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1.
Allergol. immunopatol ; 48(1): 26-33, ene.-feb. 2020. ilus, graf
Artigo em Inglês | IBECS | ID: ibc-186588

RESUMO

Introduction and Objectives: The production and consumption of oysters is increasing annually because it can provide essential nutrients and benefit for human health, leading to frequent occurrence of severe allergic reactions observed in sensitized individuals. The aim of the present study was to investigate the effects of acid and protease treatment on the conformation and IgE-binding capacity of recombinant Crassostrea gigas tropomyosin (Cra g 1). Results: Under acidic conditions, Cra g 1 did not undergo degradation, however, the changes obvious in the intensity of CD signal and ANS-binding fluorescence were observed, which was associated with a decrease in antibody reactivity. In simulated gastrointestinal fluid (SGF) and simulated intestinal fluid (SIF) digestion system, acid-treated Cra g 1 was relatively resistant to digestion, but the degradative patterns were very different. Moreover, owing to alterations of secondary structure and hydrophobic surface of the protein during digestive processing, antigenicity of acid-induced Cra g 1 reduced in SGF while it increased significantly in SIF. Conclusion: To our knowledge, this is the first study reporting that antigenicity of acid-treated oyster tropomyosin increased after SIF digestion. These results revealed that treatment with acid and pepsin, rather than trypsin, was an effective way of reducing IgE-binding capacity of tropomyosin from oyster


No disponible


Assuntos
Humanos , Imunoglobulina E/imunologia , Técnicas In Vitro/métodos , Alérgenos/química , Tropomiosina/química , Hipersensibilidade Alimentar/imunologia , Digestão , Alérgenos/imunologia , Tropomiosina/imunologia , Ostreidae/imunologia , Sistema Digestório/imunologia , Eletroforese/métodos , Análise Espectral/métodos , Ensaio de Imunoadsorção Enzimática
2.
Nutr. hosp ; 36(2): 261-266, mar.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184316

RESUMO

Antecedentes y objetivo: el ductus arterioso persistente hemodinámicamente significativo (DAP-HS) se asocia a mayor riesgo de enterocolitis necrotizante (ECN) y peor tolerancia enteral en los recién nacidos prematuros (RNPT). Se ha demostrado asociación entre el propéptido natriurético cerebral (proBNP) y el DAP-HS. Nuestro objetivo fue analizar la relación entre los niveles de proBNP y la tolerancia enteral, el riesgo de ECN y la ganancia ponderal en el RNPT. Material y métodos: estudio retrospectivo observacional, que incluyó a RNPT menores de 32 semanas de gestación y/o 1.500 g, con estudio ecocardiográfico y determinación de niveles de proBNP a las 48-72 horas de vida. Resultados: de 117 pacientes incluidos, el 65,8% tuvo un DAPHS y el 9,4% presentó ECN confirmada. El DAP-HS se asoció a mayor duración de la nutrición parenteral (p < 0,001), a ECN confirmada (p = 0,006) y a peor ganancia ponderal durante el ingreso (p < 0,001). Los valores de proBNP se relacionaron con la ECN (no ECN 12.189,5 pg/ml, rango 654-247.986; ECN 41.445 pg/ml, rango 15.275-166.172; p < 0,001), sin encontrar asociación con el resto de variables de evolución digestiva. En el análisis multivariante de regresión logística, las variables relacionadas de forma independiente con el desarrollo de ECN fueron la edad gestacional y el proBNP superior a 22.400 pg/ml (OR 13,386; IC 95% 1,541-116,262; p = 0,019). Conclusiones: el proBNP podría ser un marcador precoz de patología digestiva grave en el RNPT. Los niveles elevados podrían relacionarse con mayor riesgo de ECN en los neonatos más inmaduros


Background and objective: hemodynamically significant patent ductus arteriosus (HS-PDA) is associated with an increased risk of necrotizing enterocolitis (NEC) and worse enteral tolerance in preterm newborns (PN). An association has been demonstrated between brain natriuretic propeptide (proBNP) and HS-PDA. Our objective was to analyze the relationship between proBNP levels and enteral tolerance, NEC risk and weight gain in PN. Material and methods: a retrospective study was performed in neonates born before 32 weeks' gestation or with birth weight below 1500 grams, in whom proBNP determination and echocardiography were performed at 48 to 72 h of life. Results: 117 patients were included. 65.8% had a HS-PDA and 9.4% had an outcome of NEC. HS-PDA was associated with longer duration of parenteral nutrition (p < 0.001), a confirmed NEC (p = 0.006) and worse weight gain during admission (p < 0.001). ProBNP levels were associated to NEC (no NEC 12189.5 pg / mL, range 654-247986; NEC 41445 pg/mL, range 15275-166172, p < 0.001). No association was found with the rest of gastrointestinal outcomes. Multivariate logistic regression analysis showed a significant association of NEC with gestational age and proBNP above 22,400 pg/mL (OR 13,386, 95% CI 1,541-116,262, p = 0.019). Conclusions: proBNP could be an early marker of severe digestive pathology in PN. Increased proBNP levels could be associated with a significant increased risk of NEC in very immature newborns


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Sistema Digestório/crescimento & desenvolvimento , Recém-Nascido Prematuro , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Biomarcadores/sangue , Permeabilidade do Canal Arterial/complicações , Nutrição Parenteral , Estudos Retrospectivos , Risco , Ganho de Peso
4.
Rev. esp. enferm. dig ; 109(9): 614-618, sept. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-165846

RESUMO

Introducción: Aparato Digestivo es una de las especialidades ofertadas a los opositores que acceden a la formación sanitaria especializada cada año. Este proyecto analiza los datos de elección de Aparato Digestivo en los últimos años. Material y métodos: los datos de la elección se han obtenido de la publicación oficial de los actos de asignación de plazas del Ministerio de Sanidad, Servicios Sociales e Igualdad. Se ha recabado información de los distintos centros docentes a través de sus guías formativas, el Catálogo Nacional de Hospitales y la Organización Nacional de Trasplantes. Resultados: la mediana de elección de número de orden para Aparato Digestivo ha descendido anualmente, situando la especialidad en 2015 entre las cinco más populares en la elección. La mediana de los hospitales con mayor número de camas, actividad de trasplante hepático en adultos y Unidad de Sangrantes es significativamente menor. Lo mismo sucede al analizar los centros en base a la presencia de guardias específicas de Aparato Digestivo para residentes o vinculación con facultades de Medicina. Los datos de los últimos cinco años sitúan a Madrid, Aragón y Euskadi como las comunidades autónomas más populares. Los centros con menor mediana de número de orden para el periodo 2011-2015 fueron los hospitales universitarios Ramón y Cajal, Santiago de Compostela y Gregorio Marañón. Conclusiones: Aparato Digestivo ha ido mejorando de manera progresiva en la elección de plazas de especialización hasta llegar a situarse entre las cinco más populares. Los electores se decantan por centros grandes, de mayor complejidad asistencial y elevada actividad investigadora (AU)


Introduction: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. Material and methods: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization. Results: The median consecutive number involved in the choice of Gastroenterology training has decreased year after year, and this specialty is now positioned among the five most commonly selected residency programs in 2015. The median number of hospitals with a higher number of beds, adult liver transplantation activities and dedicated GI bleeding units is significantly lower. This is also true when centers are analyzed according to the presence of specific Gastroenterology on-call shifts for residents or their association with medical schools. Data from the past five years highlight Madrid, Aragón and the Basque Country as the autonomous communities where Gastroenterology is the most popular. Centers selected by candidates with the lowest median consecutive numbers from 2011-2015 included the university hospitals Ramón y Cajal, Santiago de Compostela and Gregorio Marañón. Conclusions: Gastroenterology has gradually escalated in the ranking of residency choices and is now one of the five most popular options. Potential residents prefer larger centers with complex-care patients and more research activity (AU)


Assuntos
Humanos , Gastroenterologia/educação , Gastroenteropatias/epidemiologia , Sistema Digestório , Educação Médica/organização & administração , Educação Médica/normas , Análise Estatística , Internato e Residência/métodos , Internato e Residência/organização & administração , Internato e Residência/tendências
5.
Rev. esp. enferm. dig ; 109(6): 435-450, jun. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-163252

RESUMO

El objetivo general del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este primer resultado se proponen procedimientos e indicadores comunes a las pruebas de endoscopia digestiva. Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la endoscopia digestiva. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva, han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en los procedimientos endoscópicos. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se ha identificado un total de 20 indicadores, de los cuales siete son de estructura; once, de proceso (cinco de preprocedimiento, tres de procedimiento y tres de posprocedimiento); y dos, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation) (AU)


The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification (AU)


Assuntos
Humanos , Endoscopia do Sistema Digestório/instrumentação , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Sistema Digestório , Projetos , Colonoscopia/métodos , Assistência Centrada no Paciente , Sedação Consciente/tendências
8.
Rev. esp. med. legal ; 41(4): 190-193, oct.-dic. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-146447

RESUMO

Dentro de las importantes modificaciones que recoge la nueva tabla 2.A.1, Baremo médico, Clasificación y valoración de secuelas, nos encontramos con las que corresponden al Sistema digestivo, Capítulo VI, tanto por reordenación como por organización y valoración, mucho más lógicas y funcionales en todos esos aspectos. Desaparecen algunas secuelas raramente traumáticas, se precisan determinados requerimientos para tomar en consideración algunas secuelas, se incrementa el número de las mismas y se mantiene en este apartado las correspondientes a funciones exclusivamente digestivas (AU)


Among the major changes contained in the new table 2.A.1, medical Scale, Classification and valuation of sequels, we find that for the Digestive System, Chapter VI, therefore reorganization as per organization and evaluation, more logical and functional in all these respects. Some rarely traumatic aftermath disappear, certain requirements to take into account some sequels are required, the number thereof is increased and maintained in this section corresponding exclusively to digestive functions (AU)


Assuntos
Feminino , Humanos , Masculino , Trato Gastrointestinal/lesões , Sistema Digestório/lesões , Medicina Legal/legislação & jurisprudência , Medicina Legal/métodos , Estatísticas de Sequelas e Incapacidade , Esôfago/lesões , Gastrectomia/métodos , Doenças dos Ductos Biliares/complicações , Doenças dos Ductos Biliares/epidemiologia , Ductos Biliares/lesões , Medicina Legal/organização & administração , Medicina Legal/normas , Diafragma/lesões , Estenose Esofágica/complicações
10.
Eur. j. anat ; 16(2): 113-118, mayo 2012. tab
Artigo em Inglês | IBECS | ID: ibc-108902

RESUMO

Forty African giant rats (AGRs), (Cricetomys gambianus) were used for the macrometric study. The rats were sacrificed according to the method of Adeyemo and Oke (1990) and the various segments of the gastrointestinal tract (GIT) and the digestive glands of each of the rats were weighed and measured. The large intestine was observed to have the highest mean weight (19.98 } 0.39 g) followed by the stomach (19.47 } 0.26 g) and then the small intestine (17.19 } 0.30S g), respectively. Of all the digestive glands, the liver was found to have the highest mean weight (21.29 } 0.43 g). The small intestine was observed to be the longest (109.17 } 28.68 cm) followed by the large intestine (75.57 } 1.78 cm). Out of all the intestinal segments (small and large), the jejunum was observed to be the longest (72.26 } 2.39 cm) followed by the colon (57.30 } 1.58 cm) (AU)


No disponible


Assuntos
Animais , Ratos , Sistema Digestório/anatomia & histologia , Intestinos/anatomia & histologia , Tamanho do Órgão , Ratos/anatomia & histologia
12.
Rev. esp. enferm. dig ; 104(1): 10-15, ene. 2012. tab
Artigo em Espanhol | IBECS | ID: ibc-95760

RESUMO

Objetivo: analizar las características epidemiológicas, clínicas y virológicas de los pacientes que han sido nuevos diagnósticos de infección activa por VHB, por la presencia de AgHBs positivo, en el servicio de Aparato Digestivo de un hospital de área. Pacientes y métodos: se trata de un estudio prospectivo realizado durante 3 años, en pacientes de nuevo diagnóstico de infección por VHB, donde se han analizado las características epidemiológicas, clínicas, marcadores completos de VHB, cuantificación de DNAVHB e infección por virus Delta. En los pacientes con alta carga viral se han estudiado genotipos y resistencias. En los pacientes con indicación de biopsias hepáticas sus resultados. Resultados: se han diagnosticado 213 pacientes, 18,8/10.000 habitantes y año. El 61% son varones, el 59% con edad comprendida entre 20 y 40 años. El 53% corresponde a población inmigrante, 46% procedentes de Rumanía y 37% de países subsaharianos. En el momento del diagnóstico, el 2,3% tenían una hepatitis aguda, todos los casos con ictericia, y el 3,3% una cirrosis hepática con hipertensión portal. El AgHBe positivo, descontando los cuadros de hepatitis aguda, estaba presente en el 9%. Las transaminasas eran normales en el 62,2%, el DNA-VHB en el 33,8% es superior a 2.000 UI/ml y la asociación del virus Delta está presente en el 3,3%. En 70 pacientes se analiza el genotipo y resistencias, siendo el más frecuente el D, seguido del A; solo se han detectado dos resistencias basales, una a adefovir y otro a entecavir. En las 36 biopsias hepáticas realizadas, el 32,4% tenían una actividad inflamatoria mayor o igual a 2, y el 23,5% una fibrosis igual o superior a 2, valorada según la clasificación de METAVIR. El 17,4% de los diagnosticados ha precisado tratamiento específico para el VHB según práctica clínica por algún motivo, lo que ha supuesto iniciar tratamiento a unos 3 pacientes por cada 100.000 habitantes y año. Conclusión: a pesar de la prevención y vacunación, la infección por VHB es un problema de salud, afecta de forma más frecuente a población inmigrante, varones y cursa en el 62,2% con transaminasas normales. El genotipo más frecuente es el D seguido del A y las resistencias basales son escasas(AU)


Objective: to analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepati - tis B surface antigen (HBsAg) in the digestive diseases department of a district hospital. Patients and methods: we performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patients who required liver biopsy. Results: we diagnosed 213 patients (18.8/10,000 inhabitants/ year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D, followed by A. Resistance was detected at baseline in only 2 cases: to adefovir in one case and to entecavir in another. Among the 36 biopsies performed, 32.4% showed inflammatory activity >= 2, and 23.5% had fibrosis >= 2 according to the METAVIR scoring system. According to clinical practice, specific treatment for HBV infection was necessary (any reason) in 17.4% of those diagnosed (3 patients per 100,000 inhabitants/year). Conclusions: despite prevention and vaccination, HBV infection is a health problem that most commonly affects the immigrant population and men. Serum transaminase levels are normal in 62.2% of patients. The most frequent genotype is D, followed by A, and baseline resistance is scarce(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/patogenicidade , Doenças do Sistema Digestório , Estudos Prospectivos , Sistema Digestório/patologia , Sistema Digestório
13.
Med. intensiva (Madr., Ed. impr.) ; 34(5): 325-333, jun.-jul. 2010. tab
Artigo em Espanhol | IBECS | ID: ibc-84048

RESUMO

La descontaminación selectiva del tracto digestivo (SDD) ha demostrado su eficacia en la prevención de la infección de origen endógeno y en la reducción de la mortalidad en pacientes críticos sometidos a ventilación mecánica prolongada. Los históricos argumentos en contra de su utilización, como son el desarrollo de resistencias bacterianas o la selección de gérmenes resistentes y la ausencia de efecto sobre la mortalidad no se han confirmado. Incluso, los ensayos clínicos más recientes, diseñados para estudiar estas variables, muestran llamativos descensos en la incidencia de bacterias resistentes y reducciones significativas de la mortalidad. Tampoco se han documentado aumentos en la carga de trabajo ni de los costes. En unos pocos estudios de seguimiento a corto y a medio plazo no se ha identificado aumento de las resistencias. La puesta en marcha de un protocolo de SDD requiere motivación y liderazgo para conseguir la participación de varias especialidades del hospital, entrenamiento de varias categorías profesionales y seguimiento de los resultados. Para facilitar el empleo de la SDD en el paciente crítico es necesario que esta medida preventiva sea incluida en las recomendaciones de las sociedades científicas nacionales e internacionales y grupos de trabajo implicados en el cuidado del paciente crítico. La implantación generalizada de SDD en nuestras unidades de cuidados intensivos debe acompañarse de un registro que permita monitorizar el efecto sobre la incidencia de las infecciones y las resistencias bacterianas. Para ello disponemos de una herramienta como el estudio de infección y resistencias en UVI, el ENVIN-HELICS, que cumple todos los requisitos de una programa de vigilancia acreditado desde hace 15 años (AU)


Selective decontamination of the digestive tract (SDD) has been proven to prevent infections of endogenous development and reduce mortality in critically ill patients under prolonged mechanical ventilation. Historical arguments against its use, like the development of bacterial resistance or the selection of resistant microorganisms and the absence of influence on mortality have not been confirmed. Moreover, recent clinical trials designed to evaluate these variables, show remarkable reductions in the incidence of resistant bacteria and a significant beneficial effect on mortality. Furthermore, no increases in workload or costs have been documented. A few studies with post-trial and intermediate range follow-up periods didn't find increases in resistance. Implementation of SDD requires motivation and leadership in order to achieve cooperation of other related hospital specialists, training of several categories of healthcare professionals, and continuous monitoring of results. In order to facilitate the use of SDD in the critically ill, this preventive measure should be incorporated in guidelines of national and international scientific societies and working groups involved in the care of the critically ill patient. The general implementation of SDD in our intensive care units must be accompanied by a registry in order to be able to monitor the effect on the incidence of infection and bacterial resistance. For this purpose, the Spanish national ICU infection and resistance surveillance programme ENVIN-HELICS, active over the last 15 years, constitutes both a more than adequate tool, and the convenient reference data base (AU)


Assuntos
Humanos , Cuidados Críticos , Infecções Bacterianas/prevenção & controle , Sistema Digestório/microbiologia , Infecções Bacterianas/epidemiologia , Descontaminação , Incidência
14.
Med. intensiva (Madr., Ed. impr.) ; 34(5): 334-344, jun.-jul. 2010. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-84049

RESUMO

La prevención de la neumonía asociada a la ventilación mecánica (NAV) es un objetivo prioritario en las unidades de cuidados intensivos (UCI). Para conseguirlo, las guías de práctica clínica recomiendan la aplicación simultánea de un conjunto heterogéneo de medidas que ha mostrado su efectividad, de manera que en la actualidad se asiste a una reducción de la incidencia de la NAV hasta cifras que hasta hace poco se consideraban inalcanzables; un mayor cumplimiento de las guías de práctica clínica se ha traducido en múltiples estudios en tasas de NAV que se aproximan a cero. Frente a las medidas recomendadas en las guías de práctica clínica, la descontaminación digestiva selectiva (DDS), aplicada junto con otras medidas de control de infecciones, ha mostrado eficacia en hospitales con elevada incidencia basal de neumonía, pero su efectividad en hospitales con buen cumplimiento de las guías de práctica clínica y tasas bajas de NAV es altamente improbable. Un serio inconveniente de la DDS es el riesgo de favorecer la selección de microorganismos resistentes, que pueden diseminarse fácilmente por la unidad de cuidados intensivos y el hospital. Con los estándares actuales de prevención de infecciones, la DDS es una medida innecesaria y de riesgo, que no debe emplearse de manera generalizada. Aún no se conoce en qué situaciones la DDS puede aumentar la efectividad de las medidas preventivas estándares correctamente aplicadas (AU)


The prevention of ventilator-associated pneumonia (VAP) is a priority in the Intensive Care Unit (ICU). To achieve this goal, clinical practice guidelines recommend the simultaneous application of a heterogeneous group of preventive measures of proven effectiveness. That is why we are presently seeing a reduction in VAP incidence to values previously considered unreachable. Better compliance with clinical practice guidelines has resulted in VAP rates approaching zero in multiple studies. Faced with the measures recommended in these guidelines, selective digestive decontamination (SDD), used together with other infection control practices, has shown efficacy in hospitals with high baseline incidence of pneumonia. However, its effectiveness in hospitals with good compliance of clinical practice guidelines and lower rates of VAP is highly unlikely. A serious drawback of DDS is the risk of favoring the selection of resistant microorganisms that can spread easily through the ICU and the hospital. With current standards of infection prevention, DDS is an unnecessary and risky measure, which should not be used on a widespread basis. Those situations in which the DDS may increase the effectiveness of properly implemented standard measures are still unknown (AU)


Assuntos
Humanos , Sistema Digestório/microbiologia , Pneumonia Bacteriana/prevenção & controle , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Antibioticoprofilaxia , Descontaminação , Farmacorresistência Bacteriana , Guias de Prática Clínica como Assunto
17.
Allergol. immunopatol ; 36(4): 215-227, ago. 2008. tab
Artigo em Inglês | IBECS | ID: ibc-67787

RESUMO

Background: Eosinophilic oesophagitis (EO) is achronic inflammatory disease of the oesophagus, with an emergent character, defined by the presence of a dense infiltrate by eosinophilic leukocytes restricted to the mucosa of this organ after excluding gastro-oesophageal acid reflux. It is manifested by chronic and/or recurrent dysphagia and episodes of oesophageal alimentary impaction, with great variation in terms of intensity, frequency, and duration of the attacks. Methods: An Internet-based search was performed for the most recent articles with relevant information concerning immunopathological mechanisms involved in EO. Results: Bibliographical data allow us to define that EO is related to an allergic or hypersensitivity-induce dreaction after exposure to foods or inhalants, with increased prevalence of sensitisation to these allergens. Data published up to now suggest a cellular hypersensitivity reaction rather than a humoral one in the physiopathology of EO. In this disease, sensitised T-lymphocytes mediate a Th2 type response, releasing cytokines such as IL-5, with a possibleTh1 component that requires further investigation.The function of the abundant CD8+ T-lymphocytes present in the oesophageal epithelium has yet to be explained. Mast cells also participate in epithelial inflammatory infiltrate in EO, and it is still unknown ifits activation, mainly through IgE, contributes to the immunopathology of the disease even though EOrarely manifests immediate hypersensitivity reactions.IL-5 and different forms of eotaxins perform an important active role in the recruitment of eosinophils to the oesophagus. Conclusions: EO is an immunologically complex and little studied entity that is associated with otherallergic diseases and in which different effector cells participate, determining an immunological response of cellular rather than a humoral hypersensitivity reaction.The data available point out that EO is a disorder of the Th2 retarded immune response, in which the triggering factor might not be IgE. Although the final inflammatory phenomena observed in EO are common for the different patients, the cascade of inflammatory mediators that lead to them might not be identical in all cases, and the morphological and functional disorders observed in EO would represent the final convergence of different activation forms of the mechanisms of inflammation


No disponible


Assuntos
Humanos , Masculino , Feminino , Esofagite/complicações , Esofagite/diagnóstico , Esofagite/imunologia , Eosinofilia/complicações , Eosinofilia/diagnóstico , Hipersensibilidade Alimentar/imunologia , Esofagite/patologia , Eosinofilia/imunologia , Eosinofilia/patologia , Eosinofilia Pulmonar/complicações , Sistema Digestório/patologia , Testes Imunológicos , Linfócitos/imunologia , Linfócitos/fisiologia
18.
Acta pediatr. esp ; 66(7): 330-336, jul. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-68122

RESUMO

La mayoría de los niños que llegan a España generalmente no presentan las tasas de desnutrición del país de origen, aunque sí determinadas carencias nutricionales específicas (hierro, vitamina A) y raquitismo. En la actualidad, el hecho de pertenecer a una minoría étnica no debería ser un factor de riesgo para padecer desnutrición carencial y, con la excepción de los hijos de los inmigrantes recién llegados, el estado nutricional y el crecimiento de estos niños han de ser similares a los de los niños con el mismo nivel socioeconómico del país de destino. Para un mejor control de los niños inmigrantes, los profesionales sanitarios deben conocer el estado nutricional de base(con la obtención de las distintas medidas antropométricas) y los aspectos genéticos y socioculturales, a fin de poder prevenir sus posibles alteraciones a largo plazo, ya que se están registrando importantes problemas de sobrepeso, especialmente en la segunda generación de esta población. También repasamos la patología abdominal en el niño inmigrante desde el punto de vista sindrómico, para poder orientar el diagnóstico y el tratamiento. Aunque en general es similar a la observada en la población autóctona, debido a las características propias ambientales y a la carga genética de estos niños podemos hallar diferencias en la prevalencia de algunas enfermedades, aparte de las afecciones propias del trópico. Además, son frecuentes las patologías reactivas o de adaptación, que se expresan fundamentalmente con somatizaciones y síntomas vagos que indican una problemática relacional, y el dolor abdominal es el síntoma más común en estos niños(AU)


In general, most of the children who arrive in Spain do not reflect the rates of malnutrition observed in their countries of origin, although certain specific nutritional deficiencies (iron, rickets, vitamin A) may be detected. At the present time, being a member of an ethnic minority should not be a risk factor for malnutrition owing to deficiency disease, and, with the exception of children of newly arrived immigrants, the nutritional status and growth of these children should be similar to that of children of the same socioeconomic status in the country of destination. For a more effective monitoring of immigrant children, health professionals should be aware of the baseline nutritional status(using different anthropometric measurements) and genetic and sociocultural aspects in order to prevent possible long-term disturbances, since these individuals are experiencing significant problems with overweight, especially those of the second generation. We also reviewed the gastrointestinal diseases that can be found in the immigrant child from the syndromic point of view in order to guide their diagnosis and treatment. Although, in general, they are similar to those observed in the native population, given the particular environmental characteristics and the genetic load of these children, we do detect differences in the prevalence of certain diseases, aside from those associated with the tropics. In addition, coping problems or adjustment disorders frequently occur and are expressed mainly in the form of somatization and vague symptoms that indicate relational problems, with abdominal pain being the most common symptom in these children(AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Migrantes , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição do Lactente/epidemiologia , Desnutrição Proteico-Calórica/diagnóstico , Sistema Digestório/patologia , Doenças do Sistema Digestório/complicações , Doenças do Sistema Digestório/dietoterapia , Síndromes de Malabsorção/complicações , Raquitismo/patologia , Análise Socioeconômica , Vigilância Nutricional , Estado Nutricional/fisiologia , Sistema Digestório/fisiopatologia , Dor Abdominal/diagnóstico
19.
Cir. Esp. (Ed. impr.) ; 82(5): 268-277, nov. 2007. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-057142

RESUMO

Objetivo. Determinar la incidencia de pacientes con efectos adversos (EA) en los servicios de cirugía general, describir las causas inmediatas del EA, definir los evitables y conocer su impacto. Material y método. Estudio retrospectivo de cohortes. Muestra aleatoria estratificada de 24 hospitales, 6 de tamaño pequeño (de menos de 200 camas), 13 de tamaño mediano (de 200 a 499 camas) y 5 de tamaño grande (500 camas o más). Pacientes ingresados, cuya hospitalización fuera superior a 24 h, que fueron dados de alta del 4 al 10 de junio de 2005. Se incluyeron los EA detectados durante la hospitalización y los que fueron consecuencia de episodios de hospitalización previa en el mismo hospital. Resultados. La incidencia de pacientes con EA fue del 10,5% (76/735), con un intervalo de confianza (IC) del 95%, 8,1%-12,5%. La presencia de factores de riesgo intrínsecos aumenta el riesgo de EA (el 14,8 frente al 7,2%; p = 0,001), y también lo hace la presencia de factores de riesgo extrínseco (el 16,2 frente al 7,0%; p < 0,001). La comorbilidad influyó en la aparición de EA (el 33,7 de EA frente al 2,2% sin comorbilidad; p < 0,001). La gravedad del EA se relacionó con el riesgo ASA (p = 0,036). El 41,7% de los EA se relacionó con la infección nosocomial; el 27,1%, con procedimientos, y el 24%, con la medicación. El 31,3% de los EA se consideraron leves; el 39,6%, moderados, y el 29,2%, graves. Un 36,5% se valoraron como evitables. El total de estancias adicionales provocadas por EA fueron de 527 (6,3 estancias adicionales por paciente), de las cuales 216 correspondieron a EA evitables. Conclusiones. Los pacientes de cirugía general y aparato digestivo tienen más riesgo de EA. Existen factores de vulnerabilidad, como son la edad, la comorbilidad y la aplicación de dispositivos externos. Una parte importante de los EA se relacionan con la infección nosocomial (especialmente infección de la herida quirúrgica) y también con el propio procedimiento. Finalmente, los EA tienen un impacto notable en el paciente y en una proporción considerable de casos pueden evitarse. El impacto sanitario, social y económico de los EA, hasta hace poco una epidemia silenciosa en nuestro país, convierte la necesidad de su estudio en una prioridad de salud pública (AU)


Objective. To determine the incidence of patients with adverse events (AE) in Spanish general surgery units, describe the immediate causes of AE, identify avoidable AE, and determine the impact of these events. Material and method. We performed a retrospective cohort study of a randomized stratified sample of 24 hospitals. Six of the hospitals were small (fewer than 200 beds), 13 were medium-sized (between 200 and 499 beds) and five were large (500 or more beds). Patients admitted for more than 24 hours to the selected hospitals and who were discharged between the 4th and 10th of June 2005 were included. AE detected during hospitalization and those occurring as a consequence of previous admissions in the same hospital were analyzed. Results. The incidence of patients with AE associated with medical care was 10.5% (76/735; 95%CI: 8.1%-12.5%). The presence of intrinsic risk factors increased the risk of AE (14.8% vs 7.2%; P=.001). Likewise, 16.2% of patients with an extrinsic risk factor had an AE compared with 7.0% of those without these risk factors (P<.001). Comorbidity influenced the occurrence of AE (33.7% of AE vs. 2.2% without comorbidity; P<.001). The severity of the AE was related to ASA risk (P=.036). AE were related to nosocomial infection (41.7%), procedures (27.1%) and medication (24%). A total of 31.3% of the AE were mild, 39.6% were moderate, and 29.2% were severe. Preventable AE accounted for 36.5%. AE caused an additional 527 days of stay (6.3 additional days of stay per patient), of which 216 were due to preventable AE. Conclusions. Patients in general and digestive surgery units have an increased risk of AE. Risk factors for these events are age, comorbidity, and the use of external devices. A substantial number of AE are related to nosocomial infection (especially surgical wound infection) and to surgical procedures. AE have an important impact on patients and a considerable proportion of these events are preventable. AE have strong health, social and economic repercussions and until recently have constituted a silent epidemic in Spain. Consequently, study of these events should be a public health priority (AU)


Assuntos
Masculino , Feminino , Pessoa de Meia-Idade , Humanos , Sistema Digestório/patologia , Sistema Digestório/fisiopatologia , Cirurgia Geral/métodos , Centro Cirúrgico Hospitalar , Estudos de Coortes , Comorbidade , Fatores de Risco , Controle de Qualidade , Qualidade da Assistência à Saúde , Gestão da Qualidade , Estudos Retrospectivos , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Seguro de Hospitalização
20.
Eur. j. anat ; 11(supl.1): 53-57, oct. 2007. tab, graf
Artigo em Inglês | IBECS | ID: ibc-138114

RESUMO

Within the three-year nursing degree course in Spain, the way in which anatomy teaching is organised shows distinct differences between different universities. At the University of Jaén, first-year students have human anatomy (HA) as a separate subject, whereas at the University of Almeria, anatomy is included within a larger module called the structure and function of the human body (SFHB). The aim of this study was to analyze the reaction of students to the organization of their anatomy courses, the resources used in their teaching, their contents, and the tutoring and evaluation system. For this purpose, a 35-item questionnaire was designed to address aspects related to these objectives and administered at the end of the 2005-6 academic year to 82 students of taking human anatomy at the University of Jaén and 52 students taking structure and function of human body at the University of Almeria. Results obtained showed differences in the evaluation of the educational organization of these subjects at the two universities. The approval rating of Jaen students for the relationship between their theoretical and practical education/training was 25% lower than that of Almeria students. This difference appears to be related to the different distributions of credits between the two subjects in the courses surveyed. Students appeared more highly to value the resources that were most frequently used during the course, suggesting that students may value most highly those resources employed most frequently within a course. There were some similarities between the students at the different universities in the importance they assigned to the different thematic units of the respective subjects. Finally, both groups revealed a preference for face-to-face tutorial sessions and for evaluation by written examinations (AU)


No disponible


Assuntos
Feminino , Humanos , Masculino , Anatomia/educação , Anatomia/métodos , Ensino/métodos , Ensino/tendências , Sistema Digestório/anatomia & histologia , Estudantes/classificação
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