RESUMEN
BACKGROUND: Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS: We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS: One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS: This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT: This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.
Asunto(s)
Craneosinostosis , Complicaciones Infecciosas del Embarazo , Efectos Tardíos de la Exposición Prenatal , Infección por el Virus Zika , Virus Zika , Embarazo , Lactante , Recién Nacido , Femenino , Humanos , Estudios de Cohortes , Infección por el Virus Zika/diagnóstico , Desarrollo InfantilRESUMEN
The reproductive failure of Senegalese sole (Solea senegalensis) cultured males (reared entirely in captivity from egg through to adult) that do not participate in reproductive behaviours to fertilise spawns, results in a problem to achieve reproductive control in captivity. However, cohabitation with wild males has led to an increase in the involvement of cultured males in reproductive behaviour, although their contribution to fertilised spawning is still lower than that of wild breeders. This study aimed to examine the effect of different social conditions, on the reproductive behaviour and spawning success of cultured breeders over three reproductive seasons. Before starting this study, different social learning opportunities were provided to the breeders from the juvenile to the pubertal stages of the individuals. Behaviour and spawning were evaluated in four experimental groups of cultured breeders: two groups (W1 and W2) that prior to this study were reared during the juvenile stage with wild breeders that fertilized spawns, a Culture breeder group (CB) that was previously reared with cultured breeders that spawned unfertile eggs, and a negative control group (CN) that was reared in isolation from adult fish. During the three reproductive seasons, spawning was obtained from all groups. Generally, the first year had the highest egg production and the third year the lowest. However, fertilised eggs were only obtained from W1 in the first year. A total of eight fertilised spawns were collected with a fertilisation rate of 28.02 ± 13.80 % and a hatching rate of 15.04 ± 10.40 %. The mean number of larvae obtained per spawn was 7,683 ± 5,947 and the total number of larvae from all eight spawns was 61,468. The paternity analysis assigned 64.3 % of larvae to a single couple of breeders, while 34.3 % of larvae were not assigned to any single family, but inconclusively to more than three parents. The highest locomotor activity was observed in W1, while no significant differences were observed in the number of movements within W2, CB and CN. In all groups, during the peak of locomotor activity (19h00-20h00), the main reproductive behaviours observed were Rest the Head and Follow, while the Guardian behaviour was low and Coupled behaviour was only observed in W1. Over time, the reproductive behaviours decreased, except for Follow. The social learning opportunities provided by cohabitation with wild fish during juvenile stages prior to spawning in W1, increased activity and fertilised spawning. However, the number of successful spawns was low and over time stopped in association with a decrease in reproductive behaviour. This suggests that other mechanisms of behavioural learning could be involved in reproductive success, such as reproductive dominance, environmental conditions or hormonal interactions that could affect physiological processes in the reproduction of captive breeders.
Asunto(s)
Peces Planos , Reproducción , Animales , Masculino , Peces Planos/fisiología , Peces Planos/crecimiento & desarrollo , Reproducción/fisiología , Femenino , Conducta ReproductivaRESUMEN
The current climate change situation could bring critical effects for marine species, especially those already considered endangered. Although some species can adapt fast to the environmental changes, it is necessary to get into the worst scenario and develop tools to anticipatedly assess the physiological effects of such environmental change. With this purpose, our study aims to determine the effect of a range of seawater temperatures and pHs on sperm motility in the European eel (Anguilla anguilla). Low seawater pH (6.5-7.4) decreased the eel sperm motility in comparison to the control (pH = 8.2). We also studied the combined effect of the pH of the artificial seminal plasma (the plasma where the sperm cells are suspended) with the pH of Artificial Sea Water (ASW, pH 7.8 or and 8.2). We did not find statistical differences in sperm motility and kinetic parameters caused by the artificial seminal plasma pH. However, seawater pH induced significantly higher values of total sperm motility, and the percentage of fast spermatozoa with a pH of 8.2 in comparison with a pH of 7.8. In contrast, the seawater temperature did not affect sperm motility parameters or sperm longevity. To study the effect of the interaction between seawater temperature and pH on sperm motility, two temperatures: 4 and 24 °C, and two pHs 7.8 and 8.2, were tested. There were significant differences between temperature and pH in several kinetic parameters and, in general, the lowest values were observed in the samples activated at low temperature and low pH (4 °C, pH 7.8). This work suggest that eel sperm motility and kinetics will not be affected by the expected changes in pH or temperature due to the climate change.
RESUMEN
COVID-19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource-limited settings is challenging. We report the results of a multidisciplinary patient-navigator-led telemedicine supportive care program in Mexico City. One-hundred sixty-three telemedicine interventions were provided to 45 patients (median age 68, 57% female). A quarter of the patients had less than or equal to elementary school education, and 15% lived in a rural area. The most common interventions were psychological care (33%), pain and symptom control (25%), and nutritional counseling (13%). Half of the interventions were provided by video conferencing. The most common patient-reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource-limited settings.
Asunto(s)
COVID-19/epidemiología , Neoplasias/terapia , Cuidados Paliativos , Telemedicina , Anciano , Consejo , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , México/epidemiología , Manejo del Dolor , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.
Asunto(s)
Neoplasias , Navegación de Pacientes , Adolescente , Adulto , Humanos , México , Neoplasias/terapia , Cuidados Paliativos , Calidad de VidaRESUMEN
INTRODUCTION: Background cross-reactivity with other coronaviruses may reduce the specificity of COVID-19 rapid serologic tests. The vast majority of women attend prenatal care, which is a unique source of population-based blood samples appropriate for validation studies. We used stored 2018 serum samples from an existing pregnancy cohort study to evaluate the specificity of COVID-19 serologic rapid diagnostic tests. METHODS: We randomly selected 120 stored serum samples from pregnant women enrolled in a cohort in 2018 in Tegucigalpa, Honduras, at least 1 year before the COVID-19 pandemic. We used stored serum to evaluate four lateral flow rapid diagnostic tests, following manufacturers' instructions. Pictures were taken for all tests and read by two blinded trained evaluators. RESULTS: We evaluated 120, 80, 90, and 90 samples, respectively. Specificity for both IgM and IgG was 100% for the first two tests (95% confidence intervals [CI] 97.0-100 and 95.5-100, respectively). The third test had a specificity of 98.9% (95% CI 94.0-100) for IgM and 94.4% (95% CI 87.5-98.2) for IgG. The fourth test had a specificity of 88.9% (95% CI 80.5-94.5) for IgM and 100% (95% CI 96.0-100) for IgG. DISCUSSION: COVID-19 serologic rapid tests are of variable specificity. Blood specimens from sentinel prenatal clinics provide an opportunity to validate serologic tests with population-based samples.
Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Atención Prenatal/métodos , Adolescente , Adulto , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Estudios de Cohortes , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Valor Predictivo de las Pruebas , Embarazo , SARS-CoV-2 , Sensibilidad y Especificidad , Pruebas Serológicas , Adulto JovenRESUMEN
BACKGROUND: Interventions aimed at improving access to timely cancer care for patients in low- and middle-income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City. MATERIALS AND METHODS: From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment. RESULTS: Seventy patients (median age 54, range 19-85) participated in this study. Ninety-six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0-49), and time to specialist appointment was 27 days (range 1-97). Ninety-one percent of patients successfully obtained appointments at cancer centers in <3 months. CONCLUSION: Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients. IMPLICATIONS FOR PRACTICE: A patient navigation program for patients with suspicion or diagnosis of cancer in a second-level hospital was feasible and acceptable. It reduced patient-reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.
Asunto(s)
Detección Precoz del Cáncer , Neoplasias/epidemiología , Navegación de Pacientes , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/patología , Neoplasias/terapia , Pobreza , Derivación y Consulta , Poblaciones VulnerablesRESUMEN
E. coli is considered one of the most important zoonotic pathogens worldwide. Highly virulent and antimicrobial-resistant strains of E. coli have been reported in recent years, making it essential to understand their ecological origins. In this study, we analyzed the characteristics of E. coli strains present in the natural population of American bison (Bison bison) in Mexico. We sampled 123 individuals and determined the presence of E. coli using standard bacteriological methods. The isolated strains were characterized using molecular techniques based on PCR. To evaluate the diversity of E. coli strains in this population, we analyzed 108 suggestive colonies from each fecal sample. From a total of 13,284 suggestive colonies, we isolated 33 E. coli strains that contained at least one virulence gene. The virotypes of these strains were highly varied, including strains with atypical patterns or combinations compared to classical pathotypes, such as the presence of escV, eae, bfpB, and ial genes in E. coli strain LMA-26-6-6, or stx2, eae, and ial genes in E. coli strain LMA-16-1-32. Genotype analysis of these strains revealed a previously undescribed phylogenetic group. Serotyping of all strains showed that serogroups O26 and O22 were the most abundant. Interestingly, strains belonging to these groups exhibited different patterns of virulence genes. Finally, the isolated E. coli strains demonstrated broad resistance to antimicrobials, including various beta-lactam antibiotics.
RESUMEN
INTRODUCTION: Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS: We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS: Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION: Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.
Asunto(s)
Neoplasias , Humanos , Anciano , Masculino , Femenino , Estudios Retrospectivos , Anciano de 80 o más Años , Neoplasias/terapia , México/epidemiología , Persona de Mediana Edad , Factores de Edad , Adulto , Metástasis de la Neoplasia , Desnutrición/epidemiología , Adulto Joven , Cuidados Paliativos , Evaluación de Necesidades , Necesidades y Demandas de Servicios de Salud , Modelos Logísticos , Fatiga/epidemiologíaRESUMEN
Wild adult females of a low trophic omnivore teleost species, the flathead grey mullet (Mugil cephalus), caught in the western Mediterranean were sampled. The lipid and fatty acid composition of ovaries, liver, muscle, and peritoneal fat were analysed at previtellogenesis, early-vitellogenesis -first observed at mid-summer (early August)-, late-vitellogenesis, and the post-spawning period -from mid-September to mid-October-. During ovarian development, the lipid content of muscle was low and constant (3.85%-4.92%), indicating that the muscle was not used to store lipids for gonadal growth. Although constant, lipid content in the liver was higher (18.46%-22.62%) than in the muscle, and HSI% increased during gonad development, suggesting a dynamism in the mobilization of the hepatic lipids. Total lipids in the gonads significantly increased with maturation (from 4.90% to 34.59%) in parallel with the GSI (from 0.8% to 15.5%) to decrease after spawning. Peritoneal fat was probably transitional fat that could be rapidly metabolized or transferred to other tissues but no specific function could be assigned because its presence in previtellogenic and early-vitellogenic females varied greatly. One of the main sources of lipids accumulated in the ovary was most likely diet. The total percentage of ΣMUFA, mainly 17:1 -previously not identified in high quantities in teleost vitellogenic ovaries and likely of bacterial origin- and 16:1, strongly increased in the ovaries with maturation. The 16:1 might be an important source of lipids for embryo development. High percentages of DHA, EPA, and ARA were found in the ovary during previtellogenesis available to be used during gonadal maturation. Understanding lipid and fatty acid changes in broodstock tissues can increase our knowledge of the nutritional requirements of the fish used in aquaculture breeding programs.
Asunto(s)
Ovario , Smegmamorpha , Femenino , Animales , Ovario/metabolismo , Ácidos Grasos/metabolismo , Gónadas/metabolismo , Hígado/metabolismo , Smegmamorpha/metabolismoRESUMEN
Cultured Senegalese sole (Solea senegalensis) breeders fail to spawn fertilized eggs. The implantation of large-scale in vitro fertilization protocols, to solve this problem, has been frustrated by low production of poor quality sperm. Cultured females were induced to ovulate with a 5 µg kg-1 single injection of gonadotropin-releasing hormone agonist (GnRHa) and viable eggs (82.6 ± 9.2% fertilization) were stripped 41:57 ± 1:46 h after the injection. Sperm was collected from cultured males, diluted in modified Leibovitz and used fresh to fertilize the eggs. Males were not treated with hormones. A nonlinear regression, an exponential rise to a maximum (R = 0.93, p < 0.0001) described the number of motile spermatozoa required to fertilize a viable egg and 1617 motile spermatozoa were sufficient to fertilize 99 ± 12% (±95% CI) of viable eggs. Similar, spermatozoa egg-1 ratios of 592 ± 611 motile spermatozoa egg-1 were used in large-scale in vitro fertilizations (190 512 ± 38 471 eggs). The sperm from a single male (145 ± 50 µl or 8.0 ± 6.8 × 108 spermatozoa) was used to fertilize the eggs. The mean hatching rate was 70 ± 14% to provide 131 540 ± 34 448 larvae per fertilization. The viability of unfertilized eggs stored at room temperature decreased gradually, and the sooner eggs were fertilized after stripping, the higher the viability of the eggs. The collection of sperm directly into a syringe containing modified Leibovitz significantly increased the percentage of motile spermatozoa (33.4 ± 12.2%) compared with other collection methods. The spz egg-1 ratios for Senegalese sole were at the lower end of ratios required for fish. Senegalese sole have a pair-spawning reproductive behaviour characterized by gamete fertilization in close proximity with no sperm competition. The provision of a large-scale in vitro fertilization protocol (200 µl of sperm per 100 ml of eggs) will enable the industry to operate sustainably and implement breeding programmes to improve production.
RESUMEN
The impact of Zika virus (ZIKV) infection on pregnancies shows regional variation emphasizing the importance of studies in different geographical areas. We conducted a prospective study in Tegucigalpa, Honduras, recruiting 668 pregnant women between July 20, 2016, and December 31, 2016. We performed Trioplex real-time reverse transcriptase-PCR (rRT-PCR) in 357 serum samples taken at the first prenatal visit. The presence of ZIKV was confirmed in seven pregnancies (7/357, 2.0%). Nine babies (1.6%) had microcephaly (head circumference more than two SDs below the mean), including two (0.3%) with severe microcephaly (head circumference [HC] more than three SDs below the mean). The mothers of both babies with severe microcephaly had evidence of ZIKV infection. A positive ZIKV Trioplex rRT-PCR was associated with a 33.3% (95% CI: 4.3-77.7%) risk of HC more than three SDs below the mean.
Asunto(s)
Microcefalia/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Infección por el Virus Zika/diagnóstico , Virus Zika/genética , Adolescente , Adulto , Femenino , Edad Gestacional , Honduras/epidemiología , Humanos , Incidencia , Microcefalia/complicaciones , Microcefalia/epidemiología , Microcefalia/virología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Diagnóstico Prenatal/métodos , Estudios Prospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/virologíaRESUMEN
Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as "severe microcephaly") and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Informático Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71-2.93) had HC < 2SD, including two (0.35%, 95% CI 0.04-1.24) with HC < 3SD, and 11 (1.9%, 95% CI, 0.79-3.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution.
RESUMEN
BACKGROUND: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. METHODS: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. RESULTS: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). CONCLUSION: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.
Asunto(s)
Neoplasias/enfermería , Cuidados Paliativos/normas , Selección de Paciente , Guías de Práctica Clínica como Asunto , Apoyo Social , Evaluación de Síntomas , Anciano , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
El proceso de superación profesional de los tutores de alumnos ayudantes de la carrera de Estomatología, constituye un eslabón esencial en la educación médica. Después del triunfo de la Revolución cubana, el proceso formativo de posgrado comenzó a germinar. Actualmente, la educación exhorta la preparación constante del profesional, debido a que la población demanda la presencia de un personal altamente calificado en los centros educativos, con elevado compromiso social con su país y una adecuada preparación político-ideológica. El objetivo se centró en fundamentar la importancia de la superación profesional de los tutores de alumnos ayudantes de la carrera de Estomatología. Se revisaron artículos originales y de revisión publicados entre 2000 y 2023, en español e inglés. La búsqueda fue realizada en la base de datos SciELO y a través del motor de búsqueda Google Académico. Las palabras clave utilizadas fueron: "superación profesional", "tutor de alumno ayudante", "componente investigativo". La superación del tutor de alumno ayudante se orientó a la transformación del proceso de enseñanza-aprendizaje y, en la misma medida, contribuyó a su propio cambio. Desde este referente, se delinean los desafíos de este importante proceso en las instituciones universitarias, como es el caso de las universidades de ciencias médicas, específicamente en la carrera de Estomatología. La superación profesional debe estar encaminada a las nuevas demandas de la sociedad, donde la preparación, el desarrollo y el intercambio de conocimientos deben integrar al profesional.
The process of professional improvement of the tutors of assistant students in the Stomatology studies is an essential linkage in Medical Education. After the triumph of the Cuban revolution, the postgraduate training process began to develop. Currently, education urges the constant training of professionals, because the population demands the presence of highly qualified personnel in educational centers, with a high social commitment to their country and adequate political-ideological preparation. The objective focused on substantiating the importance of the professional improvement of the tutors of assistant students in the Stomatology courses. Original and review articles published between 2000 and 2023 in English and in Spanish were reviewed. The search was carried out in the SciELO database and through the Google Scholar search engine. The keywords used were: "professional improvement", "assistant student tutor", "research component". The improvement of the assistant student tutor was aimed at the transformation of the teaching-learning process and, to the same extent, contributes to its own transformation. From this point of reference, the challenges of this important process in university institutions are outlined, as it is the case of the universities of medical sciences, specifically, in the studies of Stomatology. Professional improvement must be aimed at the new demands of society, where training, development and exchange of knowledge must integrate the professional.
RESUMEN
Fundamento la salud bucal es un componente de la salud general de las personas, desarrollar acciones de promoción y prevención desde temprana edad, garantiza estilos de vida saludables. Objetivo determinar la efectividad de una estrategia de intervención educativa para mejorar el nivel de conocimientos sobre salud bucal en escolares de quinto grado. Métodos estudio pre-experimental, de intervención, del tipo antes y después, en 43 escolares del municipio de Venezuela, Ciego de Ávila, Cuba, en el período septiembre de 2018 a enero de 2019. Mediante una encuesta se identificaron las necesidades de aprendizaje. Luego se confeccionó y ejecutó la estrategia de intervención educativa con actividades teórico-prácticas y técnicas afectivo- participativas acordes con la edad d os participantes. Se utilizó como unidad de resumen el por ciento; y para el análisis estadístico, la prueba de McNemar. Resultados antes de la intervención existían conocimientos insuficientes acerca de temas como la caries dental, higiene bucal y dieta cariogénica; después de aplicada la estrategia se modificaron favorablemente los conocimientos acerca de salud bucal en general (65,1 %). La información relacionada con el tiempo de cambio del cepillo, y otros medios auxiliares para realizar la higiene bucal, resultaron los tópicos mejor asimilados (93,0 % y 90,7 % cada uno) por los infantes. Conclusiones la intervención educativa fue eficaz, lo cual se evidenció al elevarse el nivel de conocimientos sobre salud bucal en la población estudiada, como resultado de las acciones educativas realizadas.
Foundation oral health is a component of people's general health, developing promotion and prevention actions from an early age to guarantee healthy lifestyles. Objective to determine the effectiveness of an educational intervention strategy to improve the oral health knowledge level in fifth grade students. Methods pre-experimental, intervention study, of the before and after type, in 43 schoolchildren from the Venezuela municipality, Ciego de Ávila, Cuba, from September 2018 to January 2019. Learning needs were identified through a survey. The educational intervention strategy was prepared and executed with theoretical-practical activities and affective-participatory techniques according to the participants' age. The percent was used as the summary unit; and for statistical analysis, the McNemar test. Results before the intervention there was insufficient knowledge about topics such as dental caries, oral hygiene and cariogenic diet; after applying the strategy, knowledge about oral health in general was modified favorably (65.1%). The information related to the time to change the toothbrush, and other auxiliary means to perform oral hygiene, were the best assimilated topics (93.0 % and 90.7 % each) by the infants. Conclusions the educational intervention was effective; it was evidenced by raising the oral health knowledge level in the studied population, as a result of the educational actions carried out.
RESUMEN
Introducción: El embarazo constituye una etapa acompañada de cambios fisiológicos, patológicos y psicológicos, que convierten a las embarazadas en pacientes especiales que demandan cuidados exclusivos. Estos cambios también se manifiestan en la cavidad bucal y la vuelven más susceptible a la aparición de patologías que repercuten en el curso del embarazo. Objetivo: Determinar el nivel de conocimientos de las embarazadas y sus familiares sobre la relación entre la salud bucal y el período de gestación. Materiales y métodos: Se realizó un estudio descriptivo donde el universo estuvo integrado por 100 gestantes y un miembro de su familia, pertenecientes al Policlínico Docente Belkis Sotomayor Álvarez, de Ciego de Ávila. La muestra estuvo constituida por 32 gestantes y su familiar correspondiente. Se aplicó un cuestionario para la obtención de información. Resultados: Predominó el número de embarazadas y sus familiares que conocían la importancia de la lactancia materna para la salud oral del futuro bebé, al igual que el de quienes consideraron que durante el período de gestación se debe acudir al estomatólogo para la revisión de la gestante -resultados favorables pero insuficientes. La mayor parte de la muestra no considera las enfermedades gingivales y los hábitos inadecuados como perjudiciales para el feto, y afirma que las pérdidas dentarias se agudizan durante la gestación. Conclusiones: El nivel de conocimientos de embarazadas y sus familiares sobre salud bucal y gestación fue regular, por lo que se debe insistir en reevaluar las estrategias para incrementar la cultura sanitaria en este grupo priorizado.
Introduction: Pregnancy is a stage accompanied by physiological, pathological and psychological changes which turn pregnant women into special patients demanding exclusive care. These changes are also manifested in the oral cavity and made them more susceptible to the appearance of pathologies that affect the course of pregnancy. Objective: To determine the level of knowledge of pregnant women and their relatives on the relation between oral health and gestation period. Materials and methods: A descriptive study was carried out, where the universe was formed by 100 pregnant women and a member of their family, belonging to the Teaching Polyclinic Belkis Sotomayor Álvarez, of Ciego de Ávila. The sample was formed by 32 pregnant women and their correspondent relative. A questionnaire was applied to obtain information. Results: The number of pregnant women and their relatives who knew the importance of maternal breastfeeding for the oral health of the future baby predominated, as well as the number of those who considered that during the pregnancy period they should go to the dentist for the oral examination -favorable but insufficient results. Most of the sample does not consider gingival diseases and inappropriate habits as harmful for the fetus, and claims that tooth loss exacerbates during pregnancy. Conclusions: The level of knowledge of pregnant women and their relatives on oral health and gestation was regular, so it is necessary to insist in reevaluating the strategies to increase the sanitary culture in this prioritized group.
RESUMEN
Introducción: Las enfermedades bucales se encuentran entre las cinco de mayor demanda de atención en los servicios de salud a nivel mundial. Materiales y métodos: Se realizó una investigación observacional analítica retrospectiva de casos y controles, con el objetivo de determinar el grado de asociación entre la caries dental y los factores de riesgo en la población infantil de 5 a 12 años del Consultorio del Médico de la Familia no. 3, pertenecientes al Policlínico Docente Belkis Sotomayor Álvarez, del municipio Ciego de Ávila, durante el período de octubre de 2021 a marzo de 2022. El grupo de casos estuvo integrado por 62 niños, al igual que el grupo control. Se utilizó la técnica de independencia basada en la distribución de Chi-cuadrado, para determinar la presencia de asociación estadística entre variables cualitativas, y se realizó el cálculo del Odd ratio para la cuantificación de riesgo. Resultados: El grupo de 5 a 8 años fue el de mayor número de niños con caries dental, para un 59,7 %. El 62,9 % solo se cepillaban los dientes con una frecuencia de dos o menos veces al día. El antecedente de caries dental, la enfermedad gingival y la ingestión de alimentos azucarados, estuvieron relacionados con la aparición de caries dental. Conclusiones: La dieta cariogénica resultó ser el factor de riesgo con mayor puntaje en la incidencia de la caries dental en la muestra estudiada.
Introduction: Oral diseases are among the five diseases demanding more care in health services worldwide. Materials and methods: A descriptive, analytic, observational research of cases and controls was carried out, with the objective of determining the association degree between dental caries and risk factors in the child population aged from 5 to 12 years from the Family Physician Consultation Nr. 3, belonging to the Teaching Polyclinic Belkis Sotomayor Alvarez, in the municipality Ciego de Avila, during the period from October 2021 to March 2022. The case group consisted of 62 children, the same as the control group. The independence technique based on the Chi-square distribution was used to determine the presence of statistical association between qualitative variables, and the Odd ratio was calculated for risk quantification. Results: The group from 5 to 8 years was the one with higher number of children with dental caries, for 59.7%. 62.9% only brushed their teeth with a frequency of two or less times a day. History of dental caries, gingival disease and sugary food ingestion were related to the appearance of dental caries. Conclusions: The cariogenic diet proved to be the risk factor with the higher score in the incidence of dental caries in the sample studied.
RESUMEN
The recent Zika virus (ZIKV) epidemic swept across Latin America and the Caribbean, where dengue virus (DENV) is endemic. The antigenic similarities of these closely related flaviviruses left researchers and clinicians with challenges to interpret serological tests. Thirty-six women attending a prenatal clinic in Honduras and with positive DENV IgM enzyme-linked immunoabsorbent assays (ELISAs) were screened with a ZIKV immunoglobulin M ELISA, reverse transcription polymerase chain reaction for ZIKV and DENV 1-4, and plaque reduction neutralization tests (PRNTs) for ZIKV and DENV-2. Plaque reduction neutralization test results were interpreted using the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) criteria. Using the WHO criteria of a PRNT90 titer ≥ 20 and a 4-fold difference between ZIKV and DENV titers, we determined that 69.4% of samples had a recent ZIKV infection, compared with 5.6% using CDC criteria. The interpretation of ZIKV PRNTs in a DENV-endemic region is highly dependent on the choice of interpretation criteria.
Asunto(s)
Pruebas de Neutralización/métodos , Pruebas Serológicas/métodos , Ensayo de Placa Viral/métodos , Organización Mundial de la Salud , Infección por el Virus Zika/diagnóstico , Anticuerpos Neutralizantes , Anticuerpos Antivirales , Antígenos Virales , Reacciones Cruzadas , Virus del Dengue , Femenino , Humanos , Embarazo , Virus Zika , Infección por el Virus Zika/virologíaRESUMEN
INTRODUCTION: Reference values for liver stiffness for healthy individuals vary worldwide. Different optimal cutoff values correspond to the stages of fibrosis in chronic liver disease. OBJECTIVES: Characterize the distribution of liver stiffness in Cuban adults without liver disease and its association with age, serum uric acid and body mass index. METHODS: A cross-sectional study was performed of 110 plasma donors recruited from the Havana Province Blood Bank January 2016 through February 2017. Measurements of liver stiffness were performed using a FibroScan elastography device on the same day of laboratory analyses and abdominal ultrasound. The Pearson coefficient was used to assess correlations, and the reference range was calculated using the mean and its 95% confidence interval. RESULTS: Liver stiffness values observed ranged from 2.2-6.3 kPa. The reference range (95% CI) for the 110 subjects without known liver disease was 4.2-4.6 kPa (mean 4.4). A positive correlation was observed between liver stiffness measurements and body mass index (r = 0.255, p ⟨0.01) and serum uric acid (r = 0.266, p ⟨0.01). There was no correlation between liver stiffness and age. Liver stiffness in women was similar to that of men, 4.3 (2.4-6.1) and 4.5 (2.2-6.3) kPa, respectively (p = 0.086). CONCLUSIONS: Liver stiffness in Cuban adults without liver disease ranges from 2.2-6.3 kPa. The reference range is 4.2-4.6 kPa. Body mass index and serum uric acid levels are positively associated with liver stiffness. CONTRIBUTION OF THIS RESEARCH: This is the first Cuban study using FibroScan to measure liver stiffness; its results will enable better assessment of liver disease in clinical practice.