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Introducción: El dengue es considerada una de las enfermedades más devastadoras a nivel mundial con un 40 % de la población viviendo en zonas de transmisión y de las más relacionadas con el clima. Objetivo: Determinar la incidencia de la variabilidad climática sobre la infestación por mosquito Aedes aegypti y la aparición del dengue en provincia Guantánamo en el periodo 2017-2019. Método: Se realizó una investigación descriptiva longitudinal, retrospectiva, donde el universo estuvo conformado por 9 municipios y 10 221 casos sospechosos de dengue. Se estudiaron las variables: infestación en depósitos por mosquitos Aedes aegypti según temporada climática, tasa de riesgo de arbovirosis según estratos, casos de dengue, temperatura y precipitación. Los datos fueron obtenidos de los registros meteorológicos mensuales y del departamento de Estadística del Centro Provincial de Higiene, Epidemiología y Microbiología. Se utilizaron frecuencias absolutas y relativas, la media, desviación estándar y coeficiente de correlación de Pearson. Resultados: La temperatura media anual varió 1 °C, los valores medios de humedad relativa y precipitación disminuyeron e impactaron en todos los estratos. La infestación ascendió con la mayor tasa de riesgo de dengue en el estrato de clima tropical de sabana, razón de tasa 0,63 (IC 95 %: 0,59-0,67) P=0,000. La temperatura y precipitación guardaron la mayor relación de asociación lineal con infestación y tasa de riesgo de dengue con coeficiente de correlación lineal R2=0,9 y R2=0,8. Conclusiones: La variabilidad climática ejerce efectos favorecedores sobre la infestación por Aedes aegypti y la transmisión de dengue durante la temporada climática húmeda, con correlación significativa en todos los estratos.
Introduction: Dengue virus is considered one of the most devastating diseases worldwide with 40% of the population living in transmission areas and one of the most climate-related diseases. Objective: To determine the incidence rate of climate variability on Aedes aegypti mosquito infestation and dengue virus appearing in Guantanamo province, period time 2017-2019. Method: A retrospective, longitudinal, descriptive research was carried out, in which 9 municipalities and 10,221 suspected cases of dengue fever were selected (as universe). The variables studied were as follows: infestation in reservoirs by Aedes aegypti mosquitoes according to climatic season, arboviroses risk rate according to stratum, dengue cases, temperature and precipitation. Data were obtained from monthly meteorological records and from the Statistics Department of Centro Provincial de Higiene, Epidemiología y Microbiología. It was used the absolute and relative frequencies, mean frequency, the standard deviation and the Pearson correlation coefficient. Results: Mean annual temperature varied by 1 °C, mean values of relative humidity and precipitation decreased and impacted all stratums. Infestation ascended with the highest dengue risk rate in the tropical savanna climate stratum, rate ratio 0.63 (95 % CI: 0.59-0.67) P=0.000. Temperature and precipitation had the strongest linear association with Aedes aegypti mosquito infestation and dengue risk rate with the linear correlation coefficient of R2=0.9 and R2=0.8. Conclusions: Climatic variability has a favorable effect on Aedes aegypti infestation and dengue transmission during the wet season, with a significant correlation in all stratums.
Introdução: A dengue é considerada uma das doenças mais devastadoras em todo o mundo com 40% da população vivendo em áreas de transmissão e uma das mais relacionadas ao clima. Objetivo: Determinar a incidência da variabilidade climática na infestação pelo mosquito Aedes aegypti e o aparecimento da dengue na província de Guantánamo no período 2017-2019. Método: Realizou-se uma investigação descritiva retrospectiva longitudinal, onde o universo foi constituído por 9 municípios e 10.221 casos suspeitos de dengue. As variáveis estudadas foram: infestação em armazéns por mosquitos Aedes aegypti de acordo com a estação climática, taxa de risco de arbovirose de acordo com estratos, casos de dengue, temperatura e precipitação. Os dados foram obtidos dos registos meteorológicos mensais e do Departamento de Estatística do Centro Provincial de Higiene, Epidemiología y Microbiología. Foram utilizadas frequências absolutas e relativas, média, desvio padrão e coeficiente de correlação de Pearson. Resultados: A temperatura média anual variou 1°C, os valores médios de umidade relativa e precipitação diminuíram e impactaram todos os estratos. A infestação aumentou com a maior taxa de risco de dengue no estrato climático de savana tropical, razão de taxa 0,63 (IC 95%: 0,59-0,67) P=0,000. Temperatura e precipitação tiveram a maior relação de associação linear com infestação de dengue e taxa de risco com coeficiente de correlação linear R2=0,9 e R2=0,8. Conclusões: A variabilidade climática exerce efeitos favoráveis na infestação por Aedes aegypti e na transmissão da dengue durante a estação chuvosa, com correlação significativa em todos os estratos.
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BACKGROUND: The assessment of motor function is vital in post-stroke rehabilitation protocols, and it is imperative to obtain an objective and quantitative measurement of motor function. There are some innovative machine learning algorithms that can be applied in order to automate the assessment of upper extremity motor function. OBJECTIVES: To perform a systematic review and meta-analysis of the efficacy of machine learning algorithms for assessing upper limb motor function in post-stroke patients and compare these algorithms to clinical assessment. MATERIAL AND METHODS: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. The review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The search was performed using 6 electronic databases. The meta-analysis was performed with the data from the correlation coefficients using a random model. RESULTS: The initial search yielded 1626 records, but only 8 studies fully met the eligibility criteria. The studies reported strong and very strong correlations between the algorithms tested and clinical assessment. The meta-analysis revealed a lack of homogeneity (I2 = 85.29%, Q = 48.15), which is attributable to the heterogeneity of the included studies. CONCLUSION: Automated systems using machine learning algorithms could support therapists in assessing upper extremity motor function in post-stroke patients. However, to draw more robust conclusions, methodological designs that minimize the risk of bias and increase the quality of the methodology of future studies are required.
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Transtornos Motores , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Extremidade Superior , Reabilitação do Acidente Vascular Cerebral/métodos , ParesiaRESUMO
RESUMEN: En este trabajo se analizan las habilidades de visualización y la generalización en la resolución por una persona ciega de dos tareas propuestas para la identificación del talento matemático. A partir de este análisis, se establecen algunas pautas para adaptar las tareas y se contrastan con las habilidades requeridas en la prueba original, especialmente en las relativas a las características del talento asociadas a la generalización. Se evidencia que las personas con discapacidad visual requieren la manifestación de otras habilidades, como por ejemplo la memoria visual y la percepción de las relaciones espaciales que no son imprescindibles en el planteamiento original.
RESUMO: Neste trabalho, analisamos as capacidades de visualização e de generalização na resolução por uma pessoa cega de duas tarefas propostas para a identificação de talentos matemáticos. A partir dessa análise, foram estabelecidas algumas diretrizes para a adaptação das tarefas e contrastadas com as competências exigidas no teste original, especialmente as relacionadas às características do talento associadas à generalização. Verificamos que as pessoas com deficiência visual requerem a manifestação de outras capacidades, tais como a memória visual e a percepção de relações espaciais, que não são essenciais na abordagem original.
ABSTRACT: In this work, we analyze the visualization skills and generalization in the resolution by a blind person of two tasks proposed for the identification of mathematical talent. From this analysis, some guidelines were established to adapt the tasks and contrasted with the skills required in the original test, especially those related to the characteristics of talent associated with generalization. We verifed that people with visual impairment require the manifestation of other skills, such as visual memory and perception of spatial relationships, which are not essential in the original statement.
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The structure of eukaryotic genes is generally a combination of exons interrupted by intragenic non-coding DNA regions (introns) removed by RNA splicing to generate the mature mRNA. A fraction of genes, however, comprise a single coding exon with introns in their untranslated regions or are intronless genes (IGs), lacking introns entirely. The latter code for essential proteins involved in development, growth, and cell proliferation and their expression has been proposed to be highly specialized for neuro-specific functions and linked to cancer, neuropathies, and developmental disorders. The abundant presence of introns in eukaryotic genomes is pivotal for the precise control of gene expression. Notwithstanding, IGs exempting splicing events entail a higher transcriptional fidelity, making them even more valuable for regulatory roles. This work aimed to infer the functional role and evolutionary history of IGs centered on the mouse genome. IGs consist of a subgroup of genes with one exon including coding genes, non-coding genes, and pseudogenes, which conform approximately 6% of a total of 21,527 genes. To understand their prevalence, biological relevance, and evolution, we identified and studied 1,116 IG functional proteins validating their differential expression in transcriptomic data of embryonic mouse telencephalon. Our results showed that overall expression levels of IGs are lower than those of MEGs. However, strongly up-regulated IGs include transcription factors (TFs) such as the class 3 of POU (HMG Box), Neurog1, Olig1, and BHLHe22, BHLHe23, among other essential genes including the ß-cluster of protocadherins. Most striking was the finding that IG-encoded BHLH TFs fit the criteria to be classified as microproteins. Finally, predicted protein orthologs in other six genomes confirmed high conservation of IGs associated with regulating neural processes and with chromatin organization and epigenetic regulation in Vertebrata. Moreover, this study highlights that IGs are essential modulators of regulatory processes, such as the Wnt signaling pathway and biological processes as pivotal as sensory organ developing at a transcriptional and post-translational level. Overall, our results suggest that IG proteins have specialized, prevalent, and unique biological roles and that functional divergence between IGs and MEGs is likely to be the result of specific evolutionary constraints.
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An annual recurrent disease causing yield reduction in cultivated watermelon (Citrullus lanatus) was documented by the growers in different farms of Campeche state, Mexico. In April 2019 and March 2020 open field grown watermelon plants showed symptoms such as leaf curling, crumpling, and leaf basal or apical necrosis (Figure S1), with an incidence ranging from 30 up to 80%. These plants also presented high populations of whitefly, especially in the most affected fields. In order to identify the causal agent of the disease, a total of 22 symptomatic watermelon plants were collected in four locations from Campeche state. Total nucleic acids (DNA and RNA) were extracted from these leaf samples. Initially, RT-PCR analysis was performed with specific primers (Table S1) for cucurbit-infecting Crinivirus transmitted by whitefly but the expected size PCR product for those viruses was not amplified in any of these samples. To investigate the presence of cucurbit-infecting begomoviruses, PCR was performed by using specific primers for those begomoviruses reported in Mexico and north/central America including Squash leaf curl virus (SLCV), Watermelon chlorotic stunt virus (WmCSV), Melon chlorotic leaf curl virus (MCLCuV), and Cucurbit leaf crumple virus (CuLCrV) (Table S1). Only the expected amplicon size of ~1089 bp for CuLCrV was amplified from DNA extracts from all 22 watermelon samples, suggesting a single cucurbit-associated virus. The putative complete genome of the CuLCrV Campeche isolate was amplified by circular DNA enrichment using a Rolling Circle Amplification (RCA) procedure from two representative samples, followed by enzymatic digestion using BamHI, EcoRI, KpnI, and SacI enzymes (Inoue-Nagata et al., 2004). Expected linearized full-length viral components (~2.7 kb) were obtained with EcoRI and SacI, and both products, from one selected sample, were cloned in to pGreen0029 vector and were fully sequenced. Sequence analysis of the EcoRI clone, designated as LV2019Camp_A (deposited in GenBank accession no. MW273384) revealed the highest identity of 97.52% to CuLCrV DNA-A isolate Baja California Sur isolate (GeneBank accession no. MN625831.1), whereas the KpnI clone, designated as LV2019Camp_B (deposited in GenBank accession no. MW273385), shared 94.87% identity with DNA B of CuLCrV isolate Arizona (GeneBank accession no. AF327559.1). Subsequently, CuLCrV isolate Campeche-derived agroinfectious clone, was obtained by constructing a partial dimeric tandem repeat of both DNA-A and DNA-B components (Bang et al., 2014). Twelve watermelon plants were agroinfiltrated with the infectious clone at the fourth true leaf stage, resulting in symptomatic plants (11/12) exhibiting leaf yellowing, curling, and crumpling 15 days after agroinfiltrated (Figure S1), and CuLCrV infection was confirmed by PCR specific detection using DNA extract from non-inoculated leaves. Previously CuLCrV has been detected in the USA (Arizona, Texas, California, Florida, South Carolina, and Georgia), and north Mexico (Coahuila) infecting cucurbits including squash, cucumber, cantaloupe, pumpkin, and watermelon (Brown et al., 2000., Keinath et al., 2018), in both single and mixed infection with other whitefly transmitted RNA viruses (CYSDV, genera Crinivirus), and DNA viruses (SLCV, genera Begomovirus) (Kuo et al., 2007). To our knowledge, this is the first report of CuLCrV infecting a cucurbit crop in the Campeche state from the Yucatán peninsula, in Mexico.
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Power generation with thermoelectric devices in internal combustion engines is an alternative to recover some of the energy loss with the exhausts. This data article supports a study that assesses the potentialities of energy recovery with thermoelectric generators in diesel engines and its influence on gaseous emissions. To this end, a set of experiments was developed with a thermoelectric generator and a waffle heat exchanger. The experimental design included nine operation points of the engine to characterize the energy recovery of the thermoelectric generator under different exploitation conditions. Three different fuels (i.e., diesel, B5, and B10) were used. The experiments were developed in a test bench with three data acquisition systems to measure the operational variables (e.g., electric power generation, pressure drop, temperature, etc.). Moreover, a gas analyzer (BrainBee AGS-688), Bacharach gas analyzer (PCA 400), and a smoke meter (BrainBee OPA-100) were used to measure exhaust emissions.
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INTRODUCTION AND OBJECTIVES: Polycystic ovary syndrome (PCOS) is the most common endocrinology disorder in women of reproductive age; these patients have a higher risk of suffering from non-alcoholic fatty liver disease (NAFLD). We determine the frequency of NAFLD in Mexican patients with PCOS and matched-controls. PATIENTS AND METHODS: Cross-sectional study, with 98 women of 18-44 years old. Rotterdam 2003 criteria integrated PCOS diagnosis. Those with significant alcohol consumption, chronic liver disease, use of steatogenic drugs, and pharmacological PCOS treatment or fertility protocol were excluded. Controls were matched in a 1:1 ratio by age and body mass index (BMI). The presence of NAFLD was determined by transient elastography performed by a single experienced operator. RESULTS: A total of 98 female volunteers at reproductive age were recruited. NAFLD denoted markedly higher in patients with than without PCOS at 69.3% vs. 34.6%, respectively. Compared to controls, PCOS patients had a significantly higher risk of NAFLD (OR=4.26, 95% CI 1.83-9.93). Severe steatosis was the most frequent NAFLD stage between women with PCOS and NAFLD. Patients with hyperandrogenism have a significantly higher mean CAP 277.83dB/m than controls without hyperandrogenism 191.57dB/m. NAFLD prevalence was 84.3% in PCOS patients with phenotype A, while in another phenotype, it was 41.1%. CONCLUSIONS: PCOS is an independent risk factor for NAFLD development. NAFLD screening needs to be considered in all PCOS patients independently of BMI, except in PCOS patients without hyperandrogenism and BMI<25.
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Hepatopatia Gordurosa não Alcoólica/epidemiologia , Sobrepeso/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Hiperandrogenismo/epidemiologia , Hiperandrogenismo/metabolismo , México/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Síndrome do Ovário Policístico/metabolismo , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
Knowledge of sequestrate Hysterangiaceae fungi in Mexico is very limited. In the present study, a new member of the family, Aroramyces guanajuatensis sp. nov., is described. This speciesis closely related to A. balanosporus, but differs from the latter in possessing a tomentose peridium 165-240 µm thick, with occasional large terminal hyphae up to 170 µm, a variable mesocutis (isodiametric to angular), and distinct bright yellowish subcutis. In contrast, A. balanosporus possesses a fibrillose peridial surface with shorter hyphae, a peridium 200-450 µm thick, and a mainly hyaline isodiametric mesocutis with a slightly wider subcutis. The phylogenetic analysis of the LSU gene separated A. guanajuatensis from A. balanosporus with a Bayesian posterior probability (PP) = 1. This is the third Aroramyces species described for the American continent.
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PURPOSE: Intensive care triage practices and end-user interpretation of triage guidelines have rarely been assessed. We evaluated agreement between providers on the prioritization of patients for ICU admission using different triage guidelines. MATERIALS AND METHODS: A multi-centered randomized study on providers from 18 different countries was conducted using clinical vignettes of oncological patients. The level of agreement between providers was measured using two different guidelines, with one being cancer specific. RESULTS: Amongst 257 providers, 52.5% randomly received the Society of Critical Care Prioritization Model, and 47.5% received a cancer specific flowchart as a guide. In the Prioritization Model arm the average entropy was 1.193, versus 1.153 in the flowchart arm (Pâ¯=â¯.095) indicating similarly poor agreement. The Fleiss' kappa coefficients were estimated to be 0.2136 for the SCCMPM arm and 0.2457 for the flowchart arm, also similarly implying poor agreement. CONCLUSIONS: The low agreement amongst practitioners on the prioritization of cancer patient cases for ICU admission existed using both general triage guidelines and guidelines tailored only to cancer patients. The lack of consensus on intensive care unit triage practices in the oncological population exposes a potential barrier to appropriate resource allocation that needs to be addressed.
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Estado Terminal , Unidades de Terapia Intensiva/normas , Admissão do Paciente/normas , Guias de Prática Clínica como Assunto , Triagem/normas , Argentina , Chile , Cuidados Críticos/normas , Árvores de Decisões , Equador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias , Estudos Prospectivos , EspanhaRESUMO
Resumen La enfermedad celíaca (EC) es un padecimiento sistémico con base inmunológica caracterizado por la intolerancia al gluten. La prevalencia mundial se ha reportado aproximadamente en 1%. El diagnóstico depende de la sintomatología, pruebas serológicas y resultado de la biopsia de intestino delgado. El cuadro clínico típico se caracteriza por diarrea, malabsorción y pérdida de peso. La enfermedad celiaca fue clásicamente descrita como una enfermedad de presentación en la infancia, sin embargo, su diagnóstico en la etapa adulta se ha vuelto más común. Existe una transición en la presentación de esta entidad, desde pacientes con síntomas típicos hasta pacientes asintomáticos. La identificación de estos últimos ha sido posible por la detección de anticuerpos séricos y los hallazgos de biopsias de intestino realizadas por otro motivo. Se presenta el caso de un hombre de 57 años de edad que acude al servicio de urgencias por síntomas gastrointestinales y clínica neuropática. A la exploración física destacó la presencia de los signos de Chvostek y Trousseau. Se solicitaron estudios de laboratorio generales en los que destacó la presencia de hipocalcemia, por lo que requirió manejo con infusión de calcio intravenoso. Se complementó el abordaje con estudios que sugirieron malabsorción. Se realizó panendoscopía y colonoscopia con toma de biopsias, en las que se reportaron hallazgos sugestivos de enfermedad celiaca Marsh 3B. Finalmente, se solicitaron anticuerpos antitransglutaminasa, los cuales se reportaron postivos. Fue así que se integró el diagnóstico de EC. Se inició manejo con dieta libre de gluten con posterior mejoría.
Abstract Celiac disease (CD) is a systemic process with an immunological basis characterized by gluten intolerance. The worldwide prevalence that has been reported is of approximately 1%. The diagnosis depends on the symptomatology, serological tests and the results of a small bowel biopsy. The typical clinical presentation is characterized by diarrhea, malabsorption and weight loss. Reports describe that the celiac disease is typically found in childhood, however, its diagnosis in adulthood has become a lot more common. A transition exists in the presentation of this nosological entity, from patients with typical symptoms to patients with an asymptomatic type. The identification of the latter has been possible with the detection of serum antibodies and the findings of bowel biopsies performed for other reasons. We present the case of a 57-year old male patient who arrived to the emergency room due to gastrointestinal and neuropathic symptoms. The physical examination highlighted the presence of Chvostek and Trousseau signs. General laboratory studies were requested, and hypocalcemia was identified; hence, a treatment with intravenous calcium infusion was required. The approach was complemented with other studies that suggested malabsorption. A panendoscopy and a colonoscopy with biopsies were performed. The findings suggested a Marsh 3B celiac disease. Finally, antitransglutaminase antibodies were requested and were reported as positive; therefore, a celiac disease diagnosis was made. The treatment started with a gluten-free diet, showing a subsecuent improvement.
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Resumen Objetivo: Estimar la prevalencia de pacientes con probable miocardiopatía diabética (sin exigir biopsia endomiocárdica), analizando sus características y comparándolas con pacientes no diabéticos con insuficiencia cardiaca idiopática. Métodos: Estudio retrospectivo sobre una cohorte de 270 pacientes que ingresaron de manera consecutiva por insuficiencia cardiaca. De estos se excluyeron del estudio todos aquellos que tuvieran una causa conocida de insuficiencia cardiaca (cardiopatía isquémica, hipertensiva, hipertrófica, valvular u otras). En total 58 pacientes, 18 de los cuales eran diabéticos (la causa de la insuficiencia cardiaca pudo ser la miocardiopatía diabética) y 40 sin diabetes (insuficiencia cardiaca idiopática). Se procedió a comparar las características entre ambos grupos. El análisis estadístico y la comparación de las distintas variables se realizó mediante el programa SPSS versión 20.0. Resultados: De 270 pacientes estudiados, 18 podrían haber sido diagnosticados con miocardiopatía diabética, lo que supone hasta un 6% de la insuficiencia cardiaca en esta serie. Conclusiones: Se considera que este estudio puede hacer reflexionar sobre la prevalencia global de la miocardiopatía diabética, sus características y sus dificultades diagnósticas.
Abstract Objective: To determine the prevalence of patients with probable diabetic cardiomyopathy (without requesting an endomyocardial biopsy), as well as to analyse its characteristics and comparing them with non-diabetic patients with idiopathic heart failure. Methods: A retrospective study was conducted on a cohort of 270 patients consecutively admitted to hospital due to heart failure. Excluded from the study were those who had a known cause of heart failure (ischaemic, hypertensive, hypertrophic, valvular, or other causes of heart disease). This left a total of 58 patients, 18 of whom were diabetics (the cause of heart failure could be due to diabetic cardiomyopathy) and 40 non-diabetics (idiopathic heart failure). A comparison was made between the characteristics of both groups. The statistical analysis and the comparison of the different variables were performed using Version 20.0 of the SPSS program. Results: Of the 270 patients studied, 18 could have been diagnosed with diabetic cardiomyopathy, which would be 6% of the cardiac failures in this series. Conclusions: It is believed that this study can lead to reflecting on the overall prevalence of diabetic cardiomyopathy, its characteristics, and the difficulties in its diagnosis.
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Humanos , Masculino , Feminino , Diabetes Mellitus , Insuficiência Cardíaca , Isquemia Miocárdica , Cardiomiopatias Diabéticas , CardiomiopatiasRESUMO
BACKGROUND: The incidence of candidemia is increasing in developing countries. Very little is known about the epidemiology of candidemia in Peru. The aim of this study is to describe the incidence, microbiology, clinical presentation and outcomes of Candida bloodstream infections in three Lima-Callao hospitals. METHODS: Candida spp. isolates were identified prospectively at participant hospitals between November 2013 and January 2015. Susceptibility testing for amphotericin B, fluconazole, posaconazole, voriconazole and anidulafungin was performed using broth microdilution method. Clinical information was obtained from medical records and evaluated. RESULTS: We collected information on 158 isolates and 157 patients. Median age of patients was 55.0 yrs., and 64.1% were males. Thirty-eight (24.2%) episodes of candidemia occurred in those <18 yrs. The frequency of non-Candida albicans was 72.1%. The most frequently recovered species were C. albicans (n = 44, 27.8%), C. parapsilosis (n = 40, 25.3%), C. tropicalis (n = 39, 24.7%) and C. glabrata (n = 15, 9.5%). Only four isolates were resistant to fluconazole, 86.7% (n = 137) were susceptible and 17 were susceptible-dose dependent. Decreased susceptibility to posaconazole was also observed in three isolates, and one to voriconazole. All isolates were susceptible to anidulafungin and amphotericin B. The most commonly associated co-morbid conditions were recent surgery (n = 61, 38.9%), mechanical ventilation (n = 60, 38.2%) and total parenteral nutrition (n = 57, 36.3%). The incidence of candidemia by center ranged between 1.01 and 2.63 cases per 1,000 admissions, with a global incidence of 2.04. Only 28.1% of cases received treatment within 72 hrs. of diagnosis. Overall, the 30-day survival was 60.4% (treated subjects, 67.4%; not-treated patients, 50.9%). CONCLUSIONS: We found a very high proportion of non-albicans Candida species. Despite this, the decreased susceptibility/resistance to fluconazole was only 13.3% and not seen in the other antifungals. Overall, the incidence of candidemia mortality was high when compared to other international studies. It is possible, that the delay in initiating antifungal treatment contributed to the elevated mortality rate, in spite of low antifungal resistance.
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Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidemia/tratamento farmacológico , Farmacorresistência Fúngica/efeitos dos fármacos , Adolescente , Adulto , Idoso , Anfotericina B/farmacologia , Anidulafungina , Candida/classificação , Candida/fisiologia , Candidemia/epidemiologia , Candidemia/microbiologia , Criança , Pré-Escolar , Equinocandinas/farmacologia , Feminino , Fluconazol/farmacologia , Humanos , Incidência , Lactente , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peru/epidemiologia , Estudos Prospectivos , Triazóis/farmacologia , Voriconazol/farmacologia , Adulto JovemRESUMO
OBJECTIVE: Adolescents from Puerto Rican backgrounds are found to have higher rates of obesity than adolescents from other ethnic groups in the US. The objective of this study is to examine whether sleeping the recommended number of hours and depression or anxiety disorder are independently related to risk for obesity in a sample of Island Puerto Rican adolescents, and whether the association between sleep and obesity is moderated by depression or anxiety disorder. METHODS: Data from the study were derived from the third wave of an island wide probability sample of Puerto Rican youth residing on the Island, 10-25 years of age (N = 825), with a response rate of 79.59%. The current study focuses on youth 10 to 19 years of age (n = 436). RESULTS: In this sample, youth who slept less than the recommended number of hours (defined as 7-9 h per night) had a significantly increased risk for obesity and were three times as likely to be obese. Youth who met criteria for a depressive/anxiety disorder were almost 2.5 times as likely to be obese. However, the presence of an anxiety/depressive disorders did not moderate the association between sleeping the recommended number of hours and risk for obesity. CONCLUSION: Sleeping less than the recommended number of hours may be an important risk factor for obesity status in Island Puerto Rican youth. These findings suggest that attention to healthy sleep behaviors and a sleep environment that promotes high quality sleep may be important for Puerto Rican adolescents at risk for obesity.
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Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Obesidade/epidemiologia , Privação do Sono/epidemiologia , Adolescente , Adulto , Criança , Comorbidade , Transtorno Depressivo/psicologia , Feminino , Hispânico ou Latino/psicologia , Humanos , Masculino , Obesidade/psicologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/psicologia , Porto Rico/etnologia , Fatores de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: Assessing dangerousness to gauge the likelihood of future violent behaviour has become an integral part of clinical mental health practice in forensic and non-forensic psychiatric settings, one of the most effective instruments for this being the Historical, Clinical and Risk Management-20 (HCR-20). OBJECTIVE: To examine the HCR-20 factor structure in Mexican psychiatric inpatients and to obtain its predictive validity and reliability for use in this population. METHOD: In total, 225 patients diagnosed with psychotic, affective or personality disorders were included. The HCR-20 was applied at hospital admission and violent behaviours were assessed during psychiatric hospitalization using the Overt Aggression Scale (OAS). Construct validity, predictive validity and internal consistency were determined. RESULTS: Violent behaviour remains more severe in patients classified in the high-risk group during hospitalization. Fifteen items displayed adequate communalities in the original designated domains of the HCR-20 and internal consistency of the instruments was high. CONCLUSION: The HCR-20 is a suitable instrument for predicting violence risk in Mexican psychiatric inpatients.
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Hospitais Psiquiátricos , Pacientes Internados/psicologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Gestão de Riscos/métodos , Violência/psicologia , Adulto , Agressão/psicologia , Feminino , Previsões , Hospitalização , Humanos , Masculino , Transtornos Mentais/epidemiologia , México/epidemiologia , Pessoa de Meia-Idade , Grupos Populacionais , Reprodutibilidade dos Testes , Adulto JovemRESUMO
INTRODUCTION: Poor self-management by families is an important factor in explaining high rates of asthma morbidity in Puerto Rico, and for this reason we previously tested a family intervention called CALMA that was found effective in improving most asthma outcomes, but not effective in increasing the use of controller medications. CALMA-plus was developed to address this issue by adding to CALMA, components of provider training and screening for asthma in clinics. METHODS: Study participants were selected from claims Medicaid data in San Juan, Puerto Rico. After screening, 404 children in eight clinics were selected after forming pairs of clinics and randomizing the clinics) to CALMA-only or CALMA-plus. RESULTS: For all three primary outcomes at 12 months, the mean differences between treatment arms were small but in the predicted direction. However, after adjusting for clinic variation, the study failed to demonstrate that the CALMA-plus intervention was more efficacious than the CALMA-only intervention for increasing controller medication use, or decreasing asthma symptoms. Both groups had lower rates of asthma symptoms and service utilization, consistent with previous results of the CALMA-only intervention. CONCLUSIONS: Compliance of providers with the intervention and training, small number of clinics available and the multiple barriers experienced by providers for medicating may have been related to the lack of difference observed between the groups. Future interventions should respond to the limitations of the present study design and provide more resources to providers that will increase provider participation in training and implementation of the intervention.
Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Educação em Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Autocuidado/métodos , Antiasmáticos/administração & dosagem , Criança , Pré-Escolar , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde/estatística & dados numéricos , Humanos , Capacitação em Serviço/organização & administração , Masculino , Medicaid , Enfermeiras e Enfermeiros , Educação de Pacientes como Assunto/organização & administração , Médicos , Porto Rico , Estados UnidosRESUMO
BACKGROUND: This article presents data on the psychometric properties of a new measure, the Adolescent Quality of Life Mental Health Scale (AQOL-MHS), designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years. Participants were recruited in Puerto Rico to have one of five prevalent mental health disorders. The initial instrument development was achieved through a grounded theory approach with the use of focus groups and in-depth interviews. METHODS: We conducted two stages of exploratory factor analyses (EFA) on 60 candidate items. The first stage was to establish the number of factors to extract, and the second was to improve the model by selecting the best items. A final EFA model retained 31 items and 3 factors labeled Emotional Regulation (11 items), Self-Concept (10 items) and Social Context (10 items). RESULTS: The instrument showed good internal consistency, test-retest reliability, and construct validity. The hypotheses-driven validity tests were all supportive of the AQOL-MHS. There was evidence for convergent validity and discriminant validity, and results for known-groups' validity were overwhelmingly supportive of the ability of the instrument to identify differences between groups. CONCLUSIONS: These preliminary findings support our conceptual model and the use of the AQOL-MHS domain and overall scores. We believe that this instrument will provide clinicians additional insight into the different aspects of quality of life that are important to adolescents with mental health problems. Therefore, we consider the AQOL-MHS a vital patient-centered outcome measure for assessment strategies in the prevention and treatment of this population.
Assuntos
Transtornos Mentais/psicologia , Saúde Mental , Avaliação de Resultados da Assistência ao Paciente , Psicometria/instrumentação , Qualidade de Vida/psicologia , Adolescente , Criança , Cultura , Emoções , Análise Fatorial , Feminino , Grupos Focais , Humanos , Masculino , Satisfação Pessoal , Valor Preditivo dos Testes , Porto Rico , Reprodutibilidade dos Testes , AutoimagemRESUMO
There is growing evidence of a positive association between asthma and suicidal ideation and behavior in the general community, although information on this potential association is scarce among older children and adolescents and Puerto Ricans, groups at risk for both conditions. Data came from wave 3 of the Boricua Youth Study, a longitudinal study of youth in the Bronx and San Juan conducted from 2000 to 2004. Logistic regressions for correlated data (Generalized Estimating Equation) were conducted, with asthma predicting suicidal ideation and behavior among participants 11 years or older. After adjustment for survey design; age; sex; poverty; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mental disorders; cigarette smoking; and stressful life events, asthma was positively associated with suicidal ideation and behavior among the Puerto Rican older children and adolescents. Public health interventions targeting Puerto Rican older children and adolescents with asthma and future studies investigating potential biological and psychological mechanisms of association are warranted.
Assuntos
Asma/etnologia , Ideação Suicida , Tentativa de Suicídio/etnologia , Adolescente , Criança , Feminino , Humanos , Entrevista Psicológica , Acontecimentos que Mudam a Vida , Modelos Logísticos , Estudos Longitudinais , Masculino , New York/etnologia , Porto Rico/etnologia , Fumar/etnologiaRESUMO
Se realizó una investigación descriptiva, prospectiva y longitudinal de los 1 067 pacientes con afecciones agudas intraabdominales, operados de urgencia por cirugía mayor ambulatoria en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba, desde enero de 2007 hasta mayo de 2010, con vistas a caracterizarles según algunas variables de interés. En la casuística predominaron el grupo etario de 31-45 años (47,7 %), el sexo masculino (50,8 %), la apendicitis aguda como diagnóstico preoperatorio (52,9 %), que además presentó complicaciones en 78,1 % del total, la operación por mínimo acceso (57,2 %), con solo 15,6 % de pacientes complicados, y la anestesia general orotraqueal (97,6 %). De acuerdo con la clasificación de la Sociedad Americana de Anestesiología, 83,8 % de los afectados perteneció al grupo I, mientras que al analizar las enfermedades asociadas, 42,8 % padecía hipertensión arterial. La modalidad quirúrgica empleada permitió incorporar nuevos diagnósticos preoperatorios, basados en adecuados criterios de selección del paciente; también se logró la satisfacción general de los operados, por lo que se recomendó extenderla a otros centros hospitalarios.
A descriptive, prospective and longitudinal investigation of the 1 067 patients with acute intraabdominal disorders, operated through an outpatient major emergent surgery in "Dr. Joaquín Castillo Duany" Teaching Clinical-Surgical Hospital in Santiago de Cuba was carried out from January, 2007 to May, 2010, with the aim of characterizing them according to some variables of interest. The age group 31-45 year old (47.7%), the male sex (50.8%), acute appendicitis as preoperative diagnosis (52.9%), which besides presented complications in 78.1% of the total, the minimal access surgery (57.2%), with only 15.6% of complicated patients, and the general orotracheal anesthesia (97.6%) prevailed in the case material. According to the classification of the American Society of Anesthesiology, 83.8% of the patients affected belonged to group I, while when analyzing the associated diseases, 42.8% suffered from hypertension. The used surgical modality allowed to incorporate new preoperative diagnoses, based on appropriate selection criteria of the patient; the general satisfaction of those patients operated was also achieved, so that it was recommended to extend it to other hospitals.
RESUMO
Objetivo: Demostrar las bondades del impacto, tiempo y costo-eficacia de la cirugía de corta estancia en sábados, domingos y días festivos. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, observacional, comparativo. Análisis estadístico: Prueba t de Student, chi cuadrada y análisis costo-eficacia. Material y método: Durante 4 años se realizaron 1,200 cirugías dentro de este programa piloto, utilizando la capacidad hospitalaria instalada y al mismo personal contratado para la atención médica de dichos días, sin contar con una unidad de cirugía de corta estancia como tal. Los procedimientos realizados fueron: plastía inguinal, resección de enfermedad pilonidal, plastía umbilical, resección de tumor benigno de partes blandas, plastía de pared, mastectomía subcutánea, hemorroidectomía, fistulectomía y excisión de tumores benignos mamarios y se comparó con los mismos procedimientos, pero realizados en forma de cirugía programada, evaluando y comparando las siguientes variables: edad, género, procedimiento realizado, tiempo de estancia hospitalaria y costo-beneficio del procedimiento. También se evaluó necesidad de hospitalización, reingreso en menos de 24 h, morbilidad y mortalidad. Resultados: Los diagnósticos incluyeron: hernias inguinales con 486 casos, tumores de partes blandas en 359 casos, hernia umbilical en 185 casos, eventración en 88 casos, enfermedad anorrectal en 27 casos, enfermedad pilonidal en 17 casos, ginecomastia en 17 casos, fimosis en 10 y otros en 11. Se realizaron plastía inguinal, resección de enfermedad pilonidal, plastía umbilical, excisión de tumor benigno de partes blandas, plastía de pared, mastectomía subcutánea, hemorroidectomía y/o fistulectomía, circuncisión y otros. El tiempo empleado para el manejo quirúrgico se redujo de 36 horas en promedio a doce horas (p < 0.05). El costo-eficacia fue del 40% menor en comparación con los pacientes que se operaron con el método tradicional. El promedio de tiempo quirúrgico y anestésico no fue diferente entre cirugía ambulatoria y el método tradicional. Conclusión: Se puede realizar con gran eficiencia cirugía de corta estancia en sábados domingos y días festivos con un ahorro de 40%.
Objective: To demonstrate the benefits of the impact, time, and cost-effectiveness of short stay surgery performed on weekends and holidays. Setting: General Hospital of Mexico (Third level health care hospital). Design: Prospective, cross-sectional, observational, and comparative study. Statistical analysis: Student's t test, chi square, and cost-effectiveness analysis. Material and method: During 4 years, 1,200 surgeries were performed within this pilot program, using the installed hospital infrastructure and the same personnel employed for medical care in those days, without having a special short stay surgery unit as such. Performed procedures were: inguinal plasty, resection of pilonidal disease, umbilical plasty, resection of benign soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy, fistulectomy, and excision of benign breast tumors, these were compared with the same procedures but performed as programmed surgeries. We assessed and compared the following variables: age, gender, performed procedure, time of hospital stay, and cost-benefit of the procedure. We also evaluated the need of hospitalization, re-admittance in less than 24 h, morbidity and mortality. Results: Diagnoses included: inguinal hernias with 486 cases, 359 cases of soft tissue tumors, 185 cases of umbilical hernia, 88 cases of eventration, 22 cases of anorectal disease, 17 cases of pilonidal disease, 17 cases of gynecomastia, 10 cases of phimosis, and 11 other diagnoses. We performed inguinal plasties, resection of pilonidal disease, umbilical plasty, excision of soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy and/or fistulectomy, circumcision and other procedures. The time used for surgical management was reduced from an average of 36 to 12 hours (p < 0.05). Cost-effectiveness was 40% lower as compared with the traditional method. Surgical and anesthetic times were not different between ambulatory and traditional surgeries. Conclusion: Short stay surgery can be performed efficiently on the weekends and holydays with a 40% savings.