RESUMO
In human ocular toxoplasmosis, serotype is related with greater severity. We analyzed Toxoplasma GRA6 serotype in 23 patients with ocular toxoplasmosis (13 confirmed, two co-infections- and eight unconfirmed cases) and 20 individuals chronically infected with Toxoplasma but without ocular involvement. In patients with ocular toxoplasmosis, we also studied host gene polymorphisms related to immune response (IL-1ß; IL-1α; IL-10; IFN-γ; TNF-α, IL-12), IL-17R, TLR-9, and P2RX7. Additionally, eight patients were studied for the production of TNFα, IL1-ß, IFN-γ and IL-10 by their peripheral leukocytes after ex vivo stimulation with soluble Toxoplasma antigens. There were no differences in the distribution of serotypes (GRA6-I versus GRA6 non-I) between infected individuals with- or without ocular involvement. Seropositivity for GRA6-I was associated with higher number of retinal lesions and higher levels of IL-1ß. Two polymorphisms were associated with specific clinical manifestations of ocular toxoplasmosis: IL-10 -819 C/T with bilateral lesions and IL-12 + 169,774 A/C with synechia. Higher levels of IL-10 were found in patients with the allele G/G at the polymorphic region IL-10 -1082. People with a GRA6 I serotype and possessing the allele G/G at the polymorphic region TNFα-857 suffered from an increased number of retinal lesions. We found a positive association between host cytokine genes polymorphisms and GRA6 serotypes correlated with specific clinical manifestations and immune response in ocular toxoplasmosis.
Assuntos
Toxoplasma , Toxoplasmose Ocular , Citocinas/genética , Humanos , Interleucina-12 , Polimorfismo Genético , Sorotipagem , Toxoplasma/genética , Toxoplasmose Ocular/genéticaRESUMO
OBJECTIVE: Assess if video-based contraceptive education could be an efficient adjunct to contraceptive counseling and attain the same contraceptive knowledge acquisition as conversation-based counseling. STUDY DESIGN: This was a multicenter randomized, controlled trial examining contraceptive counseling during labor and maternity hospitalization regarding the options of immediate postpartum contraception. At two urban public hospitals, we randomized participants to a structured conversation with a trained counselor or a 14-min video providing the same information. Both groups received written materials and were invited to ask the counselor questions. Our primary outcome was to compare mean time for video-based education and conversational counseling; secondary outcomes included intended postpartum contraceptive method, pre- and postintervention contraceptive knowledge, and perceived competence in choosing a method of contraception. RESULTS: We enrolled 240 participants (conversation group=119, video group=121). The average time to complete either type of counseling was similar [conversational: 16.3â¯min, standard deviation (SD) ±3.8â¯min; video: 16.8â¯min, SD ±4.6â¯min, p=.32]. Of women intending to use nonpermanent contraception, more participants intended to use a long-acting reversible contraceptive (LARC) method after conversational counseling (72/103, 70% versus 59/105, 56%, p=.041). Following counseling, mean knowledge assessment scores increased by 2 points in both groups (3/7 points to 5/7 correct). All but two participants in the video group agreed they felt equipped to choose a contraceptive method after counseling. CONCLUSIONS: Compared to in-person contraceptive counseling alone, video-based intrapartum contraceptive education took a similar amount of time and resulted in similar contraceptive knowledge acquisition, though with fewer patients choosing LARC. IMPLICATIONS: Video-based contraceptive education may be useful in settings with limited personnel to deliver unbiased hospital-based, contraceptive counseling for women during the antepartum period.
Assuntos
Anticoncepção , Serviços de Planejamento Familiar/educação , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos , Assistência Perinatal , Adolescente , Adulto , Feminino , Hospitalização , Humanos , Contracepção Reversível de Longo Prazo , Gravação em Vídeo , Adulto JovemRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Following Venezuelan traditional medicine, females with heavy menstrual blood loss (menorrhagia) drink Brownea grandiceps Jacq. flowers (BG) decoctions to reduce the bleeding. In a previous study, we demonstrated that BG aqueous extract (E) possesses a potent anti-fibrinolytic activity capable of inhibiting plasmin, the main serine-protease that degrades fibrin. It is widely known that plasmin inhibitors are often used as anti-fibrinolytics to reduce bleeding during surgeries with high risk of blood loss such as cardiac, liver, vascular, tooth extraction and large orthopedic procedures, as well as for menorrhagia treatments. The aim of this work was to isolate and characterize from BGE the compound responsible for the reported anti-fibrinolytic activity. MATERIALS AND METHODS: A decoction of BG was prepared; then it was homogenized, centrifuged and lyophilized to obtain BGE. Subsequently the extract was fractionated by gel filtration and reverse phase using HPLC and the active compound was characterized by MALDI-ToF MS. The kinetic parameters of anti-plasmin activity were evaluated by an amidolytic assay using a chromogenic substrate; also the anti-plasmin activity was estimated by fibrin plate method. Data were analyzed by nonparametric statistics. RESULTS: The active compound was a condensed tannin denominated Browplasminin, which is capable of inhibiting the plasmin activity in a dose-dependent manner when measured in fibrin plates or by the amidolytic activity method; it also has a minor effect on the FXa activity. However, it does not affect the activity of other serine-proteases such as trypsin, t-PA or u-PA. Browplasminin consists predominately of heteroflavan-3-ols of catechin with B-type linkages, and extents up to heptadecamers (~ 5000Da), with hexose residues attached to the polymer that presents a high degree of galloylation. Its IC50 for plasmin was 47.80µg/mL and for FXa was 237.08µg/mL, while the Ki were 0.76 and 61.61µg/mL for plasmin and FXa, respectively. CONCLUSIONS: The overall outcome of this study suggests that Browplasminin could be responsible for reducing heavy menstrual bleeding in women because its kinetic parameters showed that is a good plasmin inhibitor.
Assuntos
Antifibrinolíticos/farmacologia , Fabaceae/química , Fibrinolisina/antagonistas & inibidores , Extratos Vegetais/farmacologia , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/isolamento & purificação , Cromatografia Líquida de Alta Pressão , Relação Dose-Resposta a Droga , Flores , Taninos Hidrolisáveis , Concentração Inibidora 50 , Medicina Tradicional , Extratos Vegetais/administração & dosagem , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , VenezuelaRESUMO
Contact with the urticating setae from the abdomen of adult females of the neo-tropical moth Hylesia metabus gives rise to an urticating dermatitis, characterized by intense pruritus, generalized malaise and occasionally ocular lesions (lepidopterism). The setae contain a pro-inflammatory glycosylated protease homologous to other S1A serine proteases of insects. Deglycosylation with PNGase F in the presence of a buffer prepared with 40% H2 (18)O allowed the assignment of an N-glycosylation site. Five main paucimannosidic N-glycans were identified, three of which were exclusively α(1-6)-fucosylated at the proximal GlcNAc. A considerable portion of these N-glycans are anionic species sulfated on either the 4- or the 6-position of the α(1-6)-mannose residue of the core. The application of chemically and enzymatically modified variants of the toxin in an animal model in guinea pigs showed that the pro-inflammatory and immunological reactions, e.g. disseminated fibrin deposition and activation of neutrophils, are due to the presence of sulfate-linked groups and not on disulfide bonds, as demonstrated by the reduction and S-alkylation of the toxin. On the other hand, the hemorrhagic vascular lesions observed are attributed to the proteolytic activity of the toxin. Thus, N-glycan sulfation may constitute a defense mechanism against predators.
Assuntos
Peptídeo-N4-(N-acetil-beta-glucosaminil) Asparagina Amidase/química , Polissacarídeos/química , Serina Proteases/química , Animais , Glicosilação , Mariposas/enzimologia , Peptídeo-N4-(N-acetil-beta-glucosaminil) Asparagina Amidase/metabolismo , Polissacarídeos/metabolismo , Serina Proteases/metabolismo , Sulfatos/química , Sulfatos/metabolismoRESUMO
PURPOSE: Cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) has met with resistance from third-party payers in low- and middle-income countries because of lack of evidence regarding its cost-effectiveness. We aimed to provide information to help better inform this decision-making process. METHODS: Costs associated with a 12-week exercise-based rehabilitation program in Colombia for patients with CHF were estimated. We collected data on all medical resources used in ambulatory care and data on hospital costs incurred for treating patients with uncompensated CHF. A literature search to establish the hospitalization rates because of uncompensated CHF, death because of CHF, and potential decreases in these data because of the utilization of CR was conducted. We modeled incremental costs and effectiveness over a period of 5 years from the perspective of the third-party payer. RESULTS: All costs were converted from Colombian pesos to US dollars. For an exercise-based CR program of 12-week duration (36 sessions), costs ranged from US$265 to US$369 per patient. Monthly costs associated with ambulatory care of CHF averaged US$128 ± US$321 per patient, and hospitalization costs were US$3621 ± US$5 444 per event. Yearly hospitalization incidence rates with and without CR were 0.154 and 0.216, respectively. The incremental cost of CR would be US$998 per additional quality-adjusted life-year. Sensitivity analysis did not significantly change these results. CONCLUSIONS: Cardiac rehabilitation in patients with CHF in settings such as Colombia can be a cost-effective strategy, with minimal incremental costs and better quality of life, mainly because of decreased rates of hospitalization.
Assuntos
Assistência Ambulatorial/economia , Terapia por Exercício/economia , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/reabilitação , Hospitalização/economia , Doença Crônica , Colômbia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Hospitalização/estatística & dados numéricos , Humanos , Modelos Econômicos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de VidaRESUMO
El Observatorio Nacional de Salud del Instituto Nacional de Salud de Colombia, en su Boletín N.⦠1 de diciembre 9 de 2013, establece que las enfermedades cardiovasculares representan la primera causa de muerte en el país. En el periodo 1998-2011 se registraron 628.630 muertes por enfermedades cardiovasculares, que corresponden al 23,5% del total de las muertes en Colombia. De las defunciones atribuidas al grupo de enfermedad cardiovascular seleccionado, un 56,3% obedece a enfermedad cardiaca isquémica, 30,6% a enfermedad cerebrovascular, 12,4% a enfermedad hipertensiva y 0,5% a enfermedad cardiaca reumática crónica1 . A pesar de estas cifras y del conocido impacto social y económico que generan estas enfermedades, no se presta una atención adecuada a las enfermedades cerebrovasculares, una preocupación que no debe dejarse de lado y que implica una intervención acertada desde diferentes especialidades médicas, así como también una implementación de estrategias que mejoren la carga generada por esta.
Assuntos
Reabilitação Cardíaca , Reabilitação , Acidente Vascular Cerebral , Prevenção de DoençasRESUMO
Objetivo: realizar una aproximación a la determinación de costos directos de la falla cardiaca (FC) en el país, a través de la evaluación de costos asociados con el cuidado de pacientes atendidos en dos instituciones prestadoras de salud de Bogotá. Métodos: estudio de costos bajo la perspectiva del tercer pagador. La identificación de eventos generadores de costos en atención ambulatoria se realizó mediante revisión de historias clínicas de pacientes atendidos durante 2011 en la consulta externa especializada de una institución. Los costos de interconsultas y paraclínicos se determinaron según los valores del Acuerdo 256 de 2001, con adición de 30%. Los costos de la medicación se determinaron a partir del registro SISMED. La identificación de eventos generadores de costos en hospitalización se realizó mediante revisión de listados y facturas de pacientes atendidos entre 2009 y 2010 en dos instituciones. Los resultados se presentan resumidos por medidas de tendencia central y de dispersión, en pesos colombianos (COP) de 2011. Resultados: el costo mensual promedio del tratamiento ambulatorio de FC fue de 304.318 COP (D.E. 760.876), con una mediana de 45.280 COP (RIC 25.539 - 109.715); los medicamentos representaron la fuente principal de consumo de recursos (55,2%). El costo promedio de la hospitalización por descompensación de FC fue de 6.427.887 COP (D.E. 9.663.176); la estancia hospitalaria representó la mayor proporción del costo (29,1%). Conclusiones: los costos ambulatorios, y especialmente los hospitalarios, asociados con la FC en Colombia son sustanciales. La fuente principal de costos difiere dependiendo de si el manejo es hospitalario (estancia) o ambulatorio (medicamentos). (Acta Med Colomb 2013; 38: 208-212).
Objective: to make an approach to the determination of direct costs of heart failure (HF) in the country through the evaluation of costs associated with the care of patients seen in two health institutions in Bogota. Methods: low cost third-party payer perspective. Identification of cost generating events in ambulatory care was performed by review of medical records of patients seen during 2011 in the specialized outpatient clinic of an institution. Interconsultations and paraclinical costs were determined according to the 256 Agreement of 2001, with addition of 30%. Medication costs were determined from the SISMED register. Identification of events that generate costs in hospitalization was conducted by reviewing lists and bills of patients treated between 2009 and 2010 in two institutions. The results are presented summarized by measures of central tendency and dispersion, in Colombian pesos (COP) of 2011. Results: the average monthly cost for outpatient treatment of HF was 304,318 COP (D.E. 760 876), with a median of 45,280 COP (RIC 25,539-109,715); drugs represented the main source of resource consumption (55.2%). The average cost of hospitalization for decompensated HF was 6,427,887 COP (D.E. 9.663.176); hospital stay accounted for the largest proportion of the cost (29.1%). Conclusions: outpatient costs, and especially the inpatient ones associated with HF in Colombia are substantial. The main source of costs differs depending on whether the management is hospitable (stay) or outpatient (drugs). (Acta Med Colomb 2013; 38: 208-212).
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Insuficiência Cardíaca , Custos de Cuidados de Saúde , Efeitos Psicossociais da Doença , ColômbiaRESUMO
En el mundo médico, las decisiones del personal de Unidad de Cuidado Intensivo (UCI), Influyen tanto de manera positiva como negativa en el entorno de un paciente y su familia. El personal de salud que está vinculado al cuidado del paciente en UCI, debe ser capaz de resolver y tomar decisiones que son trascendentales para el futuro de una persona que se encuentra entre la vida y la muerte. A pesar de esta obligación moral y profesional, no existe un consenso ampliamente conocido para la toma de decisiones, que facilite al personal afrontar la situación de un paciente en estado crítico. Razón por la cual la educación universitaria en bioética es de vital Importancia, para la formación de profesionales competentes, libre pensadores con responsabilidad social, que actúen como defensores y promotores de la vida.
In the medical world, decisions of staff of Intensive Care Unit, both in a positive and negative way, may affect the patient's environment and family. The health team in charge of the patient care in critical condition should be, able to make decisions important for the future of someone who is between life and death. Despite this moral and professional duty, there is no consensus widely known for decision-making, to provide the staff means to deal this situation, a patient in critical condition. For that reason bioethics education performs vital importance for the training of competent professionals, thinkers open to social responsibility, acting as defenders and promoters of life.
Assuntos
Humanos , Bioética , Tomada de Decisões , Educação , Unidades de Terapia IntensivaRESUMO
Trypanosoma cruzi expresses mucin like glycoproteins encoded by a complex multigene family. In this work, we report the transcription in T. cruzi but not in T. rangeli of a mucin type gene automatically annotated by the T. cruzi genome project. The gene showed no nucleotide similarities with the previously reported T. cruzi mucin like genes, although the computational analysis of the deduced protein showed that it has the characteristic features of mucins: a signal peptide sequence, O-glycosylation sites, and glycosylphosphatidylinositol (GPI) anchor sequence. The presence in this gene of N-terminal and C-terminal coding sequences common to other annotated mucin like genes suggests the existence of a new mucin like gene family.
Assuntos
Genes de Protozoários/genética , Mucinas/genética , Trypanosoma cruzi/genética , Animais , Sequência de Bases , Biblioteca Genômica , Dados de Sequência MolecularRESUMO
Trypanosoma cruzi expresses mucin like glycoproteins encoded by a complex multigene family. In this work, we report the transcription in T. cruzi but not in T. rangeli of a mucin type gene automatically annotated by the T. cruzi genome project. The gene showed no nucleotide similarities with the previously reported T. cruzi mucin like genes, although the computational analysis of the deduced protein showed that it has the characteristic features of mucins: a signal peptide sequence, O-glycosylation sites, and glycosylphosphatidylinositol (GPI) anchor sequence. The presence in this gene of N- terminal and C- terminal coding sequences common to other annotated mucin like genes suggests the existence of a new mucin like gene family.
Assuntos
Animais , Genes de Protozoários/genética , Mucinas/genética , Trypanosoma cruzi/genética , Sequência de Bases , Biblioteca Genômica , Dados de Sequência MolecularRESUMO
En la historia de la humanidad la violencia ha jugado un papel importante en las diferentes etapas del desarrollo del hombre. Entre los factores más importantes que se asocian están el sexo, la edad, la ocupación, los acontecimientos del momento y la ingesta de alcohol entre otros. En este estudio se escogieron por muestreo aleatorio 151 reportes de personas fallecidas en el mes de Diciembre de 1.992 (tomadas del Instituto de Medicina Legal y Ciencias Forenses de Santafé de Bogotá, D.C). Se analizaron diferentes variables que asocian la muerte violenta con la ingesta de alcohol en un porcentaje del 23.8 por ciento que es ligeramente menor al reportado en el estudio realizado en Diciembre de 1.993 que fue del 36.6 por ciento.