Can the Dose of Belimumab be Reduced in Patients with Systemic Lupus Erythematosus?

OBJECTIVES: The aims of this study were to investigate the prevalence of dose reduction in patients with SLE treated with belimumab (BEL) in Spain, analyze treatment modalities, and determine impact on control of disease activity. METHODS: Retrospective longitudinal and multicentre study of SLE patients treated with BEL. Data on disease activity, treatments and outcomes were recorded before and after reduction (6-12 months), and they were compared. RESULTS: A total of 324 patients were included. The dose was reduced in 29 patients (8.9%). The dosing interval was increased in 9 patients receiving subcutaneous BEL and in 6 patients receiving intravenous BEL. The dose per administration was reduced in 16 patients.Pre-reduction status was remission (2021 DORIS) in 15/26 patients (57.7%) and LLDAS in 23/26 patients (88.5%). After reduction, 2/24 patients (8.3%) and 3/22 patients (13.6%) lost remission at 6 months and 12 months, respectively (not statistically significant [NS]). As for LLDAS, 2/23 patients (8.7%) and 2/21 patients (9.5%) lost their status at 6 and 12 months, respectively (NS). Significantly fewer patients were taking glucocorticoids (GCs) at their 12-month visit, although the median dose of GCs was higher at the 12-month visit (5 [0.62-8.75] vs 2.5 [0-5] at baseline). CONCLUSION: Doses of BEL can be reduced with no relevant changes in disease activity-at least in the short term-in a significant percentage of patients, and most maintain the reduced dose. However, increased clinical or serologic activity may be observed in some patients. Consequently, tighter post-reduction follow-up is advisable.

Roles of the multiplex real-time PCR assay and ß-D-glucan in a high-risk population for intra-abdominal candidiasis (IAC).

Multiplex quantitative real-time PCR (MRT-PCR) using blood can improve the diagnosis of intra-abdominal candidiasis (IAC). We prospectively studied 39 patients with suspected IAC in the absence of previous antifungal therapy. Blood cultures, MRT-PCR, and ß-D-glucan (BDG) in serum were performed in all patients. IAC was defined according to the 2013 European Consensus criteria. For MRT-PCR, the probes targeted the ITS1 or ITS2 regions of ribosomal DNA. Candidaemia was confirmed only in four patients (10%), and IAC criteria were present in 17 patients (43.6%). The sensitivity of MRT-PCR was 25% but increased to 63.6% (P = .06) in plasma obtained prior to volume overload and transfusion; specificity was above 85% in all cases. BDG performance was improved using a cutoff > 260 pg/ml, and improvement was not observed in samples obtained before transfusion. In this cohort of high risk of IAC and low rate of bloodstream infection, the performance of non-culture-based methods (MRT-PCR or BDG) was moderate but may be a complementary tool given the limitations of diagnostic methods available in clinical practice. Volume overload requirements, in combination with other factors, decrease the accuracy of MRT-PCR in patients with IAC.

Melatonin in the oral cavity: physiological and pathological implications.

BACKGROUND AND OBJECTIVES: The purpose of this article was to summarize what is known about the function of melatonin in the oral cavity. MATERIAL AND METHODS: Databases were searched for the relevant published literature to 30 November, 2013. The following search items were used in various combinations: melatonin, gingiva, periodontium, inflammation, herpes, alveolar bone, periodontal ligament, dental implants, xerostomia, methacrylate, chlorhexidine, cancer. The literature uncovered is summarized herein. RESULTS: Salivary melatonin levels exhibit a circadian rhythm with highest values at night. Melatonin has both receptor-mediated and receptor-independent actions in cells of the oral cavity. Melatonin is released into the saliva by the acinar cells of the major salivary glands and via the gingival fluid. Functions of melatonin in the oral cavity are likely to relate primarily to its anti-inflammatory and antioxidant activities. These actions may suppress inflammation of the gingiva and periodontium, reduce alveolar bone loss, abrogate herpes lesions, enhance osteointegration of dental implants, limit oral cancer, and suppress disorders that have a free radical component. Sublingual melatonin tablets or oral melatonin sprays and topical melatonin-containing gel, if used on a regular basis, may improve overall oral health and reduce mucosal lesions. CONCLUSION: Collectively, the results indicate that endogenously-produced and exogenously-applied melatonin are beneficial to the oral cavity.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

Detection of membrane fluidity in submitochondrial particles of platelets and erythrocyte membranes from Mexican patients with Alzheimer disease by intramolecular excimer formation of 1,3 dipyrenylpropane.

It has been suggested that mitochondrial dysfunction and defects in membrane structure could be implied in AD pathogenesis. The aim of the present work was the study of membrane fluidity in submitochondrial platelet particles and erythrocyte membranes from Mexican patients. Blood samples were obtained from 30 patients with Alzheimer disease and 30 aged-matched control subjects. Membrane fluidity determinations were done using a very low concentration of the fluorescent dipyrenylpropane probe incorporated in both types of membranes. This probe is able to give excimer and monomer fluorescence, therefore it can be used to monitor fluidity changes in biological membranes. The data obtained showed that in submitochondrial particles from AD patients, the excimer to monomer fluorescent intensity ratio was lower (0.231 +/- 0.008) than aged-matched control subjects (0.363 +/- 0.014). Therefore, membrane fluidity was lower in AD samples. On the other hand, we found similar membrane fluidity in erythrocytes from AD patients and aged-matched controls: the fluorescent intensity ratios were 0.312 +/- 0.03 and 0.305 +/- 0.033, respectively. In addition, lipid peroxidation in submitochondrial particles and erythrocyte membranes was higher in AD samples than in aged-matched controls. These data suggest that submitochondrial platelet particles are more sensitive to oxidative stress than erythrocyte membranes.

Altered beta-amyloid precursor protein isoforms in Mexican Alzheimer's Disease patients.

OBJECTIVE: To determine the beta-amyloid precursor protein (betaAPP) isoforms ratio as a risk factor for Alzheimer's Disease and to assess its relationship with demographic and genetic variables of the disease. METHODS: Blood samples from 26 patients fulfilling NINCDS-ADRDA diagnostic criteria for AD and 46 healthy control subjects were collected for Western blotting for betaAPP. A ratio of betaAPP isoforms, in optical densities, between the upper band (130 Kd) and the lower bands (106-110 Kd) was obtained. Odds ratios were obtained to determine risk factor of this component. RESULTS: betaAPP ratio on AD subjects was lower than that of control subjects: 0.3662 +/- 0.1891 vs. 0.6769 +/- 0.1021 (mean +/- SD, p<0.05). A low betaAPP ratio (<0.6) showed an OR of 4.63 (95% CI 1.45-15.33). When onset of disease was taken into account, a betaAPP ratio on EOAD subjects of 0.3965 +/- 0.1916 was found vs. 0.3445 +/- 0.1965 on LOAD subjects (p>0.05). CONCLUSIONS: Altered betaAPP isoforms is a high risk factor for Alzheimer's disease, although it has no influence on the time of onset of the disease.

Monosodium glutamate-induced damage in liver and kidney: a morphological and biochemical approach.

It has been demonstrated that high concentrations of monosodium glutamate in the central nervous system induce neuronal necrosis and damage in retina and circumventricular organs. In this model, the monosodium glutamate is used to induce an epileptic state; one that requires highly concentrated doses. The purpose of this study was to evaluate the toxic effects of the monosodium glutamate in liver and kidney after an intra-peritoneal injection. For the experiment, we used 192 Wistar rats to carry out the following assessments: a) the quantification of the enzymes alanine aminotransferase and aspartate aminotransferase, b) the quantification of the lipid peroxidation products and c) the morphological evaluation of the liver and kidney. During the experiment, all of these assessments were carried out at 0, 15, 30 and 45 min after the intra-peritoneal injection. In the rats that received monosodium glutamate, we observed increments in the concentration of alanine aminotransferase and aspartate aminotransferase at 30 and 45 min. Also, an increment of the lipid peroxidation products, in kidney, was exhibited at 15, 30 and 45 min while in liver it was observed at 30 and 45 min. Degenerative changes were observed (edema-degeneration-necrosis) at 15, 30 and 45 min.

Comparison of planar bone scintigraphy and single photon emission computed tomography for diagnosis of active condylar hyperplasia.

PURPOSE: The aim of this study was to compare the reliability and correlations with age and gender of two nuclear medicine tests used for diagnosis of active condylar hyperplasia, namely, planar bone scintigraphy versus single photon emission computed tomography (SPECT). MATERIAL AND METHOD: This was a descriptive observational study carried out in 61 patients (38 women and 23 men) clinically diagnosed as having facial asymmetry and suspected unilateral condylar hyperplasia. The patients had both planar bone scintigraphy and SPECT diagnostic imaging as well as reference data of the percentage of (99)Tc(m) MDP (methylenediphosphonate) uptake in the condyle, clivus, and fourth lumbar vertebra (L4), respectively, for SPECT and planar scintigraphy calculations. Radioactive counts were measured per region of interest and the respective ratios were calculated. The age range of the patients was 13-50 years (mean ± standard deviation = 21.16 ± 8.75). The two groups were compared by a nonparametric (Mann-Whitney U test. Uptake percentage and delta values had normal distribution and consequently were compared by a Student t test. RESULTS: A total of 61 anterior planar images and 61 SPECT images were compared. Eight patients presented high uptake in planar bone scintigraphy images (13.11%), while 32 patients (52.46%) had high uptake with SPECT. The prevalence of condylar hyperactivity was higher in women than in men both for right condyle (ratio 4:3) and for left condyle (10:1) and the prevalence was significantly higher for the right condyle. CONCLUSION: The study indicates that SPECT is more sensitive to identify condylar hyperactivity as compared to planar bone scintigraphy in patients with clinical presumptive diagnostic of condylar hyperplasia.

[Functional disorders of FOF1-ATPase in submitochondrial particles obtained from platelets of patients with a diagnosis of probable Alzheimer's disease]. / Alteración funcional de la F0F1-ATPasa en partículas submitocondriales obtenidas de plaquetas de pacientes con diagnóstico de enfermedad de Alzheimer probable.

INTRODUCTION: Recent studies indicate that decreased energy generation by mitochondria is a feature that is common across neurodegenerative diseases. PATIENTS AND METHODS: In order to obtain direct evidence that mitochondrial functioning is altered, we measured the hydrolytic activity of F0F1-ATPase and its capacity to generate a stable proton gradient in submitochondrial particles in 29 patients diagnosed with probable Alzheimer's disease (AD). Submitochondrial particles were obtained from platelets of patients with a diagnosis of probable AD and from clinically healthy controls. RESULTS: Data revealed that the hydrolytic activity of F0F1-ATPase increases significantly in patients with probable AD (41.7+/-4.3 nmol PO4 min-1[mg protein]-1, n=29) as compared to the control subjects (29.1+/-1.9 nmol PO4 min-1 [mg protein]-1, n=29). It is important to note that, in the male population with probable AD, we found that hydrolytic activity of F0F1-ATPase increased as cerebral deterioration progressed. We also detected a lower pH gradient in the submitochondrial particles of patients with probable AD (0.28+/-0.08 pH units, n=25) as compared to the controls (0.5+/-0.1 pH units, n=20). CONCLUSIONS: Overall, these data point to an alteration in the functioning of the enzyme.

Vigabatrin as a first-choice drug in the treatment of West syndrome.

This is a prospective study designed to evaluate the efficacy and safety of vigabatrin as first-choice monotherapy in infants with West syndrome. One hundred sixteen patients with newly diagnosed West syndrome were studied in Argentina, from June 1994 to April 1998. The follow-up ranged from 17 to 40 months (mean, 23 months). Vigabatrin was administered upon diagnosis, starting with a 50-mg/kg/day dose and increasing 50 mg/kg every 48 hours to reach a maximum dose of 200 mg/kg/day. Twenty-nine percent of cases were considered to be cryptogenic or idiopathic West syndrome, while 70.7% were symptomatic. Response to vigabatrin treatment was measured according to five categories: (1) seizures free: 61.8% of cases for cryptogenic and 29.3% for symptomatic West syndrome, (2) more than 75% reduction in the number of infantile spasms: 14.7% for cryptogenic and 26.8% for symptomatic West syndrome, (3) from 50% to 74% reduction in the number of infantile spasms: 11.8% for cryptogenic and 24.4% for symptomatic West syndrome, (4) poor or null response: 11.8% for cryptogenic and 18.3% for symptomatic West syndrome, and (5) increase in the number of infantile spasms: one symptomatic case (1.2%). All seizure-free cryptogenic cases showed normal neuropsychic development. The most effective dose of vigabatrin was 150 mg/kg of body weight per day. The most frequent adverse events were somnolence in 19 cases and irritability in 15 cases, but none required treatment interruption.

Venereal shedding of ovine lentivirus in infected rams.

OBJECTIVE: To assess shedding of ovine lentivirus (OvLV) in semen of infected rams with or without epididymitis. DESIGN: Rams 1 and 2 were naturally infected with OvLV. Rams 3-6 were inoculated with OvLV strain 85/ 34. Ram 7 was inoculated with uninfected cell culture supernatant (OvLV-negative control). 14 weeks after OvLV inoculation, rams 1-3, 6, and 7 were inoculated with Brucella ovis into the epididymis. Ram 4 was a natural case of B ovis epididymitis, and ram 5 was left noninoculated (B ovis-negative control). Blood mononuclear cells (BMNC) and semen were collected between 0 and 44 weeks after OvLV inoculation. ANIMALS: Seven 2- to 3-year-old rams. PROCEDURE: Infective OvLV in BMNC and semen was determined by virus isolation and subsequent OvLV-DNA amplification by polymerase chain reaction (PCR). Bronchoalveolar lavage cells collected after death were used for DNA extraction and PCR amplification. RESULTS: OvLV was detected in the semen of rams 3 and 6, but only after B ovis inoculation. OvLV was isolated consistently from BMNC of rams 3 and 6, but only occasionally from rams 1, 2, 4, and 5. Leukocytospermia was evident in every ejaculate of all B ovis-infected rams after infection. Semiquantitative PCR determination of OvLV DNA from bronchoalveolar lavage cells revealed the highest OvLV DNA load in rams 3 and 6. CONCLUSIONS: Leukocytospermia and a high virus load in infected animals are important factors that determine shedding of OvLV in semen. CLINICAL RELEVANCE: Dissemination of OvLV through contaminated semen could have important implications in the epidemiology and control of this infection.

[Trends in human immunodeficiency virus infection prevalence in homosexual/bisexual men in Madrid (1986-1995)]. / Evolución de la prevalencia de infección por el virus de la inmunodeficiencia humana en un colectivo de varones homo/bisexuales de Madrid (1986-1995).

BACKGROUND: We analysed the trend in seroprevalence for human immunodeficiency virus (HIV) in homosexual or bisexual men who voluntary requested the test in a sexually transmitted disease/HIV clinic in Madrid. PATIENTS AND METHODS: We studied 5,424 homo/bisexual non-injecting drug user (non-IDU) men, who came for the first time since 1986 to 1995. We analysed the HIV seroprevalence taken into account the year, age and exchange of sex by money. A hundred and thirty-six IDU homo/bisexual men were also attended during the same period and they were compared with non-IDU. RESULTS: HIV seroprevalence among the 5,424 non-IDU homo/bisexual men were 20.2%, rising from 19.6% in 1986 to 29.6% in 1990. After then, the trend decreased to 15.3% in 1995 (chi 2 for trend, 66.8; p < 0.0001). Average age was three years higher among seropositives (p < 0.0001), and showed an upward trend from 29.9 in 1986 to 34.6 in 1995 (p = 0.0059). Seroprevalence among homosexuals younger than 25 fell in the last years. One percent of individuals had ever practiced the prostitution. They were younger (average age, 27.6), and their HIV seroprevalence were 25.9%. A hundred and thirty-six IDU homo/bisexual men were also attended for the first time, being 2.4% of overall homo/bisexual men. They had a higher seroprevalence (48.5%) than non-IDU (p < 0.0001), and did not show any significative time-trend. CONCLUSIONS: A favourable evolution can be observed in HIV seroprevalence among homo/bisexual from Madrid, Spain, men who came to be tested, especially among the youngest. Prevention programs should make an effort to maintain this trend.

[HIV prevalence among homosexual and bisexual men in Spain, 1992-2000]. / Prevalencia del virus de la inmunodeficiencia humana en varones homosexuales y bisexuales, 1992-2000.

BACKGROUND: Our purpose was to describe the time trend in HIV seroprevalence among homo/ bisexual men. SUBJECTS AND METHOD: We analyzed 9,383 homo/ bisexual men who had a first voluntary test for HIV in 10 Spanish clinics from 1992 to 2000. RESULTS: HIV prevalence decreased from 20.3% in 1992 to 8.4% in 2000. In the multivariate analysis this decline appeared independently associated with the testing year and the birth cohort. CONCLUSIONS: New generations of voluntarily tested homo/bisexual men are less infected by HIV, but it is yet necessary to intensify the prevention programs.

[Work ability of subjects with chronic musculoskeletal disorders]. / Capacidade para o trabalho em indivíduos com lesões músculo-esqueléticas crônicas.

OBJECTIVE: To evaluate the impact of personal, clinical, and occupational aspects on work ability of workers with and without work-related musculoskeletal disorders using the Work Ability Index. METHODS: There were participating 127 workers of industrial production lines of a medium-size multinational company. An approved version of the Work Ability Index, a questionnaire developed by Finland's Institute of Occupational Health, was used. Pain scale was also applied. A descriptive analysis was carried out using the Chi-square test and it was also performed a logistic regression analysis. RESULTS: A significant association was identified between the Work Ability Index and all personal, clinical and occupational aspects. Regression analysis showed that pain and sick leave together accounted for 59% of poor work ability. CONCLUSIONS: Different levels of pain severity were associated with distinct as well as equivalent levels of work ability loss. The results suggest that either pain reports were consistent or being both pain and work ability self-reported they therefore reflect the same perception mechanisms. Future studies might contribute to further understanding the trends found.

[Hereditary progressive levodopa sensible: Segawa's syndrome]. / Distonía hereditaria sensible a levodopa: síndrome de Segawa.

INTRODUCTION: Hereditary progressive childhood dystonia with diurnal fluctuation of symptoms, belongs to the dopa responsive dystonias. It is dominantly inherited with variable penetrance, with deficiency in the cyclohydrolase I GTP gene. OBJECTIVE: Levodopa treatment is useful and diagnosis may be done on fluctuant dystonia in the childhood. CASE REPORTS: . We present four patients, one boy and three girls (two sisters) between 7 and 17 years of age. Neurological symptoms appears at 5, 15, 2.5 and 4 years of age respectively, with incoordination of movements ataxo paretic gait and postural dystonia. Symptoms were progressive with diurnal fluctuation. All laboratory test and image diagnosis were normal. Levodopa response, with lower doses (30 60 mg/day), were excellent. The four patients respectively are asymptomatic after 8, 4, 6 and 5 years of treatment. CONCLUSIONS: Hereditary progressive dystonia, with diurnal fluctuations is dopa responsive at lower doses, with neurological normalization and without side effects during a prolongated treatment.

Machiavellianism: dimensionality of the Mach IV and its relation to self-monitoring in a Spanish sample.

The aim of this study was to assess the measurement model of a Spanish version of the Mach IV Scale (Christie, 1970b), used to measure Machiavellianism, and its relation with the Self-Monitoring Scale (Snyder & Gangestad, 1986). 346 undergraduate students (70 males and 276 females) filled in both scales. The results of confirmatory factor analyses showed a four-factor structure to be the most adequate model for the Mach IV, with the following factors: Positive Interpersonal Tactics, Negative Tactics, Positive View of Human Nature, and Cynical View of Human Nature. These results are not in accordance with the original factor structure but are consistent with other authors' findings. A structural model between Machiavellianism and self-monitoring was tested, showing statistically significant paths between interpersonal tactics and one self-monitoring subscale.

Complicaciones postoperatorias en mujeres con cirugía por cáncer de mama / Postoperative complications among women with breast cancer surgery / Complicações pós-operatórias em mulheres com cirurgia para câncer de mama

Resumen Introducción: El cáncer de mama es una enfermedad crónica degenerativa, por su naturaleza, requiere que la mujer reciba tratamiento multimodal como la cirugía para su control, exponiéndola a numerosos riesgos que la llevan a presentar complicaciones postoperatorias. Objetivo: Identificar la prevalencia de complicaciones postoperatorias que presentan las mujeres con cáncer de mama en una institución de salud de tercer nivel de atención. Material y métodos: Estudio observacional, transversal, retrolectivo. La unidad de análisis fueron los expedientes de mujeres a quienes se les realizó cirugía en el año 2015. La muestra fue a conveniencia con la revisión de 52 casos. Para la recolección de datos se elaboró una cédula y se procesó la información con el paquete estadístico SPSS v.24. Resultados: El 42% de las mujeres presentaron alguna complicación quirúrgica: dehiscencia de herida con un 27%, seguido de infección y dolor con 23% cada una, estas se manifestaron entre los 40 días posteriores al egreso del hospital; linfedema con 23% y 4% por seroma, ambas se presentaron generalmente después de cuatro meses. Discusión: Se ha evidenciado que las complicaciones derivadas del tratamiento quirúrgico del cáncer de mama tienen una prevalencia del 42%, superior a lo reportado en otros estudios donde la proporción va de 25 al 32%. Conclusiones: Las complicaciones postoperatorias en su mayoría son esperadas y prevenibles, por ello, es necesario que los profesionales de la salud propongan estrategias para su prevención o detección temprana, a través de la identificación de factores de riesgo modificables reportados en la literatura.

Abstract Introduction: Breast cancer is a degenerative chronic illness which forces women to go through diverse treatments which often include surgery and its related postoperatory complications. Objective: To identify the prevalence of postoperatory complications among women with breast cancer treated in a tertiary healthcare institution. Methods and Materials: This is an observational, transversal, and retrolective. The units of analysis were the records on women who underwent breast cancer related surgery in the year 2015. The convenience sample included 52 corresponding cases. Data were collected through a specific form and processed with SPSS v.24. Results: 42% of women showed some type of surgical complication. From these, 27% suffered wound dehiscences, 23% pain, and 23% infections. These complications appeared within 40 days after being discharged. Also, 23% suffered lymphedema, and 4% seroma, after 4 months of the surgery. Discussion: A 25% to 42% prevalence of complications derived from breast cancer surgical treatments has been evidenced. Conclusions: Postoperatory complications are expected, but also preventable. Because of this, it is necessary that health professionals develop strategies aimed at addressing this situation by identifying the modifiable risk factors.

Resumo Introdução: O câncer de mama é uma doença crônica degenerativa, por sua natureza, requer que a mulher receba tratamento multimodal como a cirurgia para seu controle, expondo-a a numerosos riscos que a levam a apresentar complicações pós-operatórias. Objetivo: Identificar a prevalência de complicações pós-operatórias que apresentam as mulheres com câncer de mama em uma instituição de saúde de terceiro nível de atenção. Material e métodos: Estudo observacional, transversal, retroletivo. A unidade de análise foram os expedientes de mulheres a quem se lhes realizou cirurgia no ano 2015. A amostra foi a conveniência com a revisão de 52 casos. Para a recolha de dados elaborou-se uma carteira e processou-se a informação com o paquete estatístico SPSS v.24. Resultados: O 42% das mulheres apresentaram alguma complicação cirúrgica: deiscência de ferida com um 27%, seguido de infecção e dor com 23% cada uma, estas se manifestaram entre os 40 dias posteriores ao egresso do hospital; linfedema com 23% e 4% por seroma, ambas se apresentaram geralmente depois de quatro meses. Discussão: Tem se evidenciado que as complicações derivadas do tratamento cirúrgico do câncer de mama têm uma prevalência do 42%, superior ao informado em outros estudos onde a proporção vai de 25 ao 32%. Conclusões: As complicações pós-operatórias em sua maioria são esperadas e evitáveis, por isso, é necessário que os profissionais da saúde proponham estratégias para sua prevenção ou detecção precoce, através da identificação de fatores de risco modificáveis informados na literatura.

La técnica Delphi para el rediseño y validación de un instrumento que mide la comunicación enfermera-paciente / Using the Delphi method to redesign and validate an instrument measuring nurse-patient communication / A técnica Delphi para o redesenho e validação de um instrumento que mede a comunicação enfermeira-paciente

Resumen Introducción: La evaluación de la comunicación entre la enfermera y el paciente da cuenta de la dimensión interpersonal en la calidad del cuidado. Esta relación ha sido estudiada desde diversos enfoques con énfasis en algunos aspectos, como el diseño y validación de instrumentos. Objetivo: Rediseño y validación de contenido de un instrumento que mide comunicación enfermera-paciente, con base en la técnica Delphi. Metodología: Se enfoca al rediseño y validación de un instrumento, con la aplicación de la técnica Delphi, con la participación de enfermeras expertas, sensibles a la relación terapéutica; se realizaron tres rondas con integración de contenidos por las coordinadoras y la aplicación de los coeficientes de validación de contenido por reactivo (CVR) y validación de contenido integral (CVI). Resultados: El CVI del instrumento en cuestión (CECOP-23) en la primera ronda fue 0.84, posterior a ello se eliminaron cuatro reactivos y se sustituyeron dos que fueron sugeridos por los expertos. En la segunda ronda el instrumento alcanzó un CVI de 0.95, el grupo sugirió la utilización de términos más sencillos que propiciaran la cercanía con el paciente. En la tercera ronda se obtuvo un CVI de 0.96. El CECOP quedó integrado por 21 reactivos, diez que exploran empatía y once que exploran respeto. Conclusiones: El trabajo con los expertos permitió analizar los reactivos del CECOP-23, obteniendo el CECOP-21, con reactivos de mayor calidez y exploración más precisa, cumpliendo con el objetivo de diseñar un instrumento que explore ambas dimensiones manteniendo el equilibrio entre la empatía y el respeto.

Abstract Introduction: The assessment of the communication between nurses and patients is part of the interpersonal dimension of quality of care. This relationship has been studied from diverse points of view which focus on issues such as the design and validation of measuring instruments. Objective: Using the Delphi method, to redesign and validate a nurse-patient communication measuring instrument. Methodology: Together with expert and sensitive to the therapeutic relationship nurses, the Delphi method was used to redesign and validate a communication measuring instrument. The coordinators assessed the contents in three cycles calculating the Item Content Validity and Integral Content Validity coefficients. Results: The Integral Content Validity of the CECOP-23 instrument was 0.84 in the first cycle. Four items were deleted and two were substituted in agreement with the suggestions of the experts. The Integral Content Validity of the instrument was 0.95 in the second cycle. The group suggested using simpler terms which could foster closeness to the patient. The Integral Content Validity was 0.96 in the third cycle. The CECOP instrument was finally constituted by 21 items, 10 exploring empathy and 11 exploring respect. Conclusions: Working along with the experts prompted the analysis of the CECOP-23 instrument in order to produce the CECOP-21 which has more precise and "warm" items. The objective of redesigning and instrument which, maintaining the equilibrium between empathy and respect, could measure the nurse-patient communication was achieved.

Resumo Introdução: A avaliação da comunicação entre a enfermeira e o paciente dá conta da dimensão interpessoal na qualidade do cuidado. Esta relação tem sido estudada desde diversos enfoques com ênfase em alguns aspectos, como o desenho e a validação de instrumentos. Objetivo: redesenho e validação de conteúdo de um instrumento que meça a comunicação enfermeira-paciente, com base na técnica Delphi. Metodologia: Foca-se no redesenho e validação de um instrumento, com a aplicação da técnica Delphi, com a participação de enfermeiras experientes, sensíveis à relação terapêutica; realizaram-se três ciclos com integração de conteúdos pelas coordenadoras e a aplicação dos coeficientes de validação de conteúdo por item (CVR) e a validação de conteúdo integral (CVI). Resultados: O CVI do instrumento em questão (CECOP-23) na primeira volta foi 0.84, posterior a isto, eliminaram-se quatro itens e substituíram-se dois que foram sugeridos pelos especialistas. Na segunda volta o instrumento atingiu um CVI de 0.95, o grupo sugeriu a utilização de termos mais simples que propiciaram a proximidade com o paciente. Na terceira volta obteve-se um CVI de 0.96. O CECOP ficou integrado por 21 itens, dez que exploram empatia e onze respeito. Conclusões: O trabalho com os especialistas permitiu analisar os itens de CECOP-23, obtendo o CECOP-21, com itens de maior qualidade e exploração mais precisa, cumprindo com o objetivo de desenhar um instrumento que explore ambas as dimensões mantendo o equilíbrio entre a empatia e o respeito.

Eventos adversos en pacientes hospitalizados reportados por enfermería: un estudio multicéntrico en México / Nursing reported hospitalized patients adverse events: A multi-centric study in Mexico / Eventos adversos em pacientes hospitalizados relatados por enfermagem: um estudo multicéntrico no México

Introducción: Los eventos adversos (EA) son un daño no intencionado derivado de la atención sanitaria que se relacionan con los recursos humanos, los factores del sistema o las condiciones clínicas del paciente. Objetivo: Analizar factores relacionados con la calidad y la seguridad del paciente a través de los reportes de EA. Metodología: Diseño transversal, multicéntrico, realizado en 5 institutos nacionales de salud y en un hospital de alta especialidad, se estudiaron los EA ocurridos durante 18 meses, para lo cual se utilizó el instrumento SYREC 2007; análisis descriptivo y evaluación de asociación entre grado de evitabilidad y factores intrínsecos, extrínsecos y del sistema; se observaron los aspectos éticos vigentes. Resultados: Se analizaron un total de 540 EA, ocurrieron 55.5% en hombres, 58.7% estaban en estado de alerta, el 92.6% de los EA ocurrió en el servicio asignado, el 55.9% no se reportó a la familia, se consideró sin duda como evitable en el 70.5%, los factores del sistema estuvieron presentes en 80.6%, hubo asociación significativa entre estos y la evitabilidad del suceso. Discusión: Los principales resultados encontrados son coincidentes con otras investigaciones internacionales tales como: To err is human 1999, el estudio ENEAS de España 2006 y con el de prevalencia IBEAS 2010; en todos ellos se hizo evidente la necesidad de reforzar la cultura de la notificación de los EA y el clima para la seguridad del paciente, además de promover una reflexión interpersonal acerca de la calidad de los servicios asistenciales. Conclusiones: Los factores relacionados con el sistema tienen un mayor peso en la aparición de EA. Es de vital importancia su identificación a fin de poder evitarlos.

Introduction: Adverse events (AE) are unintended harms derived from human health attention, system factors, or clinical conditions in the patients. Objective: To analyze factors influencing the quality of patient healthcare and safety through the review of diverse records on AEs. Methodology: This transversal and multi-centric design study was carried out in five National Institutes of Health and a high specialty hospital. AEs in an 18 month period were studied using the SYREC 2007 instrument. Descriptive analysis, as well as assessments on the association between the preventability degree and the intrinsic, extrinsic, and system factors were all performed. Current ethical issues were observed. Results: A total of 540 AEs were analyzed; 55.5% occurred in men; 58.7% occurred during state of alertness; 92.6% occurred at the assigned service; 55.9% were not reported to the families; 70.5% were considered preventable; and system factors were present in 80.6% of them. A significant association between the AEs and the possibility to prevent them was found. Discussion: The main findings were consistent with those of other international studies including: ''To err is human'', 1999, the ENEAS study in Spain, 2006, and the IBEAS prevalence study, 2010. All of these studies emphasize the need to strengthen the culture of AE-notifying and to improve the patient safety climate, as well as to promote inter-personal reflections on to the quality of care services. Conclusions: System-related factors have the strongest influence on the occurrence of AEs, and thus, their identification becomes critical in order to enhance the quality of healthcare services.

Introdução: Os Eventos Adversos (EA) são um dano não intencionado derivado da atenção sanitária que se relaciona com os recursos humanos, os fatores do sistema ou as condições clínicas do paciente. Objetivo: Analisar fatores relacionados com a qualidade e a segurança do paciente a través dos relatórios de EA. Metodologia: Desenho transversal, multicéntrico, realizado em cinco Institutos Nacionais de Saúde e um hospital de alta especialidade, estudaram-se os EA ocorridos durante 18 meses, para o qual se utilizou o instrumento SYREC 2007; análise descritiva e avaliação de associação entre grau de evitabilidade e fatores intrínsecos, extrínsecos e do sistema; observaram-se os aspectos éticos vigentes. Resultados: Analisaram-se um total de 540 EA, ocorreram 55.5% em homens, 58.7% estavam em estado de alerta, o 92.6% o EA aconteceu no serviço assignado, o 55.9% não se informou à família, considerou-se sem dúvida como evitável no 70.5%, os fatores do sistema estiveram presentes em 80.6%, houve associação significativa entre estes e a evitabilidade do evento. Discussão: Os principais resultados encontrados são coincidentes com outras pesquisas internacionais tais como: ''To err is human'' 1999, o estudo ENEAS da Espanha 2006 e com o de prevalência IBEAS 2010; em todos eles se fez evidente a necessidade de reforçar a cultura da notificação dos EA e o clima para a segurança do paciente, além de promover una reflexão interpessoal acerca da qualidade dos serviços assistenciais. Conclusões: Os fatores relacionados com o sistema têm um maior peso na aparição de EA. É de vital importância sua identificação a fim de poder evitá-los.

Quadriplegia recovery after hemi-section and transplant model of spinal cord at the level of C5 and C6.

A spinal cord hemi-section with a homologous transplant of medullar tissue at the level of C5-C6 and preservation of the anterior spinal artery was used to evaluate the histological characteristics such as quantity and quality of axons, myelin index and blood vessels after quadriplegia recovery. Vascular changes after spinal injury results in severe endothelial damage, axonal edema, neuronal necrosis and demyelinization as well as cysts and infarction. Preservation of the anterior spinal artery has demonstrated clinical recuperation; therefore, in addition to the lesion we included a homologous transplant to visualize changes at a cellular level. Two groups of dogs (hemi-section and transplant) went through a traumatic spinal cord hemi-section of 50% at the level of C5-C6. The transplant group formed by animals which simultaneously had 4 mm of spinal cord removed and the equal amount substituted from a donor animal at the level of C5-C6 corresponding to the half right side; both preserving the anterior spinal artery. Histological evaluation of all groups took place at days 3 (acute) and 28 (chronic) post-operation. Changes of degeneration and axonal regeneration were found in the hemi-section and transplant groups at acute and chronic time, as well as same quadriplegia recovery at chronic time in the hemi-section and transplant groups which closely related to mechanisms which participate in regeneration and functional recuperation due to the preservation of the anterior spinal artery and presence of new blood vessels.