Species composition and assemblage analysis of fishes caught as bycatch by the Patagonian shrimp fishery in the southwest Atlantic.

Bottom trawl fishing is the most used worldwide gear generating large amounts of discards due to bycatch of a variety of species. Shrimp fisheries are recognized for their high incidence in global discards. In waters of Patagonia Argentina (43°S - 47°S) an industrial shrimp fishery of high economic value is developed whose target species is the Patagonian shrimp Pleoticus muelleri. The information presented in this study comprises a period of 12 years (2003-2014) and it was gathered by the On-board Observer Program. The Program collects information of all species captured in the fishing fleets. The data analyzed corresponds to the double-rigged otter trawler fleet and the coastal fleet. The fish bycatch composition was characterized in both fleets and the frequencies of occurrence of species and the assemblage areas were analyzed. A total of 101 fish species were identified (59 families) of which 69 were bony fishes, 29 cartilaginous fishes and three species of jawless fishes. The assemblages described correspond to coastal and deep waters, and they are integrated by temperate and subtropical species pointing out the area as an ecotonal zone.

Fish functional diversity as an indicator of resilience to industrial fishing in Patagonia Argentina.

The relationship between fish functional diversity and fishing levels at which its baselines shift is important to identify the consequences of fishing in ecosystem functioning. For the first time, the authors of this study implemented a trait-based approach in the Argentine Patagonian Sea to identify the vulnerability and spatiotemporal changes in functional diversity of fish assemblages incidentally captured by a trawling fleet targeting the Argentine red shrimp Pleoticus muelleri (Spence Bate, 1888) between 2003 and 2014. The authors coupled seven fish trophic traits to a reconstructed fish assemblage for the study area and by-catch and evaluated changes in fish species richness and four complementary functional diversity measures (functional richness, redundancy, dispersion and community trait values) along with fishing intensity, temporal use, latitudinal location and depth of fishing grounds, and vessel length. Resident fishes larger than 30 cm in length, with depressed and fusiform bodies, intermediate to high trophic levels, and feeding in benthic, demersal and midwater areas were vulnerable to by-catch. In addition, fish assemblages exhibited a low functional trait redundancy, likely related to species influxes in a biogeographic ecotone with tropicalisation signs. Significant increases in fish trait richness and dispersion poleward and deep suggested new functional roles in these grounds, matching trends in community body size, reproductive load, maximum depth and trophic level. Finally, a temporal increase in fish species and functional trait removal in fishing grounds led to trait homogenisation since 2003. The authors identified that tipping points in temperate fish functional trait diversity showed the importance of trait-based approaches within ecosystem-based fisheries management.

Consolidative stereotactic ablative radiotherapy (SABR) to intrapulmonary lesions is associated with prolonged progression-free survival and overall survival in oligometastatic NSCLC patients: A prospective phase 2 study.

OBJECTIVES: Stereotactic Ablative Radiotherapy (SABR) has shown high rates of local control and prolonged survival in early-stage non-small cell lung cancer (NSCLC), though its role in oligometastatic disease is undefined. This study aimed to evaluate SABR as a local consolidative therapy (LCT) in oligometastatic NSCLC patients. METHODS: In this prospective, single-arm phase 2 trial, we sought to evaluate SABR in patients with stage IV NSCLC, with ≤ five lesions, including the primary tumor. Patients received initial systemic therapy according to international guidelines. Patients without progression after front-line therapy (two months of targeted therapy and ≥ four cycles of chemotherapy) were evaluated by an 18F-FDG-PET/CT to receive consolidative SABR (45-60 Gy in 3-5 fractions) to the primary and all intrapulmonary metastatic sites. The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS) and toxicity. RESULTS: A total of 47 patients were included. Mean age was 58.9 years, 59.6 % were female, 87.2 % had adenocarcinoma histology, and the contralateral lung was the main site of metastases in 42.6 %. All patients received systemic front-line therapy, chemotherapy in 61.7 %, and a tyrosine kinase inhibitor (TKI) in 38.3 %. Disease control rate (DCR) and complete metabolic response (CMR) to SABR were 93.6 % and 70.2 %. Median PFS was 34.3 months (95 %CI; 31.1-38.8) for the total cohort; patients with a CMR had a median PFS of 53.9 monthsvs.31.9 months in those without CMR (p = 0.011). Median OS was not reached.Grade 1, 2, and 3 pneumonitis were observed in 79.5 % (31/39), 12.8 % (5/39) and 7.7 % (3/39), respectively. No grade ≥4 toxicities were observed. CONCLUSION: The use of SABR as LCT in oligometastatic NSCLC patients was well tolerated and showed favorable results regarding PFS and OS compared with historical data. The benefit was significantly higher in patients who reached a CMR as assessed by 18F-FDG-PET/CT.

Anticoagulation Management With Coumarinic Drugs in Chilean Patients.

Warfarin and acenocoumarol are used in various cardiovascular disorders to improve the prognosis of patients with thromboembolic disease. However, there is a lack of substantial efficacy and safety data on antithrombotic prophylaxis in several countries, particularly in Latin America. The aim of this study was to provide information about the efficacy of anticoagulants in Chilean patients. Data were collected from databases of the Western Metropolitan Health Service, Santiago, Chile. We identified 6280 records of patients receiving anticoagulant treatment. The three most common diagnoses were rhythm disorder (43.7%), venous thrombosis (22%), and valvular prosthesis (10.7%). The majority of patients (98.5%) received acenocoumarol while 1.5% of patients received warfarin, at weekly therapeutic doses of 13.6 mg and 30.4 mg, respectively. For total diagnoses, the median time in the therapeutic range was 50%. However, better results, 66.7%, were observed when a telemedicine strategy was used only in Santiago Province. Our findings emphasize that in Chile, where the number of patients receiving anticoagulant treatment increases every year, telemedicine, by committed teams, improves the use of oral anticoagulants and is able to increase quality indicators of anticoagulant treatment care.

Bottom trawl fishing footprints on the world's continental shelves.

Bottom trawlers land around 19 million tons of fish and invertebrates annually, almost one-quarter of wild marine landings. The extent of bottom trawling footprint (seabed area trawled at least once in a specified region and time period) is often contested but poorly described. We quantify footprints using high-resolution satellite vessel monitoring system (VMS) and logbook data on 24 continental shelves and slopes to 1,000-m depth over at least 2 years. Trawling footprint varied markedly among regions: from <10% of seabed area in Australian and New Zealand waters, the Aleutian Islands, East Bering Sea, South Chile, and Gulf of Alaska to >50% in some European seas. Overall, 14% of the 7.8 million-km2 study area was trawled, and 86% was not trawled. Trawling activity was aggregated; the most intensively trawled areas accounting for 90% of activity comprised 77% of footprint on average. Regional swept area ratio (SAR; ratio of total swept area trawled annually to total area of region, a metric of trawling intensity) and footprint area were related, providing an approach to estimate regional trawling footprints when high-resolution spatial data are unavailable. If SAR was ≤0.1, as in 8 of 24 regions, there was >95% probability that >90% of seabed was not trawled. If SAR was 7.9, equal to the highest SAR recorded, there was >95% probability that >70% of seabed was trawled. Footprints were smaller and SAR was ≤0.25 in regions where fishing rates consistently met international sustainability benchmarks for fish stocks, implying collateral environmental benefits from sustainable fishing.

Comodidad del paciente en una unidad de cuidado intensivo cardiovascular / Patient comfort at an intensive cardiovascular care unit

Resumen Los pacientes con enfermedad cardiovascular pueden requerir hospitalización en una Unidad de Cuidado Intensivo Cardiovascular (UCIC), generando incomodidad. La enfermería como disciplina brinda cuidado para recuperarla, siendo necesario reconocer la comodidad como compleja y multidimensional. Objetivo: Describir la comodidad y los factores que la afectan en el paciente hospitalizado en una UCIC. Metodología: Enfoque mixto de predominio cualitativo con recolección concurrente que finaliza en triangulación de datos. Muestra correspondiente a 45 pacientes en diciembre de 2015 y enero de 2016 en una UCIC de Bogotá. Se aplico una entrevista semiestructurada y el instrumento de comodidad (GCQ) de Kolcaba. Resultados: Se obtuvieron seis categorías que describen la comodidad en la UCIC; los factores que la alteraron fueron: percepción de no poder realizar actividades; sentirse encerrado; percepción de mucho ruido; o el tener que hacer sus funciones corporales ante personas desconocidas. Los factores que mejoran la comodidad incluyen contar con una persona cercana y el apoyo espiritual. Conclusiones: La comodidad en la UCIC fue alta; según el cuestionario GCQ, el ámbito físico fue el mas referido. Existen factores que facilitan la comodidad como el contar con una persona cercana. Las mayores incomodidades están relacionadas con la incapacidad para suplir necesidades asociadas a la higiene, dependiendo de otras personas para suplirlas. La metodología mixta permitió describir de manera amplia la comodidad de las personas en la UCIC.

Resumo Pacientes com doenca cardiovascular podem necessitar de hospitalizacao em Unidade de Terapia Intensiva Cardiovascular (UTIC), gerando desconforto em multiplos niveis. A enfermagem como disciplina oferece o cuidado de recupera-la, sendo necessario reconhecer o conforto como complexo e multidimensional. Objetivo: Descrever o conforto e os fatores que o afetam no paciente internado em uma UTIC. Metodologia: Foco misto de predominancia qualitativa com coleta simultanea de dados quantitativos para subsequentemente realizar triangulacao. Amostra correspondente a 45 pacientes em dezembro de 2015 e janeiro de 2016 em uma utic de Bogota. Aplicamos uma entrevista semiestruturada e o instrumento de conforto (GCQ) de Kolcaba. Resultados: Foram obtidas seis categorias que descrevem o conforto na UTIC, os fatores que a alteraram foram: percepcao de nao poder realizar atividades; se sentir preso; percepcao de muito ruido ou ter que fazer suas funcoes corporais perante pessoas desconhecidas. Fatores que melhoram o conforto incluem contar com a presenca de uma pessoa proxima e apoio espiritual. Conclusões: O conforto na utic foi alto de acordo com o Questionario GCQ, sendo a area fisica a mais referida. Existem fatores que facilitam o conforto, como ter uma pessoa proxima. O maior desconforto esta relacionado a incapacidade de atender as necessidades associadas a higiene, dependendo de outras pessoas para supri-las. A metodologia mista permitiu uma ampla descricao do conforto das pessoas na UTIC.

Abstract Patients with cardiovascular disease may require hospitalization in the Cardiovascular Intensive Care Unit (CVICU), generating discomfort at multiple levels. Nursing as a discipline provides care to restore comfort. It is necessary to recognize comfort as a complex and multidimensional phenomenon. Objective: To describe the comfort and the factors that affect it in the adult patient hospitalized in a CVICU. Methodology: Mixed approach involving a qualitative study and, simultaneously, the collection of quantitative data to perform a triangulation. The sample corresponds to 45 patients in December 2015 and January 2016 in a CVICU of Bogota. We applied a semi-structured interview and Kolcaba's comfort instrument (GCQ). Results: Six categories were obtained. Among the factors that altered the comfort were: perception of not being able to carry out activities; feeling confined, perception of noise or having to do their bodily functions in presence of unknown people. The factors that improved comfort were: to be able to count on a close person and the spiritual support. Conclusions: The level of comfort at the CVICU was high according to the GCQ questionnaire, the most mentioned area was the physical one. There are factors that facilitate comfort such as having a close person. The greatest discomfort is related to the inability to meet needs associated with hygiene, instead depending on other people to achieve them. The mixed methodology allowed a broad description of the comfort of patients at the cvicu.

Palliative care team visits. Qualitative study through participant observation.

OBJECTIVES: To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. METHODS: A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. RESULTS: The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. CONCLUSION: Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

OBJETIVOS: Conocer cómo se produce el encuentro clínico en la atención a los enfermos por parte de un equipo de Cuidados Paliativos, y qué elementos lo condicionan, indicando si son favorables o desfavorables en función de las expectativas y los sentimientos de los distintos participantes. MÉTODOS: Estudio de casos cualitativo, realizado mediante observación participante. Se realizaron 12 observaciones de los encuentros de los equipos de cuidados paliativos con los pacientes y familiares en diferentes entornos (domicilio, hospital y consulta). El tipo de visitas fueron de seguimiento o primera visita, programadas o a demanda. Se realizó un análisis de contenido de las observaciones. RESULTADOS: El análisis mostró una actividad normal de seguimiento de una unidad de cuidados paliativos centrada en el control de síntomas, la comunicación de información y el asesoramiento sobre pautas terapéuticas y cuidados. Se observó que los escenarios condicionan la expresión de los pacientes y el modo de relación. Como condiciones favorables del encuentro clínico destacan la afabilidad y la gratitud. Las condiciones desfavorables fueron el deterioro por la cercanía de la muerte, los objetivos poco realistas de los familiares y la escasez de recursos. CONCLUSIÓN: Las visitas domiciliarias de equipos básicos en Cuidados Paliativos tienen un importante papel, y parecen estar centradas en el control de síntomas y condicionadas por los recursos disponibles.

[Behavioral risk factors and readiness in amateur marathon runners 18-64 years of age in Bogotá, Colombia, 2014]. / Factores de riesgo del comportamiento y preparación de aficionados inscritos a carreras atléticas de fondo de 18 a 64 años en Bogotá, Colombia, 2014.

Participation in amateur street marathons has become increasingly popular and requires prior individual health risk assessment. The objective was to identify risk factors and readiness in registered runners. This was a cross-sectional study in a random sample (n = 510) of registered amateur runners 18-64 years of age, using a digital survey with IPAQ, Par-Q+, and STEPwise, with an expected physical inactivity rate of 35% (±5%). The study explored physical activity, (binge) alcohol consumption, fruit, vegetable, and salt intake, smoking, and readiness. Self-reported rates were: 97.4% recommended level of physical activity, 2.4% optimal fruit and vegetable intake, 3.7% smoking, and 44.1% binge drinking. 19.8% were Par-Q+ positive and 5.7% practiced supervised exercise. The analysis showed differences by age, sex, and socioeconomic status. Recreational runners followed the recommended levels of physical activity but did not score well on other risk factors. Prior evaluation of lifestyle-related risk factors and readiness provides a safer athletic strategy.

Palliative care team visits: Qualitative study through participant observation / Las visitas de equipos de cuidados paliativos: Estudio cualitativo mediante observación participante

Objectives: To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. Methods: A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. Results:The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. Conclusion: Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

Objetivos: Conocer cómo se produce el encuentro clínico en la atención a los enfermos por parte de un equipo de Cuidados Paliativos, y qué elementos lo condicionan, indicando si son favorables o desfavorables en función de las expectativas y los sentimientos de los distintos participantes. Métodos: Estudio de casos cualitativo, realizado mediante observación participante. Se realizaron 12 observaciones de los encuentros de los equipos de cuidados paliativos con los pacientes y familiares en diferentes entornos (domicilio, hospital y consulta). El tipo de visitas fueron de seguimiento o primera visita, programadas o a demanda. Se realizó un análisis de contenido de las observaciones. Resultados: El análisis mostró una actividad normal de seguimiento de una unidad de cuidados paliativos centrada en el control de síntomas, la comunicación de información y el asesoramiento sobre pautas terapéuticas y cuidados. Se observó que los escenarios condicionan la expresión de los pacientes y el modo de relación. Como condiciones favorables del encuentro clínico destacan la afabilidad y la gratitud. Las condiciones desfavorables fueron el deterioro por la cercanía de la muerte, los objetivos poco realistas de los familiares y la escasez de recursos. Conclusión: Las visitas domiciliarias de equipos básicos en Cuidados Paliativos tienen un importante papel, y parecen estar centradas en el control de síntomas y condicionadas por los recursos disponibles.

Evaluación inicial de parámetros de campo en un biodigestor anaeróbico para el tratamiento de aguas residuales / Preliminary evaluation of field parameters at an anaerobic biodigester designed for the treatment of wastewater

El biodigestor anaerobio utilizado en este estudio, se diseñó para tratar agua residual doméstica en un sanitario de prueba, y se caracteriza por ser de: flujo continuo, baja carga orgánica y tener cuatro etapas de proceso. La importancia del prototipo estudiado radicó en las condiciones reales en que se probó. La primera etapa consistió en la selección del sitio, construcción del prototipo en ferrocemento con capacidad de 1m³, impermeabilización y carga. En esta etapa se inoculó el reactor con materia orgánica procedente de las descargas del sanitario, durante el periodo de agosto a diciembre de 2011. La evaluación de este periodo consistió en la medición de parámetros de campo: pH, conductividad eléctrica, sólidos sedimentables, temperatura del influente - efluente y oxígeno disuelto del sistema que permitieron verificar el comportamiento del proceso del digestor durante la fase de arranque. Los resultados obtenidos para estas determinaciones a la entrada y salida del biodigestor respectivamente son los siguientes: pH (8.03; 8.43), conductividad eléctrica (1510.83 µS/cm; 1207.00 µS/cm), temperatura del proceso (19.2°C; 20.1°C), sólidos sedimentables (144.5mL/L; 0.02mL/L), oxígeno disuelto (4.5992 mg/L; 0.1924 mg/L) estos datos proporcionaron un punto de partida para el tratamiento de aguas residuales de tipo doméstica.

The anaerobic biodigester analyzed in the present study was designed for the treatment of domestic wastewater in a test restroom, characterized by its continuous flow, low organic load and a four-stage processing system. The value of the prototype under research consists in the real daily conditions under which it was tested. The first stage consisted of the site selection, and the manufacture of a waterproof iron reinforced cement prototype, with a 1m³ loading capacity. At this stage, during the period from august to december 2011, the reactor was inoculated with organic matter originating from the aforementioned restroom discharges. The evaluation of this stage consisted in taking measurements of the following field parameters: pH, electrical conductivity, sedimentable solids, and inflow and outflow temperature along the system. These records substantiated the behaviour of the processes within the digester during the starting phase. The results obtained through these determinations at both the biodigester entry and exit points are respectively: pH (8.03; 8.43), electrical conductivity (1510.83 µS/cm; 1207.00 µS/cm), inflow and outflow temperatures (19.2°C; 20.1°C), sedimentable solids (144.5mL/L; 0.02mL/L) and dissolved oxygen (4.5992 mg/L; 0.1924 g/L). These data provided a starting point for the treatment of domestic wastewater.

Factores de riesgo del comportamiento y preparación de aficionados inscritos a carreras atléticas de fondo de 18 a 64 años en Bogotá, Colombia, 2014 / Behavioral risk factors and readiness in amateur marathon runners 18-64 years of age in Bogotá, Colombia, 2014 / Fatores de risco comportamentais e prontidão em corredores amadores de 18 a 64 anos, inscritos em corridas de fundo em Bogotá, Colômbia, 2014

La participación en carreras atléticas de calle ha aumentado; esto requiere detectar riesgos previos al esfuerzo físico. El objetivo fue identificar factores de riesgo del comportamiento y preparación física de inscritos a una carrera. Estudio transversal en aficionados de 18-64 años. Encuesta digital con módulos de IPAQ, Par-Q+ y STEPwise. Muestreo aleatorio sistemático con n = 510, para una inactividad física esperada de 35% (±5%). Se evaluó nivel de actividad física, consumo de alcohol (peligroso), de fruta, verdura, tabaco y sal, y preparación. El cumplimiento de actividad física fue 97,4%; 2,4% consume un nivel óptimo de fruta o verdura (diferencias por edad, sexo y estrato), 3,7% fuma y 44,1% consumo peligroso de alcohol. El 19,8% reportó Par-Q+ positivo y 5,7% requiere supervisión. Hay diferencias por trabajo y estudio. Los aficionados cumplen el nivel de actividad física; pero no de otros factores. Una estrategia de seguridad en el atletismo de calle es evaluar los factores de riesgo relacionados con el estilo de vida, así como la preparación.

Participation in amateur street marathons has become increasingly popular and requires prior individual health risk assessment. The objective was to identify risk factors and readiness in registered runners. This was a cross-sectional study in a random sample (n = 510) of registered amateur runners 18-64 years of age, using a digital survey with IPAQ, Par-Q+, and STEPwise, with an expected physical inactivity rate of 35% (±5%). The study explored physical activity, (binge) alcohol consumption, fruit, vegetable, and salt intake, smoking, and readiness. Self-reported rates were: 97.4% recommended level of physical activity, 2.4% optimal fruit and vegetable intake, 3.7% smoking, and 44.1% binge drinking. 19.8% were Par-Q+ positive and 5.7% practiced supervised exercise. The analysis showed differences by age, sex, and socioeconomic status. Recreational runners followed the recommended levels of physical activity but did not score well on other risk factors. Prior evaluation of lifestyle-related risk factors and readiness provides a safer athletic strategy.

A participação em corridas de rua tem aumentado; isto requer uma detecção de riscos prévios ao esforço físico. O objetivo foi identificar os fatores de risco de comportamento e de readiness nos inscritos em uma corrida atlética. Estudo transversal em aficionados de 18 a 64 anos. Foi aplicado um questionário digital com módulos do IPAQ, Par-Q+ e STEPwise. Uma amostra aleatória sistemática, n = 510, para uma inatividade física estimada em 35% (± 5%). Avaliou-se o nível de atividade física, o consumo perigoso de álcool, fruta, verdura, tabaco, sal e readiness. A realização de atividade física foi de 97,4%; 2,4% consomem níveis ideais de frutas ou verduras (diferenças de idade, sexo e estrato); 3,7% são fumantes; e 44,1% consomem álcool. Dezenove vírgula oito por cento relataram Par-Q+ positivo e 5,7% requerem exercício supervisionado. Existem diferenças de trabalho e estudo.Os corredores recreacionais atendem aos níveis de atividade física, mas não de outros fatores. Uma estratégia de atletismo seguro é avaliar os fatores de risco relacionados ao estilo de vida e readiness.

Comodidad del paciente hospitalizado en una unidad de cuidado intensivo cardiovascular / Hospitalized patient comfort in a cardiovascular intensive care unit

La enfermedad cardiovascular es una condición de salud que afecta de manera importante a la población colombiana. Cuando hay deterioro importante de la función cardiovascular, se requiere de la hospitalización en una Unidad de Cuidado Intensivo cardiovascular (UCI) a fin de realizar vigilancia y cuidados especiales para la supervivencia. Esta presencia en la institución genera sensaciones de incomodidad a nivel físico, psicológico, espiritual o social. Por lo tanto, la enfermería como disciplina profesional, que provee cuidado a estos pacientes, se encuentra interesada en conocer de manera amplia la comodidad que vivencia el paciente, en virtud de que este es un fenómeno complejo y multidimensional. Los niveles afectados antes señalados demuestran la importancia que ejerce un cuidado humanizado de enfermería a los pacientes hospitalizados y a sus familias, sobresaltando el respaldo que se le debe dar al favorecimiento de las medidas de confort, basadas en brindar alivio, tranquilidad y trascendencia. Objetivo: Describir la comodidad del paciente adulto hospitalizado en una Unidad de Cuidado Intensivo cardiovascular. Diseño: El presente estudio tiene un enfoque mixto, cualitativo-cuantitativo de ejecución concurrente, lo que implica el desarrollo de un estudio cualitativo y la recolección de datos cuantitativos de manera paralela para realizar al final un análisis independiente, pero que confluye en un análisis mayor. Resultados: La muestra total fue de 45 personas a quienes se les aplicó el instrumento de Confort de Katharine Kolcaba en la Unidad de Cuidado Intensivo cardiovascular del Hospital Universitario San Ignacio de Bogotá en el mes de diciembre de 2015 y enero de 2016, con un porcentaje mayor de hombres del 73% y de mujeres del 27%. De las entrevistas, surgieron seis categorías y dieciséis códigos dentro de las expresiones de los pacientes hospitalizados. Los factores que alteraron la comodidad están relacionados con una percepción de no poder realizar alguna actividad cotidiana como moverse, comunicarse, alimentarse (ya sea por dolor e inmovilidad), el sentirse encerrado, percepción de mucho ruido o el tener que hacer sus funciones corporales ante personas desconocidas. Dentro de los factores que mejoran su comodidad, se encuentra el poder contar con el apoyo de alguien externo a la misma persona, ya sea apoyo espiritual o de otro individuo, como puede ser la familia, los amigos o el mismo personal asistencial, lo cual es de gran importancia al estar hospitalizado. Los resultados generales del cuestionario GCQ lograron evidenciar el cubrimiento de las necesidades de comodidad en un nivel medio-alto y alto por una respuesta mínima de 131 puntos, máxima de 159 puntos con un promedio que se ubica en un estado alto de comodidad con 146,07 puntos, con desviación estándar de 7,23. Conclusiones: El contexto físico es el más comprometido debido a los sentimientos de pudor que se generan por las ideas o preconceptos que la persona tiene sobre las funciones corporales, en especial con actividades íntimas como el tener que realizar funciones fisiológicas o actividades como el baño frente a personas desconocidas y con elementos de uso poco común, como el recolector de orina o coprológico. Sin embargo, los pacientes refieren su agradecimiento al contar con personal entrenado y consciente de su proceso de enfermedad. Por su parte, los pacientes acogen un acompañamiento espiritual de un ser superior que los hace sentir protegidos y los hace conscientes de buscar en la oración una forma de fortalecimiento. El acompañamiento médico y de enfermería con información acertada y oportuna brinda al paciente confianza en sus medidas de tratamiento. Además, la importancia del apoyo de la familia y amigos los hace sentir bien, amados y les da fuerza para seguir adelante con su recuperación. Las políticas institucionales incentivan a sus trabajadores a brindar un servicio humano, seguro y eficiente. Dentro del contexto ambiental, el ruido de los monitores y del ambiente de la Unidad de Cuidado Intensivo repercute en el descanso y tranquilidad del paciente. Así mismo, el espacio físico de la UCI favorece la intimidad y el recogimiento para pensar, brindar tranquilidad y paz. Un ambiente agradable en una Unidad de Cuidado Intensivo, por ende, es un aspecto importante en la consecución de la comodidad: una habitación amplia e iluminada además de una cama suave y blanda son condiciones que hacen más fácil la estadía en un servicio de salud de alta complejidad.

The cardiovascular disease is a health condition that affect in an important grade the people in Colombia. When there is a important damage in the cardiovascular function, it is required a hospitalization in the cardiovascular intensive care unit (ICU) in order to do the watchfulness and the special care to the survival, the institution generate uncomfortable sensations in physical, psychological, spiritual and in a social way. The nursery like a profession that give care to the patients it is interested in to know in a wide way the comfort the lives the patient because this is a complex and multidimensional phenomen. The above affect levels show the importance that apply the human care of the nursery in the hospitalized patients and their families, it is important the support that must be applied to the priority in the measures to improve the comfort based in bring relief, tranquility and transcendence. Objective: To describe the comfort of hospitalized adult patients in a cardiovascular intensive care unit. Design: The present study has a mixed, qualitative and quantitative approach to concurrent execution, implies the development of a qualitative study and the collection of quantitative data in parallel to perform an independent analysis at the end, but which converges in a larger analysis. Results: The total sample consisted of 45 people who were given the Katharine Kolcaba Comfort Instrument in the cardiovascular intensive care unit of the San Ignacio University Hospital in December 2015 and January 2016. With a higher percentage of Men of 73% and women 27%. From the interviews, six (6) categories emerged, and sixteen (16) codes within the expressions of hospitalized patients. The factors that alter comfort are related to a perception of not being able to perform some daily activity such as moving, communicating, feeding either by pain and immobility; Feeling closed or perceived as loud or having to do their bodily functions in the presence of unknown people. Among the factors that improve their comfort is that being able to count on the support of someone external to the same person, whether spiritual support or another individual such as family, friends, or the same care staff it has a big importance in comfort when being hospitalized. The overall results of the GCQ questionnaire were able to show the coverage of comfort needs in a medium-high level and high for a minimum response of 131 points, maximum of 159 points with an average that is in a high comfort state with 146.07 points, with a standard deviation of 7.23. Conclusions: The physical context is the most compromised due to the feelings of modesty that are generated by the ideas or preconceptions that the person has on the bodily functions, the having to perform physiological functions or activities such as the bath in front of unknown people and with elements of uncommon use like the urine collector or coprological, nevertheless they refer their gratefulness to having personnel trained and aware of their disease process. The patients receive spiritual accompaniment from a superior being who makes them feel protected and makes them aware of seeking in a pray a form of strengthening; The medical and nursing accompaniment with accurate and timely information gives the patient confidence in his treatment measures. The importance of the support of family and friends makes them feel good, loved, gives them strength to continue with their recovery. Institutional policies encourage their workers to provide a safe, efficient and humane service. Within the environmental context, the noise of the monitors and the environment of the intensive care unit has repercussions on the rest and tranquility of the patient. Likewise, the physical space of the ICU favors the intimacy and the recollection to think, offering tranquility and peace. A pleasant physical environment in an intensive care unit is an important aspect in achieving comfort: A spacious, bright room, a soft bed, are conditions that make it easier to stay in a high complexity health service.

Cardiovascular Complications of Pregnancy.

Pregnancy causes significant metabolic and hemodynamic changes in a woman's physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up.

Mediterranean Dietary Patterns and Cardiovascular Health.

The Mediterranean dietary pattern has been linked with reduced cardiovascular disease incidence and mortality. Components of the Mediterranean diet associated with better cardiovascular health include low consumption of meat and meat products, moderate consumption of ethanol (mostly from wine), and high consumption of vegetables, fruits, nuts, legumes, fish, and olive oil. Increasing evidence indicates that the synergy among these components results in beneficial changes in intermediate pathways of cardiometabolic risk, such as lipids, insulin sensitivity, oxidative stress, inflammation, and vasoreactivity. As a result, consumption of a Mediterranean dietary pattern favorably affects numerous cardiovascular disease risk factors, such as dyslipidemia, hypertension, metabolic syndrome, and diabetes. Moreover, strong evidence links this dietary pattern with reduced cardiovascular disease incidence, reoccurrence, and mortality. This review evaluates the current evidence behind the cardioprotective effects of a Mediterranean dietary pattern.

Current Treatment of Familial Hypercholesterolaemia.

Familial hypercholesterolaemia is an autosomal-dominant disorder associated with mutations in the LDL receptor gene resulting in markedly elevated plasma low-density lipoprotein cholesterol levels. FH is significantly underrecognised with as many as 1 in 300 having the heterozygous form and 1 in 1 million having the homozygous form of the disease. Early diagnosis and treatment of FH is paramount to reduce the risk of premature atherosclerotic cardiovascular disease and death. The goal of treatment is to reduce LDL-C by 50 % from baseline levels with lifestyle modification, pharmacologic lipid-lowering therapy, LDL apheresis and in rare cases, liver transplantation. Pharmacologic treatment ranges from statin medications to newer agents such as lomitapide, mipomersin and PCSK9 inhibitors. Combination therapy is frequently required to achieve goal lipoprotein level reductions and prevent complications.

Frequency and spectrum of hemoglobinopathy mutations in a Uruguayan pediatric population.

Hemoglobinopathies are the most common recessive diseases worldwide but their prevalence in Uruguay has not been investigated. In this study, 397 unrelated outpatient children from the Pereira Rosell Hospital Center (CHPR), as well as 31 selected patients with microcytic anemia and 28 ß-thalassemia carriers were analyzed for hemoglobinopathies by using biochemical and molecular biology methods. Parametric and non-parametric methods were used to compare the hematological indices between groups of genotypes. Of the 397 patients in the first group, approximately 1% (0.76% HbS and 0.25% ß-thalassemia) had a mutation in the HBB gene and 3.3% had ß-thalassemia. These mutations had a heterogeneous distribution that varied according to individual ancestry. HbS was found exclusively in individuals with declared African ancestry and had a carrier frequency of 2.2%. The frequency of α-thalassemia carriers in outpatients of European and African ancestry was 1.2% and 6.5%, respectively. In contrast, the frequency of α-thalassemia carriers in patients with microcytic anemia was 25.8%, significantly higher (p < 0.01) than that observed in the sample as a whole and in Afro-descendants and Euro-descendants. Significant differences were observed in the hematological parameters between individuals with thalassemia genotypes and those with a normal genotype. These results indicate that hemoglobinopathies are a relevant health problem in Uruguay.