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Hitherto, rings have been found exclusively around the four giant planets in the Solar System. Rings are natural laboratories in which to study dynamical processes analogous to those that take place during the formation of planetary systems and galaxies. Their presence also tells us about the origin and evolution of the body they encircle. Here we report observations of a multichord stellar occultation that revealed the presence of a ring system around (10199) Chariklo, which is a Centaur--that is, one of a class of small objects orbiting primarily between Jupiter and Neptune--with an equivalent radius of 124 ± 9 kilometres (ref. 2). There are two dense rings, with respective widths of about 7 and 3 kilometres, optical depths of 0.4 and 0.06, and orbital radii of 391 and 405 kilometres. The present orientation of the ring is consistent with an edge-on geometry in 2008, which provides a simple explanation for the dimming of the Chariklo system between 1997 and 2008, and for the gradual disappearance of ice and other absorption features in its spectrum over the same period. This implies that the rings are partly composed of water ice. They may be the remnants of a debris disk, possibly confined by embedded, kilometre-sized satellites.
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BACKGROUND: As the focus of healthcare provision shifts towards ambulatory care, increasing attention must now be given to develop opportunities for clinical teaching in this setting. AIM: To assess teacher and students' views about the strengths and weaknesses of real and simulated patient interactions for teaching undergraduate students clinical skills in the ambulatory setting. MATERIAL AND METHODS: Fourth-year medical students were exposed in a systematic way, during two weeks, to real and simulated patients in an outpatient clinic, who presented common respiratory problems, such as asthma, chronic obstructive pulmonary disease, smoking and sleep apnea syndrome. After the clinical interview, students received feedback from the tutor and their peers. The module was assessed interviewing the teachers and evaluating the results qualitatively. Students evaluated the contents and quality of teaching at the end of the rotation. RESULTS: Tutors identified the factors that facilitate ambulatory teaching. These depended on the module design, resources and patient care, of characteristics of students and their participation, leadership and interaction with professors. They also identified factors that hamper teaching activities such as availability of resources, student motivation and academic recognition. Most students evaluated favorably the interaction with real and simulated patients in the ambulatory setting. CONCLUSIONS: Teaching in the ambulatory setting was well evaluated by students and teachers. The use of qualitative methodology allowed contrasting the opinions of teachers and students.
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Assistência Ambulatorial , Educação de Graduação em Medicina , Docentes de Medicina/normas , Doenças Respiratórias , Ensino/normas , Chile , Currículo , Humanos , Pesquisa Qualitativa , Doenças Respiratórias/terapia , Ensino/métodosRESUMO
La enfermedad respiratoria aguda por coronavirus SARS-CoV-2 (COVID-19) se ha convertido en un grave problema de salud pública a nivel mundial. Objetivos: Examinar el uso de recursos sanitarios, riesgo de complicaciones y muerte en pacientes adultos con enfermedades respiratorias crónicas atendidos por COVID-19. Métodos: Estudio clínico descriptivo prospectivo realizado en pacientes adultos atendidos por COVID-19 en la Red de Salud UC Christus entre el 1 de abril y 31 de diciembre de 2020. Resultados: Se evaluaron 2.160 pacientes adultos, edad: 47 ± 17 años (rango: 18-100), 51,3% sexo masculino, 43,8% tenía comorbilidades, especialmente hipertensión (23,2%), diabetes (11,7%) y enfermedades respiratorias crónicas: asma (5%), EPOC (1,4%) y enfermedad pulmonar difusa (EPD: 0,8%). Los pacientes adultos con enfermedades respiratorias crónicas tuvieron mayor riesgo de hospitalización y uso de oxígeno suplementario; sin embargo, la evolución de los pacientes asmáticos y la sobrevida a los doce meses fue similar a los pacientes sin comorbilidades atendidos por COVID-19, mientras que en los pacientes con EPOC y EPD la admisión a la unidad de paciente crítico y riesgo de muerte fueron más elevados. En el análisis multivariado, los principales predictores clínicos asociados al riesgo de muerte en el seguimiento a doce meses en pacientes adultos con COVID-19 fueron la edad y admisión al hospital, mientras que el asma fue un factor protector. Conclusión: Los pacientes asmáticos tuvieron bajo riesgo de complicaciones y muerte asociados a COVID-19; mientras que los pacientes con EPOC y EPD tuvieron mayor riesgo de complicaciones y muerte en el seguimiento a largo plazo.
The acute respiratory disease associated to coronavirus SARS-CoV-2 (COVID-19) has become a serious public health problem worldwide. Objectives: To examine the use of healthcare resources, risk of complications and death in adult patients with chronic respiratory diseases treated for COVID-19. Methods: Prospective descriptive clinical study conducted in adult patients treated for COVID-19 in the UC Christus Healthcare Network between April 1 and December 31, 2020. Results: 2,160 adult patients were evaluated, age: 47 ± 17 years-old (range: 18-100), 51.3% male, 43.8% had comorbidities, especially hypertension (23.2%), diabetes (11.7%), and chronic respiratory diseases: asthma (5%), COPD (1,4%) and interstitial lung disease (ILD: 0.8%). Adult patients with chronic respiratory diseases were at higher risk for hospitalization and use of supplemental oxygen; however, the evolution of asthmatic patients and survival at twelve months was similar to that of adult patients without comorbidities treated for COVID-19, while in patients with COPD and ILD admission to the critical care unit and risk of death were higher. In the multivariate analysis, the main clinical predictors associated to 12-month mortality risk in adult patients with COVID-19 were age and hospital admission, while asthma was a protective factor. Conclusion: Asthmatic patients had minor risk of complications and mortality associated with COVID-19; while patients with COPD and ILD had a significant higher risk of complications and 12-month mortality.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Asma/complicações , Doenças Pulmonares Intersticiais/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , COVID-19/complicações , Asma/mortalidade , Asma/terapia , Análise de Sobrevida , Análise Multivariada , Estudos Prospectivos , Seguimentos , Doenças Pulmonares Intersticiais/mortalidade , Doenças Pulmonares Intersticiais/terapia , Medição de Risco , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Proteção , SARS-CoV-2 , COVID-19/mortalidade , COVID-19/terapiaRESUMO
Introducción: La sensibilidad a la ansiedad es un constructo poco conocido, y que sin embargo tiene un importante valor clínico, por ser un potente predictor de los trastornos de ansiedad, tanto en niños, como adolescentes y adultos. En Perú existen pocas pruebas psicométricas que evalúan la ansiedad en niños, y menos aún sobre sensibilidad a la ansiedad. Objetivo: En esta investigación se realiza un análisis psicométrico del Índice de Sensibilidad para Niños con la finalidad de estimar la validez y la confiabilidad de esta prueba que no ha sido aplicada en población peruana. Método: Se tomó una muestra no probabilística de 568 escolares de entre 8 y 12 años de cinco instituciones educativas de la ciudad de Arequipa, en Perú. Los datos se procesaron mediante el Análisis Factorial Confirmatorio de Grupo Múltiple utilizando el programa R. Resultados: Los resultados confirmaron una estructura de dos factores: Miedo a las sensaciones corporales y Miedo a síntomas mentales y sociales, con índices de confiabilidad aceptables calculados mediante la prueba Omega de McDonald. Conclusión: Se concluye que la prueba es válida y confiable, pero se sugiere profundizar en el análisis psicométrico de este instrumento.
Introduction: The anxiety sensitivity is a few known theoretical construct, although it has a relevant clinical worth, because it is a powerful predictor of the anxiety disorders, so as in children, as in adolescents and adults. Moreover, in Peru there are few psychometric tests that assess children anxiety, and even fewer about anxiety sensitivity. Objective: In this research, it was made a psychometric analysis of the Childhood Anxiety Sensitivity Index (CASI) with the aim to estimate the validity and reliability of this test that has not been applied in Peruvian population. Method: A non-probabilistic sample of 568 students among 8 and 12 years old was assessed of five elementary school from Arequipa City, in Peru. The data was processed with multiple group confirmatory factor analysis by R program. Results: The results confirm a two factors structure: Fear of body sensations and Fear of mental and social symptoms, with acceptable reliability indexes calculated by McDonald's Omega Test. Conclusion: The conclusion is that the CASI is valid and reliable; perhaps it is suggested to investigate another psychometric properties of this test.
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El síndrome de apneas obstructivas del sueño (SAOS) es un problema de salud prevalente y a menudo subdiagnosticado en el adulto mayor. Objetivos: Describir las características clínicas y trastornos del sueño en el adulto mayor de 65 años comparado con una cohorte de adultos jóvenes con SAOS (18-64 años). Métodos: Estudio clínico prospectivo realizado en sujetos roncadores atendidos en una clínica del sueño, a quienes se administraron cuestionarios de sueño y se realizó una poligrafía respiratoria o polisomnografía para confirmar el diagnóstico de SAOS. Se comparó las características clínicas y trastornos respiratorios del sueño en ambas cohortes. Resultados: Se evaluaron 1.512 pacientes, edad media: 56 ± 14 años, 70% varones, 91,2% tenían comorbilidades y 70,3% tenían SAOS moderada-severa. Los síntomas clásicos de SAOS fueron menos reportados en el adulto mayor: ronquidos (81,2% vs 86,4%, p < 0,02), apneas presenciadas (69,6% vs 79,8%, p < 0,001), fatigabilidad diurna (54,8% vs 77,3%, p < 0,001), sueño poco reparador (75,6% vs 89,6%, p < 0,001), sofocación nocturna (38,1% vs 50,7%, p < 0,001) y somnolencia diurna excesiva (43,9% vs 51,2%, p < 0,013). En el adulto mayor fueron más frecuentes las comorbilidades, especialmente cardiovascular, respiratorias y metabólicas crónicas; mientras que la obesidad objetivada por datos antropométricos (índice de masa corporal, perímetro cervical e índice cintura-cadera), índice de microdespertares, índice de desaturación (ID3%) y el índice de apneas-hipopneas fueron similares en ambos grupos. La magnitud de la hipoxemia nocturna objetivada en la oximetría de pulso (SaO2 media, SaO2 mínima y CT90%) fue superior en el adulto mayor. Conclusión: Las manifestaciones clínicas, comorbilidades y trastornos respiratorios del sueño son diferentes en el adulto mayor con síndrome de apneas obstructivas del sueño, lo cual debería ser considerado en el proceso diagnóstico y la planificación del tratamiento.
Obstructive sleep apnea syndrome (OSAS) is a prevalent and often underdiagnosed health problem in the elderly. Objectives: To describe clinical characteristics and sleep disorders in adults over 65 years-old compared to a cohort of young adults (18-64 years-old) with OSAS. Methods: Prospective clinical study carried out in snoring subjects attended in a sleep clinic, to whom sleep questionnaires were administered and respiratory polygraphy or polysomnography was performed to confirm the diagnosis of OSAS. Clinical characteristics and sleep-disordered breathing were compared among both cohorts. Results: 1,512 patients were evaluated, mean age: 56 ± 14 years, 70% male, 91.2% had comorbidities and 70.3% had moderate-severe OSAS. The classic symptoms of OSAS were less reported in older adults: snoring (81.2% vs 86.4%, p < 0.02), witnessed apneas (69.6% vs 79.8%, p < 0.001), daytime fatigue (54.8% vs 77.3%, p < 0.001), unrefreshing sleep (75.6% vs 89.6%, p < 0.001), nocturnal choking (38.1% vs 50.7%, p < 0.001) and excessive daytime sleepiness (43.9% vs 51.2%, p < 0.013). In the elderly, comorbidities were more frequent, especially chronic cardiovascular, respiratory and metabolic diseases; while obesity as measured by anthropometric data (body mass index, cervical circumference and waist-hip ratio), microarousal index, desaturation index (ID3%) and apnea-hypopnea index were similar in both groups. The magnitude of nocturnal hypoxemia observed in pulse oximetry (mean SaO2, minimum SaO2 and CT90%) was higher in the elderly. Conclusion: Clinical manifestations, comorbidities and sleep breathing disorders are different in the elderly with obstructive sleep apnea syndrome, which should be considered in the diagnostic process and treatment planning.
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A high rate of recurrence has been described in atypical hemolytic uremic syndrome renal transplant recipients, favored by certain immunosuppressant drugs that can induce complement activation. We present four case series in which three patients were diagnosed pretransplantation and a fourth who had onset in the very early post-transplantation period. The patients received different immunosuppression schedules, and all had improvement after more than 2-years. We suggest the need to stratify the risk of atypical hemolytic uremic syndrome recurrence using genetic studies and the available drugs as the main factors that allow graft survival improvement today.
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Síndrome Hemolítico-Urêmica Atípica/imunologia , Terapia de Imunossupressão/efeitos adversos , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/imunologia , Adulto , Idoso , Síndrome Hemolítico-Urêmica Atípica/cirurgia , Ativação do Complemento , Feminino , Sobrevivência de Enxerto/imunologia , Humanos , Terapia de Imunossupressão/métodos , Rim/imunologia , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de RiscoRESUMO
INTRODUCTION: Alzheimer's disease (AD) is a neurodegenerative disease which involves, among other manifestations, a progressive deterioration of memory and language, as well as behavioral disorders. In addition to non-curative pharmacological therapies, for the last years, music therapy has been developed as an effective non-pharmacological therapy in order to relieve many of these manifestations. AIM: To analyze the recent scientific evidence about the effect of music therapy on cognitive and behavioral symptoms in patients with AD. PATIENTS AND METHODS: A systematic review has been carried out by means of a bibliographical research using the database PubMed and Science Direct. The key words used for this search were 'Alzheimer's disease' and 'music therapy', as well as the boolean operator 'AND'. We selected those publications between January 2006 and December 2016 and after inclusion criteria, 21 publications were selected. RESULTS: This systematic review has demonstrated the beneficial impact of music therapy on cognition (memory, attention, language), emotion and behavior (anxiety, depression and agitation) in AD patients. CONCLUSIONS: Music therapy constitutes a non-pharmacological therapy effective for some cognitive, emotional and behavioral symptoms in patients with AD. However, further investigations and more evidence in this field are needed to claim conclusively the impact of music therapy on this disease.
TITLE: Efecto de la musicoterapia como terapia no farmacologica en la enfermedad de Alzheimer. Revision sistematica.Introduccion. La enfermedad de Alzheimer (EA) es un trastorno neurodegenerativo que conlleva, entre otras manifestaciones, una afectacion progresiva de alteraciones cognitivas, como la memoria y el lenguaje, asi como de alteraciones conductuales. Ademas de las terapias farmacologicas no curativas, la terapia con musica viene asentandose en los ultimos anos como una terapia no farmacologica eficaz para paliar muchas de las manifestaciones clinicas de la enfermedad. Objetivo. Analizar la evidencia cientifica reciente sobre el efecto de la musicoterapia en los sintomas cognitivos y conductuales en pacientes con EA. Pacientes y metodos. Se ha realizado una revision sistematica mediante una busqueda bibliografica en las bases de datos PubMed y Science Direct, empleando como palabras clave 'Alzheimer's disease' y 'music therapy', y el operador booleano 'AND'. Se consideraron los trabajos publicados entre enero de 2006 y diciembre de 2016 y, tras los criterios de inclusion, se seleccionaron 21 estudios. Resultados. Esta revision sistematica demuestra el efecto beneficioso de la musicoterapia sobre el estado cognitivo (memoria, atencion, lenguaje), emocional y conductual (ansiedad, depresion y agitacion) de los pacientes con EA. Conclusiones. La musicoterapia constituye una terapia no farmacologica eficaz para determinados sintomas cognitivos, emocionales y conductuales de pacientes con EA. No obstante, se necesitan mas investigaciones en este campo para poder definir de forma mas concluyente el efecto que produce la musicoterapia en esta patologia.
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Doença de Alzheimer/terapia , Musicoterapia , Doença de Alzheimer/psicologia , Comportamento , Cognição , Emoções , Humanos , Idioma , Memória , Qualidade de Vida , Resultado do TratamentoRESUMO
Resumen En la práctica clínica, la radiografía de tórax permite confirmar el diagnóstico y la extensión de la neumonía adquirida en la comunidad (NAC). Objetivos: Examinar las características radiográficas de la NAC según el agente causal y el grado de concordancia interobservador (CI) en la descripción de los hallazgos radiográficos. Métodos: Se evaluaron las radiografías de tórax de 300 pacientes adultos inmunocompetentes hospitalizados por NAC, tres residentes de radiología consignaron el patrón de los infiltrados pulmonares, su localización anatómica y extensión, la presencia de derrame pleural y otros hallazgos radiográficos. Se realizaron cultivos de esputo, hemocultivos, pruebas serológicas y técnicas de biología molecular de hisopado nasofaríngeo para identificar los principales patógenos respiratorios. Resultados: Las manifestaciones clínicas y los hallazgos de la radiografía de tórax fueron similares en las neumonías causadas por diferentes patógenos respiratorios: bacterias clásicas, virus respiratorios y microorganismos atípicos. En las neumonías bacterianas predominó el patrón de relleno alveolar de distribución lobar, en las neumonías vírales y atípicas predominó el patrón intersticial o mixto alvéolo-intersticial con opacidades en vidrio esmerilado. La CI fue satisfactoria (kappa > 0,6) para determinar el patrón principal de los infiltrados pulmonares, su localización anatómica y la presencia de derrame pleural, su localización y extensión. La CI fue moderada (kappa 0,4-0,6) para definir la extensión de la neumonía y detectar signos radiológicos asociados a congestión pulmonar. Conclusión: Los hallazgos de la radiografía de tórax no permitieron identificar con precisión el agente causal de la neumonía, siendo útil en la caracterización de los infiltrados pulmonares y para detectar complicaciones como el derrame paraneumónico.
In a clinical setting the chest radiograph is the reference standard in establishing the diagnosis of community-acquired pneumonia (CAP). Objectives: This study aimed to assess interobserver reliability (IR) of radiographic findings and the relationship to different respiratory pathogens in CAP. Methods: Chest radiographs of 300 immunocompetent adult patients hospitalized with pneumonia, obtained from a database, were reviewed by three residents of radiology without specific clinical information. Main pattern of pulmonary infiltrates, topographic localization, extent of pneumonia, presence of pleural fluid, thickened bronchial walls, lymphadenopathy and air bronchogram were scored. Sputum and blood cultures, serological tests and nasopharyngeal swab for respiratory virus detection by molecular diagnostic techniques were performed to identify the causative pathogen. Results: Clinical manifestations and chest X-ray findings were similar in pneumonias caused by different respiratory pathogens: classic bacteria, respiratory viruses and atypical microorganisms. The alveolar pattern of lobar distribution predominated in bacterial pneumonia; meanwhile, interstitial or mixed alveolar-interstitial pattern with ground glass opacities predominated in viral and atypical pneumonias. IR was fair to good (kappa > 0.6) for determining the main pattern of infiltrates, anatomical location and the presence of pleural effusion, their anatomical location and extension. IR was moderate (kappa 0.4-0.6) for determining the extent of pneumonia and signs of congestive heart failure. Conclusion: Simple features such as main pattern description, anatomical location, identifying the involved lobes and pleural fluid recognition showed fair to excellent interobserver reliability. Chest radiographs was of limited value in predicting the causative pathogen but were of beneficial use to characterize pulmonary infiltrates and to detect complications such as parapneumonic effusion.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Bactérias/isolamento & purificação , Vírus/isolamento & purificação , Radiografia Torácica , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , ImunocompetênciaRESUMO
El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es un trastorno respiratorio común asociado con múltiples consecuencias adversas para la salud y su prevalencia ha aumentado en paralelo con el aumento de la obesidad en la población. MÉTODOS: revisión sistemática que examina los estudios de prevalencia de SAHOS en la población general. Se incluyeron los estudios transversales y los componentes transversales de los estudios longitudinales que midieron objetivamente la prevalencia de SAHOS en adultos empleando instrumentos de laboratorio. Se evaluaron cuarenta estudios poblacionales de las 8.876 publicaciones encontradas en la búsqueda sistemática realizada en PubMed y otras bases de datos. RESULTADOS: Se ha observado importantes diferencias metodológicas en los estudios poblacionales, lo cual ha determinado una amplia variación en la prevalencia de SAHOS reportada, con un valor promedio de 36,9% (IC95% 28,3-45,4%) en hombres y 24,0% (IC 95% 16,3-31,6%) en mujeres. Se ha reportado un aumento en la prevalencia de SAHOS en el curso del tiempo desde 1987 hasta el 2020. Esta condición es más prevalente en varones, aumenta progresivamente con la edad y se asocia a la obesidad. La somnolencia diurna excesiva se ha asociado al diagnóstico de SAHOS, pero sólo una fracción de los sujetos con índice de apnea-hipopnea ≥ 5 eventos/hora presentan somnolencia diurna. CONCLUSIÓN: La prevalencia de SAHOS ha aumentado en los estudios poblacionales realizados en el curso del tiempo. La variabilidad reportada en la prevalencia de SAHOS probablemente esté relacionada con los diferentes equipos y definiciones operacionales empleados en el proceso diagnóstico, y las características de los sujetos examinados, incluyendo el importante aumento de la obesidad en la población.
Obstructive sleep apnea syndrome (OSAS) is a common disorder associated with multiple adverse health consequences and its prevalence is increasing in parallel with global rising in obesity. METHODS: We have developed a systematic review to examine obstructive sleep apnea syndrome prevalence studies in adults in the general population. We included the cross-sectional studies and the cross-sectional components of longitudinal studies that objectively measured OSAS in adults using laboratory instruments. Forty studies out of 8,876 articles found by systematically searching in PubMed and other databases were included in this review. RESULTS: Substantial methodological heterogeneity in population prevalence studies has been observed, determining a wide variation in OSAS prevalence defined at an apnea-hypopnea index (AHI) ≥ 5 events/hour, the average OSAS prevalence was 36.9% (CI95% 28.3-45.4%) in men and 24.0% (CI95% 16.3-31.6%) in women. The OSAS prevalence has increased over the time. OSAS is more prevalent in men than in women and increases with age and obesity. Excessive daytime sleepiness has been suggested as the most important symptom associated to OSAS, but only a fraction of subjects with AHI ≥ 5 events/hour report daytime sleepiness. CONCLUSION: The prevalence of OSAS has increased in epidemiological studies over time. The differences in reported prevalence of obstructive sleep apnea are probably due to different diagnostic equipment, operational definitions, study design and characteristics of included subjects, including effects of the obesity epidemic.
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Humanos , Adulto , Estudos Transversais , Apneia Obstrutiva do Sono/epidemiologia , Estudos Epidemiológicos , Prevalência , Fatores de Risco , Fatores Etários , Sobrepeso , Distúrbios do Sono por Sonolência Excessiva , Hipertensão , ObesidadeRESUMO
BACKGROUND: Serum progesterone (P) rises after ovulation in the luteinisation process. OBJECTIVE: To identify an accurate progesterone threshold to confirm ovulation in the assessment of a woman's fertility. METHODS: In a secondary analysis of an observational European multicentre study, this study included 107 women over 326 menstrual cycles and tracked daily first morning urine (FMU), changes in observed cervical mucus discharge, serum progesterone, and ultrasonography to identify the day of ovulation. A serum progesterone level was available for 102 women over a total 260 cycles with one or two P levels per cycle. RESULTS: It was found that a single serum P⩾5ng/ml is highly specific with a specificity of 98.4 (95% CI 96.0-99.5), with a sensitivity of 89.6 (95% CI 85.2-92.9). CONCLUSION: A random serum progesterone level ⩾5ng/ml confirms ovulation. This may be of use for clinicians wanting to confirm that ovulation has occurred.
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Ovulação/sangue , Progesterona/sangue , Adulto , Reações Falso-Positivas , Feminino , Fertilidade/fisiologia , Humanos , Ciclo Menstrual/fisiologia , Pessoa de Meia-Idade , Adulto JovemRESUMO
In order to evaluate iodine daily intake in 5-14 year-old school children urinary iodine excretion was measured in morning urinary samples of 134 school children. This value was corrected to microgram/ 24 h according to Jolin and Escobar del Rey's formula. Thyroid size was evaluated by two expert examiners following WHO criteria. Coincidence between both examiners was indispensable to establish goiter diagnosis. We evaluated urinary samples of 134 school children (117 normal and 17 goitrous). Urinary iodine excretion mean values were significantly different between Normal: 140.04 +/- 86.28 micrograms/24 h and Goitrous: 98.24 +/- 47.91 micrograms 24 h; p < 0.005). Goiter prevalence was found to diminish significantly when urinary iodine excretion was greater than 150 micrograms/24 h (p < 0.05). Similar mean urinary iodine excretion was observed in different socioeconomic groups. No significant differences were detected in the evaluation of two most common salt trademark consumer groups. In conclusion 1) iodoprophylaxis efficacy was assessed by urinary iodine excretion, a valid means to estimate iodine intake. Acceptable mean levels of iodine intake were found in the group under study, but the individual variability was important; 2) goitrous schoolchildren showed an iodine intake lower than normal and 3) the important variability observed in the evaluated data, the assessed relation between goiter and lower iodine intake, and the high frequency of insufficient iodine intake should justify a better control of iodoprophylaxis and a more widespread information dissemination among the population and perhaps iodine supplements in specific groups.
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Bócio Endêmico/urina , Iodo/urina , Cloreto de Sódio na Dieta , Adolescente , Criança , Pré-Escolar , Feminino , Bócio Endêmico/epidemiologia , Humanos , Incidência , Masculino , Classe Social , Fatores Socioeconômicos , Glândula Tireoide/químicaRESUMO
OBJECTIVE: To determine the prevalence and predictors of positive interferon-gamma release assays (IGRAs) and tuberculin skin tests (TSTs) in human immunodeficiency virus (HIV) infected patients in Norway, a low tuberculosis (TB) endemic country. DESIGN: Multicentre cross-sectional study of 298 HIV patients tested with QuantiFERON®-TB Gold In-Tube (QFT-GIT), T-SPOT®.TB (T-SPOT) and TST. RESULTS: A total of 77/298 (26%) QFT-GIT, 29/117 (25%) T-SPOT and 52/217 (24%) TSTs (≥ 5 mm) were positive. The median CD4 count was 427 cells/l. Three QFT-GIT results but no T-SPOT results were indeterminate. Of 52 TST-positive patients, 34 (65%) were QFT-GIT-positive (median interferon-gamma [IFN-] 4.38 international units [IU]/ml), compared to 16% of the TST-negative patients (median INF- 0.81 IU/ml, P < 0.001). Origin from a TB-endemic country, previous active TB and TB exposure were associated with a positive QFT-GIT (P 0.01). Patients from TB-endemic countries living in Norway for ≥ 10 years had lower odds of a positive QFT-GIT (12%; OR 0.17, 95%CI 0.060.53, P 0.002) than patients with 03 years' residence (49%). CONCLUSION: The prevalence of positive IGRAs in HIV-infected patients was high in this low TB endemic setting. Lower QFT-GIT positivity in long-term residents from TB-endemic countries may reflect a waning of TB-specific immune responses.
Assuntos
Coinfecção , Emigrantes e Imigrantes , Doenças Endêmicas , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Testes de Liberação de Interferon-gama , Tuberculose/diagnóstico , Tuberculose/etnologia , Adulto , Idoso , Contagem de Linfócito CD4 , Estudos Transversais , Emigração e Imigração , Feminino , Infecções por HIV/imunologia , Humanos , Testes de Liberação de Interferon-gama/métodos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Fatores de Tempo , Teste Tuberculínico , Tuberculose/imunologia , Tuberculose/microbiologia , Adulto JovemRESUMO
OBJECTIVE: Urinary hormonal markers may assist in increasing the efficacy of Fertility Awareness Based Methods (FABM). This study uses urinary pregnanediol-3a-glucuronide (PDG) testing to more accurately identify the infertile phase of the menstrual cycle in the setting of FABM. METHODS: Secondary analysis of an observational and simulation study, multicentre, European study. The study includes 107 women and tracks daily first morning urine (FMU), observed the changes in cervical mucus discharge, and ultrasonography to identify the day of ovulation over 326 menstrual cycles. The following three scenarios were tested: (A) use of the daily pregnandiol-3a-glucuronide (PDG) test alone; (B) use of the PDG test after the first positive urine luteinizing hormone (LH) kit result; (C) use of the PDG test after the disappearance of fertile type mucus. Two models were used: (1) one day of PDG positivity; or (2) waiting for three days of PDG positivity before declaring infertility. RESULTS: After the first positivity of a LH test or the end of fertile mucus, three consecutive days of PDG testing over a threshold of 5µg/mL resulted in a 100% specificity for ovulation confirmation. They were respectively associated an identification of an average of 6.1 and 7.6 recognized infertile days. CONCLUSIONS: The results demonstrate a clinical scenario with 100% specificity for ovulation confirmation and provide the theoretical background for a future development of a competitive lateral flow assay for the detection of PDG in the urine.
Assuntos
Ovulação/urina , Pregnanodiol/análogos & derivados , Adulto , Feminino , Fertilidade/fisiologia , Humanos , Pregnanodiol/urina , Estudos Prospectivos , Curva ROC , Adulto JovemRESUMO
Chronic respiratory disease is the 3rd leading cause of death in Chile and its prevalence is increasing significantly in the world, so it is very common that we find patients with these pathologies undergoing elective surgical procedures. Perioperative complications are more frequent in these patients than in the general population, so it is essential adequate preoperative evaluation and management in them. Chronic obstructive pulmonary disease (COPD) is a major predictor of postoperative complications; therefore preoperative bronchodilators and inhaled corticosteroids are indicated in patients with this disease who will undergo elective surgery, particularly related to lung cancer. Likewise, COPD patients who will undergo coronary artery bypass graft surgery (CABG) should receive oral or intramuscular corticosteroids preoperatively. Smoking is an independent risk factor for developing postoperative respiratory complications in thoracic surgery, so patients should stop this habit at least 4 weeks before elective surgery in order to significantly reduce such complications. A poorly controlled asthma is a specific risk factor for developing postoperative pulmonary complications, therefore these patients should be treated preoperatively with inhaled bronchodilators exclusive if they have mild asthma, bronchodilators associated with inhaled corticosteroids in the case of a moderate asthma, and inhaled bronchodilators associated to inhaled and oral corticosteroids, if they have severe asthma.
Las enfermedades respiratorias crónicas son la tercera causa de muerte en Chile y su prevalencia está aumentando significativamente en el mundo, por lo cual es muy frecuente que nos encontremos con pacientes con estas patologías sometiéndose a procedimientos quirúrgicos electivos. En estos casos las complicaciones perioperatorias son más frecuentes que en la población general, por lo cual es indispensable una adecuada evaluación y manejo preoperatorio. La presencia de enfermedad pulmonar obstructiva crónica (EPOC) es un predictor mayor de complicaciones postoperatorias y deben indicarse broncodilatadores y corticoides inhalatorios preoperatorios en pacientes con esta patología que serán sometidos a cirugía electiva, especialmente en la relacionada a cáncer pulmonar. Así mismo, los pacientes con EPOC que se someterán a cirugía de revascularización miocárdica deben recibir además corticoides vía sistémica en el período preoperatorio. El tabaquismo es otro factor de riesgo independiente para desarrollar complicaciones respiratorias postoperatorias en cirugía torácica, por lo que los pacientes deberían suspender el consumo de tabaco por lo menos 4 semanas antes de la cirugía programada con el fin de disminuir significativamente dichas complicaciones. El asma bronquial mal controlada también es un factor de riesgo específico para desarrollar complicaciones pulmonares postoperatorias, por lo cual estos pacientes deben tratarse preoperatoriamente con broncodilatadores inhalatorios, asociados a corticoides inhalatorios u orales según la gravedad del asma.
Assuntos
Humanos , Doenças Respiratórias/terapia , Cuidados Pré-Operatórios , Asma/terapia , Doença Crônica , Doença Pulmonar Obstrutiva Crônica/terapia , Fumar/terapiaRESUMO
En las últimas décadas se observa un notable incremento de las enfermedades crónicas no trasmisibles asociadas a estilos de vida no saludables, donde la obesidad es en sí misma una enfermedad crónica y a la vez un reconocido factor de riesgo de muchas otras. Los objetivos del presente trabajo son evaluar el valor predictivo del Índice de Masa Corporal (IMC), perímetro de cintura e índice cintura/altura para el desarrollo de hipertensión arterial (HTA), hipercolesterolemia y diabetes tipo 2 (DM2) en una cohorte de empleados públicos hospitalario de Posadas, Misiones, seguidos desde el año 2002 al 2012. La población total estuvo constituida por 989 empleados públicos, de los cuales fueron seleccionados 259 trabajadores que eran normotensos, no hipercolesterolémicos y no diabéticos al inicio del estudio. Se realizaron encuestas personales, mediciones antropométricas, de presión arterial y extracción sanguínea con ayuno de 12 horas. Para el análisis de eventos se utilizó el modelo de riesgos proporcionales de Cox, calculando los correspondientes Hazard Ratio (HR) corregidos por edad y sexo. El IMC predijo de forma significativa la presentación de HTA (HR: 1,100; IC: 1,054-1,148; p < 0,001) y DM2 (HR: 1,253; IC: 1,122-1,40; p < 0,001). El perímetro de cintura se asoció en forma significativa con HTA (HR: 2,273; IC: 1,465-3,826; p<0,001) y DM2 (HR: 5,578; IC: 1,247-24,92; p: 0,024). El índice cintura/altura predijo de forma significativa la presentación de HTA (HR: 2,173; IC: 1,438-3,283; p < 0,001) y DM2 (HR: 5,875; IC: 1,140-30,28; p: 0,034). Ninguno de los indicadores de obesidad evaluados se asoció de forma significativa con la presentación de hipercolesterolemia. Se concluye que el IMC, el perímetro de cintura y el índice cintura/altura predijeron el desarrollo de HTA y diabetes tipo 2. Se resalta así la utilidad de estos indicadores en la vigilancia de las entidades consideradas a través de mediciones antropométricas tradicionales. Rev Argent Endocrinol Metab 51:185-191, 2014 Los autores declaran no poseer conflictos de interés.
In recent decades, a significant increase has been observed in noncommunicable chronic diseases associated with unhealthy lifestyles, with obesity being a chronic disease in itself and at the same time a recognized risk factor for many other conditions. The aim of this study is to assess the predictive value of body mass index (BMI), waist circumference and waist index / height for the development of high blood pressure (hypertension), high cholesterol and type 2 diabetes (DM2) in a cohort of public hospital employees from Posadas, Misiones, who were followed up from 2002 to 2012. Of the total population of 989 public employees, we selected 259 subjects with normal blood pressure, no hypercholesterolemia and no diabetes at baseline. Personal interviews, anthropometric and blood pressure measurements were performed and blood samples were collected after a 12-hour fast. For the event analysis, the Cox proportional hazards model was used, calculating the corresponding Hazard Ratio (HR) adjusted for age and sex. BMI significantly predicted the development of hypertension (HR: 1.100, CI: 1.054 to 1.148, p < 0.001) and DM2 (HR: 1.253, CI: 1.122 to 1.40, P < 0.001). The waist circumference was associated with hypertension (HR: 2.273, CI: 1.465 to 3.826, p < 0.001) and DM2 (HR: 5.578, CI: 1.247 to 24.92, p = 0.024). The waist / height ratio significantly predicted the development of hypertension (HR: 2.173, CI: 1.438 to 3.283, p < 0.001) and DM2 (HR: 5.875, CI: 1.140 to 30.28, p = 0.034). None of the indicators of obesity evaluated was significantly associated with the development of hypercholesterolemia. We conclude that BMI, waist circumference and waist / height ratio predicted the development of hypertension and type 2 diabetes. This underlines the usefulness of these indicators for monitoring the above-referred conditions by traditional anthropometric measurements. Rev Argent Endocrinol Metab 51:185-191, 2014 No financial conflicts of interest exist.
RESUMO
Este artículo presenta un estudio sobre el cambio de las teorías subjetivas de docentes en un contexto de aprendizaje. A través de una investigación cualitativa con diseño longitudinal, se estudió a 12 profesores participantes de un diplomado de Educación de Valores en las regiones de Atacama y Metropolitana de Chile. Los principales resultados obtenidos dan cuenta de cambio en las teorías subjetivas de los docentes, caracterizados por el logro de mayor autonomía, protagonismo y percepción de eficacia. Los hallazgos son discutidos interpretando la transformación de sus teorías subjetivas desde diversos modelos de cambio representacional. Finalmente, se discute la pertinencia de la estrategia metodológica utilizada, para el estudio del cambio subjetivo en general y en específico del cambio profesional docente.
Assuntos
Docentes , Educação , Pesquisa Qualitativa , Psicologia , Valores SociaisRESUMO
Copper is an oligoelement essential for various enzymatic processes both in pathology and in human physiology. Its excessive accumulation in the liver and brain, particularly in the basal ganglia drives to the pathological syndrome known as Wilson's disease, on the other hand, this metal absence in the newborn provokes brain and cerebellar degeneration, pathology recognized as Menkes' disease. Currently its role in Parkinson, Alzheimer and lateral amyotrophic sclerosis is discussed. Our studies in rats about the copper effects in the hippocampus excitability, long term potentiation (LTP) and learning have shown a suppressor action on LTP, without memory alteration nor on the animal learning in the Morris' aquatic maze, a physiological paradoxical result and in its clinical inference also.
El cobre es un elemento esencial en diversos procesos fisiológicos y patológicos. Su acumulación excesiva en hígado, cerebro y particularmente en los ganglios basales, conduce al cuadro patológico conocido como la enfermedad de Wilson. Por otra parte, la ausencia de este metal en el recién nacido provoca degeneración cerebral y cerebelosa patología reconocida como enfermedad de Menkes. Actualmente se discute su papel en el Parkinson, Alzheimer y esclerosis lateral amiotrófica. Nuestros estudios en ratas han mostrado los efectos del cobre en la excitabilidad del hipocampo; su acción supresora de la LTP hipocámpica, sin alterar el aprendizaje y la memoria estudiados en el laberinto acuático de Morris, resultados paradójicos tanto desde la perspectiva neurofisiológica como en su inferencia clínica.
Assuntos
Animais , Ratos , Cobre/farmacologia , Hipocampo , Hipocampo/fisiologia , Aprendizagem , Memória , NeurofisiologiaRESUMO
Background: As the focus of healthcare provision shifts towards ambulatory care, increasing attention must now be given to develop opportunities for clinical teaching in this setting. Aim: To assess teacher and students' views about the strengths and weaknesses of real and simulated patient interactions for teaching undergraduate students clinical skills in the ambulatory setting. Material and Methods: Fourth-year medical students were exposed in a systematic way, during two weeks, to real and simulated patients in an outpatient clinic, who presented common respiratory problems, such as asthma, chronic obstructive pulmonary disease, smoking and sleep apnea syndrome. After the clinical interview, students received feedback from the tutor and their peers. The module was assessed interviewing the teachers and evaluating the results qualitatively. Students evaluated the contents and quality of teaching at the end of the rotation. Results: Tutors identified the factors that facilitate ambulatory teaching. These depended on the module design, resources and patient care, of characteristics of students and their participation, leadership and interaction with professors. They also identified factors that hamper teaching activities such as availability of resources, student motivation and academic recognition. Most students evaluated favorably the interaction with real and simulated patients in the ambulatory setting. Conclusions: Teaching in the ambulatory setting was well evaluated by students and teachers. The use of qualitative methodology allowed contrasting the opinions of teachers and students.
Assuntos
Humanos , Assistência Ambulatorial , Educação de Graduação em Medicina , Docentes de Medicina/normas , Doenças Respiratórias , Ensino/normas , Chile , Currículo , Pesquisa Qualitativa , Doenças Respiratórias/terapia , Ensino/métodosRESUMO
BACKGROUND: The incidence of acute renal failure requiring dialysis is not known in our country. The criteria for acute dialysis are not uniformly accepted, neither is there consensus on dialysis strategy in critically ill patients. We describe the acute dialysis activity in our hospital in 1999. MATERIAL AND METHODS: We have retrospectively recorded the indications for dialysis and the course and hospital mortality in all patients treated with acute dialysis in 1999. RESULTS: 108 patients were treated with 670 dialysis procedures; the incidence was 20.5 per 100,000 inhabitants. Continuous veno-venous haemodiafiltration accounted for 37% of all treatments. In 50% of the patients acute renal failure occurred after surgery or serious infections with a mortality of 57% and 62% respectively. Total dialysis mortality was 45%. The mortality in patients with malignancy and peripheral vascular disease was 90% and 75% respectively. 10% of the patients needed chronic dialysis. INTERPRETATION: The incidence of acute dialysis was higher than previously reported from European countries and may be related to the general increase in active treatment of patients with complicated diseases. The mortality rates are persistently high. Close cooperation between nephrologists and intensivists in the treatment of these patients is essential.
Assuntos
Injúria Renal Aguda/terapia , Cuidados Críticos/estatística & dados numéricos , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Hemofiltração/estatística & dados numéricos , Diálise Renal/mortalidade , Diálise Renal/estatística & dados numéricos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/mortalidade , Adolescente , Adulto , Idoso , Criança , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Diálise Renal/métodos , Estudos RetrospectivosRESUMO
Pulmonary sequestration is a rare lung congenital malformation that can be diagnosed in the rutine prenatal ultrasound scan. It has a wide spectrum of clinical manifestations, that range from asymptomatic fetuses to hydrops fetalis. Although prenatal Ultrasound (US) has been the traditional diagnostic tool in these cases, fetal magnetic resonance imaging (MRI) may prove useful in differential diagnosis with cistic adenomatous malformation (CCAM) and also in the evaluation of the mass efect exerted by the malformation. We present a case of a 38 year old pregnant woman with a diagnosis of fetal hydrothorax in the 29th week of gestation. Ultrasound and MRI evaluation revealed pulmonary sequestration. Management involved prenatal thoracocentesis, planned delivery and neonatal support. This case highlights the importance of a multidisciplinary approach when encountering fetal lung anomalies including radiologists and pediatricians, a thorough assessment of the lesion using US, MRI and planned delivery in a tertiary center with adecuate neonatal support.
El secuestro pulmonar es una malformación congénita pulmonar infrecuente que puede ser diagnosticada mediante el ultrasonido durante una evaluación prenatal de rutina. Sus manifestaciones clínicas van desde fetos asintomáticos hasta el hidrops fetal. Si bien la ultrasonografía ha sido el método tradicional de evaluación de estas malformaciones, la utilización de resonancia puede demostrar utilidad, en especial en el diagnóstico diferencial con malformación adenomatosa quística, como también en evaluar el efecto de compresión ejercido por la lesión, y estimar el volumen pulmonar residual. Se presenta un caso de una paciente embarazada de 38 años con diagnóstico de secuestro pulmonar a las 29 semanas y que a las 32semanas evolucionó con hidrotórax que requirió toracocentesis, interrupción programada y soporte neonatal. Este caso resalta la importancia de usar un enfoque multidisciplinario al enfrentarse con lesiones pulmonares fetales que incluya neonatólogo, radiólogo, obstetra, y una evaluación detallada de la lesión utilizando ultrasonografía y resonancia magnética como también interrupción programada en un centro terciario con adecuado soporte neonatal.