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Introduction: Cervical cancer is a public health problem in our country and worldwide. Less than 25% of cases are diagnosed in the early stages, where survival is more remarkable than 90% at five years. Here, we review surgical treatment in the early stages of cervical cancer. Methodology: A literature review was carried out in the MEDLINE database. The search was mainly limited to the English language, with priority given to systematic reviews with or without meta-analysis and randomized studies. However, only retrospective or observational evidence was found for some topics. Results: The standard treatment for early-stage cervical cancer is hysterectomy, and its radical nature will depend on the tumor size, lymphovascular permeation, and tumor-specific prognostic factors. Furthermore, the type of surgery (hysterectomy or trachelectomy) will rely on the patient's desire to preserve fertility. Nodal evaluation is indicated as part of the treatment from stage IAI with PLV. However, the sentinel lymph node is more relevant in the treatment. The incidental finding of cervical cancer after a hysterectomy requires a multidisciplinary evaluation to determine the therapeutic approach. Less radical surgery has been described as oncologically safe in low-risk groups. Conclusion: Surgical treatment in its early stages has evolved in recent decades, making it more individualized and seeking less morbidity in patients without compromising their survival.
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The public health crisis due to opioid overdose is worsening in Mexico's northern region due to the introduction of illicitly manufactured fentanyl into the local drug supply. Though there is an increase in overdose deaths, there is no accurate report of overdoses by Mexican government agencies and no comprehensive opioid overdose prevention strategy. There is currently only an anti-drug marketing strategy which is likely insufficient to mitigate the growing epidemic. In order to address the growing opioid overdose crisis in the country, it is necessary to create and implement a decentralized prevention strategy, that includes naloxone distribution, expanded treatment services in regions most in need, and create active dialogue with community organisations already implementing harm reduction actions. Decisive action must be taken by the Mexican government to ensure the health and wellbeing of the Mexican citizens, especially those at high risk for opioid overdose.
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INTRODUCTION: Appropriate size of resection margins in acral melanoma is not clearly established. OBJECTIVE: To investigate whether narrow-margin excision is appropriate for thick acral melanoma. METHODS: Three-hundred and six patients with acral melanoma were examined. Factors associated with recurrence and survival were analyzed according to surgical margin size (1 to 2 cm and > 2 cm). RESULTS: Out of 306 patients, 183 were women (59.8%). Median Breslow thickness was 6 mm; 224 cases (73.2%) were ulcerated, 154 patients (50.3%) had clinical stage III disease, while 137 were at stage II (44.8%) and 15 at stage IV (4.9%). All cases had negative margins, with a median of 31.5 mm. A Breslow thickness of 7 mm (p = 0.001) and clinical stage III (p = 0.031) were associated with recurrence; the factors associated with survival were Breslow index (p = 0.047), ulceration (p = 0.003), advanced clinical stage (p < 0.001), and use of adjuvant therapy (p = 0.003). CONCLUSION: A resection margin of 1 to 2 cm did not affect tumor recurrence or survival in patients with acral melanoma.
INTRODUCCIÓN: La extensión apropiada de los márgenes de resección en el melanoma acral no está claramente establecida. OBJETIVO: Investigar si la escisión con margen estrecho es adecuada en el melanoma acral grueso. MÉTODOS: Se estudiaron 306 pacientes con melanoma acral. Conforme a la extensión del margen quirúrgico (de 1 a 2 cm y > 2 cm), se analizaron los factores asociados a la recurrencia y la supervivencia. RESULTADOS: De 306 pacientes, 183 fueron mujeres (59.8 %). La mediana del grosor de Breslow fue 6 mm; 224 casos (73.2 %) fueron de tipo ulcerados, 154 pacientes (50.3 %) tenían enfermedad en estadio clínico III, 137 en II (44.8 %) y 15 en IV (4.9 %). Todos los casos presentaron margen negativo, con una mediana de 31.5 mm. Un grosor de Breslow de 7 mm (p = 0.001) y la etapa clínica III (p = 0.031) se asociaron a recurrencia; los factores asociados a la supervivencia fueron el índice de Breslow (p = 0.047), la ulceración (p = 0.003), la etapa clínica avanzada (p < 0.001) y el uso de adyuvancia (p = 0.003). CONCLUSIÓN: Un margen de resección de 1 a 2 cm no afectó la recurrencia tumoral ni la supervivencia en los pacientes con melanoma acral.
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Melanoma , Neoplasias Cutâneas , Humanos , Feminino , Masculino , Margens de Excisão , Neoplasias Cutâneas/patologia , Melanoma/patologia , Terapia Combinada , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Melanoma Maligno CutâneoRESUMO
Resumen Introducción: La extensión apropiada de los márgenes de resección en el melanoma acral no está claramente establecida. Objetivo: Investigar si la escisión con margen estrecho es adecuada en el melanoma acral grueso. Métodos: Se estudiaron 306 pacientes con melanoma acral. Conforme a la extensión del margen quirúrgico (de 1 a 2 cm y > 2 cm), se analizaron los factores asociados a la recurrencia y la supervivencia. Resultados: De 306 pacientes, 183 fueron mujeres (59.8 %). La mediana del grosor de Breslow fue 6 mm; 224 casos (73.2 %) fueron de tipo ulcerados, 154 pacientes (50.3 %) tenían enfermedad en estadio clínico III, 137 en II (44.8 %) y 15 en IV (4.9 %). Todos los casos presentaron margen negativo, con una mediana de 31.5 mm. Un grosor de Breslow de 7 mm (p = 0.001) y la etapa clínica III (p = 0.031) se asociaron a recurrencia; los factores asociados a la supervivencia fueron el índice de Breslow (p = 0.047), la ulceración (p = 0.003), la etapa clínica avanzada (p < 0.001) y el uso de adyuvancia (p = 0.003). Conclusión: Un margen de resección de 1 a 2 cm no afectó la recurrencia tumoral ni la supervivencia en los pacientes con melanoma acral.
Abstract Introduction: Appropriate size of resection margins in acral melanoma is not clearly established. Objective: To investigate whether narrow-margin excision is appropriate for thick acral melanoma. Methods: Three-hundred and six patients with acral melanoma were examined. Factors associated with recurrence and survival were analyzed according to surgical margin size (1 to 2 cm and > 2 cm). Results: Out of 306 patients, 183 were women (59.8%). Median Breslow thickness was 6 mm; 224 cases (73.2%) were ulcerated, 154 patients (50.3%) had clinical stage III disease, while 137 were at stage II (44.8%) and 15 at stage IV (4.9%). All cases had negative margins, with a median of 31.5 mm. A Breslow thickness of 7 mm (p = 0.001) and clinical stage III (p = 0.031) were associated with recurrence; the factors associated with survival were Breslow index (p = 0.047), ulceration (p = 0.003), advanced clinical stage (p < 0.001), and use of adjuvant therapy (p = 0.003). Conclusion: A resection margin of 1 to 2 cm did not affect tumor recurrence or survival in patients with acral melanoma.
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Background: SOBERANA-02 is a COVID-19 conjugate vaccine (recombinant RBD conjugated to tetanus toxoid). Phases 1/2 clinical trials demonstrated high immunogenicity, promoting neutralising IgG and specific T-cell response. A third heterologous dose of SOBERANA-Plus (RBD-dimer) further increased neutralising antibodies. The aim of this study is to evaluate the safety and efficacy of two immunisation regimes: two doses of SOBERANA-02 and a heterologous three-dose combination with SOBERANA-Plus added to it. Methods: From March 8th to June 24th, 2021 we conducted in Havana, Cuba a multicentre randomised, double-blind, placebo-controlled, phase-3 trial evaluating a two doses SOBERANA-02 scheme and a heterologous scheme with one dose SOBERANA-Plus added to it (RPCEC00000354). Participants 19-80 years were randomly assigned to receiving 28 days apart either the two or three dose scheme or placebo. The main endpoint was vaccine efficacy in preventing the occurrence of RT-PCR confirmed symptomatic COVID-19 at least 14 days after the second or third dose in the per-protocol population. We also assessed efficacy against severe disease and, in all participants receiving at least one vaccine/placebo dose, safety for 28 days after each dose. Findings: We included 44,031 participants (52.0% female, 48.0% male; median age 50 years, range 19-80 years; 7.0% black, 24.0% mixed-race, 59.0% white) in a context of initial Beta VOC predominance, with this variant being partially replaced by Delta near the trial's end. Vaccine efficacy in the heterologous combination was 92.0% (95%CI 80.4-96.7) against symptomatic disease. There were no severe COVID-19 cases in the vaccine group against 6 in the placebo group. Two doses of SOBERANA-02 was 69.7% (95%CI 56.5-78.9) and 74.9% (95%CI 33.7-90.5) efficacious against symptomatic and severe COVID-19, respectively. The occurrence of serious and severe adverse events (AE) was very rare and equally distributed between placebo and vaccine groups. Solicited AEs were slightly more frequent in the vaccine group but predominantly local and mostly mild and transient. Interpretation: Our results indicate that the straightforward to manufacture SOBERANA vaccines are efficacious in a context of Beta and Delta VOC circulation, have a favourable safety profile, and may represent an attractive option for use in COVID-19 vaccination programmes. Funding: This study received funds from the National Fund for Science and Technology (FONCI-CITMA-Cuba, contract 2020-20) of the Ministry of Science, Technology and Environment of Cuba.
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The new genus Maxiclavella is proposed to accommodate Clavella simplex Castro Romero and Baeza Kuroki, 1985, which differs from Clavella species, including long and narrow cephalothorax, small bulla, and simple armature of the antenna and antennule. Praeclavella nasalis, new genus and species, was found parasitizing the olfactory sacs of Isacia conceptionis. Praeclavella nasalis could be differentiated from other Clavella species by a biramous antenna with an exopod shorter than the endopod, the base of the cephalothorax with a large lobular and suborbicular projection on each side, a suborbicular bulla, mandibles without secondary teeth, and a suboval male body type. Males of both genera fit well in the Clavella-clade male type, although they differ from each other in many aspects, mainly in the position of the buccal area, which is oriented ventrally in Maxiclavella and distally in Praeclavella nasalis, and in a genital process, which is present in the latter and absent in the former. Genetic distances of mtDNA COI and 28S rDNA supported the validity of the two new genera parasitizing the same host, I. conceptionis. Also Clavella-branch (Clavellinae Wilson), a key based genera on female specimens is presented.
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Copépodes , Presbytini , Animais , Vesícula , DNA Mitocondrial , DNA Ribossômico , Feminino , Masculino , FilogeniaRESUMO
The parasitic copepod genus Parabrachiella is composed of 70 species, 14 of which are found in South America. The finding of new specimens of Parabrachiella mugilis from Turkey allowed us to compare the nucleotide sequences of the mitochondrial cytochrome c oxidase subunit I (COI) gene of this species with those of the South American Parabrachiella exilis and Parabrachiella platensis; all these species are parasites of mugilids. In addition, specimens of Parabrachiella fasciata, Parabrachiella oralis and Parabrachiella dispar from Chile, and Parabrachiella chevreuxi from Argentina were included in the comparison. Our results confirmed that the three Parabrachiella species parasitizing mugilids, which had been identified by morphology, are valid entities. However, P. exilis was recently synonymized with P. mugilis. The latter species showed a great genetic distance from P. exilis (16%) and was closer to Parabrachiella fasciata (13%) and to species with long posterior processes. Parabrachiella exilis and P. platensis (parasite on Mugil cephalus and Mugil liza, respectively) had a low genetic distance (9%) and Parabrachiella kabatai (parasite of Isacia conceptionis) had a low genetic distance (12-13%) from P. fasciata, P. platensis and P. exilis. In addition, the three parasitic copepods from South America have short and round posterior processes compared to other species, which have long posterior processes. Most species with long posterior processes are clustered together in a Pacific Ocean clade (P. hugu from the North Pacific Ocean), with the exception of P. chevreuxi, which has been found in the South Atlantic Ocean. This study adds seven new sequences, making a total of nine sequenced South American species of Parabrachiella.
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Copépodes , Smegmamorpha , Animais , Oceano Atlântico , Chile , Copépodes/genética , PeixesRESUMO
Background: Living at high altitude or with chronic hypoxia implies functional and morphological changes in the right ventricle and pulmonary vasculature with a 10% prevalence of high-altitude pulmonary hypertension (HAPH). The implications of working intermittently (day shifts) at high altitude (hypobaric hypoxia) over the long term are still not well-defined. The aim of this study was to evaluate the right cardiac circuit status along with potentially contributory metabolic variables and distinctive responses after long exposure to the latter condition. Methods: A cross-sectional study of 120 healthy miners working at an altitude of 4,400-4,800 m for over 5 years in 7-day commuting shifts was designed. Echocardiography was performed on day 2 at sea level. Additionally, biomedical and biochemical variables, Lake Louise scores (LLSs), sleep disturbances and physiological variables were measured at altitude and at sea level. Results: The population was 41.8 ± 0.7 years old, with an average of 14 ± 0.5 (range 5-29) years spent at altitude. Most subjects still suffered from mild to moderate symptoms of acute mountain sickness (mild was an LLS of 3-5 points, including cephalea; moderate was LLS of 6-10 points) (38.3%) at the end of day 1 of the shift. Echocardiography showed a 23% mean pulmonary artery pressure (mPAP) >25 mmHg, 9% HAPH (≥30 mmHg), 85% mild increase in right ventricle wall thickness (≥5 mm), 64% mild right ventricle dilation, low pulmonary vascular resistance (PVR) and fairly good ventricle performance. Asymmetric dimethylarginine (ADMA) (OR 8.84 (1.18-66.39); p < 0.05) and insulin (OR: 1.11 (1.02-1.20); p < 0.05) were associated with elevated mPAP and were defined as a cut-off. Interestingly, the correspondence analysis identified association patterns of several other variables (metabolic, labor, and biomedical) with higher mPAP. Conclusions: Working intermittently at high altitude involves a distinctive pattern. The most relevant and novel characteristics are a greater prevalence of elevated mPAP and HAPH than previously reported at chronic intermittent hypobaric hypoxia (CIHH), which is accompanied by subsequent morphological characteristics. These findings are associated with cardiometabolic factors (insulin and ADMA). However, the functional repercussions seem to be minor or negligible. This research contributes to our understanding and surveillance of this unique model of chronic intermittent high-altitude exposure.
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RESUMEN Este artículo analiza la eficiencia y los cambios productivos en la cobertura de las 32 instituciones de educación superior colombianas pertenecientes al Sistema de Universidades Estatales durante el periodo 2003-2012. Para tal fin, se empleó el análisis envolvente de datos y el índice de productividad de Malmquist para analizar los datos sobre matrícula de pregrado y posgrado, número docentes de tiempo completo, gasto en personal administrativo y recursos financieros y físicos. Los resultados muestran que, aproximadamente, todas las instituciones evaluadas obtienen eficiencias por encima de 70 % y crecimientos promedios de su productividad a una tasa aproximada de 9 %. Sin embargo, se observan profundas diferencias entre los desempeños interregionales, sobre todo entre la región andina y la región caribe.
ABSTRACT This article analyzes the efficiency and the productive changes in the coverage of the 32 Colombian Higher Education Institutions belonging to the System of State Universities (SUE), during the period 2003-2012. Data Envelopment Analysis and the Malmquist Productivity Index were used to analyze data on students enrolled in undergraduate and postgraduate programs, number of full-time teachers, administrative expenses, and financial and infrastructure resources. The results show that, on average, all the institutions of higher education obtained efficiencies above 70%, as well as increases in their productivity at an average rate of 9%. However, it was observed deep differences between the regions of Colombia, especially the central region and the north of Colombia.
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Humanos , Educação , Estudantes , EficiênciaRESUMO
Se presenta un caso de coinfección por Mycobacterium malmoense y Mycobacterium tuberculosis en un paciente cubano con síndrome de inmunodeficiencia adquirida (sida), que producía enfermedad respiratoria y hepática respectivamente. Los cultivos realizados a partir de las muestras de esputo demostraron la presencia de una cepa micobacteriana no pigmentada de crecimiento lento perteneciente al grupo III de Runyon e identificada como Mycobacterium malmoense. A partir de los cultivos del tejido hepático extraído laparoscópicamente se aisló una cepa posteriormente identificada como Mycobacterium tuberculosis. El estudio anatomopatológico confirmó el diagnóstico de tuberculosis, el paciente recibió tratamiento específico y evolucionó clínicamente bien. Se reporta un caso infrecuente de coinfección por Mycobacterium, el cual describe el primer reporte de tuberculosis hepática en una paciente con sida en Cuba.
A case is presented of coinfection with Mycobacterium malmoense and Mycobacterium tuberculosis in a Cuban patient with AIDS which produced respiratory and liver disease respectively. Cultures done from sputum samples showed the presence of a non-pigmented, slow growing mycobacterial strain belonging to Runyon group III and identified as Mycobacterium malmoense. From cultures of liver tissue removed laparoscopically, a strain was isolated and subsequently identified as Mycobacterium tuberculosis. Anatomapathologic examination confirmed the diagnosis of tuberculosis, the patient received specific treatment and had a favorable clinical course. This report of a rare case of coinfection of Mycobacterium describes the first report of hepatic tuberculosis in a patient with AIDS in Cuba.
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Humanos , Masculino , Adulto , Infecções por Mycobacterium , Mycobacterium tuberculosis , Síndrome da Imunodeficiência Adquirida , CubaRESUMO
A case is presented of coinfection with Mycobacterium malmoense and Mycobacterium tuberculosis in a Cuban patient with AIDS which produced respiratory and liver disease respectively. Cultures done from sputum samples showed the presence of a non-pigmented, slow growing mycobacterial strain belonging to Runyon group III and identified as Mycobacterium malmoense. From cultures of liver tissue removed laparoscopically, a strain was isolated and subsequently identified as Mycobacterium tuberculosis. Anatomapathologic examination confirmed the diagnosis of tuberculosis, the patient received specific treatment and had a favorable clinical course. This report of a rare case of coinfection of Mycobacterium describes the first report of hepatic tuberculosis in a patient with AIDS in Cuba.
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Síndrome da Imunodeficiência Adquirida/complicações , Coinfecção/complicações , Infecções por Mycobacterium não Tuberculosas/complicações , Tuberculose/complicações , Adulto , Humanos , MasculinoRESUMO
Introducción: La atención adecuada del paciente con infarto miocárdico agudo y la rapidez en la trombolisis, son las piedras angulares de su supervivencia. Objetivo: Caracterizar el infarto miocárdico agudo en la Unidad de Cuidados Intensivos Coronarios del Hospital General Docente "Abel Santamaría Cuadrado", Pinar del Río. Material y Método: Se realizó una investigación aplicada, descriptiva, transversal en la Unidad de Cuidados Intensivos Coronarios del Hospital General Docente "Abel Santamaría Cuadrado", Pinar del Río, desde el 1ro de enero de 2006 hasta el 31 de diciembre de 2010. Resultados: El total de ingresos fue de 3922 con cardiopatía isquémica y 1396 con infarto miocárdico agudo. La mayoría con una elevación del segmento ST (1205), de ellos, se aplicó el tratamiento trombolítico a 800 pacientes (66,4%), intrahospitalaria a (157/19,6%); predomina la extrahospitalaria con (643/80,4%). No se aplicó el tratamiento trombolítico a 405 pacientes para un (33,6%). En 1396 pacientes, la mortalidad se comportó de la siguiente manera: general 117/8,4% (infarto); en el año 2009 fue la mayor con un (9.7%); en trombolizados un (6,1%), intrahospitalarios un 8.2%, extrahospitalarios un 5,5%. La intervención educativa en los médicos de Atención Primaria y Secundaria de Salud (Servicios de Urgencias), predominó con menos de 5 años de experiencia un (69.2%), con un perfil ocupacional en Medicina General Integral fue (12/46.1%), lo que significó un aumento de la competencia en la mayoría de los profesionales; los resultados fueron estadísticamente significativos una vez aplicado el test de McNemar 5.26. Se confecciona un plan de acción gerencial para la estrategia trazada. Conclusiones: La mayoría de ingresos presentaron infarto miocárdico agudo con elevación del ST. La mortalidad en trombolizados fue menor. El índice de trombolisis debe ser superado.
Introduction: the adequate care of patients suffering from acute myocardial infarction and the rapid thrombolysis, are the cornerstone of the patient's survival. Objective: to characterize the myocardial infarction in the Coronary Intensive Care Unit at "Abel Santamaria Cuadrado" University Hospital, Pinar del Rio. Material and Method: an applied, descriptive, cross-sectional research carried out at "Abel Santamaria Cuadrado" University Hospital from January 1st 2006 to December 31 2010. Results: the total of patients admitted was 3922 who suffered from ischemic heart disease and 1396 with myocardial infarction. The majority of them showed ST-segment elevation (1205), thrombolysis was applied to 800 patients (66,4%), intra-hospital to 157 (19,65); prevailing extra-hospital 643 (80,4%). Thrombolysis was not applied in 405 patients (33,6%). In 1396 patients the mortality rate behaved the following: general 117 (8,4% infarction), during 2009 was the highest (9.7%); those undergoing thrombolysis (6,1%), intra-hospital (8.2%), extra-hospital a 5,5%. The educational intervention applied to the Primary Health Care Doctors and Secondary Care (Emergency Services) showed a prevalence of lees than 5 years of working experience (69.2%), with an occupational profile in Comprehensive Medicine 12 (46.1%), which means an increase of competences in the majority of health professionals; results were statistically significant when applying McNemar test 5.26. A management action plan to design the strategy was created. Conclusion: the majority of the patients admitted suffered from acute myocardial infarction with ST-segment elevation. Mortality rate was lower in patients undergoing thrombolysis. The rate of thrombolysis must be outnumbered.
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En la primera pandemia del siglo XXI por virus influenza A/H1N1, una importante proporción de paciente que desarrollaron neumonía y Falla Respiratoria Aguda (FRA) eran obesos. La obesidad ha sido propuesta como un factor de riesgo que aumenta la morbimortalidad; sin embargo, hay controversia al respecto. Objetivo: evaluar el impacto de la obesidad en complicaciones, estadía y/o mortalidad en pacientes adultos graves por virus influenza A/H1N1. Estudio observacional y multicéntrico realizado en 17 UCIs de Chile durante el periodo mayo-agosto 2009. Fueron incluidos en el estudio solo paciente con infección por virus Influenza A/H1N1 confirmada o probable. Los paciente obesos (IMC>30) fueron comparados con pacientes no obesos. Resultados: De un total de 136 pacientes incluidos en el estudio, 64 (47 por ciento) fueron obesos y de estos 13 obesos mórbidos (BMI >40). Los pacientes obesos tienen mayor frecuencia de: comorbilidades, ventilación mecánica y complicaciones. La estadía en UCI y en el hospital fue más prolongada en pacientes obesos (18,1+/-15 vs. 10,9+/-10,2, p=0,002 y 27,2+/-24,7 vs17,7 +/- 14,6, p=0,01 respectivamente). La mortalidad fue mayor en pacientes obesos (36 por ciento vs. 19,4 por ciento; OR 2,32; IC95 por ciento 1,07-5,05, p=0.035). El estudio de regresión logística encuentra que la FOM es un factor pronóstico independiente de mortalidad en pacientes obesos. Conclusiones: Los pacientes obesos con neumonía grave por virus influenza A/H1N1 tienen una mayor morbi-mortalidad y prolongación de su estadía en UCI y en el hospital. El desarrollo de FOM en pacientes obesos es un factor de mal pronóstico.
In the first pandemic of the 21st century due to influenza A/H1N1 virus, a significant proportion of patients who developed pneumonia and acute respiratory failure (ARF) were obese. Obesity has been proposed as a risk factor that increases morbidity and mortality, however, there is controversy about it. Objective: To determine the impact of obesity on complications, stay and / or mortality in adult patients with severe influenza A/H1N1 virus. Multicenter observational study conducted in 17 ICUs of Chile during the period May to August 2009. Were included only patients with influenza A/H1N1 virus infection confirmed or probable. Obese patients (BMI> 30) were compared with non obese patients. The results: Of a total of 136 patients included in the study, 64 (47 percent) were obese and of these 13 morbidly obese (BMI> 40). Obese patients have a higher frequency of: comorbidities, mechanical ventilation and complications. The stay in ICU and hospital was longer in obese patients (18.1 +/- 15 vs. 10.9 +/- 10.2, p = 0.002 and 27.2 +/- 24.7 vs17, 7 +/- 14.6, p = 0.01 respectively). Mortality was higher in obese patients (36 percent vs. 19.4 percent, OR 2.32, 95 percent CI 1.07 to 5.05, p = 0,035). The logistic regression analysis found that the MOF is an independent predictor of mortality in obese patients. Conclusions: Obese patients with severe pneumonia due to the influenza A/H1N1 virus have a high morbidity and mortality and prolonged stay in ICU and hospital. MOF development in obese patients is a poor prognostic factor.
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Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Influenza Humana/epidemiologia , Pneumonia Viral/epidemiologia , Obesidade/epidemiologia , Índice de Massa Corporal , Comorbidade , Chile/epidemiologia , Influenza Humana/mortalidade , Influenza Humana/virologia , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Estudos Multicêntricos como Assunto , Pneumonia Viral/mortalidade , Obesidade/complicações , Obesidade/mortalidade , Análise de Sobrevida , Vírus da Influenza A Subtipo H1N1/isolamento & purificaçãoRESUMO
En este artículo se plantea la necesidad de superar los abordajes psicologistas sobre el trabajo a partir de la ubicación del sentido y los alcances de los estudios que desde la psicología se hacen en relación con el trabajo. Igualmente, se señalan los elementos que necesariamente deben estar presentes con el objeto de que tales estudios tengan mayor pertinencia social. Para ello, se identifican y analizan los niveles de la realidad que deben ser considerados en el estudio del trabajo: 1) estructura y organización de la sociedad y el mundo, con el objetivo de reflexionar sobre el estado actual en el que se encuentra el mundo en términos de su dinámica económica y política; 2) estructura y funcionamiento de las organizaciones laborales, cuya justificación está dada no sólo con el contexto en el cual se realiza el trabajo, sino además porque en la actualidad están inmersas en procesos de cambio que, a la vez que son resultado de las modificaciones que están operando a nivel mundial, también están transformando el trabajo mismo y el comportamiento del trabajador; y 3) caracterización del trabajo como fenómeno psicosocial, lo que significa la consideración del trabajo como fuente de beneficios como de efectos negativos para la persona que trabaja. En estos niveles se presentan una serie de fenómenos que deben ser observados para realizar un estudio integral del trabajo. Este planteamiento se aplica para el caso de México y se analizan principalmente las consecuencias psicosociales negativas derivadas de las transformaciones ocurridas en el mundo del trabajo. Finalmente, se presentan una serie de conceptos relacionados con la salud física y los psicotrastornos asociados al trabajo que, atendiendo a la integridad psíquica de los trabajadores, la psicología deberá tener presente.
This article proposes the necessity to overcome psychologists focus about work since the location of sense and researches achieves under psychological view doing about work. At the same, the necessary elements are indicated, with the objective that these researches had more social significance. To do that, it identifies and analyzes the reality levels that should be considered in the work study: 1) Society an world structure and organization, with the objective to think about the nowadays worlds economic and political dynamic; 2) Industrial organizations structure and operation, which justifies because they are the work context, also immersed in change processes as results of modification operating around the world, transforming the work itself and worker behavior; 3) work description as a psycho-social phenomenon, it contemplates work consideration as a benefits and negatives effects source to worker. At these levels it presents a phenomenon series that should be observed to do an integral work research. This approach applies in Mexico case and analyzes the negatives psycho-social consequences derived from transformations in the working world. Finally, it presents concepts series related to psychical integrity, psychology must to be present.
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México , Psicologia Social , Trabalho , Trabalho/psicologiaRESUMO
Se explora la relación que existe entre la carga mental laboral (sobrecarga y subcarga) y los niveles de alteración mental presentados por trabajadores industriales, particularmente en lo que se refiere a los procesos cognitivos (atención y memoria) y emocionales (ansiedad y depresión). Los 52 sujetos evaluados son trabajadores de distintas empresas a quienes se les aplicó el Cuestionario sobre Integridad Mental y Trabajo (CIMYT), que no cuenta con datos de confiabilidad y validez. Los resultados obtenidos con ANOVA muestran diferencias estadísticamente significativas entre la variable sobrecarga y las variables memoria (F19,51= 7.88; p=.00), ansiedad (F19,51= 27.02; p=.00), depresión (F19,51= 20.41; p=.00) y fatiga mental (F19,51= 12.84; p=.00); y entre la variable subcarga y las variables atención (F12,51= 2.62; p=.01), memoria (F12,51= 10.44; p=.00), ansiedad (F12,51= 4.28; p=.00), depresión (F12,51= 2.45; p=.01) y fatiga mental (F12,51= 4.70; p=.00). Se discuten las implicaciones del estudio en el marco de la integridad psíquica de los trabajadores y de su inserción en el mundo laboral, además de señalar la necesidad de realizar la validación del CIMYT.
The objective of this paper is to explore the relationship between the mental labor load (overloaded and under loaded) and the levels of mental alteration presented by industrial workers, particularly referring to the cognitive processes (attention and memory) and emotional processes (anxiety and depression). The 52 evaluated subjects are hard-working people from different companies to whom we applied the Mental Integrity and Work Questionnaire, this questionnaire does not count with reliability and validity data. The end results with ANOVA showed statistically significant differences among the variable overload and the variables memory (F19,51 = 7.88; p=.00), anxiety (F19,51 = 27.02; p=.00), depression (F19,51 = 20.41; p=.00) and mental fatigue (F19,51 = 12.84; p=.00); and between the variable underload and the variables attention (F12,51 = 2.62; p=.01), memory (F12,51 = 10.44; p=.00), anxiety (F12,51 = 4.28; p=.00), depression (F12,51 = 2.45; p=.01) and mental fatigue (F12,51 = 4.70; p=.00). Implications of the study are discussed in the frame of the psycho integrity of the workers and their immersion in the labor world, besides pointing out the necessity to carry out the reliability of the CIMYT.
Assuntos
Masculino , Feminino , Humanos , Carga de Trabalho , Categorias de Trabalhadores , Fadiga Mental , Indústrias , Transtornos PsicofisiológicosRESUMO
Alphavirus replicon particle-based vaccine vectors derived from Sindbis virus (SIN), Semliki Forest virus, and Venezuelan equine encephalitis virus (VEE) have been shown to induce robust antigen-specific cellular, humoral, and mucosal immune responses in many animal models of infectious disease and cancer. However, since little is known about the relative potencies among these different vectors, we compared the immunogenicity of replicon particle vectors derived from two very different parental alphaviruses, VEE and SIN, expressing a human immunodeficiency virus type 1 p55(Gag) antigen. Moreover, to explore the potential benefits of combining elements from different alphaviruses, we generated replicon particle chimeras of SIN and VEE. Two distinct strategies were used to produce particles with VEE-p55(gag) replicon RNA packaged within SIN envelope glycoproteins and SIN-p55(gag) replicon RNA within VEE envelope glycoproteins. Each replicon particle configuration induced Gag-specific CD8(+) T-cell responses in murine models when administered alone or after priming with DNA. However, Gag-specific responses varied dramatically, with the strongest responses to this particular antigen correlating with the VEE replicon RNA, irrespective of the source of envelope glycoproteins. Comparing the replicons with respect to heterologous gene expression levels and sensitivity to alpha/beta interferon in cultured cells indicated that each might contribute to potency differences. This work shows that combining desirable elements from VEE and SIN into a replicon particle chimera may be a valuable approach toward the goal of developing vaccine vectors with optimal in vivo potency, ease of production, and safety.
Assuntos
Vacinas contra a AIDS/imunologia , Vírus da Encefalite Equina Venezuelana/genética , Vetores Genéticos , Replicon , Sindbis virus/genética , Vacinas Sintéticas/imunologia , Sequência de Aminoácidos , Animais , Linfócitos T CD8-Positivos/imunologia , Quimera , Cricetinae , Produtos do Gene gag/genética , Produtos do Gene gag/imunologia , Interferons/farmacologia , Camundongos , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Precursores de Proteínas/genética , Precursores de Proteínas/imunologia , RNA Viral/biossíntese , Montagem de VírusRESUMO
Se coloca un caso de embarazo molar parcial con feto coexistente en una paciente de 38 años de edad y 13 semanas de gestación. El diagnóstico se realizó por ecosonografía y se confirmó por anatomía patológica posterior al vaciamiento por aspiración endouterina. Se recomienda anticonceptivos orales y se realizó seguimiento de los niveles de hormona gonadotrofina coriónica, evolucionando satisfactoriamente
Assuntos
Humanos , Feminino , Gravidez , Mola Hidatiforme/diagnóstico , Mola Hidatiforme/patologiaRESUMO
In this work would be presented the basic ideas about Fuzzy sets, vague sets and the elementary operations and properties about Fuzzy subsets depending upon the provious ideas, to give a presentation of concepts regarding Fuzzy relations, which would allow us study some depth the ideas of Fuzzy restrictions, i.e., to think Fuzzy restrictions as Fuzzy relations which influence in a determined manner on the values which can be given to certain variables.
Neste trabalho serão apresentadas as idéias básicas do que entendemos por conjuntos fuzzy, conjuntos imprecisos, vagos e as operações e propriedades elementares entre subconjuntos fuzzy, para logo, baseados nas idéias anteriores, fazer uma apresentação dos conceitos de relações fuzzy, que nos permitirá examinar com algum detalhe as idéias de restrições fuzzy, isto é, pensar em restrições fuzzy como relações fuzzy que influem de maneira determinante sobre os valores que podem ser dados a certas variáveis.