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Chronic Chagas cardiomyopathy (CCC) has unique pathogenic and clinical features with worse prognosis than other causes of heart failure (HF), despite the fact that patients with CCC are often younger and have fewer comorbidities. Patients with CCC were not adequately represented in any of the landmark HF studies that support current treatment guidelines. PARACHUTE-HF (Prevention And Reduction of Adverse outcomes in Chagasic Heart failUre Trial Evaluation) is an active-controlled, randomized, phase IV trial designed to evaluate the effect of sacubitril/valsartan 200 mg twice daily vs enalapril 10 mg twice daily added to standard of care treatment for HF. The study aims to enroll approximately 900 patients with CCC and reduced ejection fraction at around 100 sites in Latin America. The primary outcome is a hierarchical composite of time from randomization to cardiovascular death, first HF hospitalization, or relative change from baseline to week 12 in NT-proBNP levels. PARACHUTE-HF will provide new data on the treatment of this high-risk population. (Efficacy and Safety of Sacubitril/Valsartan Compared With Enalapril on Morbidity, Mortality, and NT-proBNP Change in Patients With CCC [PARACHUTE-HF]; NCT04023227).
Assuntos
Aminobutiratos , Antagonistas de Receptores de Angiotensina , Compostos de Bifenilo , Cardiomiopatia Chagásica , Combinação de Medicamentos , Enalapril , Insuficiência Cardíaca , Tetrazóis , Valsartana , Humanos , Compostos de Bifenilo/uso terapêutico , Aminobutiratos/uso terapêutico , Enalapril/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Cardiomiopatia Chagásica/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Tetrazóis/uso terapêutico , Volume Sistólico/fisiologia , Fragmentos de Peptídeos/sangue , Doença Crônica , Peptídeo Natriurético Encefálico/sangue , Masculino , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Feminino , Resultado do TratamentoRESUMO
AIMS: Incomplete decongestion due to lack of titration of diuretics to effective doses is a common reason for readmission in patients with acute decompensated heart failure (ADHF). The natriuretic response prediction equation (NRPE) is a novel tool that proved to be rapid and accurate to predict natriuretic response and does not need urine collection. However, the NRPE has not been externally validated. The goal of this study was to externally validate the discrimination capacity of the NRPE in patients with ADHF and fluid overload. METHODS AND RESULTS: Patients admitted with ADHF who required intravenous loop diuretics were included. A spot urine sample was obtained ~2 h following diuretic administration, and a timed 6-h urine collection by study staff was carried out. Urine sodium and urine creatinine from the spot urine sample were used to predict the 6-h natriuretic response using the NRPE. The primary goal was to validate the NRPE to discriminate poor loop diuretic natriuretic response (sodium output <50 mmol in the 6 h following diuretic administration). The NRPE was compared with urine sodium and measured urine output which are the methods currently recommended by international guidelines to assess diuretic response. Eighty-seven diuretic administrations from 49 patients were analysed. Mean age of patients was 57 ± 17 years and 67% were male. Mean estimated glomerular filtration rate was 65 ± 28 mL/min/1.73 m2, and ejection fraction was 35 ± 15%. Median dose of intravenous furosemide equivalents administered the day of the study was 80 mg (IQR 40 - 160). Poor natriuretic response occurred in 39% of the visits. The AUC of the NRPE to predict poor natriuretic response during the 6-h urine collection was 0.91 (95% CI 0.85-0.98). Compared with the NRPE, spot urine sodium concentration (AUC 0.75) and urine output during the corresponding nursing shift (AUC 0.74) showed lower discrimination capacity. CONCLUSIONS: In this cohort of patients with ADHF, the NRPE outperformed spot urine sodium concentration and all other metrics related to diuretic response to predict poor natriuretic response. Our findings support the use of this equation at other settings to allow rapid and accurate prediction of natriuretic response.
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Chronic heart failure continues to be one of the main causes of impairment in the functioning and quality of life of people who suffer from it, as well as one of the main causes of mortality in our country and around the world. Mexico has a high prevalence of risk factors for developing heart failure, such as high blood pressure, diabetes, and obesity, which makes it essential to have an evidence-based document that provides recommendations to health professionals involved in the diagnosis and treatment of these patients. This document establishes the clinical practice guide (CPG) prepared at the initiative of the Mexican Society of Cardiology (SMC) in collaboration with the Iberic American Agency for the Development and Evaluation of Health Technologies, with the purpose of establishing recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. This document complies with international quality standards, such as those described by the US Institute of Medicine (IOM), the National Institute of Clinical Excellence (NICE), the Intercollegiate Network for Scottish Guideline Development (SIGN) and the Guidelines International Network (G-I-N). The Guideline Development Group was integrated in a multi-collaborative and interdisciplinary manner with the support of methodologists with experience in systematic literature reviews and the development of CPG. A modified Delphi panel methodology was developed and conducted to achieve an adequate level of consensus in each of the recommendations contained in this CPG. We hope that this document contributes to better clinical decision making and becomes a reference point for clinicians who manage patients with chronic heart failure in all their clinical stages and in this way, we improve the quality of clinical care, improve their quality of life and reducing its complications.
La insuficiencia cardiaca crónica sigue siendo unas de las principales causas de afectación en el funcionamiento y en la calidad de vida de las personas que la presentan, así como una de las primeras causas de mortalidad en nuestro país y en todo el mundo. México tiene una alta prevalencia de factores de riesgo para desarrollar insuficiencia cardiaca, tales como hipertensión arterial, diabetes y obesidad, lo que hace imprescindible contar con un documento basado en la evidencia que brinde recomendaciones a los profesionales de la salud involucrados en el diagnóstico y el tratamiento de estos pacientes. Este documento establece la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología (SMC) en colaboración con la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario y multicolaborativo de expertos. Cumple con estándares internacionales de calidad, como los descritos por el Institute of Medicine de los Estados Unidos de América (IOM), el National Institute of Clinical Excellence (NICE) del Reino Unido, la Intercollegiate Network for Scottish Guideline Development (SIGN) de Escocia y la Guidelines International Network (G-I-N). El grupo de desarrollo de la guía se integró de manera interdisciplinaria con el apoyo de metodólogos con experiencia en revisiones sistemáticas de la literatura y en el desarrollo de GPC. Se llevó a cabo y se condujo metodología de panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. Esperamos que este documento contribuya para la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos que manejan pacientes con insuficiencia cardiaca crónica en todas sus etapas clínicas, y de esta manera logremos mejorar la calidad en la atención clínica, aumentar la calidad de vida de los pacientes y disminuir las complicaciones de la enfermedad.
Assuntos
Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/diagnóstico , Doença Crônica , MéxicoRESUMO
Acute heart failure (HF) is associated with poor prognosis. After the acute event, there is a vulnerable period during which the patient has a marked risk of readmission or death. Therefore, early optimization of treatment is mandatory during the vulnerable period. The objective of this article is to provide recommendations to address the management of patients with HF during the vulnerable period from a practical point of view. A group of Mexican experts met to prepare a consensus document. The vulnerable period, with a duration of up to 6 months after the acute event - either hospitalization, visit to the emergency department or the outpatient clinic/day hospital - represents a real window of opportunity to improve outcomes for these patients. To best individualize the recommendations, the management strategies were divided into three periods (early, intermediate and late vulnerable period), including not only therapeutic options but also evaluation and education. Importantly, the recommendations are addressed to the entire cardiology team, including physicians and nurses, but also other specialists implicated in the management of these patients. In conclusion, this document represents an opportunity to improve the management of this population at high risk, with the aim of reducing the burden of HF.
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La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.
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Fundamento: El conocimiento del inglés como el idioma empleado globalmente en diversos sectores, se ha convertido, junto a las tecnologías de la información y las comunicaciones, es una herramienta de formación, trabajo y entretenimiento indispensable; el dominio de este posibilita las relaciones de cooperación e intercambio de profesionales del sector de la salud en varios países. Objetivo: Diseñar un material didáctico para el desarrollo de la competencia comunicativa audio-oral en inglés en estudiantes de posgrado de la carrera de Medicina, mediante el empleo de tecnologías de la información y la comunicación. Metodología: Se realizó una investigación de desarrollo con enfoque mixto en la Universidad de Ciencias Médicas de Holguín durante el período marzo-julio de 2022. Se asumió el método dialéctico materialista como concepción general de la investigación y se emplearon otros del nivel teórico: histórico-lógico, análisis y síntesis e inducción deducción, sistémico-estructural-funcional y revisión documental; empíricos: encuesta, entrevista y observación participativa. Resultados: Las principales dificultades estuvieron relacionadas con el insuficiente tratamiento de la competencia comunicativa audio-oral en inglés, se constató la importancia de la misma dentro del proceso de enseñanza-aprendizaje del inglés, pues establece las pautas generales que se deben seguir para una comunicación efectiva y se instituye desde una mirada holística del acto comunicativo del profesional. Conclusiones: Los especialistas valoraron el material como adecuado por su estructura y factibilidad para su implementación. Después de su aplicación se evidenció su efectividad en la consolidación del aprendizaje en este nivel educacional a través de la preparación idiomática.
Background: Knowledge of English as the language used globally in various sectors, has increasingly become, together with information and communications technologies, an indispensable training, work and entertainment tool in the current era. Its domain enables cooperation relations and exchange of professionals in the health sector in various countries. Objective: To design a didactic material for the development of audio-oral communicative competence in English in postgraduate medical students, through the use of Information and Communication Technologies (ICT). Methods: A development research with a mixed approach was carried out at the Holguín University of Medical Sciences during the period March-July 2022. It was assumed the dialectical materialist method as the general conception of the research and others of the theoretical level: historical- logical, analysis and synthesis and induction deduction, systemic-structural-functional and documentary review; empirical: survey, interview and participatory observation. Results: The main difficulties were related to an insufficient treatment of audio-oral communicative competence in English, it was confirmed its importance within the teaching-learning process of English, since it establishes the general guidelines that must be followed for an effective communication. Moreover, it is instituted from a holistic view of the professional communicative act. Conclusions: The specialists assessed the material as adequate due to its structure and feasibility for its implementation. After its application, it was evidenced its effectiveness in consolidating learning in this educational level through language training.
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Plant genomes encode a unique group of papain-type Cysteine EndoPeptidases (CysEPs) containing a KDEL endoplasmic reticulum (ER) retention signal (KDEL-CysEPs or CEPs). CEPs process the cell-wall scaffolding EXTENSIN (EXT) proteins that regulate de novo cell-wall formation and cell expansion. Since CEPs cleave EXTs and EXT-related proteins, acting as cell-wall-weakening agents, they may play a role in cell elongation. The Arabidopsis (Arabidopsis thaliana) genome encodes 3 CEPs (AtCPE1-AtCEP3). Here, we report that the genes encoding these 3 Arabidopsis CEPs are highly expressed in root-hair (RH) cell files. Single mutants have no evident abnormal RH phenotype, but atcep1-3 atcep3-2 and atcep1-3 atcep2-2 double mutants have longer RHs than wild-type (Wt) plants, suggesting that expression of AtCEPs in root trichoblasts restrains polar elongation of the RH. We provide evidence that the transcription factor NAC1 (petunia NAM and Arabidopsis ATAF1, ATAF2, and CUC2) activates AtCEPs expression in roots to limit RH growth. Chromatin immunoprecipitation indicates that NAC1 binds to the promoter of AtCEP1, AtCEP2, and, to a lower extent, AtCEP3 and may directly regulate their expression. Inducible NAC1 overexpression increases AtCEP1 and AtCEP2 transcript levels in roots and leads to reduced RH growth while the loss of function nac1-2 mutation reduces AtCEP1-AtCEP3 gene expression and enhances RH growth. Likewise, expression of a dominant chimeric NAC1-SRDX repressor construct leads to increased RH length. Finally, we show that RH cell walls in the atcep1-3 atcep3-2 double mutant have reduced levels of EXT deposition, suggesting that the defects in RH elongation are linked to alterations in EXT processing and accumulation. Our results support the involvement of AtCEPs in controlling RH polar growth through EXT processing and insolubilization at the cell wall.
Assuntos
Proteínas de Arabidopsis , Arabidopsis , Arabidopsis/metabolismo , Proteínas de Arabidopsis/genética , Proteínas de Arabidopsis/metabolismo , Regulação da Expressão Gênica de Plantas , Peptídeo Hidrolases/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismoRESUMO
Fundamento: La enseñanza del idioma inglés constituye una prioridad en la preparación integral de los profesionales de la salud. En las circunstancias actuales la modalidad de educación a distancia es una vía para garantizar la continuidad del proceso docente-educativo en la educación médica superior. Objetivo: Diseñar para su implementación un sistema de tareas docentes que contribuya a desarrollar la habilidad de expresión oral en inglés a través de la educación a distancia en los estudiantes de 2.do año de Medicina. Metodología: Se realizó un estudio experimental en la Universidad de Ciencias Médicas de Holguín durante el período de marzo hasta septiembre de 2021. Se utilizó el método dialéctico materialista como concepción metodológica general de la investigación y se emplearon otros del nivel teórico: análisis y síntesis, inducción-deducción, sistémico-estructural-funcional, histórico-lógico y modelación; empíricos: análisis documental, encuesta, observación de clases, y estadísticos. Resultados: Las principales dificultades estuvieron relacionadas con limitaciones en el tratamiento de la expresión oral en inglés, la insuficiente preparación de los estudiantes en torno a la temática abordada y sus limitaciones en la habilidad de expresión oral en este idioma, por lo que se elaboró un sistema de tareas docentes para solucionar estos aspectos. Conclusiones: Los especialistas valoraron el sistema como adecuado por su estructura y factibilidad de implementación, contribuyó de forma efectiva en la consolidación de la formación cultural y en el plano motivacional.
Background: English language teaching is a priority in the comprehensive preparation of medical professionals. In the current circumstances, distance education is a way to continue the teaching-learning process in higher medical education. Objective: To design for its implementation a system of learning tasks aimed at developing oral expression skills in English through distance education in 2.nd year medical students. Methodology: It was adopted the materialist dialectical method as the general methodological conception of the research, and other methods, from the theoretical level: analysis and synthesis, induction-deduction, systemic-structural-functional, historical-logical and modeling; empirical: documentary analysis, survey, class observation and statistical procedures. Result: The main difficulties were related to the limitations in the treatment of the oral expression in the English language, insufficient preparation of the students on the analyzed topic and their limited ability to develop oral expression in this language, so a system of learning tasks was developed to solve these aspects. Conclusions: The experts considered the system adequate in terms of its structure and feasibility of implementation, contributing effectively to the consolidation of cultural training and at the motivational level.
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Estudantes de Medicina , Universidades , Educação a Distância/métodos , Tecnologia Culturalmente Apropriada/métodos , Proficiência Limitada em InglêsRESUMO
BACKGROUND: A variety of bacterial and fungal co-infections may be attributed to the coronavirus disease 2019 (COVID-19), particularly in people who already have a medical condition such diabetes mellitus or those who received large dosages of steroids. CASE REPORT: We described a 52-year-old diabetic man who was receiving high doses of dexamethasone and antibiotics while receiving ambulatory care for COVID-19 pneumonia. His anterior rhinoscopy revealed a necrotic scab, and a sample confirmed Mucor spp. He underwent surgery and was given amphotericin as a result of the severity of the condition, palpebral ptosis, and right ocular palsy he was experiencing. The patien Ìs progression was satisfactory. CONCLUSIONS: pre-existing diabetes mellitus, previous steroid and antimicrobial use, as well as SARS-CoV-2 infection are some of the risk factors associated with Mucor spp. infection. Prompt detection of mucormycosis is important in the management of these affected patients.
ANTECEDENTES: A la enfermedad por coronavirus (COVID-19) se le han atribuido diversas coinfecciones bacterianas y fúngicas, especialmente en sujetos con enfermedades preexistentes (diabetes mellitus) o en quienes han recibido altas dosis de corticosteroides. REPORTE DE CASO: Paciente masculino de 52 años, con antecedente de diabetes mellitus, quien recibió altas dosis de dexametasona y antibióticos mientras recibía atención ambulatoria por neumonía secundaria a COVID-19. La rinoscopia anterior reveló una costra necrótica, y una muestra de exudado confirmó la coexistencia de Mucor spp. Debido a la complicación del cuadro clínico, ptosis palpebral y parálisis ocular derecha, se le administró anfotericina B y fue intervenido quirúrgicamente. La evolución del paciente fue satisfactoria. CONCLUSIONES: La diabetes mellitus preexistente, el consumo de corticosteroides y antimicrobianos, además de la infección por SARS-CoV-2 son factores de riesgo asociados con la infección por Mucor spp. Es importante la detección oportuna de mucormicosis en el tratamiento de estos pacientes.
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COVID-19 , Mucormicose , Masculino , Humanos , Pessoa de Meia-Idade , Mucormicose/complicações , Mucormicose/diagnóstico , COVID-19/complicações , SARS-CoV-2 , NarizRESUMO
BACKGROUND: Sodium restriction is recommended for patients with heart failure (HF) despite the lack of solid clinical evidence from randomized controlled trials. Whether or not sodium restrictions provide beneficial cardiac effects is not known. METHODS: The present study is a randomized, double-blind, controlled trial of stable HF patients with ejection fraction ≤ 40%. Patients were allocated to sodium restriction (2 g of sodium/day) vs. control (3 g of sodium/day). The primary outcome was change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 20 weeks. Secondary outcomes included quality of life and adverse safety events (HF readmission, blood pressure or electrolyte abnormalities). RESULTS: Seventy patients were enrolled. Median baseline sodium consumption was 3268 (2225-4537) mg/day. Adherence to the intervention based on 24-hour urinary sodium was 32%. NT-proBNP and quality of life did not significantly change between groups (p > 0.05 for both). Adverse safety events were not significantly different between the arms (p > 0.6 for all). In the per protocol analysis, patients who achieved a sodium intake < 2500 mg/day at the intervention conclusion showed improvements in NT-proBNP levels (between-group difference: -55%, 95% confidence interval -27 to -73%; p = 0.002) and quality of life (between-group difference: -11 ± 5 points; p = 0.04). Blood pressure decreased in patients with lower sodium intake (between-group difference: -9 ± 5 mmHg; p = 0.05) without significant differences in symptomatic hypotension or other safety events (p > 0.3 for all). CONCLUSIONS: Adherence assessed by 24-hour natriuresis and by the nutritionist was poor. The group allocated to sodium restriction did not show improvement in NT-proBNP. However, patients who achieved a sodium intake < 2500 mg/day appeared to have improvements in NT-proBNP and quality of life without any adverse safety signals. CLINICALTRIALS: gov Identifier: NCT03351283.
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Insuficiência Cardíaca , Sódio na Dieta , Humanos , Biomarcadores , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Qualidade de Vida , Sódio , Volume Sistólico/fisiologiaRESUMO
Introducción. La esporotricosis es una micosis de implantación causada por Sporothrix spp. Este se encuentra distribuido mundialmente y se puede encontrar en la vegetación y en el suelo. La ruta más frecuente de adquisición de la infección es por traumatismos con elementos contaminados con propágulos del hongo. Los gatos domésticos son los animales más afectados y pueden transmitirla a los humanos, por lo que es considerada una zoonosis. Las formas clínicas incluyen: la linfangítica nodular, la cutánea fija, la pulmonar (poco habitual) y la diseminada (excepcional). Objetivo. Analizar la epidemiología de la esporotricosis en Argentina entre los años 2010 y 2022. Describir la presentación clínica, los métodos de diagnóstico y el tratamiento de los casos diagnosticados en este período. Conocer los genotipos circulantes y observar su relación con el lugar geográfico de adquisición de la infección. Materiales y métodos. Se llevó a cabo un estudio analítico, retrospectivo y observacional, en el que se analizaron las historias clínicas de los pacientes con esporotricosis de 12 instituciones de salud de Argentina, entre los años 2010 y 2022. Resultados. Se presentan 54 casos en los que la forma clínica más frecuente fue la linfangítica nodular y el tratamiento de elección fue el itraconazol. En todos los casos se realizó diagnóstico convencional. El cultivo de las muestras clínicas resultó más sensible que el examen directo, ya que permitió el desarrollo de Sporothrix spp. en los 54 casos. En 22 casos se hizo identificación molecular y Sporothrix schenkii sensu stricto fue la especie más frecuentemente aislada. Conclusiones. Este estudio permitió conocer la epidemiología de esta micosis en Argentina, así como la disponibilidad de métodos diagnósticos y el tratamiento de elección.
Introduction. Sporotrichosis is an implantation mycosis caused by Sporothrix spp. It is distributed worldwide and can be found in vegetation and soil. The most frequent route of infection is by trauma with elements contaminated with fungal propagules. Since domestic cats are the most affected animals and can transmit this infection to humans, sporotrichosis is considered a zoonosis. Clinical presentations include nodular lymphangitis, fixed cutaneous, pulmonary (rare), and disseminated (exceptional). Objective. To analyze the epidemiology of sporotrichosis in Argentina during 2010 and 2022. To describe the clinical presentation, diagnostic methods, and treatment of cases diagnosed during this period. To know the circulating genotypes and to observe possible associations with the geographic location where the infection was acquired. Materials and methods. Analytical, retrospective, and observational study. We analyzed the medical records of patients with sporotrichosis from 12 health institutions in Argentina, between 2010 and 2022. Results. We present 54 cases in which the most frequent clinical form was nodular lymphangitis, and the treatment of choice was itraconazole. Conventional diagnosis was made in all cases. Culture of clinical samples was more sensitive than direct examination because it allowed the isolation of Sporothrix spp. in all 54 cases. Molecular identification was performed in 22 cases, with Sporothrix schenkii sensu stricto being the most frequently isolated species. Conclusions. This study allowed to know the epidemiology of this mycosis in Argentina, as well as the availability of diagnostic methods and the treatment of choice.
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Esporotricose , Argentina , Sporothrix , MicosesRESUMO
A series of six polybenzylic dendrons with an alkynyl focal point were synthesized for their incorporation to gold nanoparticles. Five of these compounds showed columnar mesomorphism in a wide range of temperatures. These dendrons were reacted with gold nanoparticles stabilized with a combination of a dodecanethiol and 11-azidoundecane-1-thiol. The azido group of the last compound allowed the functionalization of the nanoparticles with the six polybenzylic dendrons by 1,3-dipolar cycloaddition between their alkynyl groups and the terminal azido groups of the thiols. A high efficiency of the cycloaddition process (47-69%) was confirmed by several experimental techniques and no decomposition or aggregation phenomena were detected in the dendron-coated nanoparticles. The involved mechanism and the resulting percentage composition of the final materials are discussed. The results of the ulterior growth of the nanoparticles by thermal treatment are influenced by the size and the shape of the dendron and the temperature of the process. The structures of the final nanoparticles were investigated by TEM, DSC, TGA, NMR and UV-Vis spectroscopy. These nanoparticles do not show liquid crystal properties. However, a melting process between a crystalline and a fluid phase is observed. In the solid phase, the nanomaterials prepared show a short-range interaction between nanoparticles with a 2D local hexagonal order. A near-field effect was observed in the UV-vis spectra by coupling of different surface plasmon resonance bands (SPR) probably due to the short-range interactions. The main novelty of this work lies in the scarcity of previous studies of gold nanoparticles coated with dendrons forming themselves columnar mesophases. Most of the studies reported in the literature deal with gold nanoparticles coated with calamitic mesogens. Additionally, the effect of the thermal treatment, which in a previous paper was shown to increase the mean size of the nanoparticles without increasing their size polydispersity, has been studied in these materials.
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During the COVID-19 pandemic, reductions in heart failure (HF) hospitalizations have been widely reported, and there is an urgent need to understand how HF care has been reorganized in countries with different infection levels, vaccination rates and healthcare services. The OPTIMIZE Heart Failure Care program has a global network of investigators in 42 countries, with first-hand experience of the impact of the pandemic on HF management in different care settings. The national coordinators were surveyed to assess: 1) the challenges of the COVID-19 pandemic for continuity of HF care, from both a hospital and patient perspective; 2) the organizational changes enacted to ensure continued HF care; and 3) lessons learned for the future of HF care. Contributions were obtained from 37 national coordinators in 29 countries. We summarize their input, highlighting the issues raised and using the example of three very different settings (Italy, Brazil, and Taiwan) to illustrate the similarities and differences across the OPTIMIZE program.
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COVID-19 , Insuficiência Cardíaca , Brasil , COVID-19/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Pandemias , Inquéritos e QuestionáriosRESUMO
Although in recent years in Mexico the quality of diabetes mellitus (DM) care has improved and access to health services and medications has increased, there is a lack of adherence to the recommendations of the clinical guidelines, which could explain the poor glycemic control in many of the patients with DM. Sodium-glucose cotransporter type 2 (iSGLT2) inhibitors have been the last class of antidiabetic agents to receive approval from the Food and Drug Administration (FDA) and COFEPRIS (Mexico). In order to improve the use of SGLT2i in clinical practice in Mexico, this paper presents the recommendations issued by a panel of eleven Mexican experts based on the new published evidence for the treatment of patients with DM2.
Aunque en los últimos años en México ha mejorado la calidad de la atención de la diabetes mellitus (DM) y ha aumentado el acceso a servicios de salud y medicamentos, existe una falta de apego a las recomendaciones de las guías de práctica clínica, que podría explicar la falta de un control glucémico adecuado en muchos de los pacientes con DM. Los inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) han sido la última clase de agentes antidiabéticos en recibir la aprobación de la Food and Drug Administration (FDA) y de la Comisión Federal para la Protección contra Riesgos Sanitarios de México (COFEPRIS). Con el fin de mejorar el uso de los iSGLT2 en la práctica clínica en México, en este documento se presentan las recomendaciones emitidas por un panel de 11 expertos mexicanos con base en las nuevas evidencias publicadas para el tratamiento de los pacientes con DM2.
Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Inibidores do Transportador 2 de Sódio-Glicose , Consenso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêuticoRESUMO
Compensatory recruitment is a key demographic mechanism that has allowed the coexistence of populations of susceptible amphibians with Batrachochytrium dendrobatidis (Bd), a fungus causing one of the most devastating emerging infectious disease ever recorded among vertebrates. However, the underlying processes (e.g. density-dependent increase in survival at early life stages, change in reproductive traits) as well as the level of interpopulation variation in this response are poorly known. We explore potential mechanisms of compensatory recruitment in response to Bd infection by taking advantage of an amphibian system where male reproductive traits are easy to quantify in free-living populations. The Southern Darwin's frog Rhinoderma darwinii is a vocal sac-brooding species that exhibits a high susceptibility to lethal Bd infection. Using a 7-year capture-recapture study at four populations with contrasting Bd infection status (one high prevalence, one low prevalence and two Bd-free populations), we evaluated whether Bd-positive populations exhibited a higher adult recruitment and a higher male reproductive effort than Bd-negative populations. We also estimated population growth rates to explore whether recruitment compensated for the negative impacts of Bd on the survival of adults. In addition, we evaluated a potential demographic signal of compensatory recruitment (i.e. positive relationship between the proportion of juveniles and Bd prevalence) in response to Bd infection using raw count data from 13 R. darwinii populations. The high Bd prevalence population exhibited the highest male reproductive effort and the highest recruitment among the four monitored populations. This led to a growing population during the study period despite high mortality of adult hosts. In contrast, males from the population with low Bd prevalence had a low reproductive effort and this population, which had the lowest adult recruitment, was declining during the study period despite adults having a higher survival in comparison to the high Bd prevalence population. We also found a demographic signal of compensatory recruitment in response to Bd infection in our broader analysis of 13 R. darwinii populations. Our study underlines the importance of interpopulation variation in life-history strategies on the fate of host populations after infectious disease emergence. Our results also suggest that an increase in reproductive effort can be one of the processes underlying compensatory recruitment in populations of Bd-susceptible amphibians.
Assuntos
Quitridiomicetos , Micoses , Anfíbios/microbiologia , Animais , Anuros/microbiologia , Quitridiomicetos/fisiologia , Masculino , Micoses/epidemiologia , Micoses/microbiologia , Micoses/veterinária , Dinâmica Populacional , ReproduçãoRESUMO
Resumen Aunque en los últimos años en México ha mejorado la calidad de la atención de la diabetes mellitus (DM) y ha aumentado el acceso a servicios de salud y medicamentos, existe una falta de apego a las recomendaciones de las guías de práctica clínica, que podría explicar la falta de un control glucémico adecuado en muchos de los pacientes con DM. Los inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) han sido la última clase de agentes antidiabéticos en recibir la aprobación de la Food and Drug Administration (FDA) y de la Comisión Federal para la Protección contra Riesgos Sanitarios de México (COFEPRIS). Con el fin de mejorar el uso de los iSGLT2 en la práctica clínica en México, en este documento se presentan las recomendaciones emitidas por un panel de 11 expertos mexicanos con base en las nuevas evidencias publicadas para el tratamiento de los pacientes con DM2.
Abstract Although in recent years in Mexico the quality of diabetes mellitus (DM) care has improved and access to health services and medications has increased, there is a lack of adherence to the recommendations of the clinical guidelines, which could explain the poor glycemic control in many of the patients with DM. Sodium-glucose cotransporter type 2 (iSGLT2) inhibitors have been the last class of antidiabetic agents to receive approval from the Food and Drug Administration (FDA) and COFEPRIS (Mexico). In order to improve the use of SGLT2i in clinical practice in Mexico, this paper presents the recommendations issued by a panel of eleven Mexican experts based on the new published evidence for the treatment of patients with DM2.
RESUMO
RESUMEN Fundamento: el desarrollo de la comprensión lectora en inglés constituye una necesidad en la formación de los futuros profesionales de la salud, y la educación a distancia es una vía a través de la cual se puede lograr el desarrollo de esta habilidad. Objetivo: diseñar un manual didáctico para desarrollar la habilidad de comprensión lectora en los estudiantes de Medicina a través de la educación a distancia. Métodos: se realizó un estudio descriptivo en la Universidad de Ciencias Médicas de Holguín en el período marzo de 2019-noviembre de 2020. Se asumió el enfoque dialéctico-materialista y se emplearon los métodos del nivel teórico: análisis-síntesis, inducción-deducción, histórico-lógico y modelación; empíricos: análisis documental, observación de clases, entrevista y cuestionario; y procedimientos estadísticos. Resultados: las principales dificultades estuvieron relacionadas con el tratamiento de la comprensión lectora en las clases de inglés, así como la escasa habilidad de los estudiantes; se constató el interés en su desarrollo por su importancia en la integración de las diferentes habilidades en el proceso de comunicación, por lo que se elaboró un manual didáctico para solucionarlas mediante el empleo de la educación a distancia. Conclusiones: la labor investigativa desarrollada permitió revelar las insuficiencias en el desarrollo de la comprensión lectora en inglés. Las opiniones y valoraciones recogidas afirman que el manual contribuyó a desarrollar esa habilidad, evidenciado en el incremento de la capacidad para leer, comprender, comunicarse y escribir en un idioma extranjero.
ABSTRACT Background: the development of reading comprehension in English is a necessity in the training of future health professionals, and distance learning is a way through which the development of this skill can be achieved. Objective: to design a didactic manual to develop reading comprehension skills in Medicine students through distance learning. Methods: a descriptive study was carried out at Holguín University of Medical Sciences in from March 2019 to November 2020. The dialectical-materialist approach was assumed and the methods of the theoretical level were used: analysis-synthesis, induction-deduction, historical-logical and modeling; empirical ones: documentary analysis, class observation, interview and questionnaire; and statistical procedures. Results: the main difficulties were related to the treatment of reading comprehension in English classes, as well as the low ability of the students; The interest in its development was verified due to its importance in the integration of the different abilities in the communication process, that´s why a didactic manual was elaborated to solve them through the use of distance learning. Conclusions: the investigative work developed allowed to reveal the insufficiencies in the development of reading comprehension in English. The opinions and assessments collected affirm that the manual contributed to developing this ability, evidenced in the increase in the ability to read, understand, communicate and write in a foreign language.
Assuntos
Idioma , Educação a Distância , Educação Médica , Projetos de Tecnologias de Informação e ComunicaçãoRESUMO
Mitochondrial dysfunction and oxidative stress are extensively linked to Parkinson's disease (PD) pathogenesis. Melatonin is a pleiotropic molecule with antioxidant and neuroprotective effects. The aim of this study was to evaluate the effect of melatonin on oxidative stress markers, mitochondrial complex 1 activity, and mitochondrial respiratory control ratio in patients with PD. A double-blind, cross-over, placebo-controlled randomized clinical trial study was conducted in 26 patients who received either 25 mg of melatonin or placebo at noon and 30 min before bedtime for three months. At the end of the trial, in patients who received melatonin, we detected a significant diminution of lipoperoxides, nitric oxide metabolites, and carbonyl groups in plasma samples from PD patients compared with the placebo group. Conversely, catalase activity was increased significantly in comparison with the placebo group. Compared with the placebo group, the melatonin group showed significant increases of mitochondrial complex 1 activity and respiratory control ratio. The fluidity of the membranes was similar in the melatonin group and the placebo group at baseline and after three months of treatment. In conclusion, melatonin administration was effective in reducing the levels of oxidative stress markers and restoring the rate of complex I activity and respiratory control ratio without modifying membrane fluidity. This suggests that melatonin could play a role in the treatment of PD.