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INTRODUCTION: Previous studies have detected mitochondrial alterations in tissues of individuals with obesity and type 2 diabetes mellitus (T2DM). Metabolic surgery could be an effective treatment to improve mitochondrial morphology and reduce oxidative stress (OS). METHODS: An experimental study was carried out using 48 male Wistar rats, divided into 6 groups (n = 8): control (C), induced Metabolic Syndrome (MS); intervention with sleeve gastrectomy (SG), MS + SG with 6 weeks postoperatively (MS + SG6), MS + SG with 12 weeks postoperatively (MS + SG12), and MS + SG with 24 weeks postoperatively (MS + SG24). Biochemical markers indicative of MS (glycemia, cholesterol, and triglyceride levels) and oxidative stress markers (nitric oxide levels, Superoxide dismutase and Myeloperoxidase activity) were determined. To study mitochondrial morphology, tissue sections of the thoracic aorta, stomach, liver, heart, and kidney were observed by electron microscopy. RESULTS: MS group exhibited elevated glycemic values and dyslipidemia. SG and MS + SG groups showed improvements in glycemia and lipid profiles compared to MS. OS biomarkers indicated reduced oxidative stress in SG and MS + SG groups compared to MS. Electron microscopy revealed mitochondrial alterations in MS. SG group showed no changes compared to the control. MS + SG6 and MS + SG12 groups showed a recovery of mitochondrial morphology until reaching images similar to the control in MS + SG24. CONCLUSION: Metabolic surgery could improve mitochondrial function by restoring mitochondrial morphology and architecture and, consequently, reducing systemic oxidative stress and remitting associated metabolic alterations.
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Gastrectomia , Síndrome Metabólica , Mitocôndrias , Estresse Oxidativo , Ratos Wistar , Animais , Síndrome Metabólica/metabolismo , Masculino , Ratos , Mitocôndrias/metabolismo , Modelos Animais de Doenças , Glicemia/metabolismo , Biomarcadores/metabolismo , Biomarcadores/sangueRESUMO
While CD40 agonism is an attractive approach for activating antigen-presenting cells and initiating antitumor responses, previous attempts have encountered limited clinical efficacy coupled with toxicity. We previously demonstrated that interactions between the antibody Fc domain and the inhibitory receptor FcγRIIB are critical for enhanced antitumor activity. Here, we present the results of a phase 1 study on intratumoral administration of an anti-CD40 agonistic antibody (2141-V11) Fc-engineered to enhance FcγRIIB binding. Primary endpoints included safety, maximum tolerated dose (MTD), and recommended phase 2 dose. Secondary objectives included preliminary clinical activity and correlative studies from biospecimens. 2141-V11 was well-tolerated without dose-limiting toxicities and MTD was not reached. In ten evaluable patients with metastatic cancer, the overall response rate was 20%, with complete responses in two patients (melanoma and breast carcinoma) and stable disease in six patients. 2141-V11 induced tumor regression in injected and non-injected lesions, with increased leukocyte infiltration and tertiary lymphoid structures (TLS) formation in post-treatment biopsies. In a humanized mouse model for CD40 and FcγRs, 2141-V11 induced TLS formation in mice bearing orthotopic breast carcinoma, correlating with local and abscopal antitumor effects, systemic immune activation, and immune memory. These findings support the safety and efficacy of 2141-V11, warranting phase 2 studies and suggesting a unique mechanism of action for this Fc-enhanced immunotherapy (NCT04059588).
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Preclinical murine data indicate that fragment crystallizable (Fc)-dependent depletion of intratumoral regulatory T cells (Treg) is a major mechanism of action of anti-CTLA-4. However, the two main antibodies administered to patients (ipilimumab and tremelimumab) do not recapitulate these effects. Here, we investigate the underlying mechanisms responsible for the limited Treg depletion observed with these therapies. Using an immunocompetent murine model humanized for CTLA-4 and Fcγ receptors (FcγR), we show that ipilimumab and tremelimumab exhibit limited Treg depletion in tumors. Immune profiling of the tumor microenvironment (TME) in both humanized mice and humans revealed high expression of the inhibitory Fc receptor, FcγRIIB, which limits antibody-dependent cellular cytotoxicity/phagocytosis. Blocking FcγRIIB in humanized mice rescued the Treg-depleting capacity and antitumor activity of ipilimumab. Furthermore, Fc engineering of antibodies targeting Treg-associated targets (CTLA-4 or CCR8) to minimize FcγRIIB binding significantly enhanced Treg depletion, resulting in increased antitumor activity across various tumor models. Our results define the inhibitory FcγRIIB as an immune checkpoint limiting antibody-mediated Treg depletion in the TME, and demonstrate Fc engineering as an effective strategy to overcome this limitation and improve the efficacy of Treg-targeting antibodies.
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Neoplasias , Linfócitos T Reguladores , Humanos , Animais , Camundongos , Ipilimumab/farmacologia , Ipilimumab/uso terapêutico , Antígeno CTLA-4 , Microambiente Tumoral , Neoplasias/tratamento farmacológicoRESUMO
The increasing demand for optimizing the use of agricultural resources will require the adoption of cutting-edge technologies and precision farming management. Unmanned Aerial Vehicle (UAV) sprayers seem promising due to their potential to perform precision or spot spraying, particularly in woody crop environments where total surface spraying is unnecessary. However, incorporating this technology is limited by the lack of scientific knowledge about the environmental risks associated with UAV sprayers and the strict legal framework. Nonetheless, these spraying systems' characteristic downwash airflow and the limited swath width can potentially mitigate drift in hedgerow crops. During our study we performed comparative studies aimed to compare the airborne drift, soil, and crop depositions between a conventional orchard sprayer and a UAV sprayer in a commercial superhigh-density orchard in the South Iberian Peninsula in 2022. Our findings reveal that, in superhigh-density olive orchards, the UAV sprayer presents a substantial reduction in airborne drift, while soil depositions showed no significant differences compared to those of a conventional terrestrial orchard sprayer. Crop depositions were significantly lower when utilizing the UAV sprayer. These results suggest that introducing UAV spraying technology in Mediterranean agricultural systems, under specific scenarios, can effectively reduce the environmental impact of crop spraying and encourage the responsible use of plant protection products (PPPs).
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Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.
Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.
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RESUMEN La incertidumbre es la regla en el abordaje sanitario para mitigar la pandemia de COVID-19 en los pueblos indígenas en muchos países al sur del continente americano. Es aquí donde tiene cabida la pertinencia intercultural como herramienta necesaria para aproximar el mundo científico-tecnológico o biologicista a la cultura de cada pueblo, es decir, a la construcción dinámica de creencias, conocimientos, pensamientos y prácticas o conductas aprendidas en su relación con el medio ambiente e iguales, con el fin de lograr un acuerdo mínimo en el tratamiento de patologías emergentes, y por tanto, no incluidas en los programas sanitarios y que pueden resultar devastadoras para estos sectores debido a sus peores condiciones para enfrentarla. La pertinencia intercultural, tema de transcendental actualidad, se cree es la estrategia con la que los Estados pueden aplicar plenamente en material de salud su carta magna, toda vez que muchas reconocen la organización social, política y económica que rige a los pueblos indígenas, y particularmente sus costumbres culturales y religiosas, su lengua y hábitat.
ABSTRACT Uncertainty is the rule in the health approach to mitigate COVID-19 pandemic in indigenous peoples in many countries in the south of the American continent. This is where intercultural relevance has a place as a necessary tool to bring the scientific-technological or biological world closer together to the culture of each people, that is, to the dynamic construction of beliefs, knowledge, thoughts and practices or behaviors learned in their relationship with the environment and peers, in order to achieve a minimum agreement in the treatment of emerging pathologies, and therefore, not included in health programs and that can be devastating for these sectors due to their worse conditions to face it. Intercultural relevance, a transcendental issue today, is believed to be the strategy with which States can fully apply their Magna Carta in health matters, since many recognize the social, political and economic organization that governs indigenous peoples, and particularly their cultural and religious customs, their language and habitat.
RESUMO A incerteza é a regra na abordagem da saúde para mitigar a pandemia de COVID-19 em povos indígenas em muitos países do sul do continente americano, onde a relevância intercultural tem lugar como ferramenta necessária para aproximar o mundo científico-tecnológico ou biológico mais próximos da cultura de cada povo, ou seja, da construção dinâmica de crenças, conhecimentos, pensamentos e práticas ou comportamentos aprendidos em sua relação com o meio ambiente e com os pares, a fim de alcançar um acordo mínimo no tratamento de patologias emergentes , e, portanto, não incluídos nos programas de saúde e que podem ser devastadores para esses setores devido às suas piores condições de enfrentá-lo. A relevância intercultural, hoje uma questão transcendental, acredita-se ser a estratégia com a qual os Estados podem aplicar plenamente sua Carta Magna em matéria de saúde, já que muitos reconhecem a organização social, política e econômica que rege os povos indígenas e, particularmente, seus costumes culturais e religiosos, sua língua e habitat.
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Resumen Introducción: El Síndrome de Turner (ST) es una alteración cromosómica sexual causada por la ausencia parcial o completa del cromosoma X, además de mosaicismos y otras alteraciones estructurales del cromosoma X o Y; está presente en 1 de 2500 nacidas vivas. Objetivo: Describir las variantes citogenéticas de pacientes con síndrome de Turner y evaluar su asociación con el fenotipo de presentación y la edad del diagnóstico. Método: Estudio retrospectivo de corte transversal de una serie de 82 casos de síndrome de Turner. Los cariotipos fueron realizados utilizando el medio RPMI-1640; las preparaciones de cromosomas se obtuvieron utilizando técnicas estándar y se analizaron mediante bandas GTG con una resolución de 400-450 bandas, donde se contó con 20-50 metafases para reducir la probabilidad de no detección de mosaicismo. Resultados: 45 (55.6%) fueron diagnosticadas, con monosomía clásica del cromosoma X, mientras 29 (35,8%) mostraron anomalías estructurales del cromosoma X y 7 (8,6%) se asociaron a mosaicos numéricos del cromosoma X. Solo 21 (26%) pacientes fueron diagnosticadas por debajo de los 12 años, mientras el resto 60 (74%) se detectaron entre la adolescencia y la adultez. La baja estatura fue una característica universal en todos los grupos de estudio. Conclusiones: Las fórmulas cromosómicas en el síndrome de Turner pueden ser muy variadas y tener diversas implicaciones en el fenotipo; se destaca la baja talla como un criterio clínico relevante en la sospecha clínica.
Abstract Introduction: Turner Syndrome (TS) is a sexual chromosomal alteration caused by the partial or complete absence of the X chromosome, in addition to mosaicisms and other structural alterations of the X or Y chromosome; It is present in 1 in 2,500 live births. Objective: To describe the cytogenetic variants of Turner syndrome patients and to evaluate their association with the phenotype at presentation and age at diagnosis. Methods: Retrospective cross-sectional study of a series of 82 cases of Turner syndrome. Karyotypes were performed using RPMI-1640 medium; Chromosome preparations were obtained using standard techniques and analyzed by GTG banding with a resolution of 400-450 bands where 20-50 metaphases were counted to reduce the probability of missing mosaicism. Results: 45 (55.6%) were diagnosed with classic monosomy of the X chromosome, while 29 (35.8%) showed structural abnormalities of the X chromosome and 7 (8.6%) were associated with numerical mosaics of the X chromosome. Only 21 (26%) patients were diagnosed under 12 years of age, while the rest 60 (74%) were detected between adolescence and adulthood. Short stature was a universal characteristic in all study groups. Conclusions: The chromosomal formulas in Turner syndrome can be variable and have different implications in the phenotype; short stature stands out as a relevant clinical criterion in clinical suspicion.
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Humanos , Feminino , Síndrome de Turner/genética , Fenótipo , Síndrome de Turner/classificação , Reação em Cadeia da Polimerase , Estudos Transversais , Estudos Retrospectivos , Hibridização in Situ Fluorescente , Idade de Início , Análise Citogenética , Cromossomos Humanos X , Equador , Genótipo , Cariotipagem , MonossomiaRESUMO
Introducción: una alternativa para mitigar los efectos del virus de inmunodeficiencia humana (VIH) es la medicina complementaria, alternativa o integrativa (MCAI); sin embargo, esta puede tener una influencia negativa en los pacientes con VIH. Objetivo: estimar la relación entre la carga viral y el uso de MCAI en pacientes con VIH/SIDA. Metodología: estudio analítico con 232 pacientes de la clínica de VIH/SIDA de una unidad médica de segundo nivel de atención en Cancún, México. Previo consentimiento informado, a cada paciente se le aplicó un cuestionario para identificar el uso de la MCAI y simultáneamente se obtuvo el conteo de carga viral y el CD4 del expediente electrónico. Resultados: el 47.8% utilizaron herbolaria como tratamiento alternativo. No se encontró diferencia estadística entre la utilización de herbolaria y su conteo de carga viral (p > 0.646). La terapia cuerpo-mente, los suplementos vitamínicos, la homeopatía y la acupuntura se usaron del 5 al 24.6%, sin diferencia estadística (p > 0.05) entre los grupos. Por el contrario, el uso de sesiones de manipulación del cuerpo mostró diferencia en relación con quienes no las utilizaban (p < 0.05). Conclusiones: es importante que el profesional de la salud identifique los efectos adversos o benéficos de las terapias alternativas y complementarias, con la finalidad de orientar a sus pacientes y no afectar su tratamiento antirretroviral y, en consecuencia, su conteo de carga viral.
Introduction: An alternative to mitigate the effects of human immunodeficiency virus (HIV) is the complementary and alternative medicine (CAM); however, this could have a negative influence in patients with HIV. Objective: To estimate the relationship between viral load and the use of CAM in patients with HIV/AIDS. Method: Analytical study with 232 patients from the HIV/AIDS Clinic of a second-level healthcare unit in Cancun, Mexico. With prior informed consent, a questionnaire was administered to each patient to identify the use of CAM, and, simultaneously, the viral load and CD4 counts were obtained from their electronic file. Results: 47.8% used herbal medicine as an alternative treatment. No statistical difference was found between the use of herbal products and their viral load (p > 0.646). Body-mind therapy, vitamin supplements, homeopathy and acupuncture were used from 5 to 24.6% without statistical difference (p > 0.05) among groups. However, the use of massage therapy showed a difference in relation to those who did not use it (p < 0.05). Conclusions: It is important that health professionals identify the adverse or beneficial effects of alternative and complementary therapies, so that they can guide their patients and not affect their antiretroviral treatment and, consequently, their viral load.
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Humanos , Terapias Complementares , HIV , Atenção Secundária à Saúde , Atenção à Saúde , MéxicoRESUMO
Introducción: los pacientes con enfermedad renal crónica (ERC), y en específico los que tienen tratamiento renal sustitutivo (TRS), se ven afectados en su ciclo circadiano y en su calidad del sueño. Objetivo: evaluar la calidad del sueño de los pacientes con enfermedad renal crónica que acuden al servicio de Nefrología de una unidad médica de segundo nivel de atención. Metodología: estudio comparativo en pacientes con ERC del servicio de Nefrología, clasificados en tres grupos, dos de ellos en terapia de reemplazo renal (diálisis peritoneal y hemodiálisis) y uno sin terapia de reemplazo renal (prediálisis). Para la calidad del sueño se utilizó la escala de Pittsburgh, se incluyeron datos sociodemográficos y parámetros bioquímicos. Los datos se analizaron median- te comparación de frecuencias con Chi cuadrada, medias con t de Student y ANOVA de un factor. Resultados: se formaron tres grupos: hemodiálisis (n = 75), diálisis peritoneal (n = 58) y prediálisis (n = 71). La edad media fue de 53.5 años; la calidad subjetiva del sueño fue buena en el 48% del total y en el 54.9% de los pacientes en prediálisis (p < 0.05). Al aplicar la escala de Pittsburgh, el 80.4% del total y el 84.5% de los pacientes en diálisis reportaron una calidad de sueño mala. De las siete dimensiones evaluadas, dos fueron diferentes en los tres grupos (p < 0.05). Conclusiones: la percepción del paciente sobre la calidad del sueño habitualmente se sobreestima, lo que indica una adaptación a un sueño ineficiente. Debido a las características de estos pacientes es importante mantener un control de sus parámetros bioquímicos, que también tienen un impacto en la calidad del sueño.
Introduction: In patients with chronic kidney disease (CKD) and specifically with renal replacement therapy (RRT), their circadian cycle and consequently their sleep quality are affected. Objective: To evaluate the quality of sleep in patients with chronic kidney disease attends at the nephrology service. Methods: Comparative study in patients with chronic kidney disease from the nephrology service classified into three groups, two of them had renal replacement therapy (peritoneal dialysis and hemodialysis) and one without renal replacement therapy (predialysis). For the quality of sleep we used the Pittsburgh Scale, sociodemographic data and biochemical parameters were included. Comparison of frequencies with chi-square, means with Student's t and Anova of one factor. Results: Three groups were formed: hemodialysis (n = 75), peritoneal dialysis (n = 58) and predialysis (n = 71). The mean age was 53.5 years; the subjective quality of sleep was "good" in 48.0% of the total and in 54.9% of predialysis patients (p <0.05). When applying the Pittsburgh scale, 80.4% of the total and 84.5 of the dialysis patients reported a "poor" quality of sleep. Of the seven dimensions evaluated, two were different in the three groups (p < 0.05) Conclusions: The patient's perception of the quality of sleep is regularly overestimated, which indicates an adaptation to this dream habit. Due to the characteristics of these patients, it is important to keep a check on their biochemical parameters, which also have an impact on the quality of sleep.
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Humanos , Atenção Secundária à Saúde , Insuficiência Renal Crônica , Distúrbios do Início e da Manutenção do Sono , Diálise Peritoneal , México , NefrologiaRESUMO
RESUMEN La investigación permite el fortalecimiento de las disciplinas, particularmente aquellas que se nutren de información de varias especialidades, como la salud pública. El objetivo de este informe es proporcionar de forma consolidada perspectivas metodológicas viables para enriquecer a la salud pública como ciencia. De la revisión destacan tres elementos claves: el tipo de abordaje investigativo, los enfoques de evidencia y competencia en el contexto metodológico de la indagación en la salud colectiva. Se concluye que el conocimiento sistemático, específico, integrado al contexto y obtenido en atención a las circunstancias de la investigación, el objeto de estudio y la ubicación institucional, contribuyen con el fortalecimiento de la salud pública como ciencia multidisciplinaria, directamente implicada, por su competencia y base en la evidencia, en la toma de decisiones en materia de salud por parte del Estado en áreas tan importantes como las necesidades, los servicios y los sistemas de salud.
ABSTRACT Research allows for the strengthening of disciplines, particularly those that draw on information from various specialties, such as public health. The objective of this report is to provide consolidated methodological perspectives to enrich public health as a science. The review highlights three key elements: the type of investigative approach, the evidence and competence approaches in the methodological context of the inquiry into collective health. It is concluded that the systematic, specific knowledge, integrated to the context and obtained in attention to the circumstances of the investigation, the object of study and the institutional location, contribute with the strengthening of public health as a multidisciplinary science, directly involved, for its competence and based on the evidence, in the decision making in matters of health by the State in areas as important as needs, services and health systems.
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Humanos , Pesquisa em Sistemas de Saúde Pública/métodosRESUMO
La Leishmaniosis tegumentaria americana (LTA) es considerada un problema de salud pública por su elevada incidencia. Además, es una patología abordada en muchos países a través de programas sanitarios con estructura vertical, sin contacto social y sin considerar la cultura de los grupos poblacionales, a sabiendas que existen diferencias en cuanto a ésta en el tratamiento de la enfermedad. El objetivo es la descripción y análisis de la pertinencia cultural del proceso de atención en salud en el caso de LTA, con base en la revisión bibliográfica de literatura científica sobre esta patología y sobre el papel de la cultura sobre la misma como aporte de ideas y de conocimientos para el debate necesario en el diseño de políticas y programas sanitarios de control de patologías parasitarias.(AU)
American tegumentary Leishmaniasis (LTA) is considered a public health problem because of its high incidence. In addition, it is a pathology addressed in many countries through health programs with vertical structure, without social contact and without considering the culture of the population groups, knowing that there are differences in the treatment of the disease. The objective is the description and analysis of the cultural relevance of the health care process in the case of LTA, based on the bibliographical review of scientific literature on this pathology and on the role of culture in the same as contribution of ideas and of knowledge for the necessary debate in the design of health policies and programs to control parasitic diseases.(AU)
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Humanos , Masculino , Feminino , Doenças Parasitárias , Características Culturais , Dermatopatias , Competência Cultural , Programas Nacionais de SaúdeRESUMO
Objetivo: Determinar las características del estado periodontal en gestantes que acudieron al Hospital Materno Infantil San Pablo (HMISP) de Asunción, Paraguay en el periodo comprendido entre diciembre del 2015 a febrero del 2016. Métodos: Se realizó un estudio observacional descriptivo de corte transversal a pacientes embarazadas que asistieron a su primera consulta prenatal. Se aplicó una encuesta sobre factores sociodemográficos, hábitos de higiene oral e instrucción de salud bucal por parte del personal de salud. La evaluación del estado periodontal se realizó en una hoja de registro de datos clínicos, que incluyó el índice gingival (IG) de Löe y Silness en dientes del sextante anteroinferior. Resultados: Se evaluaron a 96 pacientes con edades comprendidas entre 15 y 37 años, con una media de 23,8, desviación estándar 5,47. Se evidenció que la gingivitis predominó en las gestantes en un 85,4% (n=82). La gingivitis moderada fue la manifestación más frecuente (49%), tanto en el primer como el tercer trimestre, en tanto que la gingivitis severa se presentó en menor proporción (3,1%). Conclusiones: La gingivitis predominó en las gestantes en un 85,4%, siendo más frecuente la gingivitis moderada en un 49% según lo registrado con el IG de Löe y Silness. Palabras clave: Embarazo; Gingivitis; Paraguay.
Objective: To determine characteristics of the periodontal status in pregnant women attending the San Pablo Mother and Child Hospital in Asunción, Paraguay, during December of 2015 to February of 2016. Methods: A descriptive cross-sectional observational study was conducted on pregnant patients who attended their first prenatal visit. A survey on sociodemographic factors, oral hygiene habits and oral health instructions, was conducted by health personnel. The periodontal status' assessment was stated as part of a clinical data record sheet, which included the Gingival Index (GI) of Löe and Silness of the lower anterior sextant. Results: A total of 96 patients between 15 and 37 years old, were evaluated, with an average of 23.8, standard deviation 5.47. Results stated that gingivitis predominated in pregnant women in 85.4% (n=82). Moderate gingivitis prevailed (49%), both in the first and third trimesters, while severe gingivitis had less prevalence (3.1%). Conclusions: Gingivitis predominated in pregnant women in 85.4%. Moderate gingivitis being prevalent in 49% according with the Löe and Silness GI results. Keywords: Gingivitis; Paraguay; Pregnancy.
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RESUMEN Objetivo Analizar la ingesta de macronutrientes y su relación con la edad y sexo en estudiantes de educación superior. Métodos Se realizó un estudio transversal conformado con 218 estudiantes de educación superior de 18 a 30 años. Se utilizó un instrumento validado y confiable, para medir el consumo de macronutrientes. Resultados Respecto a la ingesta de consumo de macronutrientes se observa que hay diferencia estadística por sexo, a favor de los hombres (p>0,05), excepto en el consumo de proteínas en los estudiantes mayores de 25 años. En el grupo etario menor a 20 años, los hombres tienen un mejor consumo de proteínas. En estudiantes de 20 a 25 años el consumo de macronutrientes es parecido entre hombres y mujeres. Discusión Los resultados evidencian que el porcentaje de consumo respecto del valor ideal de requerimiento estimado para actividad ligera según FAO/OMS/ONU 2004, está por debajo, con un déficit de consumo de macronutrientes que oscila entre el 20% y el 60%.(AU)
ABSTRACT Objective To analyze the intake of macronutrients and its relationship with age and sex in higher education students. Materials and Methods A cross-sectional study was carried out with 218 higher education students, aged between 18 and 30 years. A validated and reliable instrument was used to measure macronutrient consumption. Results Regarding the intake of macronutrients, a statistical difference by sex was observed in favor of men (p>0.05), except for the consumption of proteins in students older than 25 years. In the group under 20 years of age, men showed better protein intake. Finally, in students between 20 and 25 years, the consumption of macronutrients is similar among men and women. Discussion The results show that the percentage of consumption with respect to ideal value of the estimated requirement for light activity according to FAO/WHO/UN 2004 is below the recommendations, with a macronutrient consumption deficit that ranges between 20% and 60%.(AU)
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Humanos , Estudantes , Nutrientes , Comportamento Alimentar , Estudos Transversais/instrumentaçãoRESUMO
Introducción: la preeclampsia es un trastorno multisistémico cuyos criterios clínicos no han cambiado en la última década. De acuerdo con la OMS, la incidencia de preeclampsia oscila entre el 2 y 10% del total de embarazos, y su prevalencia es siete veces mayor en los países en vías de desarrollo que en los países desarrollados. Objetivo: describir las características epidemiológicas, clínicas y antecedentes obstétricos de las pacientes con diagnóstico de preeclampsia-eclampsia de la unidad de cuidados intensivos adultos (UCIA). Métodos: estudio descriptivo transversal retrospectivo, se incluyeron 20 expedientes clínicos de las pacientes entre 13 y 45 años de edad, con embarazo ≥ 20 semanas de gestación de la unidad de cuidados intensivos adultos, con diagnóstico confirmado de preeclampsia-eclampsia. Se aplicó un instrumento diseñado para el estudio. Resultados: edad promedio de 28.45 ± 6.57 años. El 55% presentó preeclampsia severa y síndrome de HELLP el 60%. Con estancia en la UCIA de 2.4 ± 1.43 días. Conclusiones: aunque los datos no fueron suficientes para documentar, la proporción de pacientes con hipertensión arterial y antecedentes de preeclampsia, así como, hipertensión arterial de comorbilidad fue superior a lo referido en un estudio con embarazadas en Colombia de 12.4%.
Introduction: Preeclampsia is a multisystem disorder whose clinical criteria have not changed in the last decade. According to the WHO, the incidence of preeclampsia varies between 2% and 10% of all pregnancies, and its prevalence is seven times higher in developing countries than in developed countries. Objective: To describe the epidemiological and clinical characteristics and obstetric history of patients diagnosed with preeclampsia-eclampsia of the adult intensive care unit (ICU). Methods: A retrospective cross-sectional descriptive study, 20 clinical files were included of patients between 13 and 45 years of age, with pregnancy ≥ 20 weeks gestation of the adult intensive care unit, with a confirmed diagnosis of preeclampsia- eclampsia. An instrument designed for the study was applied. Results: Average age 28.45 ± 6.57 years. 55% presented severe preeclampsia and HELLP syndrome 60%. With a stay in the UCIA of 2.4 ± 1.43 days. Conclusions: Although the data were not enough to document, the proportion of patients with hypertension and a history of preeclampsia, as well as, comorbidity hypertension were higher than that reported in a study with pregnant women in Colombia of 12.4%.
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Humanos , Pré-Eclâmpsia , Gravidez , Epidemiologia Descritiva , Estudos Transversais , Fatores de Risco , Cuidados Críticos , Hipertensão , MéxicoRESUMO
Muchas veces se usan corticoesteroides en el contexto de un shock séptico severo; pese a que en el 2008, el estudio CORTICUS no demostró su utilidad para disminuir la mortalidad. Sin embargo, su empleo como estrategia para aminorar la necesidad de apoyo vasoactivo y obtener respuesta hemodinámica precoz durante el shock séptico está ampliamente protocolizado en las unidades de cuidados intensivos a nivel mundial, aunque no siempre es fácil evaluar su real utilidad caso a caso. Se presenta un caso clínico, donde se empleó corticoterapia como estrategia de rescate en una paciente críticamente enferma; sin embargo, una adecuada y dirigida anamnesis demostró que en realidad nos enfrentábamos a una insuficiencia suprarrenal aguda, por suspensión abrupta de prednisona ( 25 mg diarios) de uso crónico, y que se presentó como un shock distributivo. En este caso, el uso de corticoesteroides es indispensable para la buena respuesta; y la importancia radica en la sospecha y la anamnesis adecuada al familiar o paciente.
Corticosteroids are widely used in the context of severe septic shock, even though the CORTICUS study in 2008 failed to show that they reduce mortality. Although their case by case utility is not always easy to assess, they continue to be included in intensive care units protocols worldwide with the aim of reducing the need for vasoactive support and achieving an early hemodynamic response during severe septic shock. In this clinical study steroids were used as an emergency measure in a critically ill patient. However, taking an exhaustive case history showed that we were indeed facing an acute adrenal insufficiency due to abrupt withdrawal of chronic use prednisone, and it presented as a distributive shock. In this case, corticosteroids use is essential for an effective response and one must first suspect the omission and take a thorough case history from the patient and/or family.
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Objetivo: Caracterizar a los nódulos tiroideos (NT) no malignos en espera de tiroidectomía no prioritaria en el Hospital Dr. Gustavo Fricke, durante los años 2002 al 2014, considerando variables clínicas y ecotomográficas, así como su evolución durante el seguimiento. Materiales y métodos: Estudio observacional descriptivo de corte transversal, de pacientes ingresados a lista de espera de tiroidectomía por diagnóstico de nódulo tiroideo. Resultados: Se obtuvo una muestra de 27 pacientes, en su mayoría mujeres, mayores de 45 años, eutiroideos y asintomáticos. La evaluación ecotomográfica de los NT mostró un tamaño promedio de 38.6 mm, predominantemente hipoecogénicos, con bordes regulares y sin adenopatías asociadas. En 21 casos se contó con Punción Aspirativa con Aguja Fina (PAAF), cuyo resultado correspondió a categoría benigna o indeterminada. Diecisiete pacientes presentaron aumento progresivo del tamaño de los NT en el seguimiento ecotomográfico. Cuatro pacientes tuvieron resolución quirúrgica dentro del período, confirmándose patología benigna en todos los casos. El tiempo de espera promedio de estos pacientes fue 6.7 años. Conclusiones: Los NT indeterminados que se encuentran en espera de resolución quirúrgica no prioritaria en nuestro hospital son resueltos en muy baja proporción además de tener un tiempo de espera de varios años, por lo que consideramos fundamental optimizar la evaluación inicial de estos NT con un estudio ecotomográfico estandarizado y un estudio anatomopatológico que incorpore la biología molecular.
Objective: To characterize non-malignant thyroid nodules awaiting a low priority thyroidectomy in Dr. Gustavo Fricke Hospital, from 2002 to 2014, considering clinical and ultrasonic variables as well as their clinical course throughout the period. Materials and Methods: Observational descriptive study of a transversal sample of patients on the thyroidectomy waiting list with the diagnosis of thyroid nodule. Results: The sample size was 27 asymptomatic patients, mainly women, over the age of 45 with normal thyroid function. The average size of the non-malignant thyroid nodule as determined by ultrasonography was 38.6mm, predominantly with decreased echogenicity, regular borders and no associated lymphadenopathies. Fine-needle aspiration biopsies had been performed on 21 nodules with benign or undetermined results. Ultrasonography follow-ups showed that the nodules had grown in seventeen patients. Four patients were operated on during the period of study, benign pathology being confirmed in all cases. The average wait for surgery was 6.7 years. Conclusions: In our hospital a very low proportion of indeterminate non-malignant thyroid nodules awaiting low priority surgical procedures receives surgical resolution and the waiting time is several years, hence it is essential to optimize the initial evaluation of these non-malignant thyroid nodules using standardized ultrasonography and cytopathological study incorporating molecular biology.
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Although radioiodine (131-I) can be used as treatment of hyperthyroidism for patients in hemodialysis, its use is limited and the experience is mainly related to differentiated thyroid carcinoma. We report a 58 years old female on hemodialysis with recurrent hyperthyroidism after propylthiouracil treatment. She was successfully treated with 131-I and four months after the intervention her euthyroid state was confirmed. We measured 131-I activity in blood, dialysate liquid and other waste products, as well as patient radiation exposure rates. We found that 131-I elimination was prolonged through time with no major dependence on hemodialysis, as opposed to the elimination of 131-I in patients with thyroid carcinoma. This was probably due to high radiotracer uptake in hyper functioning thyroid tissue. Conversely, radiation content in dialysate wastes or equipment was minimal. Furthermore, the rate of both environmental exposure and exposure of nursing staff in charge of hemodialysis sessions, was minimal and met international security standards. In conclusion, I-131 therapy showed both appropriate effectiveness and safety in this case and may be considered as a suitable treatment alternative to thyroidectomy when antithyroid drugs are unsuccessful.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/terapia , Hipertireoidismo/radioterapia , Radioisótopos do Iodo/uso terapêutico , Diálise Renal , Radioisótopos do Iodo/farmacocinéticaRESUMO
La liberación del uso terapéutico de los opioides se ha hecho cada vez mas frecuente como una propuesta para mejorar la distribución de éstos en las instituciones de salud pública y privadas con el fin de garantizar su alcance a población que cursa con dolor. A pesar de esto, aún no se logra una distribución homogénea de estos recursos en la población requirente. El objetivo de este trabajo es dar a conocer el panorama actual de los opioides en México y algunos países sudamericanos.
The release of therapeutic opioid use is mentioned with increasing frequency as a proposal to improve their tion in Public and Private Health Care Institutions, in order to scope opioids to population who needs them. Although this, homogeneous distribution of opioids is not achieved. The aim of this paper is to present the current panorama of opioids in Mexico and Latin American countries
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Humanos , Dor/tratamento farmacológico , Cuidados Paliativos/organização & administração , Manejo da Dor , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Analgésicos Opioides/provisão & distribuição , Analgésicos Opioides/uso terapêutico , Morfina/provisão & distribuição , Morfina/uso terapêuticoRESUMO
INTRODUCCIÓN: La educación en salud busca influir sobre la actitud de las personas para mejorar su salud mediante el fomento de hábitos saludables. En pacientes en hemodiálisis, su capacidad funcional suele estar disminuida por la inactividad física. OBJETIVO: Evaluar el efecto de una intervención educativa en salud para la promoción del ejercicio aeróbico, sobre la capacidad funcional de pacientes en hemodiálisis de México. MATERIAL Y MÉTODOS: Estudio cuasiexperimental antes-después con grupo control en Unidades de Atención Médica Hospitalaria del Instituto Mexicano del Seguro Social, Delegación Jalisco, con un universo de 26 pacientes con hemodiálisis muestreados propositivamente, 14 en el Grupo "A" (experimental) y 12 en el "B" (control). Se incluyeron las variables: edad, sexo y capacidad funcional. La intervención consistió en un diálogo dirigido sobre factores biopsicosociales de enfermedad renal, capacidad funcional y nutrición, con acompañamiento en ejercicios aeróbicos de 30 minutos/semana durante 20 semanas. Se evaluó la capacidad funcional con el Test Delta, y se comparó la media antes y después usando T de Student (p ≤ 0,05). RESULTADOS: No hubo diferencias estadísticamente significativas entre la edad y sexo de los pacientes en los Grupos "A" y "B". Capacidad funcional media antes y después: Grupo "A" 14 ± 5 vs 8 ± 4 (p < 0,001), Grupo "B" 16 ± 4 vs 17 ± 5 (p = 0,405). Conclusiones: La educación en salud influyó favorablemente sobre la actividad física de los pacientes en hemodiálisis y mejoró su capacidad funcional. Es recomendable implementar programas de ejercicio aeróbico durante las sesiones de hemodiálisis
INTRODUCTION: Health education search to influence on persons' attitude for to improve your health by mean of healthy habits promotion. In patients with hemodialysis your functional capacity usually is diminished for physical inactivity. OBJECTIVE: To evaluate the effect of a health education intervention for aerobic exercise's promotion on the functional capacity in hemodialysis patients from Mexico. METHODS: Quasi-experimental study beforeafter with control group in Hospital Medical Care Units of the Mexican Institute of Social Security, Jalisco's Delegation, with a universe of 26 patients with hemodialysis purposively sampled, 14 in Group "A" (experimental) and 12 in Group "B" (control). It included variables: age, gender and functional capacity. The intervention consisted of directed dialogue on biopsychosocial factors of renal disease, functional capacity and nutrition, with accompaniment in aerobic exercises of 30 minutes/week for 20 weeks. It evaluated functional capacity with Delta Test and it compared means before and after with Student's T (p ≤ 0,05). Results: There were no statistically significant differences between age and gender of patients in the "A" and "B" Groups. Mean functional capacity before and after: Group "A" 14 ± 5 vs 8 ± 4 (p < 0,001), Group "B" 16 ± 4 vs 17 ± 5(p=0,405). CONCLUSIONS: The health education influenced favorably on the physical activity of patients with hemodialysis and improved your functional capacity. To implement aerobic exercise programs during hemodialysis sessions it advisable
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Humanos , Exercício Físico , Educação em Saúde , Diálise Renal , Pessoas com Deficiência , Insuficiência Renal , Unidades Hospitalares de HemodiáliseRESUMO
Introducción: Las infecciones de vías urinarias (IVU) constituyen un problema de salud mundial. El aumento de la resistencia bacteriana a los antimicrobianos limita la administración de antibióticos económicos y de espectro limitado, lo que afecta el costo y el acceso a la atención. El objetivo de este trabajo es determinar la sensibilidad, resistencia y germen causal en urocultivos realizados en pacientes con infección clínica de vías urinarias. Métodos: Estudio transversal. Se analizaron urocultivos de pacientes con infección clínica de vías urinarias, cada urocultivo correspondió a un paciente. Las variables fueron edad, género, microorganismo causal, resistencia y sensibilidad a los antimicrobianos. Se realizó en la Unidad de Medicina Familiar No. 222 del Instituto Mexicano del Seguro Social en Toluca Estado de México. Se evaluaron urocultivos con más de 100000 Unidades formadoras de colonias. Se realizó mediciones descriptivas, frecuencias y porcentajes en el programa SPSS v. 17 para Windows. Resultados: se incluyeron urocultivos de pacientes con infección clínica de vías urinarias. La edad promedio de los pacientes fue de 50.09 ± 19.43 años, con predominio del género femenino (211 pacientes). Los agentes causales más frecuentes fueron: Escherichia Coli (51.91%), Proteus mirabilis (14.70%) y Staphylococcus (11.11 %). Los antibióticos con mayor sensibilidad fueron: imipenem, cefotetan y meropenem (34%). Los antimicrobianos con mayor resistencia fueron: ampicilina (24%), ciprofloxacino (22%) y ampicilina con sulbactam (20%). Conclusiones: los microorganismos más frecuentemente fueron: Escherichia coli y Proteus; y los antimicrobianos a los que mostraron más resistencia bacteriana fueron: ampicilina y quinolonas.
Introduction: Urinary tract infections (UTIs) are a global health problem. Increased bacterial resistance to antimicrobials limits the administration of low-spectrum antibiotics, which affect cost and access to care. The objective of this work is to determine the sensitivity, resistance and causal germ in urine cultures in patients with clinical urinary tract infection Methods: Transversal study. Urine cultures of patients with clinical urinary tract infection were analyzed, each urine culture corresponded to one patient. The variables were age, gender, causal microorganism, resistance and sensitivity to antimicrobials. It was performed at the Family Medicine Unit No. 222 of the Mexican Institute of Social Security in Toluca State of Mexico. Urocultures were evaluated with more than 100,000 colony forming units. Measurements were made frequencies and percentages in the SPSS program version 17 for Windows. Results: there were included 558 urine cultures; the average age was 50.09 ± 19.43 years, female predominance (211 patients). The most common causative microorganisms were Escherichia coli (51.91%), Proteus mirabilis (14.70%) and Staphylococcus (11.11%). Most sensitive antibiotics were: imipenem, meropenem and cefotetan (34%). Most resistance antimicrobial were: ampicillin (24%), ciprofloxacin (22%) and ampicillin with sulbactam (20%). Conclusions: Escherichia coli and Proteus were the most commonly isolated microorganisms; Ampicillin and quinolones showed more bacterial resistence.