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1.
Gac Med Mex ; 160(2): 144-153, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39116868

RESUMO

BACKGROUND: The proportion of older people living with HIV (PLWH) has increased. Non-communicable diseases occur earlier in PLWH than in the general population. OBJECTIVE: The goal of this study was to estimate the prevalence of comorbidities in PLWH and cancer in a tertiary referral center in Mexico City. MATERIAL AND METHODS: In this retrospective study, we included PLWH > 40 years with a history of cancer, coming to Instituto Nacional de Cancerologia from 2010 through 2019. All patients needed to be on antiretrovirals for at least six months. Data collected included cancer type, comorbidities, frequency of polypharmacy, FRAX score and 10-year cardiovascular risk. Patients were evaluated for depression with the Beck Inventory Depression-II Scale. Variables associated to multimorbidity (2 or more comorbidities) were evaluated. RESULTS: Of 125 patients, 69% had at least one comorbidity; 32% had ≥ 2. Common comorbidities were dyslipidemia (54%), hypertension (19%), obesity (14%) and Diabetes (12%). In patients ≥ 50 years, 29 (62%) already undergone a densitometry and 9 (31%) had osteoporosis; 56 depression questionnaires were used: 30% had mild-to-severe depression. Being ≥ 50 years was associated with multimorbidity (aOR 2.57 (1.18-5.58), p = 0.017). CONCLUSIONS: A high prevalence of multimorbidity and poor screening of bone disease and mental health is reported in patients with PLWH and cancer. A holistic approach to the PLWH in the Infectious Diseases consultation is needed to improve the detection and management of non-communicable diseases, to go beyond viral suppression and towards an improved quality of life.


INTRODUCCIÓN: La proporción de personas mayores que viven con VIH (PVVIH) va en aumento, y las enfermedades no transmisibles ocurren antes en PVVIH comparado con la población general. OBJETIVO: El objetivo de este estudio fue estimar la prevalencia de las comorbilidades en PVVIH con cáncer de un centro de tercer nivel de la Ciudad de México. MÉTODOS: Este estudio retrospectivo incluyó todas las PVVIH > 40 años con cáncer, que acudieron al Instituto Nacional de Cancerología entre 2010 y 2019). Se incluyeron datos sobre el tipo de cáncer, comorbilidades y polifarmacia. Se calcularon la puntuación FRAX, el riesgo cardiovascular a 10 años, y se aplicó un cuestionario para evaluar depresión (Beck Inventory Depression-II Scale). RESULTADOS: De 125 pacientes, 69% tenía al menos una comorbilidad; 32% tenía ≥ 2. Las comorbilidades más comunes fueron dislipidemia (54%), hipertensión (19%), obesidad (14%) y diabetes (12%). En pacientes ≥ 50 años, 29% tenía una densitometría osea; 31% tenía osteoporosis. Se aplicaron 56 cuestionarios: 30% tenía algún grado de depresión. Tener ≥ 50 años se asoció con multimorbilidad (aOR 2.57, 1.18-5.58), p = 0.017. CONCLUSIONES: Se reporta una alta prevalencia de multimorbilidad en PVVIH y cancer, con pobre escrutinio de enfermedad ósea y salud mental. Se requiere un enfoque holístico para las PVVIH en la consulta de infectología, para mejorar el manejo de las enfermedades no transmisibles, yendo más alla de la supresión virológica.


Assuntos
Infecções por HIV , Multimorbidade , Neoplasias , Humanos , México/epidemiologia , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Neoplasias/epidemiologia , Prevalência , Adulto , Idoso , Depressão/epidemiologia , Comorbidade , Fatores Etários
2.
J Trauma Nurs ; 31(4): 196-202, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38990875

RESUMO

BACKGROUND: Despite recommendations and laws for child restraint use in motor vehicles, evidence of low restraint use remains, and there is a lack of evidence addressing the effectiveness of restraint use education. OBJECTIVE: This project aims to measure the impact of an education initiative on child passenger restraint use. METHODS: This pre- and postintervention study was conducted in six elementary schools in a Southwestern U.S. metropolitan area over 5 months from October 2022 to March 2023. Motor vehicle restraint use was collected from occupants arriving at elementary schools during the morning drop-off times. Participants were provided one-on-one education regarding child passenger safety guidelines and state laws. Comparison data were collected 1-3 weeks later at the same schools to evaluate the education provided. RESULTS: A total of 1,671 occupants in 612 vehicles were observed across six schools, with 343 adults and 553 children preintervention and 306 adults and 469 children postintervention. Overall restraint adherence in children improved postintervention from 42.3% to 56.1%, a 32.6% increase (p = < .001). In the primary age group of 4-8 years, restraint adherence improved postintervention from 34.8% to 54.2%, a 55.8% increase (p = <.001). CONCLUSIONS: The study results demonstrate that one-on-one education increases child passenger restraint use.


Assuntos
Sistemas de Proteção para Crianças , Humanos , Masculino , Sistemas de Proteção para Crianças/estatística & dados numéricos , Sistemas de Proteção para Crianças/normas , Feminino , Criança , Pré-Escolar , Acidentes de Trânsito/prevenção & controle , Adulto , Educação em Saúde , Estados Unidos , Cintos de Segurança/estatística & dados numéricos , Cintos de Segurança/legislação & jurisprudência
3.
bioRxiv ; 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38798561

RESUMO

Pancreatic ß-cell stress contributes to diabetes progression. This study demonstrates that Leucine-rich repeat-containing G-protein-coupled-receptor-4 (LGR4) is critical for maintaining ß-cell health and is modulated by stressors. In vitro , Lgr4 knockdown decreases proliferation and survival in rodent ß-cells, while overexpression protects against cytokine-induced cell death in rodent and human ß-cells. Mechanistically, LGR4 suppresses Receptor Activator of Nuclear Factor Kappa B (NFκB) (RANK) and its subsequent activation of NFκB to protect ß-cells. ß-cell-specific Lgr4 -conditional knockout (cko) mice exhibit normal glucose homeostasis but increased ß-cell death in both sexes and decreased proliferation only in females. Male Lgr4 cko mice under stress display reduced ß-cell proliferation and a further increase in ß-cell death. Upon aging, both male and female Lgr4 cko mice display impaired ß-cell homeostasis, however, only female mice are glucose intolerant with decreased plasma insulin. We show that LGR4 is required for maintaining ß-cell health under basal and stress-induced conditions, through suppression of RANK. Teaser: LGR4 receptor is critical for maintaining ß-cell health under basal and stressed conditions, through suppression of RANK.

4.
Transpl Infect Dis ; 26(4): e14274, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38576133

RESUMO

BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are among patients with highest risk of adverse coronavirus disease 2019 (COVID-19) outcomes. OBJECTIVE: We compared clinical outcomes in post-HSCT patients with COVID-19 before and during the Omicron period. STUDY DESIGN: This was a retrospective study including patients post-HSCT with severe acute respiratory syndrome coronavirus 2 infection from April 2020 to March 2023 at Instituto Nacional de Cancerología, Mexico City. We describe their clinical characteristics and report the variables associated with severe clinical disease, hospitalization, and death. RESULTS: Fifty-three patients were included; 31 (58.5%) from the pre-Omicron period and 22 (41.5%) from the Omicron period. Median age was 42-years old (interquartile range 26-53), and 31 patients (59%) were men. Only four patients (16%) had received a vaccine prior to COVID-19 diagnosis in the pre-Omicron period versus 20 (91%) in the Omicron period (p < 0.001). COVID-19 severe cases were more common before Omicron: seven patients (23%) versus two patients (9%). Only one patient (3%) received an antiviral in the pre-Omicron period compared to 11 patients (50%) during the Omicron period (p < 0.01). COVID-19-associated mortality was almost double in the pre-Omicron period (16% vs. 9%, p = 0.6). CONCLUSIONS: This study reports patients with a high proportion of severe outcomes during the first 2 years of the pandemic. Outcomes improved during Omicron with better access to vaccines and antivirals and no in-hospital cases. Variables associated with worse outcomes were similar to other reports. Strengthening infection control measures in the hospital and better access to preventive strategies and therapeutic options are mandatory in these high-risk patients.


Assuntos
COVID-19 , Transplante de Células-Tronco Hematopoéticas , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/mortalidade , COVID-19/prevenção & controle , Masculino , México/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adulto , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Hospitalização/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Vacinas contra COVID-19/administração & dosagem
5.
J Trauma Nurs ; 31(1): 30-33, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38193489

RESUMO

BACKGROUND: A trauma registry review of our trauma center's alcohol misuse screening compliance noted inconsistent screening and data collection methods, putting our American College of Surgeons trauma center reverification at risk for a deficiency. OBJECTIVE: The objective of this study was to evaluate an alcohol misuse screening improvement initiative on screening compliance in trauma patients. METHODS: This before and after analysis of a quality improvement initiative to improve alcohol misuse screening was conducted from 2019 to 2021 at a Southwestern U.S. Level II trauma center on admitted trauma patients aged 13 years and older. The multicomponent initiative included a change in the screening instrument and timing of application, implementing electronic medical record documentation screens, and educating staff. The primary outcome measure was screening adherence. RESULTS: A total of n = 4,734 patients were included in the study period. Alcohol misuse screening improved from 2.9% to 87.4% and remained sustained for over a year after the initiative's implementation. CONCLUSION: The performance improvement initiative improved the alcohol misuse screening process, resulting in consistent screenings exceeding the American College of Surgeons standards of 80% for verified trauma centers.


Assuntos
Alcoolismo , Humanos , Alcoolismo/diagnóstico , Etanol , Documentação , Registros Eletrônicos de Saúde , Hospitalização
6.
Am J Infect Control ; 52(5): 517-524, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38103647

RESUMO

BACKGROUND: Health care workers (HCWs) are occupationally exposed to severe acute respiratory syndrome coronavirus (SARS-CoV-2). This study aimed to characterize COVID-19 in HCWs at an oncology hospital in Mexico City over 2-years, identify factors associated with severity, and establish transmission dynamics. METHODS: This retrospective study included HCWs with confirmed COVID-19. Socio-demographic, clinical, and outcome data were retrieved from March 2020 to March 2022. We compared the proportion of HCWs affected in each wave. A survey on COVID-19 transmission dynamics was conducted in a subgroup. RESULTS: We included 1,058 workers. The risk of COVID-19 was higher during the Omicron odds ratio (OR 2.10, 95% confidence interval [CI] 1.77-2.50, P < .001). Age ≥41 years old (OR 6.32, 95% CI 2.4-16.62) and being administrative staff (OR 5.51, 95% CI 1.72-17.6) or medical staff (OR 6.82, CI 95% 1.77-26.23), compared to nursing staff, were associated with severity. Vaccination with ≥1 vaccine against SARS-CoV-2 was a protective factor for severe disease (OR 0.04, 95% CI 0.005-0.331). CONCLUSIONS: This study highlights the impact of COVID-19 on HCWs in a cancer hospital in Mexico City and the impact of vaccination as a protective factor against severity.

7.
Sci Adv ; 9(44): eadf5238, 2023 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-37910614

RESUMO

Treatment for type 1 diabetes (T1D) requires stimulation of functional ß cell regeneration and survival under stress. Previously, we showed that inhibition of the RANKL/RANK [receptor activator of nuclear factor kappa Β (NF-κB) ligand] pathway, by osteoprotegerin and the anti-osteoporotic drug denosumab, induces rodent and human ß cell proliferation. We demonstrate that the RANK pathway mediates cytokine-induced rodent and human ß cell death through RANK-TRAF6 interaction and induction of NF-κB activation. Osteoprotegerin and denosumab protected ß cells against this cytotoxicity. In human immune cells, osteoprotegerin and denosumab reduce proinflammatory cytokines in activated T-cells by inhibiting RANKL-induced activation of monocytes. In vivo, osteoprotegerin reversed recent-onset T1D in nonobese diabetic/Ltj mice, reduced insulitis, improved glucose homeostasis, and increased plasma insulin, ß cell proliferation, and mass in these mice. Serum from T1D subjects induced human ß cell death and dysfunction, but not α cell death. Osteoprotegerin and denosumab reduced T1D serum-induced ß cell cytotoxicity and dysfunction. Inhibiting RANKL/RANK could have therapeutic potential.


Assuntos
Diabetes Mellitus Tipo 1 , Osteoprotegerina , Humanos , Camundongos , Animais , Osteoprotegerina/metabolismo , Citocinas , Diabetes Mellitus Tipo 1/tratamento farmacológico , Receptor Ativador de Fator Nuclear kappa-B/metabolismo , Denosumab/farmacologia , NF-kappa B/metabolismo , Roedores/metabolismo , Ligante RANK/metabolismo , Morte Celular
8.
Nutrients ; 15(18)2023 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-37764781

RESUMO

Diet-based approaches such as the Specific Carbohydrate Diet (SCD) have proposed health benefits for patients with Inflammatory Bowel Disease (IBD). Despite its potential effectiveness, patients and caregivers identified barriers towards implementing the SCD, and a majority expressed interest in formal education surrounding the SCD. This study aimed to determine the impact of a virtual teaching kitchen curriculum on caregivers' knowledge and perspectives on implementing the SCD. Inclusion criteria included pediatric patients with IBD aged 3-21 years and their caregivers. Participants should have fewer than 12 months of experience with the SCD or have no experience with the SCD but with an interest in learning it. Twenty-three caregivers took part in a 90-min virtual teaching kitchen curriculum and completed pre- and post-session surveys. Caregivers had statistically significant increases in total curriculum scores (p < 0.0001) as well as increases in all curricular elements post-curriculum teaching. Caregivers indicated that they plan to apply the newly acquired recipes and cooking concepts and appreciated the encouragement and support they received during the course. Curricular strengths identified included the innovative multimodal curriculum structure and professional and community support. IBD centers can use this pilot study to create or expand SCD and other nutritional curricula for the IBD community.


Assuntos
Cuidadores , Doenças Inflamatórias Intestinais , Humanos , Criança , Projetos Piloto , Currículo , Aprendizagem , Doenças Inflamatórias Intestinais/terapia
9.
Am J Infect Control ; 51(12): 1321-1323, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37355095

RESUMO

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe and life-threatening condition that can occur in critically ill patients. Mechanical ventilation is a commonly used intervention with ARDS patients, but weaning patients off the ventilator can be challenging. An ARDSnet-like ventilator weaning protocol was implemented with the goal of reducing triggers for ventilator-associated events (VAEs). METHODS: The implementation of the new protocol was used to complete a retrospective investigation of patient outcomes for 1,233 ventilator periods. Periods were included between April and December 2022 for any ventilated patient lasting at least 4 days. National Health Care Safety Network VAE criteria were used to surveille the patient data. Triggers were based on the positive end-expiratory pressure increases or fraction of inspired oxygen (FiO2) increases. The preset weaning criteria was a reduction by 2 cmH2O per 24 hours. RESULTS: Of the total 1,233 individual ventilator periods, VAE criteria were met in 10%. Of the total 126 periods with VAE, 39.2% met the criteria for appropriate protocol implementation. There was a statistically significant relationship between VAE identification and implementation of the protocol. CONCLUSIONS: The implementation of a protocol for ventilator weaning affects the outcome of developing a VAE. The findings emphasize the importance of implementing the ARDS weaning protocol as a template to reduce the triggers for VAEs and improve overall patient outcomes.


Assuntos
Pneumonia Associada à Ventilação Mecânica , Desmame do Respirador , Humanos , Estudos Retrospectivos , Respiração Artificial/efeitos adversos , Ventiladores Mecânicos
10.
Front Endocrinol (Lausanne) ; 13: 867001, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707461

RESUMO

Leucine-rich repeat-containing G protein-coupled receptor 4 (LGR4/GPR48), a member of the GPCR (G protein-coupled receptors) superfamily, subfamily B, is a common intestinal crypt stem cell marker. It binds R-spondins/Norrin as classical ligands and plays a crucial role in Wnt signaling potentiation. Interaction between LGR4 and R-spondins initiates many Wnt-driven developmental processes, e.g., kidney, eye, or reproductive tract formation, as well as intestinal crypt (Paneth) stem cell pool maintenance. Besides the well-described role of LGR4 in development, several novel functions of this receptor have recently been discovered. In this context, LGR4 was indicated to participate in TGFß and NFκB signaling regulation in hematopoietic precursors and intestinal cells, respectively, and found to be a new, alternative receptor for RANKL (Receptor Activator of NF kappa B Ligand) in bone cells. LGR4 inhibits the process of osteoclast differentiation, by antagonizing the interaction between RANK (Receptor Activator of NF kappa B) and its ligand-RANKL. It is also known to trigger anti-inflammatory responses in different tissues (liver, intestine, cardiac cells, and skin), serve as a sensor of the circadian clock in the liver, regulate adipogenesis and energy expenditure in adipose tissue and skeletal muscles, respectively. The extracellular domain of LGR4 (LGR4-ECD) has emerged as a potential new therapeutic for osteoporosis and cancer. LGR4 integrates different signaling pathways and regulates various cellular processes vital for maintaining whole-body homeostasis. Yet, the role of LGR4 in many cell types (e.g. pancreatic beta cells) and diseases (e.g., diabetes) remains to be elucidated. Considering the broad spectrum of LGR4 actions, this review aims to discuss both canonical and novel roles of LGR4, with emphasis on emerging research directions focused on this receptor.


Assuntos
Receptores Acoplados a Proteínas G , Via de Sinalização Wnt , Ligantes , NF-kappa B/metabolismo , Receptor Ativador de Fator Nuclear kappa-B , Receptores Acoplados a Proteínas G/metabolismo , Células-Tronco/metabolismo
11.
JPGN Rep ; 3(3): e222, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37168623

RESUMO

The specific carbohydrate diet (SCD) has potential health benefits for inflammatory bowel disease (IBD); however, adherence is challenging. Through an online needs assessment survey, this study explored the perspectives of patients and caregivers using the SCD to manage IBD to determine barriers, knowledge gaps, and desired areas for further learning about the SCD. Inclusion criteria included patients with IBD or their caregivers who had experience with the SCD. Of the 208 participants, 87% of participants were female with a mean age of 46 years. Fifty-seven percent had never received SCD training before starting the diet. Participants favored more education on several topics within the SCD and identified one-on-one sessions as the preferred learning modality. Barriers identified were initial steep learning curve, time commitment, and a desire for more support from healthcare professionals. This needs assessment survey highlights the gaps in educational priorities for patients on the SCD.

12.
Acta Crystallogr F Struct Biol Commun ; 77(Pt 9): 275-285, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34473104

RESUMO

Bacterial microcompartments are large supramolecular structures comprising an outer proteinaceous shell that encapsulates various enzymes in order to optimize metabolic processes. The outer shells of bacterial microcompartments are made of several thousand protein subunits, generally forming hexameric building blocks based on the canonical bacterial microcompartment (BMC) domain. Among the diverse metabolic types of bacterial microcompartments, the structures of those that use glycyl radical enzymes to metabolize choline have not been adequately characterized. Here, six structures of hexameric shell proteins from type I and type II choline-utilization microcompartments are reported. Sequence and structure analysis reveals electrostatic surface properties that are shared between the four types of shell proteins described here.


Assuntos
Proteínas de Bactérias/química , Proteínas de Bactérias/metabolismo , Colina/metabolismo , Escherichia coli/metabolismo , Organelas/metabolismo , Streptococcus intermedius/metabolismo , Sequência de Aminoácidos , Cristalografia por Raios X , Conformação Proteica , Homologia de Sequência
13.
MedEdPORTAL ; 17: 11166, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34277932

RESUMO

Introduction: Imposter syndrome (IS) is a feeling of being an intellectual fraud and is common among health professionals, particularly those underrepresented in medicine. IS is accompanied by burnout, self-doubt, and beliefs of decreased success. This workshop aims to discuss the impact of IS and develop strategies to confront IS at the individual, peer, and institutional levels. Methods: During the 75-minute interactive workshop, participants listened to didactics and engaged in individual reflection, small-group case discussion, and large-group instruction. Workshop participants and facilitators included medical students, residents, fellows, faculty, staff, and program leadership. Anonymous postworkshop evaluations exploring participants' satisfaction and intentions to change their behavior were collected. Descriptive statistics were used to analyze the quantitative data, and content analysis was used to analyze participants' intentions to change their behavior. Results: The workshop was presented at three local academic conferences and accepted at one national conference. Data were collected from 92 participants. Ninety-two percent of participants felt the workshop met its objectives, and 90% felt the workshop was a valuable use of their time. Furthermore, 90% of participants stated they would apply information learned at the workshop in the future. The participants indicated an intent to change behavior on individual, peer, and institutional levels, while recognizing that barriers exist at all those levels. Discussion: This workshop proved to be an effective means to discuss strategies on how to address IS at the individual, peer, and institutional levels. The materials can be adapted for relevance to various audiences.


Assuntos
Esgotamento Profissional , Estudantes de Medicina , Pessoal de Saúde , Humanos , Liderança , Aprendizagem
14.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(2): 56-63, ago. 2019. tab, ilus
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-1008419

RESUMO

Los adultos jóvenes constituyen gran parte de la población paraguaya y se considera que los conocimientos y prácticas sobre salud bucodental están muy relacionados al nivel de instrucción, el objetivo de este estudio fue evaluar el nivel de conocimientos y prácticas sobre salud bucodental de estudiantes de posgrado de la Carrera de Enfermería de la Facultad de Ciencias de la Salud de la Universidad Católica de Asunción (CE FCSUCA), en el 2018. Estudio observacional descriptivo de corte transversal con componente analítico en el que se incluyeron a todos los estudiantes de posgrado entre mayo y junio de 2018. La recolección de datos se realizó mediante un cuestionario sobre salud bucodental autoadministrado y de carácter anónimo. Los datos se asentaron en una planilla electrónica, y fueron analizados utilizando el Programa estadístico IBMSSPS 23.0. La muestra estuvo constituida por 166 estudiantes, en su mayoría del sexo femenino (75,3%), de entre 20 y 29 años (54,8%), cursando algún programa de especialización (57,8% y pertenecientes al área de la salud (94%). El 57,83% y el 55,42% de los estudiantes presentaron conocimientos y prácticas de salud bucodental de nivel regular, respectivamente. Se encontró asociación entre nivel de conocimiento y de práctica y entre el nivel de conocimiento y la edad. Se concluye que los niveles de conocimientos y prácticas sobre salud bucodental en los estudiantes de posgrado fueron deficientes por lo que se propone la implementación de estrategias educativas de concienciación en el área(AU)


Young adults constitute a large part of the Paraguayan population and considering that oral health knowledge and practices are closely related to the level of education, the objective of this study was to evaluate the level of knowledge and practices on oral health of postgraduate students of the Nursing Career of the Faculty of Health Sciences of the Catholic University of Asunción (CE FCSUCA), in 2018. The design was descriptive, cross-sectional with an analytical component in which all postgraduate students were included in May and June 2018. Data collection was carried out through a questionnaire on oral health self-administered and anonymous. The data were recorded in an electronic spreadsheet and analyzed using the IBMSSPS 23.0 Statistical Program. The sample consisted of 166 students, mostly female (75.3%), between 20 and 29 years old (54.8%), studying some specialization program (57.8%) and belonging to the area of Health (94%). 57.83% and 55.42% of the students presented knowledge and practices of oral health at the regular level, respectively. An association was found between the level of knowledge and practice and between the level of knowledge. It is concluded that the levels of knowledge and practices on oral health in the postgraduate students were insufficient, so the implementation of educational awareness strategies in the area is proposed(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Saúde Bucal/educação , Paraguai , Periodontite/etiologia , Estudos Transversais , Cárie Dentária/etiologia , Educação de Pós-Graduação em Enfermagem , Gengivite/etiologia
15.
Artigo em Espanhol | LILACS | ID: biblio-1005151

RESUMO

El carcinoma hepatocelular fibrolamelar (CHC-FL) es una variante poco frecuente de CHC convencional, representa el 0,85 al 16% de todos los carcinomas hepatocelulares. Se presenta en personas jóvenes, sin antecedente de enfermedad hepática crónica subyacente, alrededor del 65-85% de estos tumores ocurren en pacientes menores de 40 años. Para su diagnóstico, las modalidades de imagen cumplen un papel importante tanto el ultrasonido, tomografía y resonancia magnética principalmente ésta última podría aportar sustancialmente al diagnóstico. Se presenta el caso de un joven de 16 años con diagnóstico histopatológico de hepatocarcinoma fibrolamelar y su correlación con las diferentes modalidades de imagen, el cual fue sometido a trasplante hepático, se realiza la revisión del mismo dada la importancia del diagnóstico por imagen y las alternativas terapéuticas en estos casos.


Fibrolamellar hepatocellular carcinoma (CHC-FL) is a rare variant of conventional HCC, representing 0.85 to 16% of all hepatocellular carcinomas. It occurs in young people, without a history of underlying chronic liver disease, about 65-85% of these tumors occur in patients under 40 years. For its diagnosis, imaging modalities play an important role, both ultrasound, tomography and magnetic resonance, mainly the latter could contribute substantially to the diagnosis. We present the case of a 16-year-old boy with a histopathological diagnosis of fibrolamellar hepatocellular carcinoma and its correlation with the different imaging modalities, which underwent hepatic transplantation. He was reviewed, given the importance of imaging diagnosis and alternatives. therapeutic in these cases.


Assuntos
Humanos , Masculino , Adolescente , Carcinoma Hepatocelular , Fígado , Neoplasias , Diagnóstico por Imagem , Transplante de Fígado
16.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 16(1): 84-93, abr. 2018. tab
Artigo em Espanhol | LILACS, BDNPAR | ID: biblio-997919

RESUMO

El empoderamiento es el proceso por el cual las personas fortalecen sus capacidades, confianza, visión y protagonismo para impulsar cambios positivos de las situaciones que viven, por lo que es un desafío para los profesionales de enfermería en todos los niveles de asistencia. El objetivo de esta investigación es realizar un análisis del empoderamiento de los enfermeros asistenciales de cuidados intensivos de adultos en el Hospital Central del Instituto de Previsión Social en la ciudad de Asunción, Paraguay. Se realizó un estudio cualitativo con enfoque fenomenológico. Los datos se recolectaron a través de entrevistas semi estructuradas grabadas cuyas preguntas se fundamentaron en seis categorías de estudio: sentido de pertenencia, autonomía, liderazgo, trabajo en equipo, participación en asociaciones y percepción de empoderamiento. La muestra se determinó por conveniencia y saturación alcanzando a 17 sujetos. Las respuestas de los participantes se agruparon en ideas comunes para deducir los resultados. En el análisis se tuvo en cuenta las propuestas de Zimmerman y Benner en materia de empoderamiento y desarrollo profesional de enfermería respectivamente. En el grupo estudiado se distinguen atributos como autonomía y trabajo en equipo que favorecen el empoderamiento individual. Sin embargo, estas cualidades contrastan con un débil sentido de pertenencia, una práctica relativa del liderazgo y escasa participación en asociaciones. En consecuencia, el empoderamiento de enfermería en las unidades de cuidados intensivos estudiadas es un proceso incipiente que requiere intervenciones efectivas para consolidarse y fortalecer la identidad profesional(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Poder Psicológico , Unidades de Terapia Intensiva , Enfermeiras e Enfermeiros/psicologia , Paraguai , Autonomia Profissional , Liderança
17.
Nutr Metab (Lond) ; 14: 36, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28529534

RESUMO

BACKGROUND: Inflammation is associated with increased bone resorption; the role of inflammation in postprandial bone turnover has not been explored. Consumption of milk fat globule membrane (MFGM) reduces inflammation in animal models. This study aimed to measure postprandial changes in bone turnover after intake of high saturated fat test meals, with- and without the anti-inflammatory ingredient MFGM. METHODS: Subjects (n = 36 adults) were obese (BMI 30-39.9 kg/m2) or overweight (BMI 25-29.9 kg/m2) with two traits of Metabolic Syndrome. Subjects consumed a different test meal on four occasions at random; blood draws were taken at baseline and 1, 3, and 6 h postprandial. Test meals included whipping cream (WC), WC + MFGM, palm oil (PO) and PO + MFGM. Biomarkers of bone turnover and inflammation were analyzed from all four time points. RESULTS: Test meal (treatment) by time interactions were significant for bone resorption marker C-telopeptide of type 1 collagen (CTX) (p < 0.0001) and inflammatory marker interleukin 10 (IL-10) (p = 0.012). Significant differences in overall postprandial response among test meals were found for CTX and soluble intercellular adhesion molecule (sICAM), with the greatest overall postprandial suppression of CTX occurring in meals containing MFGM. However, test meal by MFGM interactions were non- significant for bone and inflammatory markers. Correlations between CTX and inflammatory markers were non-significant. CONCLUSION: This exploratory analysis advances the study of postprandial suppression of bone turnover by demonstrating differing effects of high SFA meals that contained MFGM; however MFGM alone did not directly moderate the difference in postprandial CTX response among test meals in this analysis. These observations may be useful for identifying foods and ingredients which maximize the suppression of bone resorption, and for generating hypotheses to test in future studies examining the role of inflammation in postprandial bone turnover. TRIAL REGISTRATION: Clinicaltrials.gov NCT01811329. Registered 11 March 2013.

18.
J Nutr Sci ; 5: e14, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27313850

RESUMO

Meals high in SFA, particularly palmitate, are associated with postprandial inflammation and insulin resistance. Milk fat globule membrane (MFGM) has anti-inflammatory properties that may attenuate the negative effects of SFA-rich meals. Our objective was to examine the postprandial metabolic and inflammatory response to a high-fat meal composed of palm oil (PO) compared with PO with an added dairy fraction rich in MFGM (PO+MFGM) in overweight and obese men and women (n 36) in a randomised, double-blinded, cross-over trial. Participants consumed two isoenergetic high-fat meals composed of a smoothie enriched with PO with v. without a cream-derived complex milk lipid fraction ( dairy fraction rich in MFGM) separated by a washout of 1-2 weeks. Serum cytokines, adhesion molecules, cortisol and markers of inflammation were measured at fasting, and at 1, 3 and 6 h postprandially. Glucose, insulin and lipid profiles were analysed in plasma. Consumption of the PO + MFGM v. PO meal resulted in lower total cholesterol (P = 0·021), LDL-cholesterol (P = 0·046), soluble intracellular adhesion molecule (P = 0·005) and insulin (P = 0·005) incremental AUC, and increased IL-10 (P = 0·013). Individuals with high baseline C-reactive protein (CRP) concentrations (≥3 mg/l, n 17) had higher (P = 0·030) insulin at 1 h after the PO meal than individuals with CRP concentrations <3 mg/l (n 19). The addition of MFGM attenuated this difference between CRP groups. The addition of a dairy fraction rich in MFGM attenuated the negative effects of a high-SFA meal by reducing postprandial cholesterol, inflammatory markers and insulin response in overweight and obese individuals, particularly in those with elevated CRP.

19.
J Nutr Sci ; 5: e9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27313852

RESUMO

Dietary recommendations suggest decreased consumption of SFA to minimise CVD risk; however, not all foods rich in SFA are equivalent. To evaluate the effects of SFA in a dairy food matrix, as Cheddar cheese, v. SFA from a vegan-alternative test meal on postprandial inflammatory markers, a randomised controlled cross-over trial was conducted in twenty overweight or obese adults with metabolic abnormalities. Individuals consumed two isoenergetic high-fat mixed meals separated by a 1- to 2-week washout period. Serum was collected at baseline, and at 1, 3 and 6 h postprandially and analysed for inflammatory markers (IL-6, IL-8, IL-10, IL-17, IL-18, TNFα, monocyte chemotactic protein-1 (MCP-1)), acute-phase proteins C-reactive protein (CRP) and serum amyloid-A (SAA), cellular adhesion molecules and blood lipids, glucose and insulin. Following both high-fat test meals, postprandial TAG concentrations rose steadily (P < 0·05) without a decrease by 6 h. The incremental AUC (iAUC) for CRP was significantly lower (P < 0·05) in response to the cheese compared with the vegan-alternative test meal. A treatment effect was not observed for any other inflammatory markers; however, for both test meals, multiple markers significantly changed from baseline over the 6 h postprandial period (IL-6, IL-8, IL-18, TNFα, MCP-1, SAA). Saturated fat in the form of a cheese matrix reduced the iAUC for CRP compared with a vegan-alternative test meal during the postprandial 6 h period. The study is registered at clinicaltrials.gov under NCT01803633.

20.
Rev Chilena Infectol ; 31(3): 298-304, 2014 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-25146204

RESUMO

INTRODUCTION: Norovirus (NoV) are RNA viruses highly contagious, stable in the environment, genetically variable, and the most common cause of viral sporadic acute gastroenteritis worldwide. This is the first study carried out in Concepcion, Chile, to investigate the presence of NoV as an etiologic agent of viral diarrheas in hospitalized children. Objective. To detect the presence and genogroup of NoV in children with diarrhea and to compare it with rotavirus (RV) and adenovirus (AdV). MATERIAL AND METHODS: A one year descriptive, prospective study in children 0-14 years old. A single diarrheic stool sample per patient was analyzed for the presence of NoV, RV and AdV. Clinical data were unknown at the moment of sampling. Real time RT-PCR with Taqman™ probes for NoV and the immunocromatography VIKIA™ kit for RoV /AV detection were used. RESULTS: Infection for NoV (25.5%) was significantly higher than for RV (15.9%) and AdV (6.2%). It was even greater in infants younger than 2yr. old (n: 103): NoV 34%, RV 17.5%, AdV 7.8%. Children 2-4 yr. old had 11.8% infection of NoV and RV. Children older than 4, only had 12% RV and 4% AdV. Children hospitalized for diarrhea (n: 92) had: 21.7% of both NoV and RV, and 7.6% AdV; whereas children hospitalized for other causes (n: 53) had 32.1% NoV,5.7% RV and 3.8% AV. The proportion of infection due to NoV was significantly higher in males (31.5%) than in females (19.4%). The average frequency during the year was higher for NoV (30.3%) than for RV (14.7%) except in summer. CONCLUSION: The presence of NoV was higher than RV in children with diarrhea. NoV infection showed defined characteristics regarding age, gender, seasonal occurrence and nosocomial transmission that are important epidemiological features.


Assuntos
Adenoviridae/isolamento & purificação , Fezes/virologia , Gastroenterite/virologia , Norovirus/isolamento & purificação , Rotavirus/isolamento & purificação , Adenoviridae/genética , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Chile/epidemiologia , Infecções Comunitárias Adquiridas/virologia , Infecção Hospitalar/virologia , Diarreia/virologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Norovirus/genética , Estudos Prospectivos , RNA Viral/sangue , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rotavirus/genética
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