RESUMO
BACKGROUND: Hand/forearm/arm transplants are vascularized composite allografts, which, unlike solid organs, are composed of multiple tissues including skin, muscle, tendons, vessels, nerves, lymph nodes, bone, and bone marrow. Over the past decade, 26 upper extremity transplantations were performed in the United States. The University of Pittsburgh Medical Center has the largest single center experience with 8 hand/forearm transplantations performed in 5 recipients between January 2008 and September 2010. Anesthetic management in the emerging field of upper extremity transplants must address protocol and procedure-specific considerations related to the role of regional blocks, effects of immunosuppressive drugs during transplant surgery, fluid and hemodynamic management in the microsurgical setting, and rigorous intraoperative monitoring during these often protracted procedures. METHODS: For the first time, we outline salient aspects of upper extremity transplant anesthesia based on our experience with 5 patients. We highlight the importance of minimizing intraoperative vasopressors and improving fluid management and blood product use. RESULTS: Our approach reduced the incidence of perioperative bleeding requiring re-exploration or hemostasis and shortened in-hospital and intensive care unit stay. Functional, immunologic and graft survival outcomes have been highly encouraging in all patients. CONCLUSIONS: Further experience is required for validation or standardization of specific anesthetic protocols. Meanwhile, our recommendations are intended as pertinent guidelines for centers performing these novel procedures.
Assuntos
Anestesia/métodos , Braço/transplante , Transplante de Mão , Adulto , Feminino , Hidratação , Antebraço , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Cuidados Pré-Operatórios , Doadores de TecidosRESUMO
Mycobacterium avium subsp. paratuberculosis (MAP) is the etiological agent of Paratuberculosis, a contagious, untreatable, and chronic granulomatous enteritis that results in diarrhea, emaciation, and death in farmed ruminants (i.e., cattle, sheep, and goats). In this study, the Ag85B antigen from MAP was expressed in transgenic alfalfa as an attractive vaccine candidate. Agrobacterium-mediated transformation allowed the rescue of 56 putative transformed plants and transgenesis was confirmed in 19 lines by detection of the Ag85B gene (MAP1609c) by PCR. Line number 20 showed the highest Ag85B expression [840 ng Ag85B per gram of dry weight leaf tissue, 0.062% Total Soluble Protein (TSP)]. Antigenicity of the plant-made Ag85B was evidenced by its reactivity with a panel of sera from naturally MAP-infected animals, whereas immunogenicity was assessed in mice immunized by either oral or subcutaneous routes. The plant-made Ag85B antigen elicited humoral responses by the oral route when co-administered with cholera toxin as adjuvant; significant levels of anti-85B antibodies were induced in serum (IgG) and feces (IgA). Long-lasting immunity was evidenced at day 180 days post-first oral immunization. The obtained alfalfa lines expressing Ag85B constitute the first model of a plant-based vaccine targeting MAP. The initial immunogenicity assessment conducted in this study opens the path for a detailed characterization of the properties of this vaccine candidate.
Assuntos
Antígenos de Bactérias/imunologia , Imunidade , Medicago sativa/metabolismo , Mycobacterium avium subsp. paratuberculosis/imunologia , Adjuvantes Imunológicos/farmacologia , Administração Oral , Animais , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Antígenos de Bactérias/sangue , Imunização , Medicago sativa/genética , Camundongos Endogâmicos BALB C , Plantas Geneticamente ModificadasRESUMO
The aim of this study was to evaluate 1-year follow-up results in an all "comers" population treated with a new cobalt chromium bare-metal stent (BMS) design. Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive patients undergoing coronary stent implantation in 11 centers in Argentina were prospectively included in our registry. The inclusion criteria were multiple-vessel disease and/or unprotected left main disease, acute coronary syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major epicardial vessel. In-stent restenosis, protected left main stenosis, or impossibility to receive dual-antiplatelet therapy was an exclusion criterion. Major adverse cardiac events (MACE) were the primary endpoint and included cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR); also, all components of the primary endpoint were separately analyzed. Completeness of revascularization was analyzed as post hoc data using residual SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel disease, 67% have ACS, and 32% have ST elevation MI. At a mean of 376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients: death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with 98% of event-free survival (P < .04). In conclusion, this prospective, multicenter, and observational all-comers registry with this novel BMS design showed a low incidence of adverse events at 1 year mainly due to coronary restenosis.
Assuntos
Doença de Chagas/prevenção & controle , Obtenção de Fundos/organização & administração , Cooperação Internacional , Programas Médicos Regionais/organização & administração , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Congressos como Assunto , Comportamento Cooperativo , Humanos , América Latina/epidemiologiaRESUMO
BACKGROUND: Renal artery stenosis (RAS) is a potentially reversible cause of hypertension and renal insufficiency and is associated with poor prognosis. METHODS: We aimed to identify simple predictors of significant RAS among patients undergoing coronary angiography. Prospective data were collected on 843 consecutive patients who underwent cardiac catheterization and abdominal aortography. Stenoses > or = 75% were considered significant. Multivariable logistic regression was used to assess the relationship between baseline characteristics and coronary anatomy with significant RAS. A simple risk score was derived from the model. RESULTS: The prevalence of RAS > or = 75% was 11.7%. Independent predictors of significant RAS were older age, higher creatinine levels, peripheral vascular disease, number of cardiovascular drugs, hypertension, female sex, and 3-vessel coronary artery disease or previous coronary artery bypass graft. The concordance index of the model was 0.802. These variables were used to develop a simple predictive score of significant RAS for patients undergoing cardiac catheterization. The prevalence of RAS increased stepwise with increasing score values: 0.6% for a score < or = 5, 1.5% for 6 to 7, 6.1% for 8 to 9, 12.2% for 10 to 11, 18.7% for 12 to 14, 35.7% for 15 to 17, and 62.1% for > or = 18 (P < .001). Approximately one third of the patients had a score > or = 11, which yielded a sensitivity of 76% and a specificity of 71%. CONCLUSIONS: Renal artery stenosis is a relatively common finding among patients referred for coronary angiography. A simple score can predict the presence of significant RAS among patients referred for cardiac catheterization.
Assuntos
Cateterismo Cardíaco , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Adulto , Idoso , Argentina/epidemiologia , Pressão Sanguínea , Colesterol/sangue , Angiografia Coronária , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doenças Vasculares Periféricas/epidemiologia , Análise de RegressãoRESUMO
Objetivo: determinar la relación entre el clima organizacional y la percepción de la calidad de los servicios de salud en una institución de salud de la ciudad de Manizales periodo 2018 2019. Materiales y métodos: es un estudio de tipo cuantitativo, analítico transversal que mide la relación entre el clima organizacional y la percepción de calidad mediante dos instrumentos: uno es la evaluación de 4 áreas críticas para describir la primera, y otro, el estudio de la calidad del servicio percibida por los clientes, en donde se consideraron 5 variables. La población estudiada referente al clima organizacional comprendió 183 personas del área asistencial y 99 del área administrativa de la clínica, y la población referida a la percepción de la calidad incluyó 382 clientes. Resultados: los resultados exponen un clima organizacional satisfactorio para el personal administrativo, frente a una percepción medianamente satisfactoria para el personal asistencial. La percepción externa de la calidad arroja una puntuación promedio entre expectativas y percepción de 6,7%, encontrándose dentro de los criterios de satisfacción. Conclusión: Se concluye que, aunque se cuente con resultados satisfactorios en el clima organizacional, la calidad de la atención en salud precisa mejorar en todas sus dimensiones. Se requiere tomar medidas para que los usuarios perciban mejor la calidad en la atención de la clínica. No necesariamente el tener un clima organizacional satisfactorio garantiza que los usuarios lo perciban igual en la atención en salud en la entidad estudiada..Au
Objective: Objective: to determine the relationship between the organizational climate and the perception of the quality of health services in a health institution in the city of Manizales for the period 2018 - 2019. Materials and methods: it is a quantitative, analytical - transversal study that measures the relationship between the organizational climate and the perception of quality through two instruments: one is the evaluation of 4 critical areas to describe the first, and another, the study of the quality of service perceived by clients, where 5 variables were considered. The population studied for the organizational climate was 183 people from the healthcare area and 99 from the clinic's administrative area and the population concerned with quality perception was 382 clients. Results: The results show a satisfactory organizational climate for the administrative staff, as opposed to a moderately satisfactory perception for the care staff. The external perception of quality yields an average score between expectations and perception of 6.7%, being within the criteria of satisfaction. Conclusion: It is concluded that, even with satisfactory results in the organizational climate, the quality of health care needs to be improved in all its dimensions. It is critical that relevant measures be taken to help users increase their perception of the quality of care to the clinic. Not necessarily, having a satisfactory organizational climate means that users perceive satisfaction in the levels of quality of health care in the entity studied..Au
Assuntos
Qualidade da Assistência à Saúde , OrganizaçõesRESUMO
Resumen Ante la era digital, la humanidad se enfrenta a nuevas coyunturas en los ámbitos sociales y psicológicos. La aparición de fenómenos como la adicción a internet, la depresión asociada al uso excesivo de los dispositivos y la pérdida de espacios reales en pro de una virtualidad cada vez mayor, además del desgaste de los recursos naturales, prende las alarmas sobre la salud y el tipo de vida que se lleva en las sociedades. La vida rápida e inmediata parece colocar a las personas en nuevos espacios cu- yos impactos aún salen del conocimiento de las ciencias sociales. La Psicología humanista apareció oficialmente en 1961 y puede brindarnos una mirada más humana. El retorno a las experiencias humanas, a las emociones, al valor del individuo y a los sentimientos de autorrealización pueden cimentar las bases de un nuevo pensamiento que ponga luz sobre las problemáticas actuales. Por eso, el objetivo de este trabajo fue el de señalar algunos problemas que llegaron con la era digital, para después dirigir sobre ellos la mirada que brinda la Psicología humanista con el fin de revitalizar los esfuerzos en pro de una vida más saludable tanto entre los individuos como con el ambiente.
Abstract: Faced with the Digital Age, humanity confronts new junctures in the social and psychological spheres. The appea- rance of phenomena such as Internet addiction, depression associated with excessive device usage and the loss of real spaces in favor of an increasing virtuality, in addition to natural resource depletion, set off alarms about health and the type of life that is carried out in societies. Fast and immediate life seems to place people in new spaces whose impacts still come out of the knowledge of the social sciences. It is here that Humanist Psychology, officia- lly appearing in 1961, can give us a more humane look. The return to human experiences, emotions, the value of the individual and feelings of self-realization can lay the foundations of a new thought that sheds light on current problems. That is why the goal of this work was to point out some problems that arose with the digital era, and then cast on them the perspective offered by Humanist Psychology in order to revitalize efforts towards a healthier life both among individuals, as well as in the environment.
Assuntos
Psicologia Social , Acesso à Internet , Rede Social , Exclusão DigitalRESUMO
La salud de los trabajadores se encuentra en pleno siglo XXI realmente en peligro. Al cansancio de horas y horas laborales, se deben sumar las que utilizan en los viajes de ida y regreso a sus respectivos trabajos. En las grandes urbes, sea Santiago de Chile o Ciudad de México, existen trabajadores y trabajadoras que para llegar a laborar a las nueve de la mañana, deben abandonar sus hogares a las cuatro o cinco de la madrugada. Darse una vuelta por las periferias de las ciudades es un buen ejercicio para ver personas en plena oscuridad movilizarse para llegar a sus puestos de trabajo. La vuelta al hogar es la misma situación: personas que llegan de noche o madrugada y deben seguir su labor con los hijos o alienarse en la televisión o los mass media. La calidad de vida en la era cibernética y la interconexión está cada día más interconectada(AU)
The health of workers is in the 21st century really in danger. When tired of working hours and hours, those used in round trips to their respective jobs must be added. In large cities, be it Santiago de Chile or Mexico City, there are workers who, in order to get to work at nine in the morning, must leave their homes at four or five in the morning. Walking around the peripheries of cities is a good exercise to see people in the dark move to get to their jobs. The return home is the same situation: people who arrive at night or early in the morning and must continue their work with their children or alienate on television or the mass media. The quality of life in the cyber age and interconnection is increasingly interconnected(AU)
Assuntos
Humanos , Qualidade de Vida , Condições Sociais , Integralidade em SaúdeRESUMO
Abstract Hyponatremia is one of the adverse effects in patients treated with oxcarbazepine. This can be seen masked by multiple symptoms which are simply attributable to other diseases, but we must always keep it in mind in a patient with a history of taking that medication. Many of patients are asymptomatic; Doses lower than 120 mmol/L show symptoms of severity which presented a patient with multiple sclerosis, which we will show below, so that diagnostic ability of clinicians plays a fundamental role. This is why the case is exposed in which a woman treated with oxcarbazepine for one of the clinical forms of multiple sclerosis, arrives at emergency departament with manifestations of this electrolytic disorder. For this reason, the clinical case served by the authors is chosen directly. It is concluded that this adverse reaction is not uncommon and that it must be taken into account in the differential diagnosis.
Resumen La hiponatremia es uno de los efectos adversos en los pacientes tratados con oxcarbazepina. Se puede ver enmascarada por múltiples síntomas, atribuibles a otras enfermedades, pero siempre debemos tenerla en mente en un paciente con antecedente de ingesta de dicho medicamento. Muchos de los pacientes son asintomáticos; cifras inferiores a 120 mmol/L ponen de manifiesto síntomas de severidad, como los presentados en el paciente con esclerosis múltiple que mostraremos a continuación. La habilidad diagnóstica del clínico, por tanto, juega un rol fundamental. Debido a esto, se expone un caso en el que una mujer tratada con oxcarbacepina, para una de las formas clínicas de esclerosis múltiple, llega a urgencias con manifestaciones de este trastorno electrolítico. Por esto se escoge el caso clínico atendido por los autores directamente. Se concluye que no es infrecuente esta reacción adversa y que hay que tenerla en cuenta a la hora de los diagnósticos diferenciales.
Assuntos
Humanos , Masculino , Feminino , Oxcarbazepina , Hiponatremia , Esclerose Múltipla , Parestesia , Carbamazepina , ColômbiaRESUMO
Resumen La porfiria intermitente aguda (PIA) es una enfermedad poco frecuente, considerada huérfana, que se caracteriza por crisis neuroviscerales, el dolor abdominal siendo su síntoma más común, acompañado en muchos casos, de síntomas inespecíficos, haciendo difícil su diagnóstico temprano. El retraso en el diagnóstico y tratamiento de esta entidad puede resultar catastrófico o incluso fatal, provocando daño neurológico a largo plazo o permanente. Reportamos el caso de un adulto joven que consulta en varias ocasiones por dolor abdominal inespecífico y 24 horas después de la admisión desarrolla inestabilidad autonómica simpática con cifras tensionales elevadas y taquicardia. Posteriormente debilidad muscular que evoluciona hasta cuadriplejia e hiponatremia con criterios para secreción inadecuada de hormona antidiurética (SIADH). Estos datos, junto con coloración rojiza en orina, llevan al diagnóstico de porfiria. Presentamos las características clínicas y bioquímicas enfatizando la importancia de incluir la porfiria dentro de los diagnósticos diferenciales de dolor abdominal y disautonomia de causa indeterminada. (Acta Med Colomb 2017; 42: 140-143).
Abstract Acute intermittent porphyria (AIP) is an infrequent and considered orphan disease, characterized by neurovisceral crisis, being abdominal pain the most common symptom, accompanied in many cases by non-specific symptoms, making early diagnosis difficult. The delay in the diagnosis and treatment of this entity can be catastrophic or even fatal, causing long-term or permanent neurological damage. The case of a young adult who attends medical consultation several times for non-specific abdominal pain and 24 hours after admission develops sympathetic autonomic instability with elevated blood pressure and tachycardia is presented. He subsequently presents muscular weakness that evolves to quadriplegia and hyponatremia with criteria for inadequate secretion of antidiuretic hormone (SIADH). These data together with reddish urine staining lead to the diagnosis of porphyria. The clinical and biochemical characteristics emphasizing the importance of including porphyria within the differential diagnoses of abdominal pain and dysautonomia of indeterminate cause are presented. (Acta Med Colomb 2017; 42: 140-143).
Assuntos
Humanos , Masculino , Adulto , Porfirias , Quadriplegia , Porfiria Aguda Intermitente , Disautonomias Primárias , Síndrome de Secreção Inadequada de HADRESUMO
Describir los factores de riesgo cardiovascular modificable y la capacidad de agencia de autocuidado que presentaban los funcionarios de una institución universitaria de Manizales. Materiales y métodos: estudio cuantitativo, de corte transversal con una muestra no probabilística de 51 funcionarios universitarios ingresados a un programa de acondicionamiento físico que presentaban dos o más factores de riesgo cardiovascular modificable. Se identificaron los factores de riesgo cardiovascular por medio de valoración clínica, toma de medidas antropométricas y datos del perfil lipídico. Para la medición del nivel de agencia de autocuidado, se aplicó la escala de Valoración de Agencia de Autocuidado versión Colombiana. Resultados: se encontraron el sedentarismo (92,1%), la obesidad abdominal (92,1%) y las dislipidemias(74,5%) como los factores de riesgo cardiovascular más prevalentes. En cuanto a la agencia de autocuidado se encontró que la mayoría de los individuos percibe tener una alta capacidad para cuidarse. En el análisis multivariado, se observa que hay una mayor discriminación de la agencia de autocuidado alta, con las variables del riesgo relacionadas con el sedentarismo, la obesidad abdominal y la obesidad clase I. Conclusión: a pesar de que los funcionarios presentan factores de riesgo cardiovascular no controlados, perciben tener una alta capacidad de autocuidado y desconocimientode la presencia y de la forma en que podrían controlar de sus factores de riesgo; estefenómeno invita a que enfermería contribuya desde el proceso del cuidado con intervenciones que garanticen la autogestión de la salud en compañía de otras disciplinas, con el fin de lograr un verdadero cambio en los estilos de vida...
Assuntos
Humanos , Doenças Cardiovasculares , Fatores de Risco , AutocuidadoRESUMO
Collagen-based biomaterials have been widely used due to its binding capabilities. However the properties and potential use of new collagen sources are still under investigation. Fish by-products are an excellent source of collagen. Thus, acid-soluble collagen (ASC) was extracted, and biochemical and physicochemically characterized from one under-utilized specie, jumbo squid (Dosidicus gigas). In addition, commercial chitosan (95-50%)-ASC (5-50%) blend films were successfully prepared by casting, and characterized by infrared spectroscopy (FT-IR) and differential scanning calorimetry (DSC). The molecular masses of the ASC subunits were about 190kDa, 110kDa, and 97kDa, the content of proline and hydroxyproline was 10.9% and 2.8%, respectively. The FT-IR and nuclear magnetic resonance spectra ((1)H NMR) confirmed collagen peptidic crosslinks, and one endothermic peak was found at 119 degrees C. The FT-IR spectrum showed that chitosan and ASC remain linked into the films mainly due to hydrogen bonding. The 85:15 (chitosan:ASC) ratio was selected for its thermal and mechanical analyses. The thermograms of this film indicated the presence of two peaks, one at 87-98 degrees C and the other at 142-182 degrees C. The chitosan:ASC blend produced a transparent and brittle film, with high percentage of elongation at break, and low tensile strength in comparison to chitosan films. D. gigas mantle might be useful as a new source of plasticizer agent in the preparation of biofilms in composites with chitosan.
Assuntos
Quitosana/metabolismo , Colágeno/metabolismo , Animais , Biofilmes , Varredura Diferencial de Calorimetria , Decapodiformes , Espectroscopia de Ressonância Magnética , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
Caso de mujer de 44 años sin antecedentes de enfermedad previa con sospecha de malformación arteriovenosa(MAV) relacionada con síndrome de Foix-Alajouanine; y como la fisiopatología de la enfermedad está ocasionadapor la conformación anómala de una fistula arteriovenosa, que se hace sintomática ante la aparición deun fenómeno trombótico y el aumento de la presión venosa subsecuente. Los síntomas comúnmente descritoscomo alteraciones somatosensoriales, debilidad de los miembros inferiores.El diagnóstico definitivo dela MAV requiere de demostración radiológica de la anomalía vascular medular. Sinembargo, en algunos casos los defectos sugestivos de la malformación podrían no ser vistos con las imágenesdiagnósticas con las que se cuenta o incluso macroscópicamente, por tal motivo se debe se debe fomentar laatención en la sospecha clínica en casos de dolor lumbar y abdominal en asociación a síntomas neurológicos...
Assuntos
Humanos , Neurologia , Paralisia , Doenças da Medula EspinalRESUMO
Se ilustra el caso de una paciente con episodios convulsivos, movimientos anormales y déficit cognitivo de varios meses de evolución. En la tomografía axial computarizada se evidenciaron lesiones ganglio basales, paraventriculares, sustancia blanca y cerebelo; clínicamente presentó síntomas típicos de la enfermedad de Fahr y con estudios de laboratorio complementarios se descartaron otras causas.
This is the case of an patient with convulsive episodes, abnormal movements and cognitive deficit of several months of evolution. The axial computed tomography demonstrated injuries ganglion basal, paraventriculares,white substance and cerebellum; presenting clinical symptoms of Fahrs disease and with laboratory studies thatreject other pathologies of similar characteristics.
Assuntos
Humanos , Atetose , Cerebelo , NeurologiaRESUMO
Yucca valida is an important potential source of steroidal saponins closely related to Yucca schidigera, the species that is commercially exploited from the wild as a source of steroidal extracts. Neither of the species has been domesticated mainly because of their slow growth and long life span before harvesting. Here, we report a micropropagation method to generate isogenic or clonal lines for plantation purposes. Seventeen clonal lines were propagated and evaluated over a period of 26 months in an experimental plantation and compared with the performance of plants from seeds. The large variability found between the plants derived from seeds is manifested in the differences observed between the different clonal lines; however, these present a much smaller internal coefficient of variation than the one observed in the population of plants derived from seeds. Some clonal lines perform in a superior manner indicating that a process of selection and cloning can generate lines of fast growing individuals for plantations that can satisfy the demand for these materials without putting a natural resource at risk.
Assuntos
Yucca/crescimento & desenvolvimento , Aclimatação/efeitos dos fármacos , Compostos de Benzil , Clonagem de Organismos , Germinação/efeitos dos fármacos , Germinação/fisiologia , Ácidos Indolacéticos/farmacologia , Cinetina/farmacologia , Tamanho do Órgão , Raízes de Plantas/efeitos dos fármacos , Brotos de Planta/efeitos dos fármacos , Brotos de Planta/crescimento & desenvolvimento , Purinas , Sementes/efeitos dos fármacos , Sementes/fisiologia , Técnicas de Cultura de Tecidos , Yucca/efeitos dos fármacosRESUMO
Después de 20 años de experiencia y de 193 trasplantes cardiacos realizados, utilizando el modelo de riesgos proporcionales de Cox, fue posible evaluar las diferentes variables de riesgo, tanto pre como intra y post-operatorias, para construir un modelo de riesgo para la población sometida al procedimiento quirúrgico. Para determinar la significancia de cada una de las variables, se utilizó la ecuación de Breslow.Las variables identificadas como de riesgo fueron: enfermedad ácido-péptica, falla hepática, historia de tabaquismo, cirugía previa que comprometiera el pericardio, tiempo de ventilación prolongado, técnica quirúrgica de implantación, edad, sangrado asociado con anticoagulación y tiempo de inicio de la ciclosporina. Finalmente, las variables incluidas en el modelo de Cox fueron: presencia de enfermedad hepática, edad y tiempo de ventilación (mayor o igual a 48 horas)...