p < 0.01). Overall, 132 patients (22%) discontinued treatment: 58 due to adverse effects, 42 due to the stopping-rule, and 32 due to breakthrough. Premature discontinuation was more frequent among patients with F3/F4 (p = 0.028), especially due to breakthrough (p < 0.001). CONCLUSIONS: This multicenter study demonstrates high efficacy and an acceptable safety profile with regard to TBT in F2-patients in clinical practice.
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Antivirais/uso terapêutico , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Cirrose Hepática/tratamento farmacológico , Oligopeptídeos/uso terapêutico , Adulto , Idoso , Antivirais/efeitos adversos , Biomarcadores/sangue , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/genética , Hepacivirus/crescimento & desenvolvimento , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/virologia , Humanos , Interferons , Interleucinas/genética , Cirrose Hepática/diagnóstico , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/efeitos adversos , RNA Viral/sangue , Fatores de Risco , Índice de Gravidade de Doença , Espanha , Fatores de Tempo , Resultado do Tratamento , Carga Viral , Adulto JovemRESUMO
El Plomo (Pb) es un metal altamente tóxico que afecta diversos órganos y tejidos. Aún no se ha descrito un mecanismo único para su toxicidad, pero se ha evidenciado que el estrés oxidativo cumple un rol fundamental. El objetivo fue relacionar niveles de plomo en sangre (PbS), malondialdehido (MDA) y vitaminas antioxidantes (A, E y C) en escolares del Municipio Naguanagua, Estado Carabobo, Venezuela. Fue un estudio descriptivo y correlacional, en el cual participaron 147 niños. Se tomaron muestras de sangre venosa para determinar PbS, MDA y vitaminas antioxidantes. El 89,8% de los niños presentaron niveles de PbS (9,85 ± 5,31 μg/dL) estadísticamente superiores (P<0,05) al límite permisible (<5 μg/dL), establecido por el Centro para el Control y Prevención de Enfermedades (CDC). El 49,6% de los escolares vivían cerca de un taller mecánico, 34,1% de un taller de latonería y pintura, 38,3 % de una parada de autobús, 49,6% de una avenida o calle muy transitada y 39,0% manifestó hábito mano-boca. Los niveles de MDA fueron significativamente superiores (P<0,05) en los niños que presentaron niveles de PbS por encima del límite permisible. Se observó correlación negativa (P<0,05) entre vitamina C y PbS y correlación positiva (P<0,05) entre MDA y PbS. Los hallazgos sugieren que el Pb puede ser capaz de producir peroxidación lipídica y que la Vitamina C parece actuar como un protector ante tal proceso. Se debe mejorar el aporte dietético de vitaminas A y E para garantizar protección antioxidante sinérgica ante la exposición al plomo.
Lead (Pb) is a highly toxic metal that affects various organs and tissues. Not yet described a unique mechanism for its toxicity, but has been demonstrated that oxidative stress plays a fundamental role. The objective was to relate blood lead levels (PbS), malondialdehyde (MDA) and antioxidant vitamins (A, E and C) in school children Naguanagua, Carabobo State, Venezuela. It was a descriptive and correlational study in which 147 children participated. Venous blood samples were taken to determine PbS, MDA and antioxidant vitamins. 89.8% of children had BPb levels (9.85 ± 5.31 mg / dL) statistically higher (P<0.05) than the permissible limit (<5 μg/dL), established by the Center for Disease Control and Prevention (CDC). 49.6% of the school children lived near a garage, 34.1% of an autobody and painting workshop, 38.3% of a bus stop, 49.6% of a busy street or avenue and 39.0% said hand-mouth habit. MDA levels were significantly higher (P<0.05) in children who had BPb levels above the allowable limit. Negative correlation (P<0.05) between vitamin C and PbS and positive correlation (P<0.05) between PbS and MDA were observed. The findings suggest that Pb may be able to produce lipid peroxidation and that vitamin C appears to act as a protector against such a process. An improvement in the dietary intake of vitamins A and E will ensure synergistic antioxidant protection from exposure to lead.
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BACKGROUND: Cardiologists are involved in the management of patients with multiple cardiovascular risk factors and chronic heart diseases, so empathy is a necessary feature to deal with them. The aim of the study was to evaluate the validity and reliability of the Spanish version of the Jefferson Scale of Physician Empathy (JSPE) among Argentine cardiologists and to explore the potential differences by age, gender, and subspecialty. METHODS: Between August and September 2012, we performed a survey in a non-randomized sample of 566 Spanish-speaking cardiologists of Argentina. A Principle Component Analysis (PCA) was used to explore the link between observed variables and latent variables in order to identify the factor structure. The PCA criteria for identifying the factor structure were examined with the Kaiser-Meyer-Olkin (KMO) analysis. RESULTS: The KMO measure of sampling adequacy was 0.86 and Bartlett's test of sphericity was highly significant (p = 0.000), determining the suitability of the data set for factor analysis. The PCA of 20 items yielded a three factor model that accounted for 40.6% of the variance. The JSPE mean rank score for women was 307.9 vs. 275.0 for men (p = 0.017). The comparison of mean rank score according to age (quartiles) showed a significant relation between older age and empathy. No difference was found when the mean rank scores were compared by respondent subspecialty. CONCLUSIONS: JSPE provides a valid and reliable scale to measure Argentine cardiologists' attitudes towards empathy. Female cardiologists seem to be more empathic than their male colleagues, and a positive relationship between age and empathy was found.
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Atitude do Pessoal de Saúde , Cardiologia , Empatia , Conhecimentos, Atitudes e Prática em Saúde , Relações Médico-Paciente , Psicometria , Especialização , Inquéritos e Questionários , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Reprodutibilidade dos Testes , Fatores Sexuais , Adulto JovemRESUMO
The purpose of this study was to analyze the attitude of a group of cardiologists on the ethical conducts they would accept or adopt when encountered with different hypothetical situations of medical practice. Between August and September of 2011, 700 Argentine cardiologists were surveyed in situations which posed ethical dilemmas in the patient-physician relationship, among colleagues or involving financial agreements with employers or the pharmaceutical industry. Ethical conflicts were evidenced in a series of inappropriate conducts such as differential fees, trips and meals sponsored by laboratories, splitting fees, overbilling, self-referral, charging for patient referral, financial compensation for ordering medical procedures, and various situations derived from the relationship with employers. In general, financial compensation from the pharmaceutical industry was more accepted than the conflictive situations which directly involved patients, colleagues or employers. The rejection of these conducts, the physicians' deontological education and the improvement of financial and organizational conditions in medical practice will help to encourage better medical professionalism and avoid unseemly behaviors.
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Atitude do Pessoal de Saúde , Cardiologistas/economia , Cardiologistas/ética , Conflito Psicológico , Indústria Farmacêutica , Honorários e Preços/ética , Relações Médico-Paciente/ética , Adulto , Idoso , Argentina , Indústria Farmacêutica/economia , Indústria Farmacêutica/ética , Emprego/economia , Emprego/ética , Ética Médica , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/éticaRESUMO
El cierre de escuelas municipales rurales en Chile es un fenómeno que cobra relevancia en los últimos años. Este ha dejado de constituirse como un conjunto de decisiones aisladas, materializándose como una política escasamente estudiada. Con los objetivos de analizar y comprender los procesos psicosociales que emergen a nivel de comunidad local y escolar cuando se cierra una escuela municipal rural, se desarrolla una investigación cualitativa con un diseño cuasi etnográfico, en dos comunidades rurales del sur de Chile cuyas escuelas fueron cerradas luego del terremoto del 2010. Los resultados muestran que el cierre de la escuela en comunidades rurales afecta la cohesión social a distintos niveles, en lo cual las formas en que los cierres se producen adquieren influencia.
The closure of rural municipal schools in Chile is a phenomenon that becomes relevant in recent years. These decisions have ceased to be isolated, materializing as a policy that has been poorly studied. With the objective to analyze and understand the psychosocial processes that emerge at the level of local community and school when closing a rural school, develops a qualitative research with quasi ethnographic in two rural communities in the south of Chile, where the schools were closed after the earthquake in 2010. The results of the research suggest that the closure or schools in rural contexts affect the social cohesion at different levels, where the particularly way of the closure happens is very important.
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Ajustamento Social , Zona Rural , EducaçãoRESUMO
Group A Rotavirus (RVA) is the leading cause of severe diarrhea in children. The aims of the present study were to determine the neutralizing activity of VP6-specific llama-derived single domain nanoantibodies (VHH nanoAbs) against different RVA strains in vitro and to evaluate the ability of G6P[1] VP6-specific llama-derived single domain nanoantibodies (VHH) to protect against human rotavirus in gnotobiotic (Gn) piglets experimentally inoculated with virulent Wa G1P[8] rotavirus. Supplementation of the daily milk diet with 3B2 VHH clone produced using a baculovirus vector expression system (final ELISA antibody -Ab- titer of 4096; virus neutralization -VN- titer of 256) for 9 days conferred full protection against rotavirus associated diarrhea and significantly reduced virus shedding. The administration of comparable levels of porcine IgG Abs only protected 4 out of 6 of the animals from human RVA diarrhea but significantly reduced virus shedding. In contrast, G6P[1]-VP6 rotavirus-specific IgY Abs purified from eggs of hyperimmunized hens failed to protect piglets against human RVA-induced diarrhea or virus shedding when administering similar quantities of Abs. The oral administration of VHH nanoAb neither interfered with the host's isotype profiles of the Ab secreting cell responses to rotavirus, nor induced detectable host Ab responses to the treatment in serum or intestinal contents. This study shows that the oral administration of rotavirus VP6-VHH nanoAb is a broadly reactive and effective treatment against rotavirus-induced diarrhea in neonatal pigs. Our findings highlight the potential value of a broad neutralizing VP6-specific VHH nanoAb as a treatment that can complement or be used as an alternative to the current strain-specific RVA vaccines. Nanobodies could also be scaled-up to develop pediatric medication or functional food like infant milk formulas that might help treat RVA diarrhea.
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Anticorpos Monoclonais/farmacologia , Anticorpos Neutralizantes/farmacologia , Anticorpos Antivirais/farmacologia , Antígenos Virais/imunologia , Proteínas do Capsídeo/imunologia , Diarreia/tratamento farmacológico , Infecções por Rotavirus/tratamento farmacológico , Rotavirus/imunologia , Animais , Anticorpos Monoclonais/genética , Anticorpos Monoclonais/imunologia , Anticorpos Neutralizantes/genética , Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/genética , Anticorpos Antivirais/imunologia , Antígenos Virais/genética , Camelídeos Americanos , Proteínas do Capsídeo/antagonistas & inibidores , Proteínas do Capsídeo/genética , Diarreia/genética , Diarreia/imunologia , Diarreia/virologia , Humanos , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/farmacologia , Rotavirus/genética , Infecções por Rotavirus/genética , Infecções por Rotavirus/imunologia , Infecções por Rotavirus/virologia , SuínosRESUMO
Las colectas móviles en puntos específicos para recolectar sangre previa, promoción, son una forma de obtener la donación voluntaria y una vía eficaz de reclutamiento y fidelidad de donantes. Se presenta un instrumento tipo encuesta de opinión para medir la calidad de la atención en donantes de sangre que asisten a colectas móviles. Se construyó el instrumento que considera variados atributos del servicio. Se validó a través del juicio de expertos y prueba piloto. Se aplicó a donantes atendidos en colectas móviles realizadas por el Centro Productivo Regional de Sangre del Maule, Chile. Del análisis de las distintas dimensiones medidas, trato personal corresponde a la mejor evaluada. En otras dimensiones se destaca competencia profesional, como la segunda mejor evaluada. Contar con un instrumento validado permite determinar niveles de calidad de la atención, conocer problemas que deben ser objeto de seguimiento, proponer acciones de mejora y evaluar su evolución, con el propósito de lograr donantes fieles
The mobile blood collection at specific sites after the promotion of this activity is a way of obtaining voluntary donations and an effective way of recruitment of loyal donors. An opinion survey-type instrument to measure the quality of care to blood donors who go to mobile blood collection activities was presented. This instrument took into account several service attributes; it was validated on the basis of expert criteria and pilot tests. It was applied to donors seen in mobile blood collection activities that are carried out by the Regional Productive Center of Blood in Maule, Chile. From the analysis of the various dimensions, the personal treatment was the best evaluated one. Similarly, professional competency was the second best evaluated. Having one validated instrument in place allows determining the levels of quality of care, knowing the problems to be followed-up, suggesting actions for improvement and evaluating their evolution. The above-mentioned is aimed at having loyal donors
Assuntos
SangueRESUMO
Recent studies have shown that the timing of death is often under the control of the physicians who treat the patient in intensive care unit (ICU), where death is commonly preceded by decisions either not to start an aggressive therapy or to discontinue life-sustaining therapy. The objective was to study end-of-life decisions and attitudes of Argentinian cardiologists when treating terminal patients in the ICU. During 2007, a survey by e-mail was carried out among 967 cardiologists across Argentina. The questionnaire consisted of the case scenario of a vegetative patient with no family and no advance directives, so the responsibility for decision making would depend exclusively on the physician or health care team. 72.7% answered the survey; 72.0% of physicians preferred to share decisions with other doctors or with an ethical committee, nevertheless they rarely involved nurses in decisions. Besides, 85.4% of cardiologists would apply the do-not-resuscitate order and 8% would choise the terminal weaning or extubation. Comparatively, these results were similar to those previously reported in Southern Europe. In conclusion, most physicians would decide with other doctors or would ask for an ethical consultant; in the same way, most of respondents would apply the do-not-resuscitate order, though a few times they would choise the terminal weaning or extubation. Since regional and international survey opinions on these issues remain highly variable, it seems difficult to reach a global consensus regarding end-of-life care in the ICU.
Assuntos
Atitude do Pessoal de Saúde , Cuidados Críticos/psicologia , Parada Cardíaca/complicações , Estado Vegetativo Persistente/etiologia , Ordens quanto à Conduta (Ética Médica)/psicologia , Assistência Terminal/psicologia , Argentina , Atitude Frente a Morte , Cardiologia , Tomada de Decisões , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Suspensão de TratamentoRESUMO
Estudios recientes muestran que el momento de la muerte está a menudo bajo el control de los médicos que cuidan pacientes en una unidad de cuidados intensivos (UCI), donde la muerte suele estar precedida por decisiones de no comenzar una terapéutica agresiva o discontinuar una terapia para sostener la vida. El objetivo fue estudiar las actitudes de los cardiólogos en las decisiones médicas al final de la vida de pacientes terminales en UCI. Durante 2007 se realizó una encuesta vía correo electrónico a 967 cardiólogos de la Argentina. Se planteó el caso hipotético de una paciente en coma vegetativo y sin familiares para participar en una serie de decisiones al final de la vida. El 72.7% respondió el cuestionario; el 72.0% prefirió compartir las decisiones con colegas o un comité de bioética, aunque sólo el 6% dio participación al personal de enfermería; además, el 85.4% optaría por la orden "No Resucitar" (NR) y el 8% elegiría el "destete o extubación terminal". Estos resultados se asemejaron a los encontrados en estudios previos en Europa meridional. En conclusión, el análisis de las actitudes de los cardiólogos mostró una tendencia a compartir con colegas o un comité de bioética las decisiones sobre el final de la vida, así como a aplicar la orden NR y a no elegir el "destete terminal", con diferencias según el sexo y actividad laboral. La variabilidad de las opiniones locales e internacionales en las encuestas, hace difícil alcanzar un consenso sobre el tratamiento al final de la vida.
Recent studies have shown that the timing of death is often under the control of the physicians who treat the patient in intensive care unit (ICU), where death is commonly preceded by decisions either not to start an aggressive therapy or to discontinue life-sustaining therapy. The objective was to study end-of-life decisions and attitudes of Argentinian cardiologists when treating terminal patients in the ICU. During 2007, a survey by e-mail was carried out among 967 cardiologists across Argentina. The questionnaire consisted of the case scenario of a vegetative patient with no family and no advance directives, so the responsibility for decision making would depend exclusively on the physician or health care team. 72.7% answered the survey; 72.0% of physicians preferred to share decisions with other doctors or with an ethical committee, nevertheless they rarely involved nurses in decisions. Besides, 85.4% of cardiologists would apply the do-not-resuscitate order and 8% would choise the terminal weaning or extubation. Comparatively, these results were similar to those previously reported in Southern Europe. In conclusion, most physicians would decide with other doctors or would ask for an ethical consultant; in the same way, most of respondents would apply the do-not-resuscitate order, though a few times they would choise the terminal weaning or extubation. Since regional and international survey opinions on these issues remain highly variable, it seems difficult to reach a global consensus regarding end-of-life care in the ICU.
Assuntos
Feminino , Humanos , Masculino , Atitude do Pessoal de Saúde , Parada Cardíaca/complicações , Cuidados Críticos/psicologia , Estado Vegetativo Persistente/etiologia , Ordens quanto à Conduta (Ética Médica)/psicologia , Assistência Terminal/psicologia , Argentina , Atitude Frente a Morte , Cardiologia , Tomada de Decisões , Pesquisas sobre Atenção à Saúde , Suspensão de TratamentoRESUMO
La presente Monografia tiene como principal objetivo principal normar el manejo del archivo de correspondencia, para un adecuado control de la misma, ubicar un sistema que nos permita clasificar y encontrar rápidamente a los funcionarios en sus gestiones administrativas y legales, resguardar todo el acervo documental producido y recibido en la Dirección en el cumplimiento de sus funciones
Assuntos
Arquivamento , BolíviaRESUMO
DevR is a transcriptional regulator that mediates the genetic response of Mycobacterium tuberculosis and Mycobacterium bovis to oxygen limitation and nitric oxide exposure. devR is part of an operon that includes the genes devS and Rv3134c, which encode an oxygen sensor protein and a protein that contains a universal stress protein domain, respectively. Here, we report the transcriptional analysis and quantitative expression of Rv3134c/devR/devS under in vitro stress conditions including oxygen limitation, low nutrients and ex vivo macrophage infection. At least three different promoters were found to control Rv3134c/devR/devS expression under the stresses tested. Two promoters were identified upstream of devR, one was active under hypoxia and the other under nutrient starvation. A single promoter was identified upstream of Rv3134c, and transcripts from this promoter were detected only under hypoxia. Rv3134c to devR were found to be co-transcribed only under hypoxia, whereas devR/devS were co-transcribed both in aerobiosis and starvation. RT-qPCR showed an increase in the ratio hypoxia/aerobiosis and in starvation/nutrients in all genes. devR/devS showed transient expression in the first days of macrophage infection. Our results indicate that Rv3134c/devR/devS of M. bovis BCG constitutes an operon with complex regulation that participates in bacterial response against a wide range of stresses.
Assuntos
Proteínas de Bactérias/genética , Mycobacterium bovis/genética , Óperon/genética , Protamina Quinase/genética , Estresse Fisiológico/fisiologia , Transcrição Gênica/genética , Animais , Proteínas de Bactérias/metabolismo , Regulação Bacteriana da Expressão Gênica/genética , Macrófagos/microbiologia , Camundongos , Mycobacterium bovis/metabolismo , Óxido Nítrico , Oxigênio , Reação em Cadeia da Polimerase , Regiões Promotoras Genéticas/genética , Protamina Quinase/metabolismoRESUMO
Child malnutrition, including wasting, underweight and stunting, is associated with infections, poor nutrient intake, and environmental and socio-demographic factors. Preschool-age children are especially vulnerable due to their high growth requirements. To target interventions for preschool-age children in a community of extreme poverty in Peru, we conducted a household survey between October 2005 and January 2006 to determine the prevalence of malnutrition and its risk factors. Of 252 children < 5 years old, the prevalence of wasting, underweight and stunting was 26.6, 28.6 and 32.1 %, respectively, based on the new WHO Child Growth Standards. Risk factors for wasting were: (1) moderate-high intensity Trichuris infection (OR 2.50; 95 % CI 1.06, 5.93); (2) hookworm infection (OR 6.67; 95 % CI 1.08, 41.05); (3) age (OR6-month 1.27; 95 % CI 1.11, 1.46); (4) maternal education (secondary incomplete) (OR 5.77; 95 % CI 2.38, 13.99); and (5) decreasing maternal BMI (OR1 kg/m2 1.12; 95 % CI 1.02, 1.23). Risk factors for underweight were: (1) moderate-high intensity Trichuris infection (OR 4.74; 95 % CI 1.99, 11.32); (2) age (OR6-month 1.22; 95 % CI 1.07, 1.38); (3) maternal education (secondary incomplete) (OR 2.92; 95 % CI 1.40, 6.12); and (4) decreasing maternal BMI (OR1 kg/m2 1.11; 95 % CI 1.02, 1.21). Risk factors for stunting were: (1) age (OR6-month 1.14; 95 % CI 1.02, 1.27) and (2) decreasing maternal height (OR1 cm 1.12; 95 % CI 1.06, 1.20). Overall, risk factors for malnutrition included both child and maternal determinants. Based on these data, locally appropriate and cost-effective dietary, de-worming and educational programmes should be targeted to mothers and preschool-age children.
Assuntos
Transtornos da Nutrição Infantil/parasitologia , Países em Desenvolvimento , Transtornos do Crescimento/parasitologia , Infecções por Uncinaria/complicações , Tricuríase/complicações , Trichuris , Adulto , Animais , Estatura , Índice de Massa Corporal , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Estudos Transversais , Saúde da Família , Feminino , Transtornos do Crescimento/etiologia , Humanos , Lactente , Masculino , Mães , Inquéritos Nutricionais , Estado Nutricional , Peru , Pobreza , Prevalência , Desnutrição Proteico-Calórica/complicações , População RuralRESUMO
Malnutrition in school-age children is common in developing countries and includes both stunting and underweight. Stunting, which represents a chronic state of nutritional stress, leads to adverse health, educational and cognitive effects. Although much research is focused on preschool-age children, recent studies show both the high prevalence of stunting and the effectiveness of interventions in school-age children. The objectives of the current study were to determine the risk factors for stunting only, and stunting and underweight. A survey was conducted in 1074 grade 5 children (mean age 10 years) from 17 schools in Belen, Peru, a community of extreme poverty. Prevalence of underweight and stunting were 10.5 and 34.5%, respectively, co-prevalence was 9.3%. Based on multivariable logistic regression analyses, significant independent risk factors (odds ratio: OR) for stunting and underweight were: age (per 1 year increment) (OR=1.55; 95% confidence interval (CI): 1.33, 1.81); diarrhoea in the last week (OR=1.96; 95% CI: 1.17, 3.29) and hookworm infection (OR=1.74; 95% CI: 1.05, 2.86). Significant independent risk factors for stunting only were: age (per 1 year increment) (OR=1.51; 95% CI: 1.35, 1.70); anaemia (OR=1.98; 95% CI: 1.26, 3.11); and moderate and heavy Trichuris and Ascaris co-infection (OR=1.95; 95% CI: 1.35, 2.82). Our results indicate a high prevalence of stunting, in addition to other adverse health indicators, in the study population. Due to the interrelation between many of these health and nutrition problems, interventions at both the school and community levels, including de-worming, feeding programs and health and hygiene education, are needed to reduce malnutrition in this and other similar populations living in conditions of extreme poverty.