Implications of receptor for advanced glycation end products for progression from obesity to diabetes and from diabetes to cancer.

Obesity and type 2 diabetes mellitus (T2DM) are chronic pathologies with a high incidence worldwide. They share some pathological mechanisms, including hyperinsulinemia, the production and release of hormones, and hyperglycemia. The above, over time, affects other systems of the human body by causing tissue hypoxia, low-grade inflammation, and oxidative stress, which lay the pathophysiological groundwork for cancer. The leading causes of death globally are T2DM and cancer. Other main alterations of this pathological triad include the accumulation of advanced glycation end products and the release of endogenous alarmins due to cell death (i.e., damage-associated molecular patterns) such as the intracellular proteins high-mobility group box protein 1 and protein S100 that bind to the receptor for advanced glycation products (RAGE) - a multiligand receptor involved in inflammatory and metabolic and neoplastic processes. This review analyzes the latest advanced reports on the role of RAGE in the development of obesity, T2DM, and cancer, with an aim to understand the intracellular signaling mechanisms linked with cancer initiation. This review also explores inflammation, oxidative stress, hypoxia, cellular senescence, RAGE ligands, tumor microenvironment changes, and the "cancer hallmarks" of the leading tumors associated with T2DM. The assimilation of this information could aid in the development of diagnostic and therapeutic approaches to lower the morbidity and mortality associated with these diseases.

Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study.

BACKGROUND: Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic. MATERIAL AND METHODS: Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March-April 2020), non-peak (May-June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay. RESULTS: 5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27-3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0-29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01-6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31-4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27-8.00), medium-volume (OR 2.79, 95% CI 1.14-7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07-4.72). CONCLUSION: FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.

Gold-Coated Superparamagnetic Iron Oxide Nanoparticles Functionalized to EGF and Ce6 Complexes for Breast Cancer Diagnoses and Therapy.

Superparamagnetic iron oxide nanoparticles (SPIONs) have some limitations in the physiological environment, however, a modification on their surface, such as a core-shell structure with gold (SPIONs@Au), can enhance their applicability. In this study, SPIONs were synthesized by the chemical coprecipitation method, stabilized by sodium citrate, and followed by the gold-coating process. SPIONs@Au were functionalized with EGF-α-lipoic acid and chlorin e6 (Ce6)-cysteamine complexes, composing a Theranostic Nanoprobe (TP). The outcomes showed that the SPIONs@Au had changed in color to red and had an absorption band centered at 530 nm. The coating was verified in the TEM micrographs in bright and dark fields by EDS mapping, which indicated the presence of Au and Fe. The Ce6-cysteamine complex had a resonant band at 670 nm that enabled the diagnosis of biological samples using fluorescence analysis. In the measure of TNBC cell uptake, the maximum value of TP fluorescence intensity was obtained within 4 h of internalization. At 2 h, the incorporation of the TP in the cytoplasm as well as in the nuclei was observed, suggesting that it could be employed as a diagnostic marker. The PTT results showed significant percentages of apoptosis in the TNBC cell line, which confirms the efficacy of the TP.

P-POSSUM as mortality predictor in COVID-19-infected patients submitted to emergency digestive surgery. A retrospective cohort study.

BACKGROUND: COVID-19 infection is associated with a higher mortality rate in surgical patients, but surgical risk scores have not been validated in the emergency setting. We aimed to study the capacity for postoperative mortality prediction of the P-POSSUM score in COVID-19-positive patients submitted to emergency general and digestive surgery. MATERIAL AND METHODS: Consecutive patients undergoing emergency general and digestive surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective cohort study. MAIN OUTCOME: 30-day mortality. P-POSSUM discrimination was quantified by the area under the curve (AUC) of ROC curves; calibration was assessed by linear regression slope (ß estimator); and sensitivity and specificity were expressed as percentage and 95% confidence interval (CI). RESULTS: 4988 patients were included: 177 COVID-19-positive; 2011 intra-pandemic COVID-19-negative; and 2800 pre-pandemic. COVID-19-positive patients were older, with higher surgical risk, more advanced pathologies, and higher P-POSSUM values (1.79% vs. 1.09%, p < 0.001, in both the COVID-19-negative and control cohort). 30-day mortality in the COVID-19-positive, intra-pandemic COVID-19-negative and pre-pandemic cohorts were: 12.9%, 4.6%, and 3.2%. The P-POSSUM predictive values in the three cohorts were, respectively: AUC 0.88 (95% CI 0.81-0.95), 0.89 (95% CI 0.87-0.92), and 0.91 (95% CI 0.88-0.93); ß value 0.97 (95% CI 0.74-1.2), 0.99 (95% CI 0.82-1.16), and 0.78 (95% CI 0.74-0.82); sensitivity 83% (95% CI 61-95), 91% (95% CI 84-96), and 89% (95% CI 80-94); and specificity 81% (95% CI 74-87), 76% (95% CI 74-78), and 80% (95% CI 79-82). CONCLUSION: The P-POSSUM score showed a good predictive capacity for postoperative mortality in COVID-19-positive patients submitted to emergency general and digestive surgery.

Esports en tiempos de una pandemia global: oportunidades y futuros desafíos al transformar el juego en un deporte en costa rica / Esports in times of a global pandemic: opportunities and future challenges when transforming gaming into a sport in Costa Rica

Resumen Rojas-Valverde, D., Fallas-Campos, A., y Alpízar-Alpízar, M. (2020). Esports en tiempos de una pandemia global: oportunidades y futuros desafíos al transformar el juego en un deporte en Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 18(2), 1- 11. En respuesta a la pandemia relacionada con COVID-19, el mundo ha sufrido una serie de cambios drásticos. Debido a ellos, se han anunciado aplazamientos y cancelaciones de múltiples grandes eventos anuales en los deportes, las cuales dan paso a nuevas alternativas digitales que responden a las disposiciones de aislamiento del gobierno. Los eSports se muestran como una alternativa en rápida evolución para mantener el espíritu deportivo y la pasión que los deportes provocan en la población en general. En Costa Rica, este deporte ha comenzado su crecimiento, tal como sucedió en todo el mundo, y se ha acelerado con una alta tasa de evolución. En este sentido, el país enfrenta grandes desafíos para su promoción, incluyendo la de futuros eventos, el desarrollo de profesionales y la creación de una estructura organizacional para su práctica óptima. Este manuscrito busca analizar cómo la pandemia global expone la necesidad de poner atención a las alternativas deportivas digitales como el eSport y los desafíos futuros que enfrenta Costa Rica al tratar de desarrollarlo de manera efectiva y eficiente.

Abstract Rojas-Valverde, D., Fallas-Campos, A., & Alpízar-Alpízar, M. (2020). Esports in times of a global pandemic: opportunities and future challenges when transforming gaming into a sport in Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 18(2), 1-11. In response to the COVID-19 global pandemic, the world has undergone a series of drastic changes. Due to this, postponement and cancellation of multiple annual big sports events have been announced, giving way to new digital alternatives that follow government isolation provisions. eSports has shown to be a rapidly evolving alternative to maintain the sportsmanship and passion that sports bring to the general population. In Costa Rica, like everywhere else, this sport has seen accelerated growth with a high rate of evolution. In this regard, the country faces significant challenges to promote future eSports events, professional development, and the creation of an organizational structure for its optimal practice. This paper aims to analyze how the global pandemic exposes the need to direct the attention to digital sports alternatives such as eSport and the future challenges that Costa Rica will face to develop it in an effective and efficient way.

Resumo Rojas-Valverde, D., Fallas-Campos, A., e Alpízar-Alpízar, M. (2020). Os esportes eletrônicos em tempos de uma pandemia global: oportunidades e futuros desafios ao transformar o jogo em um esporte na Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 18(2), 1-11. Como resposta à pandemia relacionada com a COVID-19, o mundo sofreu uma série de mudanças drásticas. Devido a isso, foram anunciados adiamentos e cancelamentos de múltiplos eventos esportivos de grande porte levados a cabo anualmente, abrindo espaço para novas alternativas digitais que respondem às disposições governamentais no que diz respeito ao isolamento. Os Esportes Eletrônicos ou eSports demonstram ser uma alternativa em rápida evolução para manter o espírito esportivo e a paixão que os esportes provocam na população em geral. Na Costa Rica, esse esporte começou a crescer, assim como aconteceu em todo o mundo, e acelerou com uma alta taxa de evolução. Neste sentido, o país enfrenta grandes desafios para sua promoção, incluindo a de futuros eventos, o desenvolvimento de profissionais e a criação de uma estrutura organizacional para que a prática seja adequada. Este manuscrito busca analisar como a pandemia global expõe a necessidade de estar alerta às alternativas esportivas digitais como o eSport e aos desafios futuros enfrentados pela Costa Rica para desenvolvê-las efetiva e eficientemente.

Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial.

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.

Esports in times of a global pandemic: opportunities and future challenges when transforming gaming into a sport in Costa Rica / Esports en tiempos de una pandemia global: oportunidades y futuros desafíos al transformar el juego en un deporte en Costa Rica

Abstract In response to the COVID-19 global pandemic, the world has undergone a series of drastic changes. Due to this, postponement and cancellation of multiple annual big sports events have been announced, giving way to new digital alternatives that follow government isolation provisions. eSports has shown to be a rapidly evolving alternative to maintain the sportsmanship and passion that sports bring to the general population. In Costa Rica, like everywhere else, this sport has seen accelerated growth with a high rate of evolution. In this regard, the country faces significant challenges to promote future eSports events, professional development, and the creation of an organizational structure for its optimal practice. This paper aims to analyze how the global pandemic exposes the need to direct the attention to digital sports alternatives such as eSport and the future challenges that Costa Rica will face to develop it in an effective and efficient way.

Resumen En respuesta a la pandemia relacionada con COVID-19, el mundo ha sufrido una serie de cambios drásticos. Debido a ellos, se han anunciado aplazamientos y cancelaciones de múltiples grandes eventos anuales en los deportes, las cuales dan paso a nuevas alternativas digitales que responden a las disposiciones de aislamiento del gobierno. Los eSports se muestran como una alternativa en rápida evolución para mantener el espíritu deportivo y la pasión que los deportes provocan en la población en general. En Costa Rica, este deporte ha comenzado su crecimiento, tal como sucedió en todo el mundo, y se ha acelerado con una alta tasa de evolución. En este sentido, el país enfrenta grandes desafíos para su promoción, incluyendo la de futuros eventos, el desarrollo de profesionales y la creación de una estructura organizacional para su práctica óptima. Este manuscrito busca analizar cómo la pandemia global expone la necesidad de poner atención a las alternativas deportivas digitales como el eSport y los desafíos futuros que enfrenta Costa Rica al tratar de desarrollarlo de manera efectiva y eficiente.

Resumo Como resposta à pandemia relacionada com a COVID-19, o mundo sofreu uma série de mudanças drásticas. Devido a isso, foram anunciados adiamentos e cancelamentos de múltiplos eventos esportivos de grande porte levados a cabo anualmente, abrindo espaço para novas alternativas digitais que respondem às disposições governamentais no que diz respeito ao isolamento. Os Esportes Eletrônicos ou eSports demonstram ser uma alternativa em rápida evolução para manter o espírito esportivo e a paixão que os esportes provocam na população em geral. Na Costa Rica, esse esporte começou a crescer, assim como aconteceu em todo o mundo, e acelerou com uma alta taxa de evolução. Neste sentido, o país enfrenta grandes desafios para sua promoção, incluindo a de futuros eventos, o desenvolvimento de profissionais e a criação de uma estrutura organizacional para que a prática seja adequada. Este manuscrito busca analisar como a pandemia global expõe a necessidade de estar alerta às alternativas esportivas digitais como o eSport e aos desafios futuros enfrentados pela Costa Rica para desenvolvê-las efetiva e eficientemente.

Accurate and objective determination of myalgic encephalomyelitis/chronic fatigue syndrome disease severity with a wearable sensor.

BACKGROUND: Approximately 2.5 million people in the U.S. suffer from myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This disease negatively impacts patients' ability to function, often resulting in difficulty maintaining employment, sustaining financial independence, engaging socially with others, and in particularly severe cases, consistently and adequately performing activities of daily living. The focus of this research was to develop a sensor-based method to measure upright activity defined as time with feet on the floor and referred to as UpTime, as an indicator of ME/CFS disease severity. METHODS: A commercially available inertial measurement unit (IMU), the Shimmer, was selected for this research. A Kalman filter was used to convert IMU data collected by the Shimmer to angle estimates. Angle estimate accuracy was confirmed by comparison to a motion capture system. Leg angle estimates were then converted to personalized daily UpTime scores using a critical angle of 39º from vertical to differentiate between upright (feet on the floor) and not upright. A 6-day, case-control study with 15 subjects (five healthy controls, five moderate-level ME/CFS, and five severe-level ME/CFS) was conducted to determine the utility of UpTime for assessing disease severity. RESULTS: UpTime was found to be a significant measure of ME/CFS disease severity. Severely ill ME/CFS patients spend less than 20% of each day with feet on the floor. Moderately ill ME/CFS patients spend between 20-30% of each day with feet on the floor. Healthy controls have greater than 30% UpTime. IMU-measured UpTime was more precise than self-reported hours of upright activity which were over-estimated by patients. CONCLUSIONS: UpTime is an accurate and objective measure of upright activity, a measure that can be used to assess disease severity in ME/CFS patients. Due to its ability to accurately monitor upright activity, UpTime can also be used as a reliable endpoint for evaluating ME/CFS treatment efficacy. Future studies with larger samples and extended data collection periods are required to fully confirm the use of UpTime as a measure of disease severity in ME/CFS. With the added perspective of large-scale studies, this sensor-based platform could provide a recovery path for individuals struggling with ME/CFS.

Hemodynamics during the 10-minute NASA Lean Test: evidence of circulatory decompensation in a subset of ME/CFS patients.

BACKGROUND: Lightheadedness, fatigue, weakness, heart palpitations, cognitive dysfunction, muscle pain, and exercise intolerance are some of the symptoms of orthostatic intolerance (OI). There is substantial comorbidity of OI in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome). The 10-minute NASA Lean Test (NLT) is a simple, point-of-care method that can aid ME/CFS diagnosis and guide management and treatment of OI. The objective of this study was to understand the hemodynamic changes that occur in ME/CFS patients during the 10-minute NLT. METHODS: A total of 150 ME/CFS patients and 75 age, gender and race matched healthy controls (HCs) were enrolled. We recruited 75 ME/CFS patients who had been sick for less than 4 years (< 4 ME/CFS) and 75 ME/CFS patients sick for more than 10 years (> 10 ME/CFS). The 10-minute NLT involves measurement of blood pressure and heart rate while resting supine and every minute for 10 min while standing with shoulder-blades on the wall for a relaxed stance. Spontaneously reported symptoms are recorded during the test. ANOVA and regression analysis were used to test for differences and relationships in hemodynamics, symptoms and upright activity between groups. RESULTS: At least 5 min of the 10-minute NLT were required to detect hemodynamic changes. The < 4 ME/CFS group had significantly higher heart rate and abnormally narrowed pulse pressure compared to > 10 ME/CFS and HCs. The < 4 ME/CFS group experienced significantly more OI symptoms compared to > 10 ME/CFS and HCs. The circulatory decompensation observed in the < 4 ME/CFS group was not related to age or medication use. CONCLUSIONS: Circulatory decompensation characterized by increased heart rate and abnormally narrow pulse pressure was identified in a subgroup of ME/CFS patients who have been sick for < 4 years. This suggests inadequate ventricular filling from low venous pressure. The 10-minute NLT can be used to diagnose and treat the circulatory decompensation in this newly recognized subgroup of ME/CFS patients. The > 10 ME/CFS group had less pronounced hemodynamic changes during the NLT possibly from adaptation and compensation that occurs over time. The 10-minute NLT is a simple and clinically useful point-of-care method that can be used for early diagnosis of ME/CFS and help guide OI treatment.

Combined microscopy and spectroscopy techniques to characterize a fossilized feather with minimal damage to the specimen.

The study of fossil feathers has been revitalized in the last few decades and has contributed significantly to paleontological studies of dinosaurs and birds. Specific morphological and physicochemical characteristics of the microscale structures of feathers and the protein keratin are key targets when preserved during the fossilization process. Keratin is a fibrous protein that composes some hard tissues such as hair, nails and feathers. It is part of the so called intermediate filaments inside keratinocyte cells and is rich in sulfur containing amino acid cysteine. To date, different microscopy and analytical methods have been used for the analysis and detailed characterization and classification of feathers. However, in this work we showed that analytical optical and electron microscopies can be quick and precise methods with minimal effects on the sample during analysis. This association of different approaches on the same sample results in correlative data albeit in different length scales. Intracellular bodies called melanosomes originally present in melanocyte cells were identified with Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM), and had well-defined orientation and a mean aspect ratio comparable to melanosomes extant in dark feathers. The detection of sulphur in melanosomes via Energy Dispersive Spectroscopy both in SEM and TEM shows that, along the fossilization process, sulphur from the degraded keratin matrix could have been trapped inside the melanosomes. Chemical groups that make up keratin and melanin in the fossil sample were detected via FT-IR Spectroscopy and Confocal Laser Scanning Microscopy (CLSM). The use of combined analytical microscopy techniques can contribute significantly to the study of fossils generating precise results with minimum damage to the original sample.

Ensayos clínicos publicados en el Boletín Médico del Hospital Infantil de México: un análisis crítico / Clinical trials published in the Boletín Médico del Hospital Infantil de México: a critical analysis

Resumen Introducción: El ensayo clínico es la manera más rigurosa de conducir los experimentos en seres humanos. Desde su introducción en investigación biomédica se han implementado cambios en el modo de establecer las bases para el diagnóstico, pronóstico y la terapéutica en la práctica clínica. Se han realizado estudios para identificar los ensayos clínicos publicados en diferentes áreas médicas, pero hasta el momento ninguno había identificado los ensayos clínicos publicados en el Boletín Médico del Hospital Infantil de México (BMHIM). El objetivo de este trabajo fue identificar y describir los ensayos clínicos controlados (ECC) publicados en el BMHIM. Métodos: Se realizó búsqueda manual y sistemática en cada uno de los números y volúmenes del BMHIM de 1968 a 2016. Se registraron los ECC para obtener sus principales características. Adicionalmente, se evaluó su calidad metodológica mediante la herramienta de riesgo de sesgo. Los resultados se presentan de forma descriptiva, gráfica y temporal. Resultados: Se revisaron 73 números con 363 volúmenes, analizando 4925 artículos. La proporción de ECC identificados en el BMHIM fue del 1% (67/4925). En general, los ensayos clínicos se realizaron en el contexto nacional, en el tercer nivel de atención, con un tamaño de muestra reducido, y las intervenciones farmacológicas fueron las más utilizadas. La calidad metodológica de los estudios fue baja, con alto riesgo de sesgo. Conclusiones: Los ensayos clínicos representan el 1% de todos los artículos de investigación originales publicados en el BMHIM. Aún existen áreas de investigación pediátrica, las cuales requieren del desarrollo de ECC para mejorar la práctica clínica, así como para elevar la calidad de la investigación.

Abstract Background: Controlled clinical trials (CCT) are the study design with the highest accuracy and evidence level. From its introduction in biomedical research, changes have been implemented in the way of establishing the basis for diagnosis, prognosis and treatment in clinical practice. Studies to identify published CCTs regarding different medical fields have been carried out. To date, none of them has identified the clinical trials that have been published in the Boletín Médico del Hospital Infantil de México (BMHIM). The aim of this study was to identify and describe the controlled clinical trials published in the BMHIM. Methods: A manual and systematic search was performed in each of the volumes of the BMHIM from 1968 to 2016. CCTs were recorded to obtain their main characteristics. Additionally, their methodological quality was assessed through the "risk of bias" tool. Results are presented in a descriptive, graphic and time-based manner. Results: In total, 73 issues with 363 volumes were reviewed, and 4925 articles were analyzed. The proportion of CCTs identified in the BMHIM was 1% (67/4925). In general, clinical trials were performed in the national context and in the third-level of medical care. CCTs also presented reduced sample sizes; pharmacological interventions were the most frequent. The methodological quality of the studies was low with a high risk of bias. Conclusions: Clinical trials represented 1% of all the original research articles published in the BMHIM. There are still pediatric research fields that require CCTs to be developed in order to improve clinical practice, as well as to increase the quality of the research.

Fracturas de cadera: satisfacción posquirúrgica al año en adultos mayores atendidos en Méderi-Hospital Universitario Mayor, Bogotá, DC / Hip Fractures: Postsurgical Satisfaction a Year After in Older Adults Treated at Méderi-Hospital Universitario Mayor, Bogotá, DC / Fraturas de quadril: Satisfação pós-cirúrgica no ano seguinte em idosos atendidos em Méderi-Hospital Universitário Mayor, Bogotá, DC

Introducción: el envejecimiento poblacional mundial ha aumentado la incidencia de fracturas de cadera, este cambio genera un alto impacto económico, social y constituye un reto para la salud pública. Este estudio busca evaluar la satisfacción con el manejo posquirúrgico en adultos mayores con fracturas de cadera al año de la intervención y conocer los desenlaces en este tiempo. Materiales y métodos: estudio exploratorio, observacional, descriptivo de corte transversal, mediante encuesta telefónica en adultos de 65 o más años, un año después de intervención quirúrgica por fracturas de cadera en Méderi - Hospital Universitario Mayor, de Bogotá. Se describen variables evaluativas de satisfacción y atención en salud, así como otras relacionadas. Resultados: de 287 pacientes, 116 cumplen los criterios de inclusión y aceptan participar. El rango de edad oscila entre 65 y 99 años, media de 81,3 ± 8,17. Las mujeres y los hombres representan, respectivamente, 76% y 24% de la muestra. Mortalidad anual 28%, por género: 23% mujeres y 43% hombres. 29,3% presenta reingresos hospitalarios, 50% recupera su habilidad para la marcha. 81% considera buena la atención intrahospitalaria por ortopedia. 64% no califica el servicio intrahospitalario por fisioterapia ya que no lo recibe. 70% expresa satisfacción con los servicios ambulatorios de ortopedia y rehabilitación. Conclusiones: estudio novedoso y único que da voz como sujeto activo al paciente para evaluar el sistema de salud, sugiere el grado de dolor como elemento trazador de calidad de vida y obliga a implementar programas y servicios para adultos mayores con fracturas de cadera.

Introduction: World aging increases the incidence of hip fracture in adults over sixty years of age, pathology of economic and social burden being a challenge for public health. This study seeks to assess patient degree of satisfaction with health care services and assess outcomes. Materials and methods: Exploratory, observational, descriptive cross sectional study, with a telephone survey in patients 65 years or older, one year after hip fracture surgical intervention in Méderi - Hospital Universitario Mayor, Bogotá. Results: Of 287 patients 116 met the inclusion-exclusion criteria and accepted to participate. Age ranges between 65 and 99 years with a mean of 81,3 ± 8,17. Women and men represent respectively 76% and 24% of the sample. Mortality a year after is 28%, gender: 23% women and 43% men. 29,3% of the patients reentered the hospital, 50% recovered their previous functional capacity. 81% express as good the inpatient care by orthopedic service. 64% does not grade inpatient care by rehabilitation services because it was not given. 70% are satisfied with the outpatient services of orthopedic and rehabilitation. Conclusions: This study represents a novel and unique approach as it gives voice to the patient allowing assessment of the health services. Suggests the degree of pain as a tracer of quality of life and brings upon compulsory attention to implement health services improvement programs for hip fractures in the elderly.

Introdução: o envelhecimento populacional mundial tem aumentado a incidência de fraturas de quadril, mudanças que gera um alto impacto económico, social e constitui um desafio para a saúde pública. O estudo busca avaliar a satisfação com o manejo pós-cirúrgico em idosos com fraturas de quadril no ano posterior à intervenção e conhecer os desenlaces neste tempo. Materiais e métodos: estudo exploratório, observacional, descritivo, de corte transversal, mediante questionário por telefone em adultos de 65 ou mais anos, um ano após da intervenção cirúrgica por fraturas de quadril em Méderi - Hospital Universitário Mayor, de Bogotá D.C. Descrevem-se variáveis avaliativas de satisfação e atenção em saúde, assim como outras relacionadas. Resultados: de 287 pacientes, 116 cumprem os critérios de inclusão e aceitam participar. O rango de idade oscila entre 65 e 99 anos, média de 81,3 ± 8,17. As mulheres e os homens representam respetivamente 76% e 24% da amostra. Mortalidade anual 28%, por gênero: 23% mulheres e 3% homens. 29,3% apresenta reingressos hospitalários, 50% recupera a sua habilidade para a marcha. 81% considera boa a atenção intra-hospitalar por ortopedia. 64% não qualifica o serviço intra-hospitalar por fisioterapia já que não o recebe. 70% expressa satisfação com os serviços ambulatórios de ortopedia e reabilitação. Conclusões: estudo novo e único que dá voz como sujeito ativo ao paciente para avaliar o sistema de saúde, sugere o grau de dor como elemento traçador de qualidade de vida e obriga a implementar programas e serviços para idosos com fraturas de quadril.

Preventable deaths and potentially preventable deaths. What are our errors?

BACKGROUND: A variety of systems have been applied to identify and address errors in the management of multiple trauma patients. This lack of standardisation represents a serious problem. OBJECTIVES: Detect preventable and potentially preventable deaths, and classify all the errors with universal language. METHODS: We studied all trauma patients over 16 admitted to the critical care unit or who died before. In multidisciplinary sessions we decided which deaths were preventable, potentially preventable and non preventable. Guided by ATLS protocols, we detected errors in their management that were classified using the taxonomy of Joint Commission. RESULTS: We registered 1236 trauma patients (ISS 20.77). Of the 115 trauma deaths, 19 were preventable or potentially preventable deaths. We recorded 130 errors in all deaths, 46 of them in preventable or potentially preventable deaths. Using our own classification, the main errors were delay in starting correct treatment or performance of CT in hemodynamically unstable patients. Using the taxonomy of Joint Commission, the main type error was clinical, during the intervention: the delay in initiating correct treatment. Mistakes were made in the emergency department by medical specialists. The incidence of therapeutic and diagnostic errors was similar. The main cause of error was human failure, specifically 'rule-based' errors CONCLUSIONS: Measuring and recording the results is the first step on the way to improving the quality of care for trauma patients. A common language like the taxonomy of Joint Commission will help standardise patient safety data, thus improving the recording of incidents and their analysis and treatment.

Gold nanoparticles do not induce myotube cytotoxicity but increase the susceptibility to cell death.

Gold nanoparticles (AuNP) have been widely used for many applications, including as biological carriers. A better understanding concerning AuNP safety on muscle cells is crucial, since it could be a potential tool in the nanomedicine field. Here, we describe the impact of polyethylene glycol-coated gold nanoparticles (PEG-AuNP) interaction with differentiated skeletal muscle C2C12 cells on cell viability, mitochondria function, cell signaling related to survival, cytokine levels and susceptibility to apoptosis. Intracellular localization of 4.5 nm PEG-AuNP diameter size was evidenced by STEM-in-SEM in myotube cells. Methods for cytotoxicity analysis showed that PEG-AuNP did not affect cell viability, but intracellular ATP levels and mitochondrial membrane potential increased. Phosphorylation of ERK was not altered but p-AKT levels reduced (p<0.01). Pre-treatment of cells with PEG-AuNP followed by staurosporine induction increased the caspases-3/7 activity. Indeed, cytokines analysis revealed a sharp increase of IFN-γ and TGF-ß1 levels after PEG-AuNP treatment, suggesting that inflammatory and fibrotic phenotypes process were activated. These data demonstrate that PEG-AuNP affect the myotube physiology leading these cells to be more susceptible to death stimuli in the presence of staurosporine. Altogether, these results present evidence that PEG-AuNP affect the susceptibility to apoptosis of muscle cells, contributing to development of safer strategies for intramuscular delivery.

Avaliação do serviço de saúde prestado aos pacientes diabéticos em uma unidade de saúde de Goiânia-GO / Evaluation of the health service provided to diabetic patients at health units in Goiânia, GO

O diabetes mellitus é uma síndrome de etiologia múltipla e um dos principais agravos de saúde pública no Brasil. O controle desse agravo nos serviços básicos é fundamental, em virtude de sua magnitude crescente, transcendência e complexa vulnerabilidade. O objetivo deste estudo foi avaliar o tratamento e acompanhamento de pacientes diabéticos, segundo as recomendações da Sociedade Brasileira de Diabetes (SBD), em duas unidades básicas de saúde do município de Goiânia ? GO. Os dados foram obtidos por meio da revisão de prontuários médicos referentes ao período de janeiro de 2007 a dezembro de 2009, totalizando 250 prontuários, consolidados no software Epi InfoTM . Houve maior frequência de diabetes mellitus tipo 2 (96,65%) em relação ao tipo 1. Em 78% dos prontuários, havia descrição de hipertensão arterial e, destes, 77,4% tinham prescrição de IECA, e em 30,4% dos prontuários havia prescrição de AAS. Em média, pequena porcentagem de prontuários atendeu às recomendações da SBD: quase 50% dos pacientes estavam com pressão arterial controlada na unidade UBESF ?A? e 35%, na unidade UBESF ?B?; cerca de 25% estavam com LDL inferior a 100mg/dL em ambas as unidades e aproximadamente 25% dos prontuários da unidade UBESF ?B? tinham HbA1c inferior a 7%, e 18%, na UBESF ?A?. Quanto ao estudo de utilização de medicamentos, 41,1% dos prontu- ários tinham prescrição de metformina e um secretagogo, e apenas 20,4% dos pacientes com HbA1c>9% tinham prescrição de insulina.

Diabetes mellitus is a syndrome of multiple etiology and a major public health problem in Brazil. The control of this disease in basic services is crucial because of its growing magnitude, transcendence, and complex vulnerability. This retrospective study aimed to evaluate the treatment and monitoring of diabetic patients according to the Brazilian Diabetes Society guidelines in two basic health units (UBESFs) in the city of Goiânia/GO. Data were collected by review of medical records from January 2007 to December 2009, resulting in 250 records, consolidated in the Epi InfoTM software. There was a higher frequency of diabetes mellitus type 2 (96.65%) compared to type 1. In 78% of the records, arterial hypertension had been detected and of these, 77.4% had a prescription for ACE inhibitors. In 30.4% of the records, aspirin had been prescribed. On average, a small percentage of the medical records met the recommendations of the Brazilian Diabetes Society: almost 50% of the patients had controlled blood pressure in UBESF unit ?A? and over 35% in UBESF unit ?B?; about 25% had LDL less than 100mg/dL in both units, and approximately 25% had HbA1c below 7% in UBESF unit ?B? and 18% in UBESF unit ?A?. As to the study of medication use, 41.1% of the records had prescriptions for metformin and a secretagogue, and only 20.4% of the patients with HbA1c >9% had an insulin prescription.

Informe de 3 casos de reanimación extrahospitalaria en la ciudad de Querétaro: Importancia de un sistema integral de atención de emergencias médicas / Prehospital cardiac resuscitation in Queretaro, Mexico: Report of 3 cases. Importance of an integral emergency medical care system

En México, el paro cardiaco que ocurre fuera de las instalaciones hospitalarias representa un problema de salud pública debido a que se estima que es responsable de 33,000 a 150,000 muertes al año. La mortalidad que se informa, en las escasas publicaciones que existen en México, son tan elevadas que incluso llegan al 100% de los eventos, cifras mucho más altas que las informadas en otros países. En la ciudad de Querétaro no se tenían documentados casos de reanimación exitosa en los últimos 5 años, sin embargo, en el 2012 se informaron varios casos en los que la reanimación logró obtener el retorno de la circulación espontánea. Se presentan3 casos con retorno de la circulación espontánea en la escena y pulso a la llegada al hospital. De ellos, 2 egresaron con vida del hospital; pero uno de estos con pobre actividad cerebral. Factores como reanimación cardiopulmonar comunitaria, desfibrilación en los primeros minutos y mejores tiempos de respuesta del sistema de urgencia se relacionan con la supervivencia de las víctimas. Podrían mejorarse los resultados de este poco explorado problema de salud en el contexto mexicano con la mejora de la calidad del servicio de manera continua, con la difusión de estrategias de educación pública en reanimación cardiopulmonar asistida por la persona que está en ese momento, la participación de la policía en la reanimación cardiopulmonar y la desfibrilación, con los programas de acceso público a la desfibrilación y la determinación de indicadores de retroalimentación.

In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results.

Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario / Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response

OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE) como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE iniciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100 por ciento, tiempos de respuesta elevados y 10.8 por ciento recibió reanimación cardiopulmonar (RCP) por testigos presenciales. En 63.7 por ciento de los eventos la policía llegaba antes que la ambulancia y en 1.5 por ciento el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo.

OBJETIVE: Out-of-hospital cardiac arrest (OCHA) is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100 percent, response times high and 10.8 percent of the victims were receiving cardiopulmonary resuscitation (CPR) by bystanders. In 63.7 percent of the events the police arrived before the ambulance, in 1.5 percent of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Quality of previous diabetes care among patients receiving services at ophthalmology hospitals in Mexico / Calidad de la atención previa de los pacientes diabéticos atendidos en hospitales de oftalmología en México

OBJECTIVE: To survey a large sample of type 2 diabetes mellitus (T2DM) patients in Mexico City to determine if patient experience, access to basic services, treatment, and outcomes differed between those with social security coverage and those without. METHODS: From 2001-2007 a total of 1 000 individuals with T2DM were surveyed in outpatient clinics of the three largest public ophthalmology hospitals in Mexico City. Patients reported information about their health status and receipt of basic diabetes services, such as laboratory glycemic monitoring and diabetes education. Rates were compared between those with (n = 461) and without (n = 539) social security. RESULTS: Almost half of the patients (46 percent) in these public facilities were social security patients that were unable to access other services and had to pay out-of-pocket for care. Half of respondents were originally identified as potentially diabetic based on symptom complaints (51 percent), including 11 percent with visual impairment. Most patients (87.9 percent) reported that their glycemic level was being monitored exclusively via fasting blood glucose testing or random capillary blood glucose tests; only 5.3 percent reported ever having a glycated hemoglobin test. While nearly all respondents reported an individual physician encounter ever, only 39 percent reported ever receiving nutrition counseling and only 21 percent reported attending one or more sessions of diabetes education in their lifetime. Processes of care and outcomes were no different in patients with and those without social security coverage. CONCLUSIONS: In Mexico, the quality of diabetes care is poor. Despite receiving social security, many patients still have to pay out-of-pocket to access needed care. Without policy changes that address these barriers to comprehensive diabetes management, scientific achievements in diagnosis and pharmacotherapy will have limited impact.

OBJETIVO: Determinar si hay diferencias en cuanto a las experiencias de atención de la diabetes, el acceso a los servicios básicos, el tratamiento y la evolución clínica entre las personas que disponen o no de seguro social de salud mediante la encuesta de una muestra amplia de pacientes que padecen diabetes mellitus tipo 2 en la Ciudad de México. MÉTODOS: Se encuestó a 1 000 pacientes con diabetes tipo 2 en la consulta externa de los tres hospitales públicos de oftalmología más importantes de la Ciudad de México. Los pacientes proporcionaron información acerca de su estado de salud y su experiencia respecto de la atención básica de diabetes; por ejemplo, el control de la glucemia mediante análisis de laboratorio y la información que recibieron acerca de la enfermedad. Se compararon los datos estadísticos entre quienes disponían de un seguro social de salud (n = 461) y quienes carecían de este tipo de seguro (n = 539). RESULTADOS: Casi la mitad de los pacientes (46 por ciento) que se atienden en estos hospitales públicos disponen de seguro social de salud, pero no pudieron acceder a otros servicios y debieron pagar de su bolsillo para recibir atención. La mitad de los entrevistados (51 por ciento) eran pacientes que habían sido considerados presuntos diabéticos a partir de los síntomas que habían referido, de los cuales 11 por ciento presentaron discapacidad visual. La mayoría de los pacientes (87,9 por ciento) refirieron que solo se controlaban mediante análisis glucemia en ayunas o análisis aleatorios (sin ayunar) de una muestra de sangre capilar; solo 5,3 por ciento refirieron que alguna vez se habían efectuado el análisis de glucohemoglobina (HbA1c). Si bien prácticamente la totalidad de los encuestados refirieron haber tenido alguna consulta médica, solo 39 por ciento informaron haber recibido orientación nutricional en alguna ocasión y solo 21 por ciento refirieron haber asistido a una o más sesiones informativas sobre la diabetes. ...

Atenção farmacêutica em Goiânia: inserção do farmacêutico na estratégia saúde da família / Pharmaceutical care in Goiânia: inclusion of the pharmacist in the family health strategy

Com vistas no estabelecido na Política Nacional de Medicamentos, a Faculdade de Farmácia da UFG implantou, em parceria com a Secretaria Municipal de Saúde de Goiânia/Goiás, projeto de extensão universitária que propõe a inserção do farmacêutico na Estratégia Saúde da Família. Encontros foram realizados para sensibilização e apresentação do projeto às respectivas unidades de saúde, e a equipe de farmacêuticos local foi treinada para o exercício da atenção farmacêutica. Em 12 meses de desenvolvimento do projeto, 50 pacientes (70 por cento femininos), com idade média de 50 anos, foram assistidos. Entre estes, 40 (80 por cento) apresentavam mais de uma enfermidade associada e 46 (92 por cento) faziam o uso de dois ou mais fármacos, simultaneamente prescritos. Foram detectados 154 Problemas Relacionados com Medicamentos (PRM), com incidência de 3,1 PRM por paciente. O PRM mais frequente foi a falta de efetividade na terapêutica (49 por cento), sendo 26,3 por cento desses devido à falta de adesão ao tratamento. Conclui-se que a problemática envolvida na assistência à saúde devido à falta de eficiência da farmacoterapia assume dimensões importantes. Atenção Farmacêutica como estratégia de Assistência Farmacêutica mostrou-se, potencialmente, capaz de melhorar a assistência à saúde dos usuários do SUS.

In agreement with the Brazilian National Drug Policy, the School of Pharmacy of Universidade Federal de Goiás, in partnership with the Municipal Health Department of Goiânia, state of Goiás, created and implemented a university development project suggesting the inclusion of the pharmacist in the Family Health Strategy. Meetings were held in order to introduce the project to the respective primary care units and to train the teams of pharmacists in the exercise of pharmaceutical assistance. In the 12 months of the project, 50 patients with hypertension (70% female), with average age of 50, were assisted. Among those, 40 (80%) presented more than one associated illness and 46 (92%) used 2 or more drugs, simultaneously prescribed. In the study, 154 Medication-Related Problems (MRP) were detected, with an incidence of 3.1 MRP per patient. The most frequent MRP was lack of therapeutic efficacy (49%), and 26.3% of these were caused by lack of treatment adherence. It can be concluded that the health care problems caused by lack of pharmacotherapy efficiency assume important proportions. Pharmaceutical Care as a strategy of Pharmaceutical Assistance in Family Health can be an efficient alternative to obtain better clinical and economic results, and to improve the healthcare provided for users of Brazil's National Health System.

Depressão ou angústia?: embaraços do desejo em um processo analítico / Depression or anxiety?: embarrassments of desire in a process analytical

Capturada pelo discurso contemporâneo acerca da depressão, analisante retoma tratamento psicanalítico em grave estado de angústia, que a paralisava. A instalação da angústia deu-se por conta do nascimento da filha, que atualiza o ponto traumático de sua inserção no desejo do Outro, tornando-o insuportável. Posicionada e identificada ao desejo materno, interpretado como desejo de morte, sua posição no laço social era equivalente à do estudante no discurso universitário: continuar a saber sempre mais. A paralisação de sua produção profissional leva-a a crer que está deprimida. A saída subjetiva que encontra opera analiticamente através do trabalho significante e do resto recolhido pela elaboração de dois sonhos, que permitem o enquadramento da fantasia e a abertura ao desejo.

Identified to the contemporary discourse about the depression, the patient takes psychoanalytic treatment in severe state of distress, which paralyzed her. The installation of the anxiety occurred due to the birth of her daughter that updates the traumatic point of its insertion in the Other's desire, making it unbearable. Positioned identified to the maternal desire, interpreted as a desire for death, its position in the social bond was equal to the position of the student in the university discourse, according to J. Lacan: continue to learn ever more. The stoppage of its production at work led her to believe that she is depressed. The analytical and subjective solution that she finds operates through the significant development and the analysis of two dreams, which allow the framework of fantasy and the overture to the desire.