Upregulated Nuclear Expression of Soluble Epoxide Hydrolase Predicts Poor Outcome in Breast Cancer Patients: Importance of the Digital Pathology Approach.

Breast cancer (BC) is the most common cancer in women, with incidence rates increasing globally in recent years. Therefore, it is important to find new molecules with prognostic and therapeutic value to improve therapeutic response and quality of life. The polyunsaturated fatty acids (PUFAs) metabolic pathway participates in various physiological processes, as well as in the development of malignancies. Although aberrancies in the PUFAs metabolic pathway have been implicated in carcinogenesis, the functional and clinical relevance of this pathway has not been well explored in BC. To evaluate the clinical significance of soluble epoxide hydrolase (EPHX2) expression in Mexican patients with BC using tissue microarrays (TMAs) and digital pathology (DP). Immunohistochemical analyses were performed on 11 TMAs with 267 BC samples to quantify this enzyme. Using DP, EPHX2 protein expression was evaluated solely in tumor areas. The association of EPHX2 with overall survival (OS) was detected through bioinformatic analysis in public databases and confirmed in our cohort via Cox regression analysis. Clear nuclear expression of EPHX2 was identified. Receiver operating characteristics (ROC) curves revealed the optimal cutoff point at 2.847062 × 10-3 pixels, with sensitivity of 69.2% and specificity of 67%. Stratification based on this cutoff value showed elevated EPHX2 expression in multiple clinicopathological features, including older age and nuclear grade, human epidermal growth factor receptor 2 (HER2) and triple negative breast cancer (TNBC) subtypes, and recurrence. Kaplan-Meier curves demonstrated how higher nuclear expression of EPHX2 predicts shorter OS. Consistently, multivariate analysis confirmed EPHX2 as an independent predictor of OS, with a hazard ratio (HR) of 3.483 and a 95% confidence interval of 1.804-6.724 (p < 0.001). Our study demonstrates for the first time that nuclear overexpression of EPHX2 is a predictor of poor prognosis in BC patients. The DP approach was instrumental in identifying this significant association. Our study provides valuable insights into the potential clinical utility of EPHX2 as a prognostic biomarker and therapeutic target in BC.

Cancer-Related Malnutrition: Epidemiological Results from the Latin American Study of Malnutrition in the Oncology Practice.

Malnutrition can affect the patient diagnosed with, and treated for, cancer. However, until a dedicated study is completed, estimates of malnutrition rates will be disparate and unrepresentative of cancer patients' nutritional reality. Objective: To estimate the prevalence of malnutrition among patients being cared for cancer in Latin American (LATAM) hospitals by means of a multicenter, multinational study. Methods: The Latin American Study of Malnutrition in Oncology (LASOMO) was completed with 1,842 patients (Women: 56.2%; Age ≥ 60 years: 43.2%; Chemotherapy: 55.1%; Radiotherapy: 17.8%; Surgery: 27.1%) assisted at 52 health centers from 10 LATAM countries. Malnutrition prevalence was estimated from the (B + C) scores assigned to the patient with the Subjective Global Assessment by Detsky et al. (1987). Malnutrition prevalence was distributed regarding the demographic features of the patient, the primary tumor location, and the current cytoreducing treatment. Results: Malnutrition affected 59.1% of the surveyed patients. Malnutrition prevalence was higher among male patients and those with tumors of the digestive tract and the hemolymphopoietic system. Malnutrition was also associated with the current cytoreducing modality, with chemotherapy returning the highest prevalence. Conclusions: Malnutrition can be present in more than half of the patients being cared for cancer in LATAM health centers.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.2014902.

Factors associated with early platelet activation in obese children.

OBJECTIVE: To investigate the factors associated with platelet activation in obese children. DESIGN: Cross-sectional study. SETTING: Department of Pediatrics of Regional Hospital N∘ 1 of Mexican Institute of Social Security in Morelia, Michoacán, Mexico. PARTICIPANTS: 79 obese and 64 non-obese children between the ages of 5 and 10 years. MAIN OUTCOMES MEASURES: Obese children (body mass index [BMI] >85 in growth curves for Centers for Disease Control/National Center for Health Statistics), and the control group of 64 non-obese children (percentile <85), % body fat, platelet activation was assessed by sP-selectin. Other measures were leptin, uric acid (UA), von Willebrand Factor (vWF), plasminogen activator inhibitor (PAI-1), lipid profile, and glucose. RESULTS: Obese children displayed higher plasma sP-selectin, leptin, PAI-1, and vWF than non-obese children. In the univariate logistic regression analysis, leptin, vWF, UA, and high density lipoprotein (HDL), but not with PAI-1, were factors associated with platelet activation. By stepwise linear regression analysis adjusted by sex and age, the best predictor variables for platelet activation were leptin (ß:0.381; t:4.665; P=0.0001), vWF (ß:0.211; t:2.926; P=0.004), UA (ß:0.166; t:2.146; P=0.034), and HDL (ß:-0.215; t:-2.819; P=0.006). CONCLUSIONS: Obese children have a higher risk of developing early platelet activation. Factors associated with platelet activation were Leptin, vWF, UA, and HDL. Further studies involving larger numbers of patients over a longer duration are needed to understand the possible molecular mechanism underlying the association between leptin, vWF, and UA and endothelial activation and/or endothelial damage/dysfunction in obese children and its influence in cardiovascular disease in adults.

Advanced Oxidative Protein Products Had a Diagnostic Accuracy for Identifying Chronic Kidney Disease in Adult Population.

Chronic Kidney Disease (CKD) is a serious public health problem. Hyperglycemia stimulates the production of reactive oxygen species that cause oxidative damage to proteins. AOPPs constitute a group of oxidized dityrosine-containing proteins that are generated during periods of oxidative stress. They have proved to be a valuable early marker of oxidative tissue damage and active mediators of inflammation associated with the uremic state. To analyze if advanced oxidative protein products (AOPPs) have diagnostic accuracy for identifying chronic kidney disease (CKD) in the adult population. We conducted a diagnostic test validation study in 302 adults ≥20 years old, of both sexes, with and without T2D. After obtaining informed consent, a comprehensive clinical history, anthropometric measurements (weight, BMI) and blood pressure were recorded. Glucose, cholesterol, triglyceride, HDL-c, LDL-c and AOPPs were determinates. Glomerular filtration rate (GFR) was calculated using Cockcroft-Gault (C-G) corrected by body surface area (BSA, mL/min/1.73 m2), CKD-EPI and MDRD equations to identify five stages of CKD. This study follows the Standards for Reporting Diagnostic Accuracy Studies (STARD). The median value of AOPPs was 198.32 µmol/L (minimum-maximum value: 113.48-522.42 µmol/L). The group with patients diagnosed with T2D exhibited higher concentrations (median: 487.39 µmol/L) compared to the non-diabetic group (median: 158.50 µmol/L, p = 0.0001). The selected cut-off point was ≥200 µmol/L using the closest to the median value of AOPPs with sensitivity and specificity as follows: C-G: sensitivity 96.58%; specificity 80%; likelihood ratio: 4.83; CKD-EPI: sensitivity 95.76%; specificity 79.89%; likelihood ratio: 4.76; MDRD: sensitivity 86.55%; specificity: 73.22%; likelihood ratio: 3.23. A difference was observed between AOPPs and chronic kidney disease stage. This study provides evidence that AOPPs ≥ 200 µmol/L have diagnostic accuracy in identifying stage 4-5 CKD by C-G, MDRD and CKD-EPI equations in adults with and without T2D.

Sequencing and description of the genome of a strain of Stenotrophomonas geniculata isolated from a patient infected with COVID-19 at Hospital Regional No.1 de Charo, Michoacán, México.

Stenotrophomonas is a bacterial genus that can be found in various environments, such as water, soil, and clinical samples. Due to their high genetic and phenotypic diversity, it is difficult to properly identify and classify all isolates. The COVID-19 pandemic caused an increase in nosocomial infections, which played a major role in the high mortality rate among patients in intensive care. This is the first report of the identification of S. geniculata as a nosocomial opportunistic pathogen isolated from a patient with COVID-19. Their genome was isolated, sequenced, and assembled, and it consists of 4,488,090 bp in 24 contigs, 4,103 coding sequences, and a G+C content of 66.58%.

C4d expression in focal segmental glomerulosclerosis.

BACKGROUND: There is a little information about of expression of C4d (complement fragment) in Focal segmental glomerulosclerosis (FSGS) subtypes. Our aim was to determine the expression of C4d in FSGS subtypes in percutaneous native renal biopsies in a second-level hospital and its correlation with clinical, biochemical and histological variables. MATERIAL AND METHODS: A retrospective study in paraffin blocks of patients with biopsy with FSGS aged 16-65 years, indistinct sex, not diabetic or obese. Immunohistochemistry was performed for C4d and their expression was analyzing in non-sclerosed glomerular capillaries (GC) and sclerosis areas (SA). Clinical and biochemical variables were recorded. The cases were divided into C4d positive and C4d negative groups and compared. The correlation between C4d staining scores in CG and SA with clinical and biochemical variables were analyzed. RESULTS: Twenty samples were analyzed, 4 for each subtype. At the time of biopsy average age 38.8 ±â€¯18.6 years, 65% male, 8.7% were hypertension. The percentage of positivity for C4d was 40% in GC, 30% SA and 35% in mesangium. The highest expression was for cellular and collapsing subtypes. C4d positivity cases had increased proteinuria (p = 0.035). A significant correlation was found between percentage of C4d expression in CG with SA (p = 0.012) and SA with tubular atrophy and interstitial fibrosis (p < 0.05). CONCLUSIONS: C4d expression in FSGS predominated in the cellular and collapsing subtypes, which translates complement activation. C4d is a possible surrogate marker in GSFS.

An observational study investigating soluble immune checkpoints as indicators of severe COVID-19.

This study aimed to investigate the immunomodulatory behavior of soluble immune checkpoints (sICPs) and other biomarkers in the pathophysiology of SARS-CoV-2 infection. The study included 59 adult participants, 43 of whom tested positive for SARS-CoV-2. Patients were divided into three cohorts: those with moderate disease (n = 16), recovered patients with severe disease (n = 13), and deceased patients with severe disease (n = 16). In addition, 16 participants were pre-pandemic subjects negative for SARS-CoV-2. The relative activity of neutralizing antibodies (rNAbs) against SARS-CoV-2 and the values of 14 sICPs in peripheral blood were compared between the four groups. Because the increase of markers values of inflammation [NLR > 12; CRP > 150 mg/L] and venous thromboembolism [D-dimer > 0.5 mg/L] has been associated with mortality from COVID-19, the total and differential leukocyte counts, the NLR, and CRP and D-dimer values were obtained in patients with severe disease. No differences in rNAbs were observed between the cohorts. Only the levels of five sICPs, sCD27, sHVEM sTIM-3, sPD-1, and sPDL-1, were significantly higher in patients with severe rather than moderate disease. The sPDL-2 level and NLR were higher in deceased patients than in recovered patients. However, there was no difference in CRP and D-dimer values between the two groups. Of the five soluble biomarkers compared among patients with severe disease, only sPDL-2 was higher in deceased patients than in recovered patients. This suggests that immuno-inhibitory sICPs might be used as indicators for severe COVID-19, with sPDL-2 used to assess individual risk for fatality.IMPORTANCECOVID-19, the disease caused by a SARS-CoV-2 infection, generates a broad spectrum of clinical symptoms, progressing to multiorgan failure in the most severe cases. As activation of the immune system is pivotal to eradicating the virus, future research should focus on identifying reliable biomarkers to efficiently predict the outcome in severe COVID-19 cases. Soluble immune checkpoints represent the function of the immune system and are easily determined in peripheral blood. This research could lead to implementing more effective severity biomarkers for COVID-19, which could increase patients' survival rate and quality of life.

Prevalence and metabolic risk factors of chronic kidney disease among a Mexican adult population: a cross-sectional study in primary healthcare medical units.

Introduction: The intricate relationship between obesity and chronic kidney disease (CKD) progression underscores a significant public health challenge. Obesity is strongly linked to the onset of several health conditions, including arterial hypertension (AHTN), metabolic syndrome, diabetes, dyslipidemia, and hyperuricemia. Understanding the connection between CKD and obesity is crucial for addressing their complex interplay in public health strategies. Objective: This research aimed to determine the prevalence of CKD in a population with high obesity rates and evaluate the associated metabolic risk factors. Material and Methods: In this cross-sectional study conducted from January 2017 to December 2019 we included 3,901 participants of both sexes aged ≥20 years who were selected from primary healthcare medical units of the Mexican Social Security Institute (IMSS) in Michoacan, Mexico. We measured the participants' weight, height, systolic and diastolic blood pressure, glucose, creatinine, total cholesterol, triglycerides, HDL-c, LDL-c, and uric acid. We estimated the glomerular filtration rate using the Collaborative Chronic Kidney Disease Epidemiology (CKD-EPI) equation. Results: Among the population studied, 50.6% were women and 49.4% were men, with a mean age of 49 years (range: 23-90). The prevalence of CKD was 21.9%. Factors significantly associated with an increased risk of CKD included age ≥60 years (OR = 11.70, 95% CI [9.83-15.93]), overweight (OR = 4.19, 95% CI [2.88-6.11]), obesity (OR = 13.31, 95% CI [11.12-15.93]), abdominal obesity (OR = 9.25, 95% CI [7.13-11.99]), AHTN (OR = 20.63, 95% CI [17.02-25.02]), impaired fasting glucose (IFG) (OR = 2.73, 95% CI [2.31-3.23]), type 2 diabetes (T2D) (OR = 14.30, 95% CI [11.14-18.37]), total cholesterol (TC) ≥200 mg/dL (OR = 6.04, 95% CI [5.11-7.14]), triglycerides (TG) ≥150 mg/dL (OR = 5.63, 95% CI 4.76-6.66), HDL-c <40 mg/dL (OR = 4.458, 95% CI [3.74-5.31]), LDL-c ≥130 mg/dL (OR = 6.06, 95% CI [5.12-7.18]), and serum uric acid levels ≥6 mg/dL in women and ≥7 mg/dL in men (OR = 8.18, 95% CI [6.92-9.68]), (p < 0.0001). These factors independently contribute to the development of CKD. Conclusions: This study underscores the intricate relationship between obesity and CKD, revealing a high prevalence of CKD. Obesity, including overweight, abdominal obesity, AHTN, IFG, T2D, dyslipidemia, and hyperuricemia emerged as significant metabolic risk factors for CKD. Early identification of these risk factors is crucial for effective intervention strategies. Public health policies should integrate both pharmacological and non-pharmacological approaches to address obesity-related conditions and prevent kidney damage directly.

SARS-CoV-2 Variants and Clinical Outcomes: A Systematic Review.

BACKGROUND: From the start of the COVID-19 pandemic, new SARS-CoV-2 variants have emerged that potentially affect transmissibility, severity, and immune evasion in infected individuals. In the present systematic review, the impact of different SARS-CoV-2 variants on clinical outcomes is analyzed. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Two databases (PubMed and ScienceDirect) were searched for original articles published from 1 January 2020 to 23 November 2021. The articles that met the selection criteria were appraised according to the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Thirty-three articles were included, involving a total of 253,209 patients and 188,944 partial or complete SARS-CoV-2 sequences. The most reported SARS-CoV-2 variants showed changes in the spike protein, N protein, RdRp and NSP3. In 28 scenarios, SARS-CoV-2 variants were found to be associated with a mild to severe or even fatal clinical outcome, 15 articles reported such association to be statistically significant. Adjustments in eight of them were made for age, sex and other covariates. CONCLUSIONS: SARS-CoV-2 variants can potentially have an impact on clinical outcomes; future studies focused on this topic should consider several covariates that influence the clinical course of the disease.

Glycogen Synthase Kinase 3ß Modulates the Inflammatory Response Activated by Bacteria, Viruses, and Parasites.

Knowledge of glycogen synthase kinase 3ß (GSK3ß) activity and the molecules identified that regulate its function in infections caused by pathogenic microorganisms is crucial to understanding how the intensity of the inflammatory response can be controlled in the course of infections. In recent years many reports have described small molecular weight synthetic and natural compounds, proteins, and interference RNA with the potential to regulate the GSK3ß activity and reduce the deleterious effects of the inflammatory response. Our goal in this review is to summarize the most recent advances on the role of GSK3ß in the inflammatory response caused by bacteria, bacterial virulence factors (i.e. LPS and others), viruses, and parasites and how the regulation of its activity, mainly its inhibition by different type of molecules, modulates the inflammation.

Behavior of Eosinophil Counts in Recovered and Deceased COVID-19 Patients over the Course of the Disease.

Knowledge about the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, particularly regarding the function of eosinophils, has been steadily emerging recently. There exists controversy regarding the implications of eosinophils in the coronavirus disease 2019 (COVID-19)'s pathology. We report a retrospective cohort study including the comparison of leukocyte counts in COVID-19 patients, considering the outcomes of recovery (n = 59) and death (n = 60). Among the different types of leukocytes, the eosinophil counts were those that showed the greatest difference between recovered and deceased patients. Eosinopenia (eosinophil count < 0.01 × 109/L) was more frequently observed in deceased than recovered patients (p = 0.0012). The eosinophil counts more rapidly increased and showed a greater proportion over the course of the disease in the recovered than deceased patients. Furthermore, the estimated survival rate was greater in patients without eosinopenia than in patients with eosinopenia (p = 0.0070) during hospitalization. Importantly, recovered but not deceased patients showed high negative correlations of the eosinophils with the neutrophil-to-lymphocyte ratio (NLR) and neutrophil counts at Day 9 of the onset of clinical symptoms (p ≤ 0.0220). Our analysis suggests that eosinopenia may be associated with unfavorable disease outcomes and that the eosinophils have a beneficial function in COVID-19 patients, probably contributing by controlling the exacerbated inflammation induced by neutrophils.

[Anthropometric parameters as predictors of insulin resistance in overweight and obese adults]. / Parámetros antropométricos como predictores de resistencia a la insulina en adultos con sobrepeso y obesidad.

OBJECTIVE: To evaluate which of the anthropometric parameters that estimate overweight and obesity are the best predictors of insulin resistance (IR) in adults from Family Medicine Unit N degrees 80 of IMSS in Morelia, Michoacán, México. DESIGN: Descriptive cross-sectional study. SETTING: Family Medicine Unit N 80 of Mexican Social Security Institute in Morelia, Michoacán, Mexico. PARTICIPANTS: A random sample of 147 adults with overweight or obesity. MAIN MEASUREMENTS: Age and sex. Anthropometrics: weight, body mass index (BMI), waist and mid arm circumference, % corporal fat; Skin folds thickness: bicipital, tricipital, subscapularis, abdominal skin folds; analyses: glucose, lipid profile, insulin; clinical: diastolic and systolic pressure, cardiovascular risk and insulin resistance by HOMA > or =2.5. RESULTS: IR was found in 41.49% of patients. ROC curves were made and the cut off point of bicipital skin fold > or =4.50mm, mid arm > or =27.50 cm were predictors of IR in 97.4%; BMI > or =25kg/m(2) was a predictor of IR in 92.3%, and by linear regression these parameters were the better predictors of IR. CONCLUSIONS: A total of 41.49% of patients were identified with IR (HOMA > or =2.5). BMI, bicipital skins fold and mid arm were the better predictors of IR. Specific studies are needed to determine the optimum cut off point of different parameters for estimating overweight and obesity in each sector in México.

[Effect of pentoxifylline on the evolution of diabetic nephropathy]. / Efecto de la pentoxifilina sobre la evolución de la nefropatía diabética.

BACKGROUND AND OBJECTIVE: Diabetic nephropathy (DN) is the principal cause of end-chronic kidney disease. Metabolic and hemodynamic components are directly involved. However, convincing data have shown that inflammation participates in the diabetic complications. The aim of this study was to investigate whether the inhibition of the inflammation and pro-inflammatory cytokines with pentoxifylline (PXF) attenuate the progression of the DN. SUBJECTS AND METHOD: In a prospective, randomized, double-blind, placebo- controlled study, we evaluated the effect of PXF (1200 mg daily) during 12 months, in 34 patients with incipient or established DN. Evaluated parameters were inflammation, pro-inflammatory cytokines and urinary albumin excretion (UAE). RESULTS: PXF treatment had a reno-protective effect determined by a significant reduction in the UAE in both incipient and established (p<0,01) DN patient. This effect was attributed to a reduction in the C-reactive protein, interleukin-6, tumor necrosis factor-alpha and leptin serum levels (p<0,01). CONCLUSIONS: PXF treatment caused regression and prevented the progression of renal damage. Thus, PXF should be used in the preventive treatment of DN. These results showed that inflammation and pro-inflammatory cytokines are related to the progression of diabetic nephropathy.

[Impact of delayed renal function in the renal graft receptor survival from cadaver donor]. / Impacto de la función renal retardada en la sobrevida del injerto renal de donador de cadáver.

OBJECTIVE: to determine the risk factors that lead to delayed graft function (DGF) on long-term renal transplant survival (LTRTS). METHODS: we studied 58 patients who received cadaver transplant. DGF was defined as failure to decrease creatinine plasmatic levels spontaneously during the first postoperative week, requiring at least one dialysis treatment during the first postoperative week or urinary volume < 1 L/24 hr by 2 consecutive days in the first postoperative week. RESULTS: by the Kaplan-Meier and Log rank test, we observed that the DGF > 15 days is associated with a reduction in the LTRTS (Log rank = 4.15, p = 0.042). The logistic regression analysis suggested that cold ischemia time > 12 hr (adjusted OR = 7.99, 95 % CI = 2.36-27.04, p = 0.001) and dialysis of the recipients > 3 years (adjusted OR = 1.67, 95 CI = 1.14-3.47, p = 0.032), were associated with DGF of the renal graft. CONCLUSIONS: this results suggest that DGF > 15 days is associated with a reduction in a LTRTS graft and it supports the presence of risk factors that reduce the graft survival: cold ischemia time > 12 hr and a dialysis time > 3 years for the recipients.

[Creatinin as predictor value of mortality in patients with acute coronary syndrome]. / Creatinina sérica como pronóstico de mortalidad en pacientes con síndrome coronario agudo.

BACKGROUND: Cardiovascular diseases have become the leading cause of death worldwide. OBJECTIVE: To estimate serum creatinine (Cr) as a prognostic value of mortality in patients with Acute Coronary Syndrome (ACS), which was admitted to the shock room in the emergency department (ED). MATERIAL AND METHODS: A transversal, prospective study, which included 95 patients with ACS who were admitted to the shock room. The following variables were studied: laboratory tests with Cr, cardiovascular risk factors (CVRF), days of hospital stay, service to which it was derived and discharge condition (alive or dead). Statistical analysis was through SPSS v. 23. RESULTS: The diagnosis of admission was ACS without ST elevation (NSTE-ACS), 72.6%; and Acute Myocardial Infarction with ST elevation (STEMI), 27.4%. The 63.2% were discharged alive, 13.7% transferred to a third level hospital and 23.2% died. There was a difference in the level of Cr between living and deceased (p = 0.0001). CONCLUSIONS: CR on admission of the patient with SCA provides prognostic information for mortality, and can be established as a prognostic marker of easy access and available in the ED.

INTRODUCCIÓN: las enfermedades cardiovasculares se han convertido en la principal causa de muerte a nivel mundial. OBJETIVO: estimar la creatinina (Cr), sérica como valor pronóstico de mortalidad en pacientes con síndrome coronario agudo (SCA) que ingresaron a sala de choque en el servicio de urgencias (SU). MATERIAL Y MÉTODOS: estudio prospectivo, transversal, que incluyó a 95 pacientes con SCA ingresados en sala de choque. Se estudiaron las siguientes variables: estudios de laboratorio con Cr, factores de riesgo cardiovascular (FRCV), días de estancia hospitalaria, servicio al que se derivó y condición de egreso (vivo/ muerto). El análisis estadístico fue mediante SPSS v. 23. RESULTADOS: el diagnóstico de ingreso fue de SCA sin elevación del ST (SCASEST), 72.6%; e infarto agudo al miocardio con elevación del segmento ST (IAMCEST), 27.4%. Egresaron vivos el 63.2%, fueron trasladados a hospital de tercer nivel el 13.7% y falleció el 23.2%. Se encontró una diferencia en el nivel de Cr entre vivos y fallecidos (p = 0.0001). CONCLUSIONES: la Cr al ingreso del paciente con SCA proporciona información pronostica para mortalidad, y se puede establecer como un marcador pronóstico de acceso fácil y disponible en el SU.

Transition to the Role of Family Caregiver of Older Adults After a Stroke: A Specific Theory / Transición del rol cuidador familiar de la persona adulta mayor post accidente cerebrovascular (ACV): teoría específica / Transição ao papel de cuidador familiar no idoso após acidente vascular cerebral (AVC): teoria específica

Introduction: Nursing professionals develop situation-specific theories to describe, explain, and provide comprehensive care during a family member's transition to the caregiver role. Objective: To develop a situation-specific theory about the transition to the role of family caregiver of older adults after a stroke. Methodology: The integrating approach by Meleis and Im was applied, which consists of five stages: 1) Description of the context and target population, 2) Verification of assumptions regarding the philosophical stance, 3) Exploration of multiple sources, 4) Theorization of concepts, and 5) Proposal of empirical indicators for validation and verification. Results: The prescriptive theory was developed in the light of Afaf Meleis' Theory of Transitions and was supported by an exhaustive literature review, with four underlying concepts: Situational transition to the family caregiver role, Care-related knowledge and skills, Self-confidence and coping in adopting the caregiver role, and Nursing therapeutic education. The following assumption emerges from these concepts: a healthy transition to the family caregiver role is directly dependent on the care-related knowledge and skills provided by Nursing therapeutic education to develop self-confidence and coping in adopting the caregiver role. Conclusions: The proposal provides a conceptual framework that identifies the transition challenges and needs faced by family caregivers to adopt the role of caregivers of older adults after a stroke.

Introducción: los profesionales de enfermería desarrollan teorías de situación específica para describir, explicar y proporcionar cuidados integrales durante la transición del familiar al rol cuidador. Objetivo: desarrollar una propuesta de teoría de situación específica sobre la transición al rol cuidador familiar de la persona adulta mayor post accidente cerebrovascular. Metodología: se aplicó el enfoque integrador de Meleis e Im, que consta de cinco etapas: 1) descripción del contexto y población blanco; 2) comprobación de suposiciones en relación con la postura filosófica; 3) exploración de múltiples fuentes; 4) teorización de conceptos; y 5) propuesta de indicadores empíricos para la validación y comprobación. Resultados: la teoría prescriptiva fue desarrollada a la luz de la teoría de las transiciones de Afaf Meleis y se apoyó en una revisión exhaustiva de literatura, con cuatro conceptos subyacentes: transición situacional del rol cuidador familiar, conocimiento y habilidad del cuidado, confianza y afrontamiento en la adopción del rol cuidador, y educación terapéutica de enfermería. A partir de estos, surge la siguiente proposición: la transición saludable al rol cuidador familiar depende directamente de los conocimientos y habilidades de cuidado que brinda la terapéutica de enfermería para el desarrollo de confianza y afrontamiento en la adopción del rol cuidador. Conclusiones: la propuesta proporciona un marco conceptual que identifica los desafíos y necesidades de transición de los cuidadores familiares para la adopción del rol cuidador de la persona adulta mayor post accidente cerebrovascular.

Introdução: os profissionais de enfermagem desenvolvem teorias específicas para descrever, explicar e prestar cuidados holísticos durante a transição do familiar para o papel de cuidador. Objetivo: desenvolver uma proposta de teoria específica sobre a transição para o papel de cuidador familiar do idoso pós-AVC. Metodologia: foi aplicada a abordagem integrativa de Meleis e Im, composta por cinco etapas: 1) descrição do contexto e da população-alvo; 2) teste de hipóteses em relação à postura filosófica; 3) exploração de múltiplas fontes; 4) teorização de conceitos; e 5) proposta de indicadores empíricos para validação e teste. Resultados: a teoria prescritiva foi desenvolvida à luz da teoria das transições de Afaf Meleis e com o suporte de uma revisão exaustiva da literatura, com quatro conceitos subjacentes: transição situacional do papel de cuidador familiar, conhecimentos e competências de cuidado, confiança e enfrentamento na adoção do papel de cuidador e educação terapêutica em enfermagem. Destes conceitos emerge a seguinte proposição: a transição saudável para o papel de cuidador familiar depende diretamente do conhecimento e das competências de cuidado proporcionadas pela enfermagem terapêutica para o desenvolvimento de confiança e capacidade de enfrentamento na adoção do papel de cuidador. Conclusões: A proposta fornece um quadro conceitual que identifica os desafios e as necessidades de transição dos cuidadores familiares na adoção do papel de cuidador do idoso após acidente vascular cerebral (AVC).

Aplicaciones móviles para el autoaprendizaje en el cuidador del adulto mayor con accidente cerebrovascular: Revisión integradora / Mobile applications for self-learning in the caregiver of the elderly with stroke: integrative review

Resumen Objetivo: Analizar la evidencia disponible en la literatura sobre intervenciones con aplicaciones móviles para favorecer el autoaprendizaje de atención y asistencia en el cuidador primario del adulto mayor, con secuelas físicas de accidente cerebrovascular. Material y Métodos: Revisión integradora de la literatura publicada entre Enero de 2018 y Junio 2022 en las bases de datos CINAHL, EMBASE, LILACS, PubMed, Scopus y EBSCOhost. Los datos obtenidos se analizaron en cuatro etapas: identificación del tema, muestreo, selección y categorización de estudios y análisis, evaluación e interpretación de resultados bajo el método CASPe. Resultados: 2 fueron cualitativos y 1 cuantitativo; las intervenciones digitales fueron: mHealth, Movies4Stroke y MoCaB utilizadas para el autoaprendizaje y asistencia en el cuidador primario en las dimensiones control de la presión arterial, glucosa, colesterol y adherencia farmacológica. Las intervenciones educativas digitales aumentan el autoaprendizaje y facilita la atención en el cuidador del adulto mayor con secuelas físicas por accidente cerebrovascular. Conclusiones: Las intervenciones educativas digitales para el autoaprendizaje y asistencia en el cuidador primario desde la evidencia científica son mínimas. Es necesario diseñar intervenciones digitales accesibles, dinámicas y de fácil interacción para el autoaprendizaje en la generación de habilidades de cuidados en el encargado primario del adulto mayor con secuelas físicas post accidente cerebrovascular.

Abstract Objective: To analyze the evidence available in the literature on interventions with mobile applications to promote self-learning of care and assistance in the primary caregiver of the elderly with physical sequelae of stroke. Material and Methods: Integrative review of the literature published between January 2018 and June 2022 in the CINAHL, EMBASE, LILACS, PubMed, Scopus and EBSCOhost databases. The data obtained was analyzed in four stages: theme identification, sampling, selection and categorization of studies and analysis, evaluation and interpretation of results under the CASPe method. Results: 2 were qualitative and 1 quantitative; the digital interventions were: mHealth, Movies4Stroke and MoCaB used for self-learning and assistance in the primary caregiver in the dimensions of blood pressure control, glucose, cholesterol and pharmacological adherence. Digital educational interventions increase self-learning and facilitate care in the caregiver of the elderly with physical sequelae due to stroke. Conclusions: Digital educational interventions for self-learning and assistance in the primary caregiver from the scientific evidence are minimal. It is necessary to design accessible, dynamic and easy-to-interact digital interventions for self-learning in the generation of care skills in the primary caregiver of the elderly with post-stroke physical sequelae.

Copeptin Plasma Levels are Associated with Decline of Renal Function in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Chronic kidney disease (CKD) is a leading complication of type 2 diabetes mellitus (T2DM) and is considered as a public health problem. Copeptin is a surrogate marker of arginine vasopressin (AVP) system and is proposed as a biomarker of decline renal function. OBJECTIVE: Evaluate whether plasma copeptin levels may be used as a biomarker of decline renal function in patients with T2DM. RESEARCH DESIGN AND METHODS: A total of 480 patients with T2DM and different stages of CKD were included. Plasma levels of copeptin, cystatin-C, and other biochemical parameters were measured. The correlation between copeptin and glomerular filtration rate (GFR), estimated based on plasma cystatin-C levels, was investigated. RESULTS: Plasma copeptin levels were gradually increased from the stage 1-5 of CKD in the patients with T2DM. In univariate linear regression analysis, high plasma levels of copeptin were associated with lower GFR (Standardized ß = -0.535, R2 = 0.287, p <0.0001). This association remained significant even after being adjusted for glucose levels and years of T2DM diagnosis, mean blood pressure, pharmacological treatment, gender, and age. CONCLUSIONS: The results show that high plasma copeptin levels are associated with the decline of renal function in patients with T2DM and, therefore, copeptin may be considered as a biomarker of renal function. Further evaluation of plasma copeptin levels to predict morbidity and mortality of T2DM patients, with or without CKD, has been taken into our consideration.

Association between angiotensin-1 converting enzyme gene polymorphism and the metabolic syndrome in a Mexican population.

Metabolic Syndrome (MS) is recognized as a cluster of cardiovascular risk factors. All components of MS have a genetic base. Genes of the renin angiotensin system are potential candidate genes for MS. We investigated whether angiotensin converting enzyme (ACE) gene polymorphism increases susceptibility to MS as an entity in a Mexican population. In a cross-sectional study, 514 individuals were studied including 245 patients with MS and 269 subjects without MS criteria. ACE gene polymorphism was detected using PCR. MS was defined according to The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) criteria, except that the raised fasting plasma glucose

[Angiotensin-1 converting enzyme insertion/deletion gene polymorphism in a Mexican population with diabetic nephropathy]. / Polimorfismo inserción/deleción del gen de la enzima de conversión de la angiotensina en una población mexicana con nefropatía diabética.

BACKGROUND AND OBJECTIVE: Diabetic nephropathy is a polygenic and multifactorial disease. Studies of familial clustering and genetic predisposition suggest that genetic factors are involved. Among candidate genes, the coding for angiotensin-converting enzyme (ACE) polymorphism has been described. Our objective was to investigate the association ACE gene insertion/deletion (I/D) polymorphism with the development of diabetic nephropathy in a Mexican population. PATIENTS AND METHOD: In a cross-sectional study, we evaluated 204 patients with type 2 diabetes: 43 with incipient diabetic nephropathy, 45 with established diabetic nephropathy and 116 without diabetic nephropathy. Diabetic nephropathy was defined according the American Diabetes Association criteria. The ACE I/D gene polymorphism was detected by polymerase chain reaction. RESULTS: Patients with type 2 diabetes with both incipient diabetic nephropathy and established diabetic nephropathy significantly differed from controls with respect to variables that determined kidney damage (P<.0001) and serum lipids ( P<.01). The genotype DD was strongly associated with the development of incipient diabetic nephropathy (odds ratio [OR] adjusted = 2.83; 95% confidence interval, 1.74-4.59; P<.0001) and established diabetic nephropathy (OR adjusted = 2.95; 95% CI, 1.83-4.73; P<.0001). CONCLUSIONS: The ACE DD genotype is associated with the development of incipient diabetic nephropathy and established diabetic nephropathy in a Mexican population.