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Carcinoma Basocelular , Carcinoma de Células Escamosas , Enfermedades de la Uña , Neoplasias Cutáneas , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Humanos , Cirugía de Mohs , Enfermedades de la Uña/patología , Enfermedades de la Uña/cirugía , Uñas , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaRESUMEN
Interferon (IFN)-γ release assays (IGRAs) are used to diagnose latent tuberculosis (TB) infection (LTBI). To improve the accuracy of these tests, different approaches, such as alternative cytokine detection and using different antigens, are considered. Following this purpose, this study aims to evaluate the addition of EspC, EspF and Rv2348-B to those present in the QuantiFERON-TB Gold In-Tube (QFN-G-IT). We included 115 subjects: 74 active TB patients, 17 LTBI individuals and 24 healthy controls. Whole blood samples were collected in QFN-G-IT and in-house tubes containing different combinations of EspC, EspF and Rv2348-B, together with ESAT-6, CFP-10, and TB7.7. After overnight incubation at 37 ºC, plasma was harvested and IFN-γ quantified. IFN-γ levels in the QFN-G-IT and in-house tubes correlated very good (Spearman Rho(r) > 0.86). In-house antigen combinations distinguished healthy individuals from those with active TB and LTBI (specificities and sensitivities higher than 87.5% and 96.3%, respectively [AUC > 0.938]). Adding EspC, EspF and Rv2348-B, increased the sensitivity of the test, being the addition of EspC and Rv2348-B the combination that yielded a higher sensitivity with no specificity loss. Addition of these antigens could improve diagnosis in patients with impaired or immature immune response who are at high risk of developing TB.
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Antígenos Bacterianos/inmunología , Tuberculosis Latente/diagnóstico , Mycobacterium tuberculosis/inmunología , Tuberculosis/diagnóstico , Adulto , Estudios de Casos y Controles , Diagnóstico Precoz , Femenino , Humanos , Ensayos de Liberación de Interferón gamma , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , España , Prueba de Tuberculina , Tuberculosis/inmunologíaAsunto(s)
Enfermedades por Deficiencia de Complemento Hereditario/tratamiento farmacológico , Omalizumab/uso terapéutico , Urticaria/tratamiento farmacológico , Vasculitis/tratamiento farmacológico , Complemento C1q/genética , Femenino , Humanos , Inmunoglobulina E/inmunología , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Resumen Introducción Los estudiantes de enfermería deben adquirir conocimientos, habilidades, actitudes y valores, para proporcionar cuidados de calidad. Las prácticas clínicas son el contexto ideal para lograr algunas de las competencias requeridas. Objetivo Explorar las percepciones de los estudiantes sobre sus vivencias durante sus prácticas clínicas. Método Abordaje metodológico descriptivo de tipo cualitativo y con un encuadre sociocrítico. Se analizaron los 45 portafolios de estudiantes de 4º curso de la Escuela Universitaria de Enfermería (EUE) Cruz Roja, donde explican sus vivencias en prácticas. Se optó por un portafolio semiestructurado en función de la competencia a demostrar definiendo previamente las tareas o evidencias Se realizó un análisis de contenido que comprendía las siguientes fases: reducción de los datos; categorización-codificación, presentación de datos y conclusiones/verificación de los datos. Se alcanzó saturación en la información sobre las categorías presentadas. Resultados Del análisis de los datos emergen distintas unidades de significado que se engloban en tres categorías: aprendizaje en prácticas, dificultades del entorno, crecimiento personal y profesional. Conclusiones El estudio evidencia la importancia de las prácticas clínicas para los estudiantes dentro del plan de estudios, ya que es donde aplican lo que han aprendido en el aula y son conscientes de la realidad a la que se enfrentan. El entorno clínico y la relación que se establezca entre este y el estudiante determina en muchas ocasiones el aprendizaje. Queda patente que los estudiantes durante sus prácticas clínicas toman conciencia de aquellos conocimientos del saber, saber hacer y saber estar.
Abstract Introduction Nursing students need specific knowledge, skills, attitudes and values in order to provide quality of care; and the clinical practices represent an ideal context to develop some of these required competences. Objective To explore the perceptions of nursing students about their own experiences in their clinical practices. Method This a qualitative descriptive study with social and critical focus. 45 practice-files from nursing students in the 4th course of a Mexico Red Cross School of Nursing were analyzed considering the following stages: data reduction, categorization-coding, data presentation, and data verification and conclusions. Data saturation was reached from the identified categories. Results From the data analysis, diverse units of meaning emerged within three main categories: learning in practices, difficulties in the environment, and personal and professional growth. Conclusions The study highlights the importance of clinical practices since it is there where students apply in real life what they learn in the classroom. The relationship between the student and the clinical environment greatly determines the quality of learning. So, it is suggested that students keep in mind reflecting on their to know, to know how, and to know how to be.
Resumo Introdução Os estudantes de enfermagem devem adquirir conhecimentos, habilidades, atitudes e valores, para proporcionar cuidados de qualidade. As práticas clínicas são o contexto ideal para atingir algumas das competências requeridas. Objetivo Explorar as percepções dos estudantes sobre suas vivências durante suas práticas clínicas. Método Abordagem metodológica descritiva de tipo qualitativo e com um enfoque sociocrítico. Analisaram-se os 45 portfolios de estudantes de 4º curso da Escuela Universitaria de Enfermería (EUE) Cruz Roja, onde explicam suas vivências em práticas. Optou-se por um portfólio semiestruturado em função da competência a demostrar definindo previamente as tarefas ou evidências. Realizou-se uma análise de conteúdo que compreendia as seguintes fases: redução dos dados; categorização-codificação, apresentação de dados e conclusões/verificação dos dados. Atingiu-se saturação na informação sobre as categorias apresentadas. Resultados Da análise dos dados emergem distintas unidades de significado que abrangem três categorias: aprendizagem em práticas, dificuldades do entorno, crescimento pessoal e profissional. Conclusões O estudo evidencia a importância das práticas clínicas para os estudantes dentro do plano de estudos, já que é onde aplicam o que aprenderam na aula e são conscientes da realidade à que se enfrentam. O entorno clínico e a relação que se estabeleça entre este e o estudante determina em muitas ocasiões a aprendizagem. É evidente que os estudantes durante suas práticas clínicas tomam consciência daqueles conhecimentos do saber, saber fazer e saber estar.
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INTRODUCTION: Spinal cord injury is a complex and life-disrupting condition. The functional recovery of the upper limb has been considered as an important objective in tetraplegia because it improves significantly the quality of living in these patients. Virtual reality is a new emerging tool of rehabilitation in spinal cord injured patients. AIM: To carry out a systematic review about the information about the application of these systems in spinal cord injury in the rehabilitation of the upper limb. PATIENTS AND METHODS: This review includes clinical trials dated until April 2018, which investigate the functional recovery of the upper limb through virtual reality systems in patients with complete or incomplete tetraplegia. The following databases were used to search for those clinical trials: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL and Brain. RESULTS: Five articles were selected for this review, including randomized clinical trials and clinical trials. The main results show a good tendency on the functional recovery with the combination of virtual reality systems and conventional therapy. CONCLUSIONS: The main limitations and the low quality of the studies show the necessity of further investigations with this new tool of rehabilitation. However, the incorporation of virtual reality systems as a rehabilitation supplement might be a beneficial tool on the functional recovery in spinal cord injury.
TITLE: Efectividad de la realidad virtual en la rehabilitacion del miembro superior en la lesion de la medula espinal. Revision sistematica.Introduccion. La lesion de la medula espinal es un estado funcional complejo que limita gravemente la vida de la persona. Por ello, la recuperacion de la funcionalidad del miembro superior en la tetraplejia se considera un objetivo primordial, ya que mejora significativamente la calidad de vida de estas personas. Ademas de las terapias convencionales, la realidad virtual supone un nuevo enfoque terapeutico en la rehabilitacion del lesionado medular. Objetivo. Realizar una revision sistematica sobre la efectividad de la rehabilitacion del miembro superior en pacientes con lesion medular a traves de la realidad virtual. Pacientes y metodos. Se recopilaron datos de ensayos clinicos hasta abril de 2018 que investigaran la rehabilitacion con sistemas de realidad virtual en los miembros superiores de pacientes con lesion medular completa e incompleta. Las bases de datos consultadas en esta revision incluyeron: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL y Brain. Resultados. Se analizaron cinco articulos, los cuales incluyeron ensayos controlados aleatorizados y ensayos clinicos. Los principales resultados de los estudios muestran buena tendencia de la rehabilitacion a traves de la realidad virtual en combinacion con terapia convencional. Conclusiones. Las limitaciones encontradas en los estudios, asi como su baja calidad metodologica, suponen la necesidad de mayores investigaciones acerca de la efectividad de esta nueva herramienta. Aun asi, la buena tendencia de los estudios se considera de interes para futuras investigaciones.
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Cuadriplejía/rehabilitación , Traumatismos de la Médula Espinal/rehabilitación , Extremidad Superior/fisiopatología , Realidad Virtual , Actividades Cotidianas , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuadriplejía/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Traumatismos de la Médula Espinal/complicaciones , Resultado del Tratamiento , Interfaz Usuario-Computador , Adulto JovenRESUMEN
INTRODUCTION: The clinical information process is the basis of the doctor-patient relationship. It starts with the information provided before signing informed consent and ends on the termination of the doctor-patient relationship. The influence of demographic variables in the information process has not been thoroughly studied for inpatients undergoing surgery. In this study we aim to answer two questions: 1) Does gender have an influence on the information process for these patients? 2) Are there other factors that affect the process? METHOD: A prospective study carried out using an 'ad hoc' designed survey on a 200-inpatient sample after undergoing surgery in the trauma and orthopaedics department of our hospital. Sampling was simple random. RESULTS: We found differences in the consistency of the answers by gender in the question regarding surgical priority, with the women having a better understanding of it (p=.04). The rest of the questions show no differences by gender. However, in the population analyzed, age and educational level are the main modifiers of understanding, and they are both related to gender (p<.0001; p=.003, respectively). CONCLUSIONS: In clinical practice, it is fundamental to keep in mind the factors that affect the information process. According to our results, the factors that define greater vulnerability in relation to the information process are age and low educational level.
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Comprensión , Consentimiento Informado , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Heridas y Lesiones/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores Sexuales , Factores SocioeconómicosRESUMEN
Arsenic intake in the world is linked with drinking water and food; the main sources of inorganic As (i-As) exposure in food are rice and rice-based products. The consumption of rice in Ecuador is 53.2 kg year-1 and it is the most commonly used cereal for the preparation of many popular dishes especially for subjects with celiac disease. Objectives of this research were: (i) to determine the content of i-As in foods widely consumed by Ecuadorians with celiac disease, (ii) to calculate the i-As dietary intake, and (iii) to model and predict the health risks of the population under study as a result of their exposure to i-As from rice-based food. The estimated daily intakes of Ecuadorian children (below 3 years of age) and adults were established at 0.52 and 0.55 µg kg-1 body weight d-1, respectively. These values were above the lower BMDL01 value established for i-As established by the EFSA; consequently, it can be concluded that health risk cannot be excluded for the Ecuadorian population with celiac disease.
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Arsénico/análisis , Análisis de los Alimentos , Contaminación de Alimentos/análisis , Oryza/química , Adulto , Preescolar , Ecuador , Femenino , Inocuidad de los Alimentos , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
The aim of this study was to test the use of IP-10 detection in dried plasma from contact studies individuals (contacts of smear positive patients), by comparing it with IP-10 and IFN-γ detection in direct plasma, to establish IP-10 detection in DPS as a useful assay for LTBI diagnosis. Whole blood samples were collected from 80 subjects: 12 with active tuberculosis (TB), and 68 from contact studies. The amount of IFN-γ produced by sensitized T cells was determined in direct plasma by QuantiFERON Gold In-Tube test. IP-10 levels were determined in direct and dried plasma by an in-house ELISA. For dried plasma IP-10 determination, two 25 µl plasma drops were dried in Whatman903 filter paper and sent by mail to the laboratory. Regarding TB patients, 100.0%, 91.7% and 75.0% were positive for IFN-γ detection and IP-10 detection in direct and dried plasma, respectively. In contacts, 69.1%, 60.3% and 48.5% had positive results after IFN-γ and IP-10 in direct and dried plasma, respectively. The agreement among in vitro tests was substantial and IP-10 levels in direct and dried plasma were strongly correlated (r = 0.897). In conclusion, IP-10 detection in dried plasma is a simple and safe method that would help improve LTBI management.
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Pruebas con Sangre Seca/métodos , Tuberculosis Latente/diagnóstico , Adulto , Quimiocina CXCL10/sangre , Trazado de Contacto , Citocinas/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Ensayos de Liberación de Interferón gamma/métodos , Tuberculosis Latente/sangre , Masculino , Servicios Postales , Curva ROC , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Streptococcus pyogenes is a significant cause of bacterial infections in children. The aim of the study is to analyse resistance rates and phenotypes of S. pyogenes isolates in a paediatric population in Northern Spain over the last 11 years. METHODS: Descriptive retrospective study of S. pyogenes isolates from paediatric patients between 2005 and 2015 in a region of Asturias (Spain). Resistance rates and changes in erythromycin resistance phenotypes in two time periods (2005-2009 and 2010-2015) were studied. RESULTS: A total of 1,794 S. pyogenes isolates were registered (70% from 2005 to 2009). 87.5% were obtained from pharyngeal swabs and 0.2% from blood cultures. Resistance rates to tetracycline (8.8% to 4.3%, p=0.02), erythromycin (22% to 9.3%, p<0.01) and clindamycin (6% to 1.7%, p<0.01) decreased between the two study periods. A reduction in erythromycin-resistant isolates with the MLSB phenotype was observed. CONCLUSIONS: A decrease in S. pyogenes resistance rates to erythromycin and clindamycin and a change in the erythromycin resistance phenotype were observed along the study period.
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Farmacorresistencia Bacteriana , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/efectos de los fármacos , Adolescente , Niño , Preescolar , Eritromicina/farmacología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Fenotipo , Estudios Retrospectivos , España/epidemiologíaRESUMEN
X-linked agammaglobulinemia (XLA) is caused by BTK mutations, patients typically show <2% of peripheral B cells and reduced levels of all immunoglobulins; they suffer from recurrent infections of bacterial origin; however, viral infections, autoimmune-like diseases, and an increased risk of developing gastric cancer are also reported. In this work, we report the BTK mutations and clinical features of 12 patients diagnosed with XLA. Furthermore, a clinical revision is also presented for an additional cohort of previously reported patients with XLA. Four novel mutations were identified, one of these located in the previously reported mutation refractory SH3 domain. Clinical data support previous reports accounting for frequent respiratory, gastrointestinal tract infections and other symptoms such as the occurrence of reactive arthritis in 19.2% of the patients. An equal proportion of patients developed septic arthritis; missense mutations and mutations in SH1, SH2 and PH domains predominated in patients who developed arthritis.
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Agammaglobulinemia/genética , Agammaglobulinemia/patología , Enfermedades Genéticas Ligadas al Cromosoma X/genética , Enfermedades Genéticas Ligadas al Cromosoma X/patología , Mutación Missense/genética , Agammaglobulinemia/complicaciones , Agammaglobulinemia/diagnóstico , Artritis/complicaciones , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Enfermedades Genéticas Ligadas al Cromosoma X/diagnóstico , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina A/genética , Inmunoglobulina G/sangre , Inmunoglobulina G/genética , Inmunoglobulina M/sangre , Inmunoglobulina M/genética , MéxicoRESUMEN
The aim of this study was to evaluate the GenoFlow DR-MTB array test (DiagCor Bioscience, Hong Kong) on 70 cultured isolates and 50 sputum specimens. The GenoFlow array test showed good sensitivity and specificity compared to the phenotypic Bactec 460TB. This array accurately detected mutations inrpoB,katG, andinhAassociated with resistance to rifampin and isoniazid.
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Antituberculosos/farmacología , Farmacorresistencia Bacteriana , Técnicas de Genotipaje/métodos , Isoniazida/farmacología , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/genética , Rifampin/farmacología , Proteínas Bacterianas/genética , Catalasa/genética , Genotipo , Humanos , Mutación , Oxidorreductasas/genética , ARN Polimerasa II/genética , Sensibilidad y EspecificidadRESUMEN
A new observation of 13q deletion syndrome: severe undescribed features: 13q deletion syndrome is characterized by a wide phenotypic spectrum resulting from a partial deletion-of the long arm of chromosome 13. It consists predominantly of mental and motor retardation, craniofacial dysmorphia, growth retardation, and several congenital malformations. We present a new case with 13q deletion syndrome phenotypically characterized by severe major malformations, some of them still undescribed, consisting of left diaphragmatic hernia, right pulmonary sequestration, hypoplastic left heart syndrome, pancreatic agenesis, polysplenia, and catastrophic central nervous system malformations: semilobar holoprosencephaly, occipital myelomeningocele, partial agenesis of the corpus callosum and agenesis of olfactory bulbs. Fluorescence in situ hybridization technique using the probe LSI D13S319 (13q1l4) SO/ LSI 13q34 SG determined partial monosomy of chromosome 13 in 39/100 cells (mosaicism).
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Trastornos de los Cromosomas/patología , Enfermedades del Recién Nacido/genética , Deleción Cromosómica , Cromosomas Humanos Par 13 , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/patologíaRESUMEN
Aspergillus flavipes FP-500 grew up on submerged cultures using lemon peel as the only carbon source, developing several batch and pulsed fed-batch trials on a stirred tank reactor. The effect of carbon source concentration, reducing sugar presence and initial pH on exopectinase and endopectinase production, was analyzed on batch cultures. From this, we observed that the highest substrate concentration favored biomass (X max) but had not influence on the corresponding specific production (q p) of both pectinases; the most acid condition provoked higher endopectinase-specific productions but had not a significant effect on those corresponding to exopectinases; and reducing sugar concentrations higher than 1.5 g/L retarded pectinase production. On the other hand, by employing the pulsed fed-batch operation mode, we observed a prolonged growth phase, and an increase of about twofold on endopectinase production without a significant raise on biomass concentration. So, pulsed fed-batch seems to be a good alternative for obtaining higher endopectinase titers by using high lemon peel quantities without having mixing and repression problems to the system. The usefulness of unstructured kinetic models for explaining, under a theoretic level, the behavior of the fungus along the batch culture with regard to pectinase production was evident.
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Aspergillus/crecimiento & desarrollo , Reactores Biológicos , Citrus/química , Frutas/químicaRESUMEN
We studied serotypes circulating dengue virus (DENV) cases, entomological Breteau index, rain-fall index and epidemiology of groups affected during the 2010 outbreak in Nuevo Leon, Mexico. From 2,271 positive cases, 94% were dengue classic and 6% dengue hemorrhagic fever; DENV1 was mainly isolated (99%) (Central-American lineage of American-African-genotype). We found correlation between two environmental phenomena (Increment of rainfall and vector-indexes) (p ≤ 0.05) with epidemiological, clinical and risk of DENV-1 ongoing transmission.
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Virus del Dengue , Dengue/epidemiología , Dengue/virología , Brotes de Enfermedades , Dengue Grave/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Dengue/historia , Virus del Dengue/clasificación , Virus del Dengue/genética , Femenino , Genotipo , Historia del Siglo XXI , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Filogenia , Vigilancia de la Población , Estaciones del Año , Serogrupo , Dengue Grave/epidemiología , Dengue Grave/historia , Adulto JovenAsunto(s)
Rabia/epidemiología , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos , España/epidemiologíaRESUMEN
AIM: To evaluate the antimicrobial effect of 2.5% sodium hypochlorite alone (NaOCl) and associated with 9% HEBP (NaOCl/HEBP), 2% peracetic acid (PAA) and 2% chlorhexidine (CHX), on the viability of Enterococcus faecalis biofilms attached to dentine. METHODOLOGY: Biofilms of E. faecalis were grown on the surface of dentine blocks for 5 days and then exposed to the irrigating solutions for 3 min. Distilled water was used as the control. The total biovolume and the percentage of dead cells of the infected dentine were measured by means of confocal microscopy and the live/dead technique. Nonparametric tests were used to determine statistical differences (P < 0.05). RESULTS: NaOCl and the NaOCl/HEBP mixture were associated with a significantly greater percentage of dead cells, followed by PAA (P < 0.05). No significant antimicrobial effect of CHX was observed in comparison with the control group. Total biovolume decreased significantly in NaOCl, NaOCl/HEBP and PAA solutions in comparison with the CHX and control groups. CONCLUSIONS: NaOCl alone or associated with HEBP were the most effective irrigant solutions in dissolving and killing E. faecalis biofilms.
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Antiinfecciosos/farmacología , Biopelículas/efectos de los fármacos , Conservadores de la Densidad Ósea/farmacología , Clorhexidina/farmacología , Dentina/microbiología , Enterococcus faecalis/efectos de los fármacos , Ácido Etidrónico/farmacología , Ácido Peracético/farmacología , Irrigantes del Conducto Radicular/farmacología , Hipoclorito de Sodio/farmacología , Humanos , Técnicas In Vitro , Microscopía ConfocalRESUMEN
BACKGROUND/OBJECTIVE: Knowledge does not automatically translate into behaviour change. This study examined the relationship between knowledge of appropriate foods and beverages needed for weight loss and the diet of patients seeking weight management. SUBJECTS/METHODS: A cross-sectional study of 104 consecutive first-time patients (55 women and 49 men) seeking weight management, with a mean age of 37.3 ± 11.8 years and a BMI of 44.9 ± 9.4 kg/m(2), was carried out; 67.3% of these patients had a BMI of 40 kg/m(2) or greater. Patients were told to design a detailed weight-loss diet that they would recommend to a person with the same characteristics (recommended diet or RD) as themselves and asked whether the RD was similar to their own. Consumed diet (CD) was assessed by a different dietitian through a 24-h diet recall. Estimated energy requirement (EER), energy content of RD and CD and number of fruit, vegetable, cereal and sweetened-beverage portions were calculated. Statistical differences were assessed through the Pearson's correlation and the Wilcoxon's rank-sum tests. RESULTS: RD and CD were 1104 ± 243 and 1976 ± 708 kcal for women and 1254 ± 287 and 2743 ± 1244 kcal for men, with statistical differences for both genders (P<0.001). Energy content of the RD was lower than the EER in men and women (P<0.001); CD was lower than the EER in women (P=0.033). Number of fruit/vegetable portions was lower in CD than in the RD in women (P<0.001), whereas cereal and sweetened-beverage portions were higher in CD than in the RD in both genders (P<0.001). RD was not followed by 46.1% of the patients. CONCLUSIONS: Patients with obesity seeking care have knowledge of the appropriate dietary strategies needed for weight loss, but do not translate it into practice. Treatment approaches should include tools that help patients to implement their nutrition knowledge.