RESUMO
BACKGROUND: Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations' Decade of Action and the Sustainable Development Goals. METHODS: From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. RESULTS: 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20-59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. CONCLUSIONS: Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.
Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Ambulâncias , Cidades/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Ferimentos e Lesões/epidemiologiaRESUMO
BACKGROUND: Speeding is responsible for countless traffic collisions and road traffic injuries (RTIs) around the world. It threatens the lives of passengers in motor vehicles as well as the safety of other individuals sharing the public roads. Little evidence has been provided by low- and middle-income countries on speed transgression patterns. OBJECTIVE: To document the prevalence of speeding in motor vehicles with four or more wheels and to analyse the associated factors in four Mexican cities. METHODS: We conducted a cross-sectional study in the cities of Guadalajara-Zapopan, León, Cuernavaca and Villahermosa. Data on speed, drivers, vehicles, road infrastructure and the environment were collected from a randomly selected sample of urban road segments. We identified the factors associated with speeding through a logistic multiple regression model. RESULTS: With an overall prevalence of 47% (95% CI 45.83 to 48.18), speeding occurred most frequently in Villahermosa (61.07%, 95% CI 59.10 to 63.01) as compared to León (51%, 95% CI 48.07 to 53.92), Cuernavaca (47.6%, 95% CI 45.35 to 49.85) and Guadalajara-Zapopan (20.76%, 95% CI 18.75 to 22.88). Speeding increased in the afternoons, on roads with numerous lanes, on Thursdays and Sundays and in foggy weather, but decreased in cities with speed control strategies and on roads with low visibility. No differences were observed between sexes or among age groups. CONCLUSIONS: Evidence from our study highlights the urgent need to implement speed control measures such as changes in road infrastructure and design, and to promote comprehensive speeding legislation aimed at reducing exposure to this important risk factor.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Veículos Automotores/estatística & dados numéricos , Adolescente , Adulto , Idoso , Cidades , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Saúde Pública , Fatores de Risco , Adulto JovemRESUMO
The aim of this article was to analyze the timeliness of emergency medical care (time transpired between the injury and the first contact with the Emergency Medical System) and its assocation with different negative health outcome in traffic accident victims treated at two Mexican hospitals, one in Guadalajara, Jalisco, and the other in León, Guanajuato, based on data from the Motor Vehicle Accident Epidemiological Surveillance System of the Bloomberg Philanthropies' Global Road Safety Program. Information was obtained on all patients treated for motor vehicle injuries in referral hospitals from May 2012 to November 2014. Multinomial logistic regression was used to model the health outcomes, categorized as short stay, prolonged hospitalization, disability, and death, compared to timeliness of care, adjusted by different target variables. A total of 2,575 patients were analyzed. Time from injury to care was 103.74 minutes (± 231.36) in León and 75.37 minutes (± 156.87) in Guadalajara; it was 38.02 and 36.23 minutes, respectively, in patients that received prehospital medical care. Timely care was associated with less prolonged hospital stay, but not with lower incidence of disability or death. Receiving prehospital medical care was associated statistically with negative health consequences. Timely care was associated with lower probability of prolonged hospitalization. Strategies are needed to evaluate and in turn improve the technical quality of prehospital medical care, including timeliness of care and adequate regulation.
El objetivo fue analizar la oportunidad de la atención médica de emergencias (tiempo transcurrido desde que ocurrió la lesión hasta el primer contacto con el Sistema Médico de Emergencias -SME) y su relación con distintas consecuencias negativas en salud, en pacientes con lesiones causadas por el tránsito, atendidos en dos hospitales de México, uno en Guadalajara, Jalisco y otro en León, Guanajuato. Se utilizó información del Sistema de Vigilancia Epidemiológica de las Lesiones Causadas por el Tránsito, establecido como parte del Programa Global de Seguridad Vial de la Filantropía de Bloomberg. Se recabó información de todos los pacientes atendidos por lesiones causadas por el tránsito en dos hospitales de referencia, de mayo 2012 a noviembre 2014. Se realizó una regresión logística multinomial para modelar los resultados en salud, categorizados en estancia corta, hospitalización prolongada, discapacidad y defunción, con la oportunidad de la atención, ajustando por distintas variables de interés. 2.575 lesionados fueron analizados. La oportunidad de la atención fue 103,74min (± 231,36) en León y 75,37min (± 156,87) en Guadalajara, siendo 38,02 y 36,23min en quienes recibieron atención médica prehospitalaria, respectivamente. La oportunidad de la atención se asoció con una menor estancia hospitalaria prolongada, pero no con una menor incidencia de discapacidad o muerte. Recibir atención médica prehospitalaria estuvo asociado con consecuencias negativas en salud. Una atención oportuna está asociada a una menor posibilidad de tener hospitalizaciones prolongadas. Es necesario impulsar estrategias para evaluar, y eventualmente mejorar la calidad técnica de la atención médica prehospitalaria, incluyendo la oportunidad de la atención y la adecuada regulación.
O objetivo deste estudo foi analisar a oportunidade da atenção médica de emergências (tempo transcorrido desde que ocorreu a lesão até o primeiro contato com o Sistema Médico de Emergências) e sua relação com distintas consequências negativas para a saúde, em pacientes com lesões causadas pelo trânsito, atendidos em dois hospitais do México, um em Guadalajara, Jalisco e outro em León, Guanajuato. Foi utilizada informação do Sistema de Vigilância Epidemiológica das Lesões Causadas pelo Trânsito, estabelecido como parte do Programa Global de Segurança Rodoviária da Filantropia de Bloomberg. Foram recolhidas informações de todos os pacientes atendidos por lesões causadas pelo trânsito nos hospitais de referência, de maio 2012 a novembro 2014. Foi realizada uma regressão logística multinomial para modelar os resultados na saúde, categorizados como: permanência curta hospitalar, hospitalização prolongada, portadores de deficiência e óbito com oportunidade de atenção, sendo ajustada por diferentes variáveis de interesse. Foram analisados 2.575 lesionados. A chance da atenção foi 103,74min (± 231,36) em León e 75,37min (± 156,87) em Guadalajara, sendo 38.02 e 36.23 min naqueles que receberam atenção médica pré-hospitalar, respectivamente. A chance da atenção foi associada com uma menor permanência hospitalar prolongada, mas não com uma menor incidência de deficiência ou morte. Receber atenção médica pré-hospitalar foi associado com consequências negativas na saúde. Uma atenção oportuna está associada à uma menor possibilidade de sofrer hospitalizações prolongadas. É necessário estimular estratégias para avaliar, e eventualmente melhorar a qualidade técnica da atenção médica pré-hospitalar, incluindo a chance da atenção e uma adequada regulação.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Ambulâncias/estatística & dados numéricos , Criança , Cidades/estatística & dados numéricos , Escolaridade , Feminino , Humanos , Tempo de Internação , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
Acute coronary syndrome (ACS) groups different cardiac diseases whose development is associated with inflammation. Here we have analyzed the levels of inflammatory cytokines and of members of the TLR/IRAK pathway including IRAK-M in monocytes from ACS patients classified as either UA (unstable angina), STEMI (ST-elevation myocardial infarction) or NSTEMI (non-ST-elevation myocardial infarction). Circulating monocytes from all patients, but not from healthy individuals, showed high levels of pro-inflammatory cytokines, TNF-alpha and IL-6, as well as of IRAK-M and IL-10. TLR4 was also up-regulated, but IRAK-1, IRAK-4 and MyD88 levels were similar in patients and controls. Further, we investigated the consequences of cytokines/IRAK-M expression on the innate immune response to endotoxin. Ex vivo responses to LPS were markedly attenuated in patient monocytes compared to controls. Control monocytes cultured for 6 h in supplemented medium (10% serum from ACS patients) expressed IRAK-M, and LPS stimulation failed to induce TNF-alpha and IL-6 in these cultures. Pre-incubation of the serum with a blocking anti-TNF-alpha antibody reduced this endotoxin tolerance effect, suggesting that TNF-alpha controls this phenomenon, at least partially. We show for the first time that inflammatory responses associated with ACS induce an unresponsiveness state to endotoxin challenge in circulating monocytes, which correlates with expression of IRAK-M, TLR4 and IL-10. The magnitude of this response varies according to the clinical condition (UA, STEMI or NSTEMI), and is regulated by TNF-alpha.
Assuntos
Angina Instável/imunologia , Regulação da Expressão Gênica/imunologia , Quinases Associadas a Receptores de Interleucina-1/imunologia , Lipopolissacarídeos/imunologia , Monócitos/imunologia , Infarto do Miocárdio/imunologia , Angina Instável/metabolismo , Angina Instável/patologia , Anticorpos Bloqueadores/farmacologia , Tolerância a Medicamentos/imunologia , Feminino , Humanos , Quinases Associadas a Receptores de Interleucina-1/genética , Quinases Associadas a Receptores de Interleucina-1/metabolismo , Interleucina-6/imunologia , Interleucina-6/metabolismo , Lipopolissacarídeos/farmacologia , Masculino , Pessoa de Meia-Idade , Monócitos/efeitos dos fármacos , Monócitos/metabolismo , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , RNA Mensageiro/metabolismo , Fator de Necrose Tumoral alfa/imunologia , Fator de Necrose Tumoral alfa/metabolismo , Regulação para Cima/imunologiaRESUMO
Resumen Objetivo: Identificar las barreras que existen para la atención de las conductas suicidas, desde la perspectiva de las/los profesionales de la salud mental del primer nivel de atención de la Ciudad de México. Metodología: Estudio cualitativo exploratorio, basado en 35 entrevistas semiestructuradas, dirigidas a personal de salud de dos unidades de salud mental de referencia nacional. El análisis de la información se hizo mediante el Framework Analysis. Resultados: Las/los participantes consideraron que las conductas suicidas no han sido definidas como una prioridad dentro de los trastornos de salud mental. La ausencia de políticas públicas, la sobrecarga de trabajo, la falta de seguimiento a las/los pacientes, entre otras, fueron identificadas como barreras para una atención adecuada y oportuna. Conclusiones: Los programas de prevención de las conductas suicidas deben tomar en cuenta el contexto socioeconómico de la población y las características de los servicios de salud, así como las necesidades de las personas prestadoras de servicios de salud. Se requiere ampliar el entrenamiento profesional y mejorar el sistema de referencia y contrarreferencia entre los distintos niveles de atención.
Abstract Objective: To identify the existing barriers to the care of suicidal behavior from the perspective of mental health professionals at the first level of care in Mexico City. Methodology: Qualitative exploratory study based on 35 semi-structured interviews conducted on health personnel from two national reference mental health facilities. The data were analyzed with Framework Analysis. Results: The participants considered that suicidal behavior has not been prioritized among mental health disorders. The absence of public policies, work overload, lack of patient follow-up, among others, were identified as barriers to adequate and timely care. Conclusions: Suicidal behavior prevention programs should consider the socioeconomic context of the population, the characteristics of health services, and the needs of health care providers. Professional training should be enhanced, and the referral and counter-referral system across levels of care should be improved.
Resumo Objetivo: Identificar as barreiras existentes para a atenção das condutas suicidas, desde a perspectiva dos profissionais de saúde mental de atenção básica da Cidade do México. Metodologia: Estudo qualitativo exploratório, baseado em 35 entrevistas semiestruturadas, dirigidas a profissionais de saúde de duas unidades de saúde mental de referência nacional. A análise da informação foi feita através do Framework Analysis. Resultados: Os participantes consideraram que as condutas suicidas não têm sido definidas como uma prioridade dentro dos transtornos de saúde mental. A ausência de políticas públicas, a sobrecarga de trabalho, a falta de seguimento aos pacientes, entre outras, foram identificadas como barreiras para uma atenção adequada e oportuna. Conclusões: Os programas de prevenção das condutas suicidas devem considerar o contexto socioeconômico da população e as características dos serviços de saúde, além das necessidades dos profissionais de saúde. É necessário ampliar o treinamento profissional e melhorar o sistema de referência e contrarreferência entre os diferentes níveis de atenção.
RESUMO
BACKGROUND & AIMS: Ghrelin is a peptide mainly secreted in stomach with a potent growth hormone releasing activity both in vitro and in vivo. The trophic mucosal effect of an enriched protein diet may be related with ghrelin and growth hormone plasma levels since peptides from the somatotrophic axis are well-known trophic factors. The possible relationship between nutritionally regulated active ghrelin plasma levels and the intestinal trophic effects of a high-protein diet was probed in rats with intestinal hypotrophy induced by an elemental diet. METHODS: Normal and elemental-diet-induced intestinally hypotrophic rats were treated with either a normoproteic or a high-protein diet for 1 week. It was determined ghrelin and IGF-1 plasma levels, fundic and duodenal ghrelin concentrations, ghrelin mRNA content and intestinal morphometric, proliferative and apoptotic parameters were determined. Growth hormone plasma levels were measured indirectly through IGF-1 plasma levels. RESULTS: Ghrelin plasma levels increased in elemental diet-induced intestinally hypotrophic rats fed either diet. Duodenum mRNA content, but not fundus, increased under the same conditions where plasma was studied. Dietary treatment did not modify the IGF-1 plasma levels. However, animals previously fed an elemental diet to induce intestinal hypotrophy had significantly lower levels of IGF-1. CONCLUSIONS: The trophic effects on the intestine of an enriched protein diet are associated with increased ghrelin serum peptide level and mRNA content, and this increase might be related to the IGF-1 plasma levels in elemental diet-induced intestinally hypotrophic rats.
Assuntos
Proteínas Alimentares/uso terapêutico , Fator de Crescimento Insulin-Like I/metabolismo , Mucosa Intestinal/efeitos dos fármacos , Hormônios Peptídicos/metabolismo , Animais , Proteínas Alimentares/administração & dosagem , Duodeno/anatomia & histologia , Duodeno/efeitos dos fármacos , Duodeno/metabolismo , Fundo Gástrico/anatomia & histologia , Fundo Gástrico/efeitos dos fármacos , Fundo Gástrico/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Grelina , Hormônio do Crescimento/sangue , Imuno-Histoquímica , Mucosa Intestinal/anatomia & histologia , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Hormônios Peptídicos/sangue , RNA Mensageiro/metabolismo , Distribuição Aleatória , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
BACKGROUND: In vivo treatment with growth hormone reduces radiation-associated mortality. The molecular mechanisms underlying this effect are unknown. It has been described that increased sensitivity to ionising radiation can be due to defects in machinery involved in detection and/or repair of DNA double-strand breaks. OBJECTIVE: To study the mechanisms involved in growth hormone action on the increased survival in irradiated cells. MATERIALS AND METHODS: CHO-4 cells stably expressing the growth hormone receptor were used. A cell viability assay was carried out to analyse the increase in survival induced by growth hormone in irradiated cells. To investigate whether the DNA repair mechanism could be implicated in this effect we performed DNA reactivation assays using pHIV-LUC and pCMV-betagal plasmids as control. Identical studies were also conducted using the radiomimetic drug, bleomycin. RESULTS: Growth hormone protects CHO-4 cells from bleomycin- and radiation-induced cell death. In pHIV-LUC transfected cells, a time-dependent decrease in luciferase activity was observed after irradiation in the absence of growth hormone. However, cells pretreated with this hormone maintained reporter activity. When cells were transfected with irradiated pHIV-LUC plasmid, only the hormone-treated cells recovered the transcriptional activity. CONCLUSIONS: Growth hormone exerts a radioprotective effect in CHO-4 cells stably transfected with the complementary DNA for the rat growth hormone receptor. The radioprotection is triggered directly by the hormone and it is also observed with bleomycin. The increased survival in response to radiation and bleomycin treatment induced by growth hormone correlates with an enhanced ability of the cells to repair damaged DNA.
Assuntos
Morte Celular/efeitos dos fármacos , Morte Celular/efeitos da radiação , Hormônio do Crescimento/farmacologia , Protetores contra Radiação/farmacologia , Animais , Células CHO , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos da radiação , Cricetinae , Dano ao DNA/efeitos dos fármacos , Reparo do DNA/efeitos dos fármacos , Humanos , Rim/citologia , TransfecçãoRESUMO
OBJECTIVE: The intestinal side effects of anti-tumoural therapy can be so severe as to preclude its clinical efficacy, although the use of selected nutrients and growth factors may ameliorate the noxious effects. This study examines whether dietary supplementation with the polyunsaturated fatty acid docosahexaenoic acid (DHA) potentiates the protective action of growth hormone in the intestine and whether a synergetic effect occurs with dietary protein and DHA enrichment and growth hormone treatment. METHODS: Male Wistar rats were divided into nine groups and received a standard diet, or a diet supplemented with protein, or a diet supplemented with DHA, or a diet supplemented with both protein and DHA. Three days later, the rats were given 5-fluorouracil (5-FU) and treated with either growth hormone or placebo. A further group of animals fed a standard diet was not treated and served as a control group. Intestinal morphometry, proliferation and apoptosis were determined. RESULTS: Supplementing the diet with DHA prevented the negative action of 5-FU on mucosal morphometry, but protein supplementation was necessary to prevent the increased apoptosis. When growth hormone was also given with the dietary supplementation, the hypoproliferative effect of 5-FU was also prevented. CONCLUSION: Enriching the diet with DHA protects against intestinal lesions produced by the anti-tumoural drug 5-FU but requires the joint administration of supplementary protein and growth hormone to reduce the noxious effects of 5-FU.
Assuntos
Proteínas Alimentares/administração & dosagem , Suplementos Nutricionais , Ácidos Docosa-Hexaenoicos/administração & dosagem , Hormônio do Crescimento Humano/administração & dosagem , Intestinos/efeitos dos fármacos , Animais , Apoptose , Translocação Bacteriana , Divisão Celular , Fluoruracila/uso terapêutico , Absorção Intestinal/efeitos dos fármacos , Intestinos/microbiologia , Intestinos/patologia , Masculino , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
OBJECTIVE: Growth hormone has been proposed as an effective preventative treatment against radiotherapy- and chemotherapy-induced toxicity in the gut. The aim of this study was to determine whether exogenously administered growth hormone modified the effect of 5-fluorouracil on the gut and an implanted colon adenocarcinoma in the rat METHODS: An adenocarcinoma was implanted into rats that had been treated with 5-fluorouracil and growth hormone 3 days previously. Tumour growth, plus tumour and intestinal pathology, proliferation, apoptosis and p53 expression were determined. RESULTS: Growth hormone protected the intestines against 5-fluorouracil by increasing proliferation and mucosal length, and decreasing apoptosis and p53 expression. Growth hormone did not modify the effects of 5-fluorouracil on the tumour. CONCLUSIONS: Growth hormone protects the intestines from the deleterious effects of 5-fluorouracil while preserving its antitumoural action on the adenocarcinoma in the short term. Within the crypt, p53 expression is likely to be modulated by growth hormone after 5-fluorouracil treatment.
Assuntos
Adenocarcinoma/tratamento farmacológico , Antimetabólitos Antineoplásicos/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Fluoruracila/efeitos adversos , Hormônio do Crescimento/uso terapêutico , Intestinos/efeitos dos fármacos , Adenocarcinoma/patologia , Animais , Apoptose/efeitos dos fármacos , Translocação Bacteriana/efeitos dos fármacos , Peso Corporal , Linhagem Celular Tumoral , Neoplasias do Colo/patologia , Intestinos/patologia , Masculino , Ratos , Ratos Endogâmicos , Receptores da Somatotropina/análise , Proteína Supressora de Tumor p53/análiseRESUMO
The municipalities of Guadalajara and Zapopan, Jalisco State, Mexico, have participated in efforts to reduce road traffic injuries. They have participated actively in the Mexican Road Safety Initiative since 2008. As a result, in September 2010 they passed laws to reduce the legal alcohol levels for driving motor vehicles. To assess the short-term impact of these measures on rates and severity of alcohol-related collisions and injuries, we conducted a secondary analysis of official databases on mortality, morbidity, and collisions. We performed a time-series analysis to assess the trend. Significant changes were observed in the monthly proportion of alcohol-related deaths and collision rates following these interventions. The article concludes with recommendations to improve the reform's enforcement and results.
Assuntos
Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Acidentes de Trânsito/mortalidade , Consumo de Bebidas Alcoólicas/prevenção & controle , Cidades , Hospitalização , Humanos , México/epidemiologia , Fatores de Risco , População Urbana , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
Resumen: El objetivo fue analizar la oportunidad de la atención médica de emergencias (tiempo transcurrido desde que ocurrió la lesión hasta el primer contacto con el Sistema Médico de Emergencias -SME) y su relación con distintas consecuencias negativas en salud, en pacientes con lesiones causadas por el tránsito, atendidos en dos hospitales de México, uno en Guadalajara, Jalisco y otro en León, Guanajuato. Se utilizó información del Sistema de Vigilancia Epidemiológica de las Lesiones Causadas por el Tránsito, establecido como parte del Programa Global de Seguridad Vial de la Filantropía de Bloomberg. Se recabó información de todos los pacientes atendidos por lesiones causadas por el tránsito en dos hospitales de referencia, de mayo 2012 a noviembre 2014. Se realizó una regresión logística multinomial para modelar los resultados en salud, categorizados en estancia corta, hospitalización prolongada, discapacidad y defunción, con la oportunidad de la atención, ajustando por distintas variables de interés. 2.575 lesionados fueron analizados. La oportunidad de la atención fue 103,74min (± 231,36) en León y 75,37min (± 156,87) en Guadalajara, siendo 38,02 y 36,23min en quienes recibieron atención médica prehospitalaria, respectivamente. La oportunidad de la atención se asoció con una menor estancia hospitalaria prolongada, pero no con una menor incidencia de discapacidad o muerte. Recibir atención médica prehospitalaria estuvo asociado con consecuencias negativas en salud. Una atención oportuna está asociada a una menor posibilidad de tener hospitalizaciones prolongadas. Es necesario impulsar estrategias para evaluar, y eventualmente mejorar la calidad técnica de la atención médica prehospitalaria, incluyendo la oportunidad de la atención y la adecuada regulación.
Abstract: The aim of this article was to analyze the timeliness of emergency medical care (time transpired between the injury and the first contact with the Emergency Medical System) and its assocation with different negative health outcome in traffic accident victims treated at two Mexican hospitals, one in Guadalajara, Jalisco, and the other in León, Guanajuato, based on data from the Motor Vehicle Accident Epidemiological Surveillance System of the Bloomberg Philanthropies' Global Road Safety Program. Information was obtained on all patients treated for motor vehicle injuries in referral hospitals from May 2012 to November 2014. Multinomial logistic regression was used to model the health outcomes, categorized as short stay, prolonged hospitalization, disability, and death, compared to timeliness of care, adjusted by different target variables. A total of 2,575 patients were analyzed. Time from injury to care was 103.74 minutes (± 231.36) in León and 75.37 minutes (± 156.87) in Guadalajara; it was 38.02 and 36.23 minutes, respectively, in patients that received prehospital medical care. Timely care was associated with less prolonged hospital stay, but not with lower incidence of disability or death. Receiving prehospital medical care was associated statistically with negative health consequences. Timely care was associated with lower probability of prolonged hospitalization. Strategies are needed to evaluate and in turn improve the technical quality of prehospital medical care, including timeliness of care and adequate regulation.
Resumo: O objetivo deste estudo foi analisar a oportunidade da atenção médica de emergências (tempo transcorrido desde que ocorreu a lesão até o primeiro contato com o Sistema Médico de Emergências) e sua relação com distintas consequências negativas para a saúde, em pacientes com lesões causadas pelo trânsito, atendidos em dois hospitais do México, um em Guadalajara, Jalisco e outro em León, Guanajuato. Foi utilizada informação do Sistema de Vigilância Epidemiológica das Lesões Causadas pelo Trânsito, estabelecido como parte do Programa Global de Segurança Rodoviária da Filantropia de Bloomberg. Foram recolhidas informações de todos os pacientes atendidos por lesões causadas pelo trânsito nos hospitais de referência, de maio 2012 a novembro 2014. Foi realizada uma regressão logística multinomial para modelar os resultados na saúde, categorizados como: permanência curta hospitalar, hospitalização prolongada, portadores de deficiência e óbito com oportunidade de atenção, sendo ajustada por diferentes variáveis de interesse. Foram analisados 2.575 lesionados. A chance da atenção foi 103,74min (± 231,36) em León e 75,37min (± 156,87) em Guadalajara, sendo 38.02 e 36.23 min naqueles que receberam atenção médica pré-hospitalar, respectivamente. A chance da atenção foi associada com uma menor permanência hospitalar prolongada, mas não com uma menor incidência de deficiência ou morte. Receber atenção médica pré-hospitalar foi associado com consequências negativas na saúde. Uma atenção oportuna está associada à uma menor possibilidade de sofrer hospitalizações prolongadas. É necessário estimular estratégias para avaliar, e eventualmente melhorar a qualidade técnica da atenção médica pré-hospitalar, incluindo a chance da atenção e uma adequada regulação.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Adulto Jovem , Acidentes de Trânsito/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Fatores de Risco , Ambulâncias/estatística & dados numéricos , Cidades/estatística & dados numéricos , Escolaridade , Tempo de Internação , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
Los municipios de Guadalajara y Zapopan, Jalisco, México, han participado en los esfuerzos para reducir la incidencia de las lesiones causadas por el tránsito a lo largo de los años. Así, han sido partícipes de la Iniciativa Mexicana de Seguridad Vial desde 2008, y en septiembre de 2010 entró en vigor la reducción del límite legal de alcoholemia para conducir vehículos de motor. Con el fin de evaluar el impacto en el corto plazo de estas dos acciones en la ocurrencia de colisiones y lesiones, relacionadas con el consumo de alcohol, así como la gravedad de las mismas, se realizó un análisis secundario de las bases de datos oficiales de mortalidad, morbilidad y eventos viales. Se realizó un análisis de series de tiempo, con el objetivo de analizar la tendencia. Se observaron cambios significativos en el porcentaje mensual de muertes asociadas con alcohol y en la tasa de choques a partir de la aplicación de estas intervenciones. Se realizan diversas recomendaciones para mejorar la aplicación y resultados de esta reforma.
The municipalities of Guadalajara and Zapopan, Jalisco State, Mexico, have participated in efforts to reduce road traffic injuries. They have participated actively in the Mexican Road Safety Initiative since 2008. As a result, in September 2010 they passed laws to reduce the legal alcohol levels for driving motor vehicles. To assess the short-term impact of these measures on rates and severity of alcohol-related collisions and injuries, we conducted a secondary analysis of official databases on mortality, morbidity, and collisions. We performed a time-series analysis to assess the trend. Significant changes were observed in the monthly proportion of alcohol-related deaths and collision rates following these interventions. The article concludes with recommendations to improve the reform’s enforcement and results.
Os municípios de Guadalajara e Zapapan, Jalisco, México, têm particidado dos esforços para reduzir a incidência de lesões causadas pelo trânsito ao longo dos anos. Assim, têm participado da Iniciativa Mexicana de Seguridad Vial desde 2008, e em setembro de 2010 entrou em vigor a redução do limite legal de alcoolemia para condução de veículos automotores. Com o objetivo de avaliar o impacto de curto prazo dessas ações na ocorrência de acidentes e lesões relacionados ao consumo de álcool, assim como a gravidade das mesmas, realizou-se análise de séries temporais, com dados secundários das bases de dados oficiais de mortalidade, morbidade e acidentes de trânsito, de modo a analisar a tendência destes. Observou-se alterações significativas no porcentual mensal de mortes associadas ao álcool e na taxa de acidentes a partir da implementação dessas intervenções. São apresentadas diversas recomendações para melhorar a aplicação e os resultados dessa reforma.
Assuntos
Humanos , Acidentes de Trânsito/prevenção & controle , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Acidentes de Trânsito/mortalidade , Consumo de Bebidas Alcoólicas/prevenção & controle , Cidades , Hospitalização , México/epidemiologia , Fatores de Risco , População Urbana , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
Introducción: la incidencia del cáncer cérvicouterino se ha incrementado en los últimos años y en la actualidad en algunos países de América Latina constituye la primera causa de mortalidad en la población femenina. Objetivo: caracterizar a las pacientes con citologías orgánicas alteradas en el Policlínico Universitario Tula Aguilera. Métodos: se realizó un estudio descriptivo, transversal en las pacientes con citologías orgánicas alteradas en el Policlínico Universitario Tula Aguilera del municipio Camagüey, en el período de agosto de 2010 a enero de 2011. El universo de estudio estuvo constituido por 180 pacientes y la muestra quedó conformada por las 115 mujeres que cumplían los criterios de inclusión y que eran atendidas en la consulta provincial de patología de cuello del Hospital Materno Ana Betancourt de Mora...
Introduction: cervical uterine cancer incidence has increased lately and currently it is the first leading cause of death in women in some countries of Latin America. Objective: to characterize patients with altered organic cytologies in the Tula Aguilera Unviversity Polyclinic . Methods: we conducted a cross-sectional study in patients with altered functional cytology in the Policlinico Universitario Tula Aguilera of Camagüey municipality from August 2010 to January 2011. The study group consisted of 180 patients and the sample consisted of 115 women who met the inclusion criteria and were treated at the provincial consultation Cervical Pathology Maternity Hospital Ana Betancourt de Mora. The information was stored in a database created using the Excel program of Office XP...
Assuntos
Biologia Celular , Técnicas Citológicas , Fatores de Risco , Neoplasias do Colo do ÚteroRESUMO
El carcinoma epidermoide es una neoplasia poco frecuente en el pene, que por su localización trae como consecuencias serias afectaciones de la calidad de vida de los pacientes, ocasiona daños tanto físicos, psíquicos como sexuales, por lo que su prevención resulta muy importante. Su causa es multifactorial, las infecciones por papiloma virus humano, así como una inadecuada higiene del pene, favorecen la formación de este tumor. Caso clínico: paciente masculino de 52 años de edad, color de la piel negra, residente en Jeremie, república de Haití, que acudió a consulta de medicina interna por presentar lesión en la piel del pene de cuatro años de evolución, refirió el comienzo de la enfermedad con un "granito" que inicialmente fue diagnosticado y tratado como un condiloma acuminado, al no notar mejoría abandonó el tratamiento y la lesión continuó aumentando de tamaño, se acompañaba de dolor y ardor. Posteriormente apareció una secreción uretral, de color amarillento y mal oliente, recibió tratamiento con ciprofloxacino donde desapareció la misma; pero cuatro meses después reapareció otra lesión pequeña en el cuerpo del pene, la cual creció rápidamente de forma exfoliaría, acompañada de secreción purulenta por la uretra y otros signos importantes de sepsis, por tal motivo recibió tratamiento con antimicrobianos , una vez que se controló la infección local del pene se tomaron las muestras para el estudio histológico.
Epidermoid carcinoma is an infrequent neoplasia of penis that because of its localization has serious consequences in the quality of life of patients causing either physical, psychical as sexual damage that is why its prevention is so important. It has multifactorial cause; infections by human papilloma virus, as well as an inadequate hygiene of penis favor the formation of this tumor. Clinical case: a 52 years old, black race, male patient, resident in Jeremie, Republic of Haiti, came to the internal medicine consultation with a skin lesion in the penis of 4 years of evolution which started as a small pimple initially diagnosed and treated as a condyloma acuminatum. The patient abandoned treatment after no improvement, and the lesion continued growing accompanied by pain and burning. Later a yellowish fetid urethral secretion appeared. He was treated with ciprofloxacin and the lesion disappeared. But 4 months later another lesion in the body of penis appeared, growing quickly accompanied by purulent secretion through the urethra as well as other relevant signs. Due to this, the patient was treated with antimicrobials. Once the local infections of penis were under control, samples for a further histological study were collected.
Assuntos
Humanos , Masculino , Carcinoma de Células Escamosas , Neoplasias Penianas/diagnósticoRESUMO
Although blood monocytes possess significant cytotoxic activity against tumor cells, tumor-infiltrating monocytes are commonly deactivated in cancer patients. Monocytes pre-exposed to tumor cells show significantly decreased expression levels of TNF-alpha, IL-12p40, and IL-1R-associated kinase (IRAK)-1. Activation of the Ser/Thr kinase IRAK-1 is an important event in several inflammatory processes. By contrast, another IRAK family member, IRAK-M, negatively regulates this pathway, and is up-regulated in cultures of endotoxin-tolerant monocytes and in monocytes from septic patients within the timeframe of tolerance. In this study, we show that IRAK-M expression is enhanced at the mRNA and protein level in human monocytes cultured in the presence of tumor cells. IRAK-M was induced in monocytes upon coculturing with different tumor cells, as well as by fixed tumor cells and medium supplemented with the supernatant from tumor cell cultures. Moreover, blood monocytes from patients with chronic myeloid leukemia and patients with metastasis also overexpressed IRAK-M. Low concentrations of hyaluronan, a cell surface glycosaminoglycan released by tumor cells, also up-regulated IRAK-M. The induction of IRAK-M by hyaluronan and tumor cells was abolished by incubation with anti-CD44 or anti-TLR4 blocking Abs. Furthermore, down-regulation of IRAK-M expression by small interfering RNAs specific for IRAK-M reinstates both TNF-alpha mRNA expression and protein production in human monocytes re-exposed to a tumor cell line. Altogether, our findings indicate that deactivation of human monocytes in the presence of tumor cells involves IRAK-M up-regulation, and this effect appears to be mediated by hyaluronan through the engagement of CD44 and TLR4.
Assuntos
Receptores de Hialuronatos/fisiologia , Glicoproteínas de Membrana/fisiologia , Monócitos/imunologia , Monócitos/metabolismo , Proteínas Quinases/biossíntese , Receptores de Superfície Celular/fisiologia , Receptores de Interleucina-1/biossíntese , Regulação para Cima/imunologia , Adulto , Anticorpos Bloqueadores/farmacologia , Comunicação Celular/imunologia , Linhagem Celular Tumoral , Técnicas de Cocultura , Regulação para Baixo/imunologia , Regulação Neoplásica da Expressão Gênica/imunologia , Células HL-60 , Células HeLa , Humanos , Receptores de Hialuronatos/imunologia , Ácido Hialurônico/farmacologia , Quinases Associadas a Receptores de Interleucina-1 , Células Jurkat , Ativação de Macrófagos/imunologia , Masculino , Glicoproteínas de Membrana/antagonistas & inibidores , Glicoproteínas de Membrana/imunologia , Pessoa de Meia-Idade , Proteínas Quinases/genética , Proteínas Quinases/metabolismo , RNA Mensageiro/antagonistas & inibidores , RNA Mensageiro/biossíntese , Receptores de Superfície Celular/antagonistas & inibidores , Receptores de Superfície Celular/imunologia , Receptor 4 Toll-Like , Receptores Toll-Like , Células Tumorais Cultivadas , Fator de Necrose Tumoral alfa/biossíntese , Fator de Necrose Tumoral alfa/genéticaRESUMO
The activation of interleukin receptor associated kinases (IRAK) is an important event in several inflammatory processes. However, exposing monocytes to a nitric oxide (NO) donor inhibits the activity of IRAK-1 and its molecular interaction with TNF receptor associated factor-6 (TRAF6). Despite the fact that NO is known to regulate many events in the immune and vascular system, the mechanism that underlies this inhibition remains unknown. We have recently demonstrated that IRAK-M inhibits the TLR/IRAK pathway during endotoxin tolerance and thus, we hypothesized that IRAK-M may be involved in the inhibition of IRAK-1 activity in the presence of NO. Hence, we have analyzed the expression of IRAK-M in human monocytes following exposure to a NO donor (GSNO) and we have observed that GSNO was capable of inducing IRAK-M mRNA and protein expression 8 and 20 h after stimulation, respectively. It is known that NO induces the expression of TNF-alpha in monocytes and we found that exposure to TNF-alpha induced IRAK-M mRNA expression in human monocytes within 2 h of stimulation. Furthermore, the expression of IRAK-M induced by GSNO was inhibited by the presence of a blocking antibody raised against TNF-alpha. Thus, our data indicate that stimulation of human monocytes with a NO donor results in a clear induction of IRAK-M and this is dependent on the release of TNF-alpha by this kind of cells.
Assuntos
Monócitos/metabolismo , Óxido Nítrico/fisiologia , Proteínas Quinases/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Sequência de Bases , Primers do DNA , Humanos , Quinases Associadas a Receptores de Interleucina-1 , Proteínas Quinases/genética , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Growth hormone (GH) protects the intestines from antitumoral therapy, but it is not known whether or not the tumor is also protected in vivo. The aim of the present work was to determine whether GH administration modifies the response by a colonic adenocarcinoma to radiation in vitro and in vivo. BDIX rats were implanted with a colonic adenocarcinoma and two weeks later GH treatment was started. Animals were then irradiated, and four days later samples from the intestines and tumor were taken for analysis. In vitro assays were performed in parallel to confirm the effects observed in vivo. GH reduced radiation-induced intestinal injury by improving proliferation and reducing apoptosis and p53 expression. However, tumor proliferation was reduced by GH while apoptosis and p53 expression remained unchanged. A similar response was observed in vitro. Thus, GH administration before radiotherapy protects the intestines but not the implanted adenocarcinoma in the rat.
Assuntos
Adenocarcinoma/radioterapia , Neoplasias do Colo/radioterapia , Hormônio do Crescimento Humano/farmacologia , Intestinos/efeitos dos fármacos , Lesões por Radiação/prevenção & controle , Protetores contra Radiação/farmacologia , Adenocarcinoma/patologia , Animais , Apoptose , Divisão Celular , Neoplasias do Colo/patologia , Modelos Animais de Doenças , Técnicas In Vitro , Intestinos/patologia , Intestinos/efeitos da radiação , Masculino , Ratos , Proteínas Recombinantes/farmacologia , Resultado do TratamentoRESUMO
Se realizó una revisión sobre la caracterización de los anticonceptivos inyectables solo de progestinas y sus beneficios en la planificación familiar. Se analizó su eficacia, mecanismos de acción, ventajas y desventajas de su uso, indicaciones específicas, el manejo de los efectos colaterales o secundarios, la elegibilidad del método para iniciar su uso, los procedimientos y categorías seleccionados por la OMS para indicarlo, cuáles son los pasos para comenzarlo, así como también el seguimiento de las mujeres que eligen este método. Se concluyó que los inyectables solo de progestinas traen beneficios a la planificación familiar, pues tienen una alta eficacia, y su utilización por mujeres con condiciones crónicas, depende de una adecuada consejería. Afirmamos que es una buena opción anticonceptiva para nuestras pacientes
Assuntos
Humanos , Feminino , Adulto , Acetato de Medroxiprogesterona , Anticoncepcionais Femininos , Injeções Intramusculares , Progestinas , Serviços de Planejamento FamiliarRESUMO
Se realizó un estudio descriptivo con el objetivo de caracterizar epidemiológicamente a las mujeres con alto riesgo preconcepcional controladas con anticoncepción hormonal y que fueron atendidas en la consulta de planificación familiar perteneciente al policlínico docente "Tula Aguilera" de la ciudad de Camagüey, en el período comprendido del 1ro. de enero al 31 de diciembre de 1998. El universo de estudio estuvo constituido por 185 mujeres. El registro primario lo constituyó una encuesta confeccionada según revisión bibliográfica. Los factores de riesgo más relevantes fueron: desnutrición materna III o IV (60,68 porciento), antecedentes de asma bronquial (58,33 porciento) y antecedentes de bajo peso anterior (42,86 porciento). El anticonceptivo más usado fue la tableta (71,35 porciento), y fue el inyectable el de más efectos secundarios (amenorrea). Se consideró como eficaz el uso de los anticonceptivos hormonales
Assuntos
Humanos , Feminino , Anticoncepcionais Orais Hormonais , Planejamento Familiar , Epidemiologia DescritivaRESUMO
Se realiza un estudio de cohorte histórico que analiza la repercusión del hábito de fumar en la ventilación pulmonar. Como universo se toma la población de 15 y más años del municipio Camagüey y como unidad de análisis, cada individuo procedente de 3 cohortes retrospectivos (fumador activo, pasivo y no fumador). Se valoran los resultados espirométricos de ventilación pulmonar disminuida y se realiza una encuesta que incluyó examen clínico y microespirometría a las 120 personas (40 procedentes de cada cohorte). Se señala que el 60 porciento de los fumadores presentó alteración en la ventilación pulmonar con primacía de los fumadores activos (80 porciento), la combinación cigarrillos-puros ofrece mayor repercusión en la ventilación pulmonar. El tiempo diario de exposición al humo del cigarro afecta de manera estable al fumador activo, mientras que el riesgo aumenta en el fumador pasivo a medida que es mayor el tiempo de exposición al día. El examen físico es un patrón relevante para el diagnóstico precoz de daño ventilatorio, sin necesidad de prueba especializada