RESUMEN
BACKGROUND: A high proportion of health professionals in training suffer from work-related stress and may develop a burnout syndrome. OBJECTIVES: To study the incidence of burnout after the first year of residency in a teaching hospital and to identify baseline psychological, psychosocial work conditions, and biological risk factors. METHODOLOGY: We assessed the following in a prospective cohort of residents at baseline (first month residence) and after 1 year: background factors (socio-demographics, psychiatric history), perceived stress score (Perceived Stress Scale), Maslach Burnout Inventory score, and psychosocial factors (Job Content Questionnaire). Blood samples were obtained to study serum cortisol, IL-6, and TNF-α concentrations. The cumulative incidence was modelled by multivariate log-binomial regression analysis. RESULTS: We included 71 participants with a female majority (64.8%), age 26.4 (2.65) years, psychiatric history in 20%, and burnout in 13%. Among those without burnout initially (N = 59), it had developed by 1 year in 22% of residents. Increased job demand (RR = 1.259, 95%CI = 1.019-1.556, p = 0.033) and decreased cortisol levels (RR = 0.877, 95%CI = 0.778-0.989, p = 0.032) predicted burnout after 1 year of residency among medical trainees. CONCLUSION: Burnout syndrome develops in 22% of residents by 1 year of training and can be predicted by increased work demands and decreased cortisol levels.
Asunto(s)
Agotamiento Profesional , Médicos , Adulto , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Agotamiento Psicológico , Femenino , Humanos , Hidrocortisona , Médicos/psicología , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
Single ion magnet behaviour is reported for a mononuclear Mn(iii) ion with tridentate Schiff-base ligands which exhibits a tetragonal Jahn-Teller elongation along the Namine-Mn-Namine axis and crystallises with two crystallographically distinct Mn(iii) cations (unit A and unit B). While magnetic measurements show a large and negative axial zero-field splitting (D = -4.73 cm(-1)), HF-EPR reveal two distinct large axial Ds (D = -4.60 cm(-1) for unit A and D = -4.18 cm(-1) for unit B), thus resulting in the largest D known to date for a Mn(iii) single ion magnet. AC magnetic measurements at 2000 Oe allowed determination of the energy barrier for spin reversal (10.19 K) and spin reversal relaxation time (1.476 × 10(-6) s) for the Mn(iii) ion. Computational studies were used to characterise the electronic structure and substantiate the zero field splitting in the Mn(iii) complex.
RESUMEN
Irisin, a hormone secreted by myocytes induced in exercise, acts as a muscle-derived energy-expenditure signal that binds to undetermined receptors on the white adipose tissue surface, stimulating its browning and uncoupling protein 1 (UCP1) expression. The purpose of this study was to assess the effect of an intradialytic resistance exercise training program (RETP) on plasma irisin levels of hemodialysis (HD) patients and compare the baseline plasma irisin levels of HD patients to healthy subjects. This longitudinal study enrolled 26 patients undergoing HD (50% men, 44.8±14.1 years, body mass index (BMI) 23.5±3.9 kg/m²). The healthy subjects group consisted of 11 women and 7 men with mean age of 50.9±6.6 years and BMI, 24.2±2.7 kg/m². Anthropometric and biochemistry parameters (Irisin by Enzyme-Linked Immunosorbent Assay) were measured at the baseline and after 6 months of RETP (in both lower limbs). There was no difference regarding gender, age, and BMI between HD patients and healthy subjects. Plasma irisin levels in HD patients were lower than in healthy subjects (71.0±41.6 vs. 101.3±12.5 ng/ml, p<0.05). Although the muscle mass increased in consequence of exercise [evaluated by arm muscle area from 27.9 (24.1) to 33.1 (19.0) cm²], plasma irisin did not differ significantly after exercises (71.0±41.6 vs. 73.3±36.0 ng/ml). HD patients seem to have lower plasma irisin when compared to healthy subjects. Moreover, a resistance exercise training program was unable to augment plasma irisin despite increasing muscle mass.
Asunto(s)
Ejercicio Físico , Fibronectinas/sangre , Diálisis Renal , Entrenamiento de Fuerza , Adulto , Antropometría , Femenino , Salud , Humanos , Masculino , Fuerza Muscular/fisiología , Aptitud FísicaRESUMEN
Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.
Asunto(s)
Neoplasias Colorrectales/terapia , Toma de Decisiones , Medicina de Precisión , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Consejo , Humanos , Grupo de Atención al Paciente , PronósticoRESUMEN
We report a measurement of the proton-air cross section for particle production at the center-of-mass energy per nucleon of 57 TeV. This is derived from the distribution of the depths of shower maxima observed with the Pierre Auger Observatory: systematic uncertainties are studied in detail. Analyzing the tail of the distribution of the shower maxima, a proton-air cross section of [505±22(stat)(-36)(+28)(syst)] mb is found.
RESUMEN
In this work, we report the genetic basis of C7 deficiency in two different Spanish families. In family 1, by using exon-specific polymerase chain reaction and sequencing, a recently described mutation was found in homozygosity in the patient; a single base change in exon 15 (C2107T) leading to a stop codon that causes truncation of the C-terminal portion of C7 (Q681X). Patient's father, mother and sister were heterozygous for this mutation. Interestingly, patient's parents were not related. In family 2, a new single base mutation in exon 2 (G90A), leading to a stop codon that causes the premature truncation of C7 (W8X), was found in the patient, mother and sister 1. Additionally, patient 2, her father and sisters, displayed a missense mutation in exon 9 (G1135C) resulting in a change of aminoacid (G357R). Although sister 1 bore the same mutations in the C7 gene that patient 2, she remains asymptomatic. Because both mutations were found in the patient and her sister, we analyse other defence mechanisms such as FcgammaR polymorphisms as well as mannose-binding lectin alleles (MBL2 gene) and MBL levels. Results showed that both siblings bore identical combinations of FcgammaR allotypes and different MBL2 alleles, exhibiting patient 2 a MBL-insufficient genotype. Normal MBL levels were found in patient 1 and in two previously studied C7-deficient siblings, suggesting the involvement of other mechanisms of immunity distinct of FcgammaR variants and the MBL pathway, for the absence of meningococcal recurrent infections in certain C7-deficient individuals.
Asunto(s)
Complemento C7/deficiencia , Infecciones Meningocócicas/genética , Infecciones Meningocócicas/inmunología , Neisseria meningitidis/inmunología , Secuencia de Aminoácidos , Secuencia de Bases , Complemento C7/genética , Complemento C7/inmunología , ADN/química , ADN/genética , Femenino , Predisposición Genética a la Enfermedad , Variación Genética , Humanos , Masculino , Lectina de Unión a Manosa/química , Lectina de Unión a Manosa/genética , Datos de Secuencia Molecular , Linaje , Reacción en Cadena de la Polimerasa , Polimorfismo de Nucleótido Simple , Receptores de IgG/química , Receptores de IgG/genética , EspañaRESUMEN
We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.
RESUMEN
Se presenta el caso clínico de una mujer de 60 años que acude al Servicio de Ginecología y Obstetricia del Hospital Padre Hurtado, bajo la sospecha de un mioma cervical pequeño. Se realiza una ecografía transva-ginal la cual evidencia incidentalmente un tumor vesical sólido, vascularizado, intravesical y dependiente de la mucosa. La paciente no refería espontáneamente hematuria. El estudio urológico definitivo es de un carcinoma papilar de células transicionales. El tratamiento endoscópico logró la resección completa del tumor. El hallazgo ecográfico permitió realizar el diagnóstico en una forma poco habitual para esta enfermedad, aprovechando una instancia definida para otros fines. Se rescata la importancia de observar detenidamente todas las estructuras pélvicas al alcance visual del equipo de ecografía.
We present a clinical case of a 60 year-old patient, who concurs to the Obstetrics and Gynecology Department of the Padre Hurtado Hospital under the suspect of a uterine-cervical myoma. A transvaginal ultrasonography was performed which incidentally revealed a bladder tumor which was solid, vascularized, clearly inside of the bladder and attached to the bladder mucosa. The definitive urological study was compatible with a transitional cells papillary carcinoma. The woman did not refer hematuria spontaneously. The finding allowed an unusual diagnosis in an ultrasound aimed for different purposes, which underlines the potential use of this method in other pelvic organs.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Carcinoma Papilar , Carcinoma de Células Transicionales , Hallazgos Incidentales , Neoplasias de la Vejiga Urinaria , Carcinoma Papilar/cirugía , Carcinoma de Células Transicionales/cirugía , Hematuria/etiología , Incontinencia Urinaria de Esfuerzo/etiología , Neoplasias de la Vejiga Urinaria/cirugía , VaginaRESUMEN
Potential racemization of L-amino acids (AA) in ready-to-eat (RTE) cooked ham after hygienization by electron-beam irradiation between 1 and 8kGy was studied. An indirect chiral method based on the derivatization reaction of AA with o-phthaldialdehyde and N-acetyl-L-cysteine followed by reversed-phase HPLC and fluorimetric detection was applied to detect ten enantiomeric pairs of free AA (Asp, Ser, Thr, Ala, Tyr, Val, Trp, Phe and Leu). Five of the D-AA were not found in any of the samples analyzed; the other five remaining D-AA (D-Asp, D-Ser, D-Ala, D-Val and D-Leu) were detected both in irradiated and non-irradiated cooked ham samples, their content being in the range 1.25-13.79µg/g. Although significant differences appeared for a few of the samples and doses, no positive correlation between the D-AA content and the irradiation doses was observed. Therefore, the electron-beam irradiation technique could be useful for sanitation of packed RTE cooked ham at doses allowed by WHO and EU, since it remains chemically safe to eat.
RESUMEN
Introducción: La Pielonefritis Xantogranulomatosa (PNF XG) es una patología de baja prevalencia, frecuentemente asociada a litiasis y destrucción del parénquima renal. Dada la gran masificación de la tomografía axial computada su diagnóstico y manejo es cada vez más precoz disminuyendo así la morbi-mortalidad perioperatoria. Objetivos: Describir la experiencia de nuestro servicio en PNF XG y realizar un análisis de la literatura sobre los conceptos actuales en el diagnóstico y tratamiento de esta patología. Materiales y métodos: Análisis retrospectivo de todas la nefrectomías totales realizadas en nuestro servicio entre los años 2000 y 2007. Se incluyeron sólo las piezas con el diagnóstico histológico de PNF XG. Resultados: Se encontraron 11 casos con el diagnóstico histológico de PNF XG. La edad promedio de presentación fue de 54 años con una leve tendencia al sexo femenino. En todos los pacientes se encontró una historia actual o reciente de litiasis urinaria. En todos los casos se realizó un estudio imagenológico preoperatorio, siendo 9 de ellos estudiados con TAC de abdomen y encontrándose la presencia de litiasis en 7 pacientes. Todos los pacientes fueron manejados mediante una nefrectomía total por lumbotomía, sin registrarse mortalidad. Conclusiones: La PNF XG constituye un desafío en sí misma. A pesar de ser una patología rara y de difícil diagnóstico, una cuidadosa evaluación preoperatoria y alto índice de sospecha, pueden ayudarnos a realizar un diagnóstico oportuno y realizar el manejo más adecuado, disminuyendo así las complicaciones perioperatorias.
Introduction: Xanthogranulomatous pyelonephritis (XG PNF) is a low prevalence disease, often associated with lithiasis and renal parenchymal destruction. The wide availability of tomographic (CT) diagnosis allows for frequent early management decreasing perioperative morbidity and mortality. We describe the experience at our institution in XG PNF and perform an analysis of the literature onthe current concepts in diagnosis and treatment of this condition. Materials and methods: Retrospective analysis of all nephrectomies performed at our department between 2000 and 2007. Only surgical specimens with histological diagnosis of XG PNF were included. Results: We found 11 cases with histologic diagnosis of XG PNF. Average age of presentation was 54 years with a slight tendency towards females. All patients had a current or recent history of urolithiasis. In all cases a preoperative imaging study was made, 9 of them were studied with abdominal CT scan and found the presence of stones in 7 patients. All patients were treated by an open total nephrectomy without mortality. Conclusions: The XG PNF is a challenge in itself. Despite being infrequent and difficult to diagnosis, a careful preoperative evaluation and a high index of suspicion can help to make an early diagnosis and management, thus reducing perioperative complications.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Pielonefritis Xantogranulomatosa/diagnóstico , Pielonefritis Xantogranulomatosa/terapia , Estudios RetrospectivosRESUMEN
El paso de un nivel educativo a otro nivel ha generado desde hace años,diferentes opiniones críticas que oscilan entre responzabilizar y desacreditar la eficiencia de uno de los niveles y por otro lado justificar los mecanismos de selección y exclusión de alumnos ingresantes al nivel superior. Siempre, con base en esas posiciones críticas se expresa como mensaje y demanda sociopolítica la necesidad de mojorar la calidad de la educación. La presente propuesta introduce un principio de coherencia nucleado alrededor de los tres ámbitos del aprendizaje-conceptual, procedimental, actitudinal- como elementos a los que todos los componentes del diseño curricular deben someterse. Ello permite vincular de manera lógica los propósitos, los contenidos, las metodologías y los instrumentos de evaluación, impidiendo que el maestro incurra en el habitual error de evaluar lo que no enseña. Debemos integrar la práctica hospitalaria con el conocimiento teórico adecuado en cada especialidad y esto sólo se puede conseguir con un desarrollo simultáneo de práctica y teoría, que permita demostrar las competencias, y conocimientos durante la práctica. El propósito de esta materia es que el estudiante conozca el concepto de glaucoma, haga su diagnóstico oportuno, y sepa iniciar el tratamiento o remitirlo en el momento más indicado, ya que consiste actualmente una de las cinco primeras causas de ceguera, y la primera causa prevenible de ceguera en el mundo.
Asunto(s)
Derivación y Consulta , Enseñanza , Glaucoma , OftalmologíaRESUMEN
El paso de un nivel educativo a otro nivel ha generado desde hace años,diferentes opiniones críticas que oscilan entre responzabilizar y desacreditar la eficiencia de uno de los niveles y por otro lado justificar los mecanismos de selección y exclusión de alumnos ingresantes al nivel superior. Siempre, con base en esas posiciones críticas se expresa como mensaje y demanda sociopolítica la necesidad de mojorar la calidad de la educación. La presente propuesta introduce un principio de coherencia nucleado alrededor de los tres ámbitos del aprendizaje-conceptual, procedimental, actitudinal- como elementos a los que todos los componentes del diseño curricular deben someterse. Ello permite vincular de manera lógica los propósitos, los contenidos, las metodologías y los instrumentos de evaluación, impidiendo que el maestro incurra en el habitual error de evaluar lo que no enseña. Debemos integrar la práctica hospitalaria con el conocimiento teórico adecuado en cada especialidad y esto sólo se puede conseguir con un desarrollo simultáneo de práctica y teoría, que permita demostrar las competencias, y conocimientos durante la práctica. El propósito de esta materia es que el estudiante conozca el concepto de glaucoma, haga su diagnóstico oportuno, y sepa iniciar el tratamiento o remitirlo en el momento más indicado, ya que consiste actualmente una de las cinco primeras causas de ceguera, y la primera causa prevenible de ceguera en el mundo.
Asunto(s)
Derivación y Consulta , Enseñanza , Glaucoma , OftalmologíaRESUMEN
The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.
RESUMEN
The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.
RESUMEN
Using data collected at the Pierre Auger Observatory during the past 3.7 years, we demonstrated a correlation between the arrival directions of cosmic rays with energy above 6 x 10(19) electron volts and the positions of active galactic nuclei (AGN) lying within approximately 75 megaparsecs. We rejected the hypothesis of an isotropic distribution of these cosmic rays with at least a 99% confidence level from a prescribed a priori test. The correlation we observed is compatible with the hypothesis that the highest-energy particles originate from nearby extragalactic sources whose flux has not been substantially reduced by interaction with the cosmic background radiation. AGN or objects having a similar spatial distribution are possible sources.
RESUMEN
The rate of oxalate absorbed from intestine is highly influenced by calcium intake in healthy subjects. It is unknown whether commonly used phosphate binders modify intestinal absorption and renal excretion of oxalate in chronic kidney disease (CKD) patients. This study aims to determine if calcium carbonate or sevelamer influences on urinary oxalate excretion. Twenty patients with CKD (stage 4 and 5 pre-dialysis) were included. Two treatment (1500 mg of calcium carbonate or 2400 mg of sevelamer), two-period (21 days each), crossover study with balanced assignment of the order of administration, and two washout periods were the main characteristics of this study design. Laboratory analyses in each phase included: serum creatinine, calcium, phosphorus, bicarbonate, total cholesterol, and 24 h urinary excretion of oxalate, creatinine, and urea. Creatinine clearance, protein catabolic rate (PNNA), total urinary oxalate excretion, and urinary oxalate / creatinine ratio were determined. Seventeen patients completed both treatment sequences. Total urinary oxalate excretion and urinary oxalate / creatinine ratios decreased significantly with respect to washout periods either after sevelamer or calcium carbonate treatment. The decrease in urinary oxalate excretion was greater after calcium carbonate (41.2+/-17.4%) than after sevelamer treatment (30.4+/-23.8%). There were not significant changes in renal function or PNNA values throughout the study periods. In conclusion, either calcium carbonate or sevelamer significantly reduces urinary oxalate excretion in CKD patients. Further studies will be needed to ascertain whether the type of phosphate binder influences on the accumulation of oxalate in CKD patients.
Asunto(s)
Carbonato de Calcio/uso terapéutico , Quelantes/uso terapéutico , Fallo Renal Crónico/tratamiento farmacológico , Fallo Renal Crónico/orina , Oxalatos/orina , Poliaminas/uso terapéutico , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , SevelamerRESUMEN
The increase in patients on dialysis awaiting transplantation has led to the use of grafts from suboptimal donors. The aim of this study was to analyze the function of suboptimal grafts. The secondary objectives were to study vascular and urological complications, as well as delayed renal function and acute rejection episodes. The study included 135 transplantations performed over 4 years with 27% of grafts being from suboptimal donors. Early graft loss was 12%, of which 69% were due to vascular thrombosis. These thromboses were more frequent among grafts from suboptimal donors (30% vs 4%, P < .001). There were no significant differences between the groups in the incidence of acute rejection episodes (17% vs 13%) or delayed graft function (14% vs 13%). A greater incidence of urologic complications was observed among recipients of grafts from older donors. The 1-year creatinine clearance was significantly lower among recipients of grafts from older donors (73 +/- 19 vs 51 +/- 14 mL/min, P < .0001). Sequential immunosuppressive therapy resulted in a lack of significant differences in creatinine clearance at 6 months, 1 year, or 2 years after transplantation between suboptimal grafts with cold ischemia greater or less than 20 hours or in warm ischemia greater or less than 60 minutes. Logistic regression analysis showed that the best determinant of graft loss was donor age older than 60 years. Accordingly, grafts from suboptimal donors were more likely to be lost during the first month after transplantation, particularly because of thrombosis, which was not due to a higher degree of technical complexity of the transplant operation.
Asunto(s)
Trasplante de Riñón/fisiología , Donantes de Tejidos/estadística & datos numéricos , Cadáver , Creatinina/metabolismo , Estudios de Seguimiento , Rechazo de Injerto/epidemiología , Humanos , Incidencia , Pruebas de Función Renal , Estudios Retrospectivos , España , Trombosis/mortalidad , Resultado del TratamientoRESUMEN
Serum cystatin C (CysC) has been shown to be more accurate than serum creatinine (Cr) in estimating renal function, especially in patients with mildmoderate chronic renal failure. However, it is unknown whether CysC provides or not any advantage over Cr in severe chronic renal failure. The aim of this study was to establish the accuracy of CysC in estimating the glomerular filtration rate (GFR) in advanced chronic renal failure patients. The study group consisted of 94 patients (57 females, mean age 61 +/- 16 years) with advanced chronic renal failure. None of them had thyroid dysfunction or was on corticoid treatment. CFR was measured by TC99mDTPA, and simultaneously, serum CysC (particle enhanced immunonephelometry) and Cr (modified Jaffe's kinetic reaction) were also determined. Serum Cr and CysC levels were correlated with GFR, and the influences of age, sex and diabetes on these correlations were analyzed. The predictive value of CysC and Cr to estimate a GFR less than 15 ml/min/1.73 m2 was analyzed by measuring the crea-under-the-curve (AUC) with Receiver-Operating Characteristics (ROC) plots. The mean CFR was 16.49 +/- 4.65 ml/min/1.73 m2. The mean concentrations of Cr and CysC were 4.19 +/- 1.19 mg/L and 3.44 +/- 0.73 mg/L, respectively. Both Cr and CysC correlated significantly with GFR (R = 0.49, p < 0.0001 and R = 0.52, p < 0.0001, respectively). Age and sex influenced on the correlation between Cr and GFR, but these demographic characteristics did not influence on the correlation between CysC and GFR. The AUC for the prediction of a GFR less than 15 ml/min/1.73 m2 with serum Cr was 0.675 (p = 0.004), while with CysC was 0.633 (p = 0.030). In conclusion, both serum Cr and CysC are highly inaccurate markers of renal function in advanced chronic renal failure patients.