Discapacidad y calidad de vida después de un accidente de tránsito en Medellín y su área metropolitana. Estudio de cohorte

Objetivo: Comparar al año, el funcionamiento, calidad de vida (cv), dolor y depresión entre adultos menores y mayores de 60 años que tuvieron lesiones moderadas y graves en accidentes de tránsito ocurridos en Medellín y su área metropolitana. Metodología: Análisis secundario de dos cohortes de pacientes con lesiones moderadas y graves ocurridas en Medellín y su área metropolitana en 2009-2010 y 2015-2016. Se hizo evaluación para el funcionamiento, la cv, depresión y el dolor, con instrumentos validados para ello. Las diferencias entre las cohortes 12 meses después del accidente se compararon con t-Student. Se hizo un análisis de regresión lineal múltiple para determinar los factores explicativos de discapacidad y cv. Resultados: Se incluyeron 837 pacientes, de los cuales el 84,8 % completó el seguimiento. La motocicleta fue el principal vehículo involucrado (86,1 y 60,7 %). Se observó mejor funcionamiento en mayores de 60 años en cuidado personal, y mayor compromiso en las actividades de la vida diaria, laborales y funcionamiento global. La cv fue significativamente mejor en menores, en desempeño emocional, desempeño físico y función física. En el análisis multivariado, el mayor compromiso en el funcionamiento fue explicado por ser mujer, tener más edad, lesión más grave, mayor dolor y depresión. La mejor cv fue explicada por ser hombre, menos edad, menor gravedad de la lesión, dolor y síntomas depresivos. Conclusiones: La edad, el sexo, la gravedad de la lesión, el dolor y la depresión explican la discapacidad y las dimensiones de la cv 12 meses después del accidente de tránsito.

Objective: To compare functioning, quality of life (QoL), pain, and depression at one year between adults under and over 60 years of age who had moderate and severe injuries in traffic accidents in Medellin and its metropolitan area. Methodology: Secondary analysis of two cohorts of patients with moderate and severe injuries that occurred in Medellín and its metropolitan area in 2009-2010 and 2015-2016. They were evaluated at baseline and 12 months with functioning (who-das ii), QoL (sf-36), pain (vas), and depression (phq-9). The differences between cohorts 12 months after the accident were compared with t-Student test. A multiple linear regression analysis was done to determine factors related to disability and QoL. Results: 837 patients were included, 84,8% completed the follow-up. The motorcycle was the main vehicle involved (86,1% vs. 60,7). Better functioning was observed in people over 60 years of age in personal care, and greater commitment in activities of daily living, work and global functioning. QoL was significantly better in minors, in emotional performance, physical performance and physical function. In the multivariate analysis, the greater compromise in functioning was explained by being female, older, more severe injury, greater pain, and depression. The best QoL was explained by being male, younger, less severe injury, pain, and depressive symptoms. Conclusions: Age, sex, injury severity, pain, and depression explain disability and QoL dimensions 12 months after the traffic accident.

Objetivo: Comparar a funcionalidade, qualidade de vida (QV), dor e depressão entre adultos com menos e mais de 60 anos de idade que sofreram lesões moderadas e graves em acidentes de trânsito ocorridos em Medellín e sua região metropolitana. Metodologia: Análise secundária de duas coortes de pacientes com lesões moderadas e graves que ocorreram em Medellín e sua área metropolitana em 2009-2010 e 2015-2016. Foi feita avaliação funcional, cv, depressão e dor, com instrumentos validados para isso. As diferenças entre as coortes 12 meses após o acidente foram comparadas com o teste t de Student. Uma análise de regressão linear múltipla foi realizada para determinar os fatores explicativos para deficiência e cv. Resultados: foram incluídos 837 pacientes, dos quais 84,8% completaram o seguimento. A motocicleta foi o principal veículo envolvido (86,1 e 60,7%). Melhor funcionamento foi observado em pessoas com mais de 60 anos nos cuidados pessoais e maior comprometimento nas atividades de vida diária, trabalho e funcionamento global. A QV foi significativamente melhor nos menores, no desempenho emocional, no desempenho físico e na função física. Na análise multivariada, o maior comprometimento funcional foi explicado por ser mulher, ser mais velho, lesão mais grave, maior dor e depressão. A melhor QV foi explicada por ser homem, menor idade, menor gravidade da lesão, dor e sintomas depressivos. Conclusões: Idade, sexo, gravidade da lesão, dor e depressão explicam as dimensões de incapacidade e QV 12 meses após o acidente de trânsito.

Existential phenomenological view of health care experiences from the perspective of cancer survivors.

OBJECTIVES: to understand the experience of post-discharge health care of primary cancer treatment from the perspective of survivors. METHODS: a descriptive study with a qualitative approach, using Martin Heidegger's Existential Phenomenology framework. Analysis of semi-structured interviews of 11 cancer survivors, after primary treatment, was carried out through vague and median and hermeneutic understanding. RESULTS: three units of meaning emerged in the search for the unveiling of the phenomenon: Respecting physical limitations after cancer; Transcending themselves after illness; and Overcoming the ghost of fear. FINAL CONSIDERATIONS: cancer survivors experience care in intentional choices favorable to health, when they overcome their own limitations, fear of relapse or new cancer. The need to improve continuous professional monitoring in order to answer questions reinforce favorable attitudes and enhance the chances of better quality of life for cancer survivors.

Existential phenomenological view of health care experiences from the perspective of cancer survivors / Vista fenomenológica existencial de las experiencias de atención médica en la perspectiva de los supervivientes del cáncer / Olhar fenomenológico existencial das vivências de cuidado à saúde na perspectiva de sobreviventes ao câncer

ABSTRACT Objectives: to understand the experience of post-discharge health care of primary cancer treatment from the perspective of survivors. Methods: a descriptive study with a qualitative approach, using Martin Heidegger's Existential Phenomenology framework. Analysis of semi-structured interviews of 11 cancer survivors, after primary treatment, was carried out through vague and median and hermeneutic understanding. Results: three units of meaning emerged in the search for the unveiling of the phenomenon: Respecting physical limitations after cancer; Transcending themselves after illness; and Overcoming the ghost of fear. Final Considerations: cancer survivors experience care in intentional choices favorable to health, when they overcome their own limitations, fear of relapse or new cancer. The need to improve continuous professional monitoring in order to answer questions reinforce favorable attitudes and enhance the chances of better quality of life for cancer survivors.

RESUMEN Objetivos: comprender la experiencia de la atención médica después del alta del tratamiento primario contra el cáncer desde la perspectiva del sobreviviente. Métodos: estudio descriptivo, con enfoque cualitativo, utilizando el marco metodológico de la Fenomenología Existencial de Martin Heidegger. El análisis de las entrevistas semiestructuradas de 11 sobrevivientes de cáncer, después del tratamiento primario, se realizó a través de una comprensión vaga, mediana y hermenéutica. Resultados: surgieron tres unidades de significado en la búsqueda para revelar el fenómeno: Respetar las limitaciones físicas después del cáncer; Trascendirte después de la enfermedad; y Superar el fantasma del miedo. Consideraciones finales: el sobreviviente de cáncer experimenta atención en elecciones intencionales favorables para la salud, cuando supera sus propias limitaciones, miedo a la recurrencia o cáncer nuevo. Se enfatiza la necesidad de mejorar el monitoreo profesional continuo para responder preguntas, reforzar actitudes favorables y aumentar las posibilidades de una mejor calidad de vida para los sobrevivientes de cáncer.

RESUMO Objetivos: compreender a vivência do cuidado à saúde pós-alta do tratamento oncológico primário na perspectiva do sobrevivente. Métodos: estudo descritivo, de abordagem qualitativa, utilizando-se o referencial metodológico da Fenomenologia Existencial de Martin Heidegger. Análise das entrevistas semiestruturadas de 11 sobreviventes ao câncer, após tratamento primário, foi realizada por meio da compreensão vaga e mediana e hermenêutica. Resultados: surgiram três unidades de significado na busca pelo desvelamento do fenômeno: Respeitando as limitações físicas após o câncer; Transcendendo a si próprio após a doença; e Superando o fantasma do medo. Considerações Finais: o sobrevivente ao câncer vivencia o cuidado nas escolhas intencionais favoráveis à saúde, quando supera suas próprias limitações, medo de recidiva ou novo câncer. Ressalta-se a necessidade de aprimorar o acompanhamento profissional contínuo no intuito de sanar dúvidas, reforçar atitudes favoráveis e potencializar as chances de melhor qualidade de vida dos sobreviventes ao câncer.

Lesiones graves y moderadas por accidentes de tránsito en mayores de 60 años. Medellín, Colombia / Severe and moderate injuries in people over 60 years of age caused by road traffic accidents in Medellín, Colombia

Resumen Introducción. Cada día, 3 400 personas mueren en el mundo por un accidente de tránsito (AT); miles sufren lesiones o adquieren una discapacidad cada año por la misma causa. En Colombia, en 2016 se registró una tasa de 92.8 heridos y 14.9 muertes por cada 100 000 habitantes. Objetivo. Describir las características de los AT y el entorno de su atención en mayores de 60 años con lesiones moderadas o graves en Medellín, Colombia, durante el periodo 2015-2016. Materiales y métodos. Estudio descriptivo de las características de personas mayores de 60 años con lesiones moderadas y graves después de un AT. Resultados. Se evaluaron247 personas, 93.1% con lesiones moderadas; el 94.1% de las lesiones graves ocurrieron cuando se atropelló un peatón. En 60.7% de los AT una moto estuvo involucrada. El puntaje global del WHODAS-II fue de 40.6 y los dominios de funcionamiento más afectados fueron actividades domésticas, actividades fuera de la casa y movilidad; en cuanto a la calidad de vida, se afectó la función física, el desempeño físico y el cambio en salud. Conclusión. Los mayores de 60 años con lesiones por AT fueron, en su mayoría, peatones atropellados por motocicletas. El AT afectó la calidad de vida y el funcionamiento de los pacientes.

Abstract Introduction: Every day, 3 400 people are killed in road traffic accidents (RTA) in the world; thousands are injured or disabled each year from the same cause. In Colombia, a rate of 92.8 injured and 14.9 deaths per 100 000 inhabitants was reported in 2016. Objective: To describe the characteristics of RTA, clinical care and quality of life of people over 60 years of age with moderate or severe injuries in Medellín, Colombia, during the period 2015-2016. Materials and methods: Descriptive study of the characteristics of people over 60 years of age with moderate and severe injuries after a a RTA. Results: 247 people were included in the study, of which 93.1% had moderate injuries; 94.1% of the severe injuries occurred when a pedestrian was hit. In 60.7% of the RTA, a motorcycle was involved. The overall WHODAS-II Score was 40.6 and the most affected operational domains were domestic activities, activities outside the home and mobility. In terms of quality of life, physical function, physical performance and change in health were affected. Conclusion: People over 60 years of age with RTA injuries were mostly pedestrians and motorcycles were the most frequent vehicle involved. RTA affected patients' quality of life and functioning.

Análisis de costo-efectividad de dabigatran, rivaroxaban y apixaban comparado con warfarina para prevención de fenómenos tromboembólicos e isquémicos en pacientes adultos con fibrilación auricular no valvular en Colombia / Cost-effectiveness analysis of dabigatran, rivaroxaban, and apixaban compared to warfarin for prevention of thromboembolic and ischemic events in adult patients with non-valvular atrial fibrillation in Colombia

Problema de investigación: Calcular los costos y la efectividad esperada de dabigatran, rivaroxaban y apixaban, comparado con warfarina, para prevención de fenómenos tromboembólicos e isquémicos en pacientes adultos con fibrilación auricular no valvular en Colombia. Tipo de evaluación económica: Evaluación de costo-efectividad. Población objetivo: Pacientes adultos con fibrilación auricular no valvular en Colombia, análisis del subgrupo de pacientes en falla. Intervención y comparadores: Dabigatran 110 mg y 150 mg, rivaroxaban y apixaban, comparado con warfarina. Horizonte temporal: Tiempo trascurrido entre diagnóstico y expectativa de vida. Perspectivas: Sistema general de Seguridad\tSocial en salud de Colombia. Tasa de descuento: En el caso base se empleó una tasa de descuento común tanto a los costos como a los desenlaces en salud, equivalente al 5% anual. Adicionalmente, se realizaron análisis de sensibilidad de 0 %, 3,5 %, 7 % y 12 %. Estructura del modelo: Modelo de Markov. Fuentes de datos de efectividad y seguridad: \r\nRevisiones sistemáticas de literatura, de acuerdo a la población y tecnologías de la pregunta de investigación. Desenlaces y valoración: Años de Vida Ajustados por Calidad (AVAC). Costos incluidos: Costos directos del tratamiento de acuerdo a las alternativas evaluadas y seguimiento a los pacientes. Fuentes de datos de costos: Los medicamentos fueron costeados con la información del SISMED, el costo de los procedimientos fue estimado a partir de los valores contenidos en el Manual Tarifario ISS2001 + 30%. Resultados del caso base: Los nuevos anticoagulantes orales son más costosos pero más efectivos que el tratamiento con warfarina. La relación de costo-efectividad incremental oscila entre $ 74.462.000 para dabigatran 150 mg y $ 97.501.541 para apixaban y para dabigatran 110 mg es de 72.107.742. Es decir, a los precios actuales, estas no serían alternativas costo-efectivas para un umbral equivalente a 3 veces el PIB per cápita. Análisis de sensibilidad: Los resultados del caso base son sensibles a cambios en el precio de los nuevos anticoagulantes y las probabilidades de ACV isquémico y sangrado. A partir de los resultados del análisis de sensibilidad se concluye que para que los nuevos anticoagulantes orales sean costo ­ efectivos, es necesaria una reducción del precio de los nuevos anticoagulantes orales. Conclusiones y discusión: Los resultados de esta evaluación muestran que desde la perspectiva del Sistema General de Seguridad Social de Colombia, los nuevos anticoagulantes orales dabigatran, apixaban y rivaroxaban, son más efectivos que warfarina, en el esquema de prescripción habitual, para la prevención de eventos tromboembólicos e isquémicos en pacientes adultos iguales o mayores a 60 años con diagnóstico de fibrilación auricular no valvular sin falla renal y con falla renal, pero no son estrategias costo-efectivas, a los precios actuales.(AU)

Lead isotope ratios in six lake sediment cores from Japan Archipelago: Historical record of trans-boundary pollution sources.

Sediment cores from six lakes situated from north to south on the Japanese Archipelago were collected during 2009-2010 to investigate the hypothesis that deposition of lead (Pb) was coming from East Asia (including China, South Korea and eastern part of Russia). Accumulation rates and ages of the lake sediment were estimated by the (210)Pb constant rate of supply model and (137)Cs inputs to reconstruct the historical trends of Pb accumulation. Cores from four lakes located in the north and central Japan, showed clear evidence of Pb pollution with a change in the (206)Pb/(207)Pb and (208)Pb/(207)Pb ratios in the recent sediment as compared to the deeper sediment. Among the six studied lakes, significant inputs of anthropogenic lead emissions were observed at Lake Mikazuki (north Hokkaido in north Japan), Lake Chokai (north of Honshu), and Lake Mikuriga (central part of Honshu). Pb isotopic comparison of collected core sediment and previously reported data for wet precipitation and aerosols from different Asian regions indicate that, before 1900, Pb accumulated in these three lakes was not affected by trans-boundary sources. Lake Mikazuki started to receive Pb emissions from Russia in early 1900s, and during the last two decades, this lake has been affected by trans-boundary Pb pollution from northern China. Lake Chokai has received Pb pollutant from northern China since early 1900s until 2009, whereas for the Lake Mikuriga the major Pb contaminant was transported from southern China during the past 100years. The results of our study demonstrate that Japan Archipelago has received trans-boundary Pb emissions from different parts of East Asian region depending on location, and the major source region has changed historically.

Nitrogen, carbon, and sulfur isotopic change during heterotrophic (Pseudomonas aureofaciens) and autotrophic (Thiobacillus denitrificans) denitrification reactions.

In batch culture experiments, we examined the isotopic change of nitrogen in nitrate (δ(15)NNO3), carbon in dissolved inorganic carbon (δ(13)CDIC), and sulfur in sulfate (δ(34)SSO4) during heterotrophic and autotrophic denitrification of two bacterial strains (Pseudomonas aureofaciens and Thiobacillus denitrificans). Heterotrophic denitrification (HD) experiments were conducted with trisodium citrate as electron donor, and autotrophic denitrification (AD) experiments were carried out with iron disulfide (FeS2) as electron donor. For heterotrophic denitrification experiments, a complete nitrate reduction was accomplished, however bacterial denitrification with T. denitrificans is a slow process in which, after seventy days nitrate was reduced to 40% of the initial concentration by denitrification. In the HD experiment, systematic change of δ(13)CDIC (from -7.7‰ to -12.2‰) with increase of DIC was observed during denitrification (enrichment factor εN was -4.7‰), suggesting the contribution of C of trisodium citrate (δ(13)C=-12.4‰). No SO4(2-) and δ(34)SSO4 changes were observed. In the AD experiment, clear fractionation of δ(13)CDIC during DIC consumption (εC=-7.8‰) and δ(34)SSO4 during sulfur use of FeS2-S (around 2‰), were confirmed through denitrification (εN=-12.5‰). Different pattern in isotopic change between HD and AD obtained on laboratory-scale are useful to recognize the type of denitrification occurring in the field.

Improved stability of multivalent antibodies containing the human collagen XV trimerization domain.

We recently described the in vitro and in vivo properties of an engineered homotrimeric antibody made by fusing the N-terminal trimerization region of collagen XVIII NC1 domain to the C-terminus of a scFv fragment [trimerbody (scFv-NC1) 3; 110 kDa]. Here, we demonstrated the utility of the N-terminal trimerization region of collagen XV NC1 domain in the engineering of trivalent antibodies. We constructed several scFv-based trimerbodies containing the human type XV trimerization domain and demonstrated that all the purified trimerbodies were trimeric in solution and exhibited excellent antigen binding capacity. Importantly, type XV trimerbodies demonstrated substantially greater thermal and serum stability and resistance to protease digestion than type XVIII trimerbodies. In summary, the small size, high expression level, solubility and stability of the trimerization domain of type XV collagen make it the ideal choice for engineering homotrimeric antibodies for cancer detection and therapy.

Surface characterization and biological response of carbon-coated oxygen-diffused titanium having different topographical surfaces.

The materials (C-ODTi) with different topographical surfaces that possess interstitial oxygen atoms into the host titanium lattice and an upper nanometric surface layer of anatase-TiO(2) covered by a carbon thin layer were fabricated in this study. The carbon thin layer on the surface of C-ODTi was composed of amorphous carbon and nano-graphite crystals. In vitro tests, using human bone marrow-derived mesenchymal cells (hBMCs), were performed to check cytotoxicity, examining in particular cell morphology, cell proliferation, cell differentiation, and mineralization capability. After 10 days of culture a higher degree of cell viability was observed on the surface of C-ODTi with an abraded surface. We also observed that hBMCs cultured in direct contact with C-ODTi maintained their capability to express alkaline phosphatase activity (ALP) and formed mineralized nodules similar to the control cultures. Our results demonstrate that the carbon layer coating on the surface of C-ODTi possess better biological response than commercially pure titanium (cp Ti), which was evidenced by the higher proliferation rates of osteoblasts, higher osteo-differentiation and a higher mineralization capability.

Titanium Implants after alkali heating treatment with a [Zn(OH)4]2 complex: analysis of interfacial bond strength using push-out tests.

BACKGROUND: Clinical demands for stronger and faster bone bonding to implants have motivated the development of chemically and topographically modified surfaces capable of chemical bonding. This study presents a new one-step alkali heat treatment performed with a solution containing [Zn(OH)(4)](2-) complex as an alternative to the conventional NaOH solution. PURPOSE: The objective of this work is to assess the effect of a Zn-modified surface chemistry on bone-implant shear strength using a rabbit model. MATERIALS AND METHODS: The study was conducted on mechanical-grinded and smooth surfaces of Ti cylindrical implants. The topographical structure, chemical surface composition, and structural properties of the chemically modified titanium surface were studied by scanning electron microscopy, x-ray photoelectron spectroscopy, and x-ray diffractometry. Implant-bone shear strength was evaluated by push-out tests undertaken at 4, 12, and 24 weeks after insertion in rabbit femora. RESULTS: Implants with smooth and rough surfaces chemically-modified with a solution containing [Zn(OH)(4)](2-) complex demonstrated significantly stronger bone fixation than nonmodified implants at all healing times (p < 0.05). CONCLUSIONS: The obtained results suggest that biochemical bonding at the bone-implant interface, stimulated by the Zn(2+) ion release in combination with mechanical interlocking definitively improved the implant fixation.

Fabrication and characterization of oxygen-diffused titanium for biomedical applications.

Although titanium has been successful as an orthopedic or dental implant material, performance problems still persist concerning implant-bone interfacial bonding strength. In this study a novel oxygen-diffused titanium (ODTi), fabricated by introducing oxygen into the titanium crystal lattice by thermal treatment, was investigated. The fabricated material is the result of a surface modification made on commercially pure titanium (cp Ti) previously coated with poly(vinyl alcohol) (PVA) by means of a thermal treatment performed at 700 degrees C in an ultra-pure argon atmosphere. The thermal treatment at 700 degrees C led to the formation of an anatase TiO(2) film on the cp Ti surface and a concentration gradient of oxygen into titanium. The surface of the fabricated ODTi consisted of an outer nanometric layer of anatase TiO(2) and an inner nanometric layer of Ti(2)O(x) (x<1) in which the oxygen is in solid solution with the titanium metal. It was found that ODTi possesses in vitro apatite formation ability after being soaked into simulated body fluid (SBF) solution. This apatite formation ability is attributed to the presence of the anatase TiO(2) outermost surface layer and to abundant hydroxyl groups (-OH) formed on the ODTi surface after immersion in SBF.

In vitro corrosion resistance of Lotus-type porous Ni-free stainless steels.

The corrosion behavior of three kinds of austenitic high nitrogen Lotus-type porous Ni-free stainless steels was examined in acellular simulated body fluid solutions and compared with type AISI 316L stainless steel. The corrosion resistance was evaluated by electrochemical techniques, the analysis of released metal ions was performed by inductively coupled plasma mass spectrometry (ICP-MS) and the cytotoxicity was investigated in a culture of murine osteoblasts cells. Total immunity to localized corrosion in simulated body fluid (SBF) solutions was exhibited by Lotus-type porous Ni-free stainless steels, while Lotus-type porous AISI 316L showed very low pitting corrosion resistance evidenced by pitting corrosion at a very low breakdown potential. Additionally, Lotus-type porous Ni-free stainless steels showed a quite low metal ion release in SBF solutions. Furthermore, cell culture studies showed that the fabricated materials were non-cytotoxic to mouse osteoblasts cell line. On the basis of these results, it can be concluded that the investigated alloys are biocompatible and corrosion resistant and a promising material for biomedical applications.

Monitorización con potenciales evocados somatosensoriales durante la descompresión occipitocervical en un lactante con acondroplasia: reporte de un caso / Somatosensorial evoked potentials monotoring during occipitocervical decompression in an achondroplasic child: Case report

Se revisa el caso de un paciente de ocho meses de edad, con acondroplasia y síntomas sugestivos de compresión cervicomedular. Los síntomas incluían convulsiones tónico-clónicas generalizadas, irritabilidad, episodios frecuentes de apnea, control cefálico nulo, flacidez generalizada, reflejos osteotendinosos abolidos y fontanela abombada. Los estudios radiológicos incluyeron tomografía computarizada (TC) y resonancia magnética (RM) que mostraron la compresión, y signos de mielopatía cervical crónica, esto último fue confirmado con estudio de potenciales evocados somatosensoriales (PESS) preoperatorios del nervio mediano. Al paciente se le hicieron descompresión de la fosa posterior y laminectomía de C-1. La monitorización con PESS intraoperatorios continuos se usó para observar los cambios electrofisiológicos que se pueden presentar con la descompresión medular, y además para ayudar a determinar la extensión de la descompresión requerida.