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BACKGROUND & OBJECTIVES: Patients with non-alcoholic fatty liver disease (NAFLD) have high prevalences of hypertension (HTN), type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD), and vice versa. The mechanism of this development is unknown but appears to be related to an underlying metabolic derangement that affects multiple organs. This study aimed to determine the prevalences of these conditions in patients with diagnosed NAFLD. METHODS: Our cohort study aimed to determine the prevalences of HTN, T2DM, and CVD in NAFLD patients registered in the liver database of the University of Puerto Rico School of Medicine; this information is recorded in their medical records. Patients whose liver disease had a different etiology were excluded. The study was approved by the UPR Medical Sciences Campus Institutional Review Board. RESULTS: Our final sample consisted of 141 NAFLD patients; 64.5% (n = 91) of them were females. The average age was 69 (±10.2 years). The prevalences of HTN, T2DM, and CVD were 53.9%, 57.5%, and 7.8%, respectively. In patients with NAFLD, there was a significant association between T2DM and being 65 years old or older (P < 0.001). CONCLUSION: Our data indicate that HTN and T2DM are highly prevalent in NAFLD patients in PR; however, CVD prevalence was lower than expected. Additional, studies are required to further define the associations. We recommend metabolic condition screening for all NAFLD patients.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Hipertensão , Hepatopatia Gordurosa não Alcoólica , Idoso , Feminino , Humanos , Masculino , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Hispânico ou Latino , Hipertensão/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Prevalência , Fatores de Risco , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Past studies have demonstrated that women with inflammatory bowel disease (IBD) have a higher risk of gynecological conditions than do women without it. We aimed to characterize the gynecological histories of Hispanic Women living in Puerto Rico with IBD. METHODS: We identified women, aged 21 to 55 years, with a confirmed IBD diagnosis and receiving follow-up care from the University of Puerto Rico IBD clinics from 2017 through 2020. A questionnaire was administered to acquire sociodemographics, family history, past medical history, IBD diagnosis, and gynecologic aspects. RESULTS: One hundred eighty-six women were recruited. Fifty-three (28%) patients had ulcerative colitis, while 133 (72%) had Crohn's disease. Fifty-six percent of all the participants had a chronic illness in addition to than their IBD. Seventy-four out of 186 patients reported having had at least 1 late period within the last 12 months. Fifty-three (28%) described their period patterns as irregular. Thirty-nine (21%) of the patients reported having been vaccinated against human papillomavirus (HPV), and 8 (4%) had been infected by it. Nine out of 186 (5%) patients reported suffering from infertility. CONCLUSION: The results showed that our Hispanic patients (living in Puerto Rico) had a prevalence of irregular menstrual cycles that was similar to that observed in other populations. On the other hand, the presence of HPV, infertility, and cervical cancer were lower and the frequency of Papanicolaou smears performed higher than what has been seen in the continental United States, suggesting that this topic should be investigated in future studies.
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Colite Ulcerativa , Doenças dos Genitais Femininos , Infertilidade , Doenças Inflamatórias Intestinais , Infecções por Papillomavirus , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Colite Ulcerativa/epidemiologia , Papillomavirus HumanoRESUMO
PURPOSE: The aim of this study was to determine ostomy-related quality of life (QOL) in Hispanic Puerto Ricans living with an enteral stoma and inflammatory bowel disease (IBD). We analyzed possible associations between QOL and sex, diagnosis, and type and duration of stoma. DESIGN: Prospective cohort study. SUBJECTS AND SETTINGS: The sample comprised 102 adults living with IBD and an ostomy; 60 of 101 (59.4%) were males, 44 of 102 (43.1%) had Crohn's disease, and 60 of 102 (58.9%) had an ileostomy. Participants were receiving care at the Center for IBD of the University of Puerto Rico in San Juan, Puerto Rico, between January 2012 and December 2014. METHODS: One-hundred two adults Puerto Ricans with IBD completed the Stoma Quality of Life (Stoma-QOL) questionnaire. Data were analyzed using frequency distributions for categorical variables and summary statistics for continuous variables. Independent-group t test and one-way analysis of variance, with the post hoc Tukey test, were used to determine group differences for the variables of age, sex, civil status, time living with an ostomy, type of ostomy, and IBD diagnosis. Results were analyzed according to the number of responses to each variable; the denominator varied for some variables. RESULTS: Having an ostomy for more than 40 months was significantly associated with a higher QOL score (59.0 vs 50.7; P = .05). Males had significantly higher scores than females (59.94 vs 50.23; P = .0019). Age, IBD diagnosis, and type of ostomy were not associated with the Stoma-QOL scores. CONCLUSIONS: The achievement (over 40 months) to attain improved ostomy-related QOL suggests that early training in the care of the ostomy and advanced planning when leaving home may enhance ostomy-related QOL. Lower QOL in women may represent an opportunity for a sex-specific educational intervention.
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Doenças Inflamatórias Intestinais , Estomia , Adulto , Masculino , Humanos , Feminino , Qualidade de Vida , Estudos Prospectivos , Ileostomia , Inquéritos e QuestionáriosRESUMO
Management of inflammatory bowel disease (IBD) often relies on biological and immunomodulatory agents for remission through immunosuppression, raising concerns regarding the SARS-CoV-2 vaccine's effectiveness. The emergent variants have hindered the vaccine neutralization capacity, and whether the third vaccine dose can neutralize SARS-CoV-2 variants in this population remains unknown. This study aims to evaluate the humoral response of SARS-CoV-2 variants in patients with IBD 60 days after the third vaccine dose [BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna)]. Fifty-six subjects with IBD and 12 healthy subjects were recruited. Ninety percent of patients with IBD (49/56) received biologics and/or immunomodulatory therapy. Twenty-four subjects with IBD did not develop effective neutralizing capability against the Omicron variant. Seventy percent (17/24) of those subjects received anti-tumor necrosis factor therapy [10 = adalimumab, 7 = infliximab], two of which had a history of COVID-19 infection, and one subject did not develop immune neutralization against three other variants: Gamma, Epsilon, and Kappa. All subjects in the control group developed detectable antibodies and effective neutralization against all seven SARS-CoV-2 variants. Our study shows that patients with IBD might not be protected against SARS-CoV-2 variants, and more extensive studies are needed to evaluate optimal immunity.
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ABSTRACT: The aim of the present study was to describe the epidemiological and clinical characteristics of inflammatory bowel disease (IBD), including medical and surgical treatments, in several countries in Latin America and the Caribbean.IBD is recognized as a global health problem because its incidence and prevalence have increased significantly over the last few years.This multicenter retrospective cohort study included 4714 patients with IBD diagnosed from 9 countries in Latin America and the Caribbean: Colombia, Cuba, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela.Crohn disease (CD) was more frequent in Puerto Rico (71.9%), the Dominican Republic (61.0%), and Peru (53.1%). Ulcerative colitis was more frequent in Colombia (78.6%), Venezuela (78.2%), Mexico (75.5%), Cuba (69.9%), Ecuador (64.1%), and Uruguay (60.9%). The following clinical characteristics were more frequent in the Caribbean: penetrating behavior in CD, steroid dependence, steroid resistance, intolerance to thiopurines, extraintestinal manifestations, surgeries, hospitalizations due to IBD, and family history of IBD. The factors associated with the use of biological therapy were pancolitis in ulcerative colitis, penetrating behavior in CD, steroid resistance and dependence, presence of extraintestinal manifestations, and the need for surgery.This study from Latin America and the Caribbean demonstrated the different epidemiological and clinical characteristics of IBD.
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Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Hospitalização/estatística & dados numéricos , Doenças Inflamatórias Intestinais/epidemiologia , Adolescente , Adulto , Região do Caribe/epidemiologia , Doença Crônica , Colite Ulcerativa/diagnóstico , Doença de Crohn/diagnóstico , Feminino , Humanos , Incidência , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/terapia , América Latina/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: Inflammatory Bowel Disease has increased in Hispanics. This study estimates its prevalence in Puerto Rico for 2013 and compares it with prior reports. METHODS: The database of commercial and government insurance claims of the Department of Health for 2013 was used. A case was defined as having at least two medical claims of outpatient services or one or more hospitalizations and emergency department visits with an ICD-9 code for Crohn's disease or ulcerative colitis. Cases with codes for both were classified as undetermined inflammatory bowel disease. Prevalence was calculated for inflammatory bowel disease, Crohn's disease, and ulcerative colitis overall and by age, sex, and health insurance. RESULTS: 5,378 persons were classified as having inflammatory bowel disease, for an overall prevalence of 181.54/100,000. Of these, 2,154 had Crohn's disease and 2,689 had ulcerative colitis, with prevalences of 72.71 and 90.77/100,000 respectively. Crohn's disease was more prevalent in males and ulcerative colitis in females. Both types were more prevalent in the government insured population. 719 children had inflammatory bowel disease, for a prevalence of 89.8/100,000. Of these, 480 were classified as Crohn´s disease and 169 as ulcerative colitis. Prevalences for pediatric Crohn's disease and ulcerative colitis were 60.0 and 21.2/100,000 respectively. CONCLUSION: When compared with a report for 2005, the prevalence for inflammatory bowel disease in Puerto Rico for 2013 showed a 4-fold increase overall and a 3-fold increase in children. Inflammatory bowel disease was more prevalent in government-insured as opposed to commercially insured persons, in contrast with previous findings.
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Colite Ulcerativa/epidemiologia , Doença de Crohn , Doenças Inflamatórias Intestinais/epidemiologia , Revisão da Utilização de Seguros/estatística & dados numéricos , Criança , Atenção à Saúde , Feminino , Humanos , Masculino , Prevalência , Porto Rico/epidemiologiaRESUMO
OBJECTIVE: In 2017, the government of Puerto Rico legalized medical cannabis for several conditions including Crohn's disease (CD). There is little information about cannabis use in this population. This study aimed to develop a demographic characterization and evaluate patient perception on cannabis use for Inflammatory Bowel Disease (IBD) at the University of Puerto Rico Center for Inflammatory Bowel Diseases. METHODS: One hundred patients of ages 21 or older with a confirmed diagnosis of IBD were recruited to complete a voluntary anonymous questionnaire. RESULTS: 27% of the surveyed participants reported use of cannabis. Of these, 39% reported moderate knowledge and 53% reported little to no knowledge of medical cannabis. The majority did not discuss cannabis use with their physician (78%), and most saw improvement of their symptoms (68%). CONCLUSION: Cannabis is frequently considered by patients as a treatment option for IBD but most have limited knowledge about its use. The low number of patients that discuss cannabis use with their physician suggests the need for physician awareness of unreported use. It should also lead to the development of strategies for patient orientation regarding the uses, properties, and expectations of cannabis as a therapy.
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Cannabis/química , Doença de Crohn/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Doenças Inflamatórias Intestinais/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Porto Rico , Adulto JovemRESUMO
Patients with immune conditions and immune-modifying therapies were excluded from the Covid-19 vaccine trials. Studies have shown conflicting response to different vaccines in persons receiving immune suppressors or biologics. The aim of this study is to evaluate humoral and cellular response to Covid-19 vaccines in patients with Inflammatory Bowel Disease (IBD) using biologic and/or immunomodulatory (IMM) therapies. Methods: Participants are adults with IBD receiving biologics or IMM planning to receive a Covid 19 vaccine. Cellular immunity (CD4+ and CD8+ T cell levels) with flow cytometry are measured at baseline and 2 weeks after each vaccine dose. Humoral immunity (antibody titers and neutralizing capacity,VNT%) is analyzed by ELISA at baseline, 2 weeks after each dose, and 6 and 12 months after vaccine. We present the early results of the first 19 subjects. The study is approved by the IRB. Results: 19 subjects (18 in biologics and 1 in IMM) who received 2 doses of the Pfizer-BioNTech vaccine are included. Total IgG antibodies increased 21.13 times after the first dose and 90 times after the second dose. VTN% increased 11.92 times after the first dose and 53.79 times after the second dose. When compared with a healthy control cohort, total IgG antibodies and VTN% were lower in the subjects after the first dose. After the second dose, IgG antibodies increased but remained lower than controls, but VTN% were similar to controls. CD4 and CD8 mean levels had an upward trend after vaccination. Conclusions: Neutralizing capacity response to the vaccine in subjects was similar to a healthy cohort in spite of lower increases in total IgG antibodies. The CD4 and CD8 results observed may support the capacity to mount an effective cellular response in patients on biologics. Larger studies are needed to determine vaccine efficacy in these patients.
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OBJECTIVE: Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain and altered bowel habits. A high prevalence has been reported in medical students around the globe. This study aimed to investigate the prevalence of IBS and associated risk factors in medical students in Puerto Rico (PR). METHODS: A cross sectional study was conducted in a sample of medical students from first to fourth year currently enrolled at the University of PR School of Medicine. Participants completed a self-administered, anonymous questionnaire that contained questions about general socio-demographic data, lifestyle habits, degree of subjective psychological stress and the Rome III criteria: IBS Module. RESULTS: 314 medical students were included for analysis. The mean age was 24.8±3.25; 48.1% were females. The prevalence of IBS was 36.3%. Among the IBS subjects, 78 (24.8%) were classified as IBS mixed. Family history of IBS and psychological stress were significantly associated to IBS (p<0.05), whereas cigarette smoking was found to be protective for IBS (OR = 0.26 + .17, P=.04). CONCLUSION: This is the first study to describe the prevalence of IBS in medical students in PR. A higher prevalence of IBS was found as compared to that reported for medical students in other countries. Additional studies aimed at estimating the impact of IBS on quality of life and academic performance of the medical students are essential.
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Síndrome do Intestino Irritável/epidemiologia , Qualidade de Vida , Estudantes de Medicina/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Síndrome do Intestino Irritável/psicologia , Masculino , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Estudantes de Medicina/psicologia , Adulto JovemRESUMO
RESUMEN Objetivo: Evaluar la actividad antioxidante y antiinflamatoria en extractos hidroalcohólicos de las partes aéreas de Kalanchoe daigremontiana Raym. -Hamet & H. Perrier. Materiales y métodos: Se obtuvieron extractos hidroalcohólicos utilizando como solventes etanol (EtOH) y metanol (MeOH) en diferentes concentraciones. Los fenoles totales y los flavonoides se cuantificaron con el método de Folin Ciocalteu y el de complejación de aluminio respectivamente. Metodología: Para determinar la actividad antioxidante en los extractos se utilizó la técnica de decoloración del radical libre DPPH¼ (2,2-difenil-1-picrilhidracilo) y para la actividad antiinflamatoria se evaluó la capacidad inhibitoria de la enzima lipoxigenasa (LOX). Resultados: El extracto etanólico al 70% presentó mayor capacidad antioxidante frente a los radicales DPPH¼ y mayor inhibición sobre la enzima lipooxigenasa como respuesta antiinflamatoria, lo cual estaría relacionado con el contenido de fenoles y flavonoides. Conclusiones: Esto sugiere que el K. daigremontiana posee propiedades antioxidantes y antiinflamatorias.
SUMMARY Aim: To evaluate the antioxidant and anti-inflammatory activity in hydroalcoholic extracts of the aerial parts of Kalanchoe daigremontiana Raym. -Hamet & H. Perrier. Materials and methods: Extracts were obtained using ethanol (EtOH) and methanol (MeOH) as solvents at different concentrations. Total phenols and flavonoids were quantified using the Folin-Ciocalteu method and the aluminum complexation reaction, respectively. Methodology: The antioxidant activity of the extracts was determined using the DPPH¼ (2,2-diphenyl-1-picrylhydracil) free radical discoloration technique, while lipoxygenase (LOX) inhibition assays were used to measure the anti-inflammatory activity. Results: The 70% ethanolic extract showed a greater antioxidant capacity against DPPH¼ and a greater inhibition of the lipoxygenase enzyme, which should be related to the overall phenols and flavonoids content, suggesting that K. daigremontiana exhibits antioxidant and anti-inflammatory properties.
RESUMO Objetivo: Avaliar a atividade antioxidante e anti-inflamatória em extratos hidroalcoólicos da parte aérea de Kalanchoe daigremontiana Raym. -Hamet & H. Perrier. Materiais e métodos: Os extratos foram obtidos usando etanol (EtOH) e metanol (MeOH) como solventes em diferentes concentrações. Fenóis e flavonóides totais foram quantificados pelo método de Folin-Ciocalteu e pela reação de complexação com alumínio, respectivamente. Metodologia: A atividade antioxidante dos extratos foi determinada pela técnica de descoloração do radical livre DPPH¼ (2,2-difenil-1-picrilidracila), enquanto ensaios de inibição da lipoxigenase (LOX) foram utilizados para medir a atividade anti-inflamatória. Resultados: O extrato etanólico 70% apresentou maior capacidade antioxidante contra DPPH¼ e maior inibição da enzima lipoxigenase, que deve estar relacionada ao teor geral de fenóis e flavonoides, sugerindo que K. daigremontiana apresenta propriedades antioxidantes e anti-inflamatórias.
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OBJECTIVE: Inflammatory bowel disease (IBD) negatively impacts quality of life-related issues including intimacy, body image, and sexual activity. Sexual dysfunction in patients with IBD is often unrecognized. In this study, we aimed to describe sexual function in Puerto Rican women with IBD. METHODS: We conducted a cross-sectional study of women with IBD at the University of Puerto Rico Center for IBD. Patients were invited to anonymously complete the validated Spanish version of the Female Sexual Function Index (FSFI) questionnaire. On this 36-point scale, a score of 26.55 or less is defined as sexual dysfunction. Data were analyzed by diagnosis, presence of an ostomy, and age, using descriptive statistics, ANOVA, Student's t test, and logistic regression. RESULTS: One hundred women completed the FSFI questionnaire, with subjects having Crohn's disease (CD) outnumbering those having ulcerative colitis (UC) 2:1. The mean sexual function score was 21.92 (95% CI: 20.08-23.76). No statistical difference was observed in total FSFI scores between subjects with CD and UC (p = 0.084) and those with an ostomy (p = 0.891). Sexual function decreased with age (p = 0.001). The domains of excitation, lubrication, orgasm, and satisfaction were the most negatively affected (p<0.05) by increasing age. Multivariate analysis confirmed the effect of age on excitation, lubrication, orgasm, and pain. CONCLUSION: Our study showed sexual dysfunction to be present in this sample of Puerto Rican Hispanic women with IBD. Physicians treating patients with IBD need to be aware of these findings to explore the concerns of individuals with this disease and develop strategies to address those concerns.
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Colite Ulcerativa/complicações , Doença de Crohn/complicações , Disfunções Sexuais Fisiológicas/etiologia , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/fisiopatologia , Doença de Crohn/epidemiologia , Doença de Crohn/fisiopatologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Libido/fisiologia , Pessoa de Meia-Idade , Osteotomia/estatística & dados numéricos , Porto Rico/etnologia , Qualidade de Vida , Análise de Regressão , Comportamento Sexual , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Adulto JovemRESUMO
OBJECTIVE: In this study, we assessed the Kidney Donor Risk Index (KDRI) in Puerto Rican deceased kidney donors whose donations took place from 2009 to 2011 and evaluated short-term graft survival in the recipients of those kidneys. The results highlight differences between the distributions of KDRI values in the populations of the 48 contiguous states of the United States, Alaska, and Hawaii and that of Puerto Rico. Additionally, we evaluated the impacts of polyomavirus (BKV) infection and anti-donor HLA antibodies on the recipients. METHODS: Of the 377 kidneys obtained from deceased donors by LifeLink of Puerto Rico from 2009 to 2011, 187 were transplanted in Puerto Rico. Data was collected from the deceased donors of these 187 kidneys for calculating KDRI, as well as from the transplant recipients. KDRI values of the donors were calculated using the same formula as previously reported for the United States; death-censored graft survival, incidence of antibody-mediated rejection, and prevalence of polyoma virus infection (BKV) were examined in the recipients. RESULTS: The mean KDRI value was 1.19. However, the distribution of KDRI values in the Puerto Rican population deviates substantially from that of the United States (not including Puerto Rico). A 1-peak distribution pattern describes Puerto Rican KDRI values. Graft survival for the study period was 89.6%. The prevalence of BKV was 16.9%. Of the patients studied, 6.25% developed overt nephropathy, 46.2% developed de novo post-transplant donor-specific alloantibodies, and 19.5% had pre-existing alloantibodies. CONCLUSION: Our study evidences the role of various characteristics in the distribution of KDRI values in the Puerto Rican population, suggesting that the identification of variables specific to a geographically distinct group may result in better donor categorization for predicting transplant outcomes. In addition, our graft-survival results, despite the elevated rates of BKV and anti-donor antibodies, highlight the increasing need to monitor the presence of antibodies in a prospective and an anticipatory manner to identify and manage patients at risk for antibodymediated rejection.
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Sobrevivência de Enxerto , Transplante de Rim , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Porto Rico , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Doadores de Tecidos , Resultado do Tratamento , Adulto JovemRESUMO
ABSTRACT Objective: To know the socio-demographic characteristics of the elderly adults (60-70 years), of the population of Mataró (Barcelona), and their relationship with the knowledge degree and training needs perceived to face a healthy aging. Materials and methods: Descriptive observational cross-sectional study in which a sample of 306 people was analysed. Socio-demographic data and variables related to leisure activities, health status, training, formative needs and predisposition to take a course on aging were evaluated. Results: About a 60 % of the respondents showed interest in receiving training about; healthy habits (59,1 %), proper diet (62,0 %), work out (59,6 %), future limitations (62,6 %), why we grow old (61,0 %), frequent illnesses in the elderly (62,5 %), use of medication (66,1 %), use of the health system (61,9 %), social resources (70,0 %), new technologies (64,0 %), care of sick people (60,5 %), and security aspects (61,6 %). Conclusions: There is a need to receive training among the elderly adult population in order to cope with aging in a healthier way. The main needs perceived by the elderly are: Healthy habits, possible future limitations due to the aging process, use of medication, functioning of the health system and access to social resources, new technologies and, finally, caring for sick relatives.
RESUMEN Objetivo: conocer las características sociodemográficas de las personas adultas mayores (60-70 años) de la población de Mataró (Barcelona) y su relación con el grado de conocimientos y las necesidades formativas percibidas para afrontar un envejecimiento saludable. Materiales y método: estudio observacional descriptivo transversal en una muestra de 306 personas. Se valoraron datos sociodemográficos y variables relacionadas con el tiempo libre, el estado de salud, la formación, los intereses formativos y la predisposición a realizar un curso sobre envejecimiento. Resultados: el 60 % de los encuestados mostró interés en recibir formación sobre hábitos saludables (59,1 %), dieta adecuada (62,0 %), ejercicio físico (59,6 %), limitaciones futuras (62,6 %), por qué envejecemos (61,0 %), enfermedades frecuentes en la tercera edad (62,5 %), uso de medicamentos (66,1 %), uso del sistema sanitario (61,9 %), recursos sociales (70,0 %), nuevas tecnologías (64,0 %), cuidado de las personas enfermas (60,5 %) y aspectos de seguridad (61,6 %). Conclusiones: existe la necesidad de recibir formación, entre la población adulta mayor, para afrontar el envejecimiento saludablemente. Así, es preciso tener un conocimiento amplio sobre las posibles limitaciones causadas por el envejecimiento, el uso de medicamentos, el funcionamiento del sistema sanitario, el acceso a los recursos sociales, las nuevas tecnologías, el cuidado de los familiares enfermos y hábitos de vida saludables.
RESUMO Objetivo: conhecer as características sociodemográficas das pessoas idosas (60-70 anos) da população de Mataró (Barcelona) e sua relação com o grau de conhecimentos e com as necessidades formativas percebidas para encarar um envelhecimento saudável. Materiais e método: estudo observacional descritivo transversal com uma amostra de 306 pessoas. Dados sociodemográficos e variáveis relacionadas com o tempo livre, o estado de saúde, a formação, os interesses formativos e a predisposição a fazer um curso sobre envelhecimento foram avaliados. Resultados: 60 % dos entrevistados demostrou interesse em receber formação sobre hábitos saudáveis (59,1 %), dieta adequada (62 %), exercício físico (59,6 %), limitações futuras (62,6 %), motivos do envelhecimento (61 %), doenças frequentes na terceira idade (62,5 %), uso de medicamentos (66,1 %), uso do sistema sanitário (61,9 %), recursos sociais (70 %), novas tecnologias (64 %), cuidado de pessoas doentes (60,5 %) e aspectos de segurança (61,6 %). Conclusões: entre a população idosa, existe a necessidade de receber formação para encarar o envelhecimento saudável. Assim, é preciso ter um conhecimento amplo sobre as possíveis limitações causadas pelo envelhecimento, pelo uso de medicamentos, pelo funcionamento do sistema sanitário, pelo acesso aos recursos sociais, pelas novas tecnologias, pelo cuidado dos familiares doentes e pelos hábitos de vida saudáve.
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Humanos , Idoso , Envelhecimento , Conhecimento , Estilo de Vida Saudável , Hábitos , Aposentadoria , Saúde , TutoriaRESUMO
RESUMEN Objetivo: evaluar la validez y la fiabilidad de la versión española del instrumento Expectativas y conocimiento recibido del paciente hospitalizado (ECPH/CRPH) en pacientes con osteoartritis intervenidos de artroplastia total de rodilla. Material y métodos: el proceso de validación siguió las recomendaciones internacionales: validez de contenido, validez de constructo, validez de criterio y fiabilidad. Un total de 248 pacientes que debían intervenirse de artroplastia total de rodilla en 5 hospitales públicos españoles contestaron la ECPH antes de ser hospitalizados y 220 pacientes contestaron el CRPH al darles el alta hospitalaria. Resultados: el análisis factorial confirmó las dimensiones de la escala original para el conocimiento recibido, pero no en la escala para las expectativas. La correlación de las dimensiones de la ECPH con la Escala de Opinión de la Salud de Krantz (KHOS) y la correlación de las dimensiones de la CRPH con la Escala de Acceso a la Información (AKS) indicaron la validez de criterio mostrando unas relaciones positivas. Los resultados señalaron buena fiabilidad con valores de alfa Cronbach elevados. Conclusión: el proceso de validación indica que la versión española del ECPH/CRPH es un instrumento válido y fiable para medir las expectativas y el conocimiento recibido en pacientes quirúrgicos en el contexto español.
ABSTRACT Objective: The objective of the study was to assess the validity and reliability of the Spanish version of Expectations and Received Knowledge in the Hospitalized Patient (ECPH / CRPH), specifically among patients with osteoarthritis who are undergoing total knee arthroplasty. Material and methods: The validation process followed international recommendations in terms of content validity, construct validity, criterion validity and reliability. A total of 248 patients who were about to undergo total knee arthroplasty at five (5) Spanish public hospitals answered the ECPH before being hospitalized and 220 patients answered the CRPH when they were discharged. Results: Factor analysis confirmed the dimensions of the original scale for the knowledge received, but not with respect to the scale for expectations. The correlation of the ECPH dimensions with the Krantz Health Opinion Scale (KHOS) and the correlation of the CRPH dimensions with the Information Access Scale (AKS) indicated criterion validity, showing positive relationships. The results suggested good reliability with high Cronbach alpha values. Conclusion: The validation process showed the Spanish version of ECPH / CRPH is a valid and reliable instrument to measure the expectations and knowledge received in surgical patients in the Spanish context.
RESUMO Objetivo: avaliar a validade e a confiabilidade da versão espanhola do instrumento Expectativa e Conhecimento Recebido do Paciente Hospitalizado (ECPH/CRPH) em pacientes com osteoartrite submetidos à artroplastia total de joelho. Métodos: o processo de validação seguiu as recomendações internacionais: validade de conteúdo, validade de construto, validade de critério e confiabilidade. 248 pacientes que devem ser submetidos à artroplastia total de joelho em cinco hospitais públicos espanhóis responderam ao ECPH antes de serem hospitalizados, e 220 pacientes responderam ao CRPH ao ganharem alta. Resultados: a análise fatorial confirmou as dimensões da escala original para o conhecimento recebido, mas não na escala para as expectativas. A correlação das dimensões do ECPH com a Escala de Opinião da Saúde de Krantz (KHOS) e a correlação das dimensões do CRPH com a Escala de Acesso à Informação (AKS) indicaram a validade de critério e mostraram umas relações positivas. Os resultados indicam boa confiabilidade com valores de alfa Cronbach elevados. Conclusões: o processo de validação indica que a versão espanhola do ECPH/CRPH é um instrumento válido e confiável para medir as expectativas e o conhecimento recebido em pacientes em regime de internamento no contexto espanhol.
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Humanos , Osteoartrite , Enfermagem Ortopédica , Estudo de Validação , Educação em Saúde , ConhecimentoRESUMO
Avocado (Persea americana) is one of the most important crops in Mexico as it is the main producer, consumer, and exporter of avocado fruit in the world. However, successful avocado commercialization is often reduced by large postharvest losses due to Colletotrichum sp., the causal agent of anthracnose. Chitosan is known to have a direct antifungal effect and acts also as an elicitor capable of stimulating a defense response in plants. However, there is little information regarding the genes that are either activated or repressed in fruits treated with chitosan. The aim of this study was to identify by RNA-seq the genes differentially regulated by the action of low molecular weight chitosan in the avocado-chitosan-Colletotrichum interaction system. The samples for RNA-seq were obtained from fruits treated with chitosan, fruits inoculated with Colletotrichum and fruits both treated with chitosan and inoculated with the fungus. Non-treated and non-inoculated fruits were also analyzed. Expression profiles showed that in short times, the fruit-chitosan system presented a greater number of differentially expressed genes, compared to the fruit-pathogen system. Gene Ontology analysis of differentially expressed genes showed a large number of metabolic processes regulated by chitosan, including those preventing the spread of Colletotrichum. It was also found that there is a high correlation between the expression of genes in silico and qPCR of several genes involved in different metabolic pathways.
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AIM: To determine serum vitamin D levels and colonic vitamin D receptor (VDR) expression in inflammatory bowel disease (IBD) and non-IBD patients and correlate these with histopathology. METHODS: Puerto Rican IBD (n = 10) and non-IBD (n = 10) patients ≥ 21 years old scheduled for colonoscopy were recruited. Each patient completed a questionnaire and provided a serum sample and a colonic biopsy of normal-appearing mucosa. For IBD patients, an additional biopsy was collected from visually diseased mucosa. Serum vitamin D levels were measured by ultra-performance liquid chromatography and mass spectrometry. Hematoxylin and eosin stained tissue sections from colonic biopsies were classified histologically as normal or colitis (active/inactive), and scored for the degree of inflammation present (0-3, inactive/absent to severe). Tissue sections from colonic biopsies were also stained by immunohistochemistry for VDR, for which representative diagnostic areas were photographed and scored for staining intensity using a 4-point scale. RESULTS: The IBD cohort was significantly younger (40.40 ± 5.27, P < 0.05) than the non-IBD cohort (56.70 ± 1.64) with a higher prevalence of vitamin D deficiency (40% vs 20%, respectively) and insufficiency (70% vs 50%, respectively). Histologic inflammation was significantly higher in visually diseased mucosa from IBD patients (1.95 ± 0.25) than in normal-appearing mucosa from control patients (0.25 ± 0.08, P < 0.01) and from IBD patients (0.65 ± 0.36, P < 0.05) and correlated inversely with VDR expression in visually diseased colonic tissue from IBD patients (r = -0.44, P < 0.05) and from IBD patients with Crohn's disease (r = -0.69, P < 0.05), but not in normal-appearing colonic tissue from control patients or IBD patients. Control and IBD patient serum vitamin D levels correlated positively with VDR expression in normal colon from control and IBD patients (r = 0.38, P < 0.05) and with patient age (r = 0.54, P < 0.01). CONCLUSION: Levels of serum vitamin D correlate positively with colonic VDR expression in visually normal mucosa whereas inflammation correlates negatively with colonic VDR expression in visually diseased mucosa in Puerto Rican patients.
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Colite Ulcerativa/sangue , Colo/química , Doença de Crohn/sangue , Mucosa Intestinal/química , Receptores de Calcitriol/análise , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , Idoso , Biomarcadores/sangue , Biópsia , Estudos de Casos e Controles , Cromatografia Líquida , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Colo/patologia , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Feminino , Humanos , Imuno-Histoquímica , Mucosa Intestinal/patologia , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Prevalência , Porto Rico/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Adulto JovemRESUMO
Women with inflammatory bowel disease (IBD) may be at increased risk of human papilloma virus (HPV) infection and HPV-related malignancies, as many are immunocompromised secondary to the use of immunosuppressant agents. Several studies have addressed the knowledge about cervical cancer risk factors in different populations, particularly HPV infection and its association with cervical malignancies; most of these studies show poor patient knowledge. The purpose of this study is to describe the knowledge of females with IBD about HPV infection and the HPV vaccine. We performed a cross-sectional study in 147 consecutive patients attending the clinics of the University of Puerto Rico Center for IBD from 2009 to 2010. An interviewer-administered questionnaire was used to collect information on demographics, lifestyles, and HPV-related knowledge of participants. Bivariate analysis using the chi-square statistics and Fisher's exact test was used to examine factors associated with HPV awareness. The mean age of participants was 36.6 years (SD = 13.91 years). Three fourth (77 %) of women had awareness of the existence of HPV, and 58 % did know about the existence of HPV vaccines. Among those who had heard about HPV, 79.6 % knew that HPV can cause cervical cancer, and 57.5 % knew that the virus is sexually transmitted. Among those who knew of the vaccine, 75.3 % learned about its existence through the media, while only 15.3 %, through their health-care provider. Only three women within recommended ages (2 %) had been vaccinated against HPV, although 50 % of participants indicated that they would definitely/probably vaccinate against HPV in the future. A significant trend was observed, where more educated women were more likely to have heard of HPV (p for trend = 0.0017). Women who were high school graduates/some college (OR = 6.63, 95 % CI = 1.71-25.66) and those with at least an associate degree (OR = 11.69, 95 % CI = 3.05-45.89) were more likely to be aware of the HPV vaccine than women without a high school degree. Our study documents poor knowledge of HPV and HPV vaccine in this population of IBD patients in Puerto Rico. Although vaccination coverage is low in this population, women are receptive to the possibility of vaccination in the future. Given that this population may be at an increased risk of HPV infection and related morbidities, education and vaccination programs should be promoted among them.
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Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispânico ou Latino/psicologia , Doenças Inflamatórias Intestinais/etnologia , Infecções por Papillomavirus/etnologia , Vacinas contra Papillomavirus , Adulto , Estudos Transversais , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Infecções por Papillomavirus/prevenção & controle , Porto Rico , Fatores de Risco , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/virologiaRESUMO
Since the introduction of liver transplant as treatment for end-stage liver disease, thousands of lives have been saved. To prevent organ rejection, immunosuppression is given chronically and hence, patients are at increased risk for opportunistic infections related to immunosuppression, especially within the first year after the transplant. However, opportunistic infections can occur years after the transplantation. Disseminated nocardiosis is one of these infections, and although the common presentation includes involvement of skin, lungs, and central nervous system. We present an uncommon presentation of nocardiosis in which cholestasis and elevated liver enzymes predominate, mimicking organ rejection and liver disease recurrence. Infectious etiologies, including opportunistic microorganisms, must always be ruled out in patients presenting elevation in liver enzymes and cholestasis after liver transplant as early diagnosis can prevent complications such as re-transplantation and even death.
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Colestase/diagnóstico , Hepatopatias/diagnóstico , Nocardiose/diagnóstico , Nocardia/isolamento & purificação , Adulto , Colestase/etiologia , Colestase/microbiologia , Rejeição de Enxerto/diagnóstico , Humanos , Fígado/enzimologia , Fígado/patologia , Hepatopatias/enzimologia , Transplante de Fígado , Masculino , Nocardiose/complicações , RecidivaRESUMO
Within the past decade, researchers and hepatitis C specialists in Puerto Rico have highlighted the burden of hepatitis C and associated disease outcomes in the island to raise public awareness about this problem and set out a call to action to tackle prevention and control efforts, yet so far no concrete actions have taken place. The population-based studies on hepatitis C have documented that the main risk factor is the sharing of syringes and drug paraphernalia to inject drugs, that most seropositive individuals are unaware of their infection status, and that there are large knowledge deficits about the disease, its risk factors, and measures of prevention and control. The subject is further complicated by the fact that despite hepatitis C reporting is mandatory, there is no effective epidemiological surveillance system to provide the information needed for planning, implementation, monitoring, and evaluation of intervention strategies for this infection and access to medical and other existing therapies is limited. This document addresses the disparities in HC V infection and its adverse outcomes experienced among Puerto Ricans and attempts to set out strategies to address a public health response for hepatitis C at the meso and macro levels of the social-ecological model. Diverse organizations and major stakeholders are urged to mount an adequate response to hepatitis C by transforming current scientific evidence into public health actions to increase awareness, identify those who are actively infected, and link infected individuals into comprehensive care and treatment.
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Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Humanos , Saúde Pública , Porto Rico/epidemiologiaRESUMO
Recent medical literature agrees that celiac disease (CD) is much more prevalent in western civilization than it was thought to be in the past. Given the potential complications and consequences of untreated CD, screening programs have been considered. Symptoms of celiac disease may resemble those of Irritable Bowel Syndrome. A group of patients with IBS was screened for CE using the Tissue Transglutaminase Antibody IgA serum test. A total of 18 patients were screened. All of our patients tested negative for TTG IgA. This finding may indicate that the prevalence of CD may be low in our population. Further population studies are needed to confirm our finding.