Factores asociados con la fragilidad en un servicio ambulatorio de geriatría de un hospital universitario en Bogotá (Colombia) / Factors Associated with Frailty in the Geriatric Outpatient Service of a University Hospital in Bogotá (Colombia) / Fatores associados à fragilidade no ambulatório de geriatria de um hospital universitário de Bogotá (Colômbia)

Introducción: la fragilidad, entendida como un estado previo a la discapacidad, confiere mayor vulnerabi-lidad a estresores externos y contribuye a desenlaces negativos como caídas, hospitalización, discapacidad y mortalidad. El objetivo de este estudio fue identificar su prevalencia y evaluar los factores asociados en los pacientes del Servicio Ambulatorio de Geriatría del Hospital Universitario San Ignacio (husi) en Bogotá (Colombia). Materiales y métodos: estudio de corte transversal con 689 pacientes atendidos en la consulta externa de geriatría del husi entre agosto de 2016 y marzo de 2020. Mediante regresiones logísticas se iden-tificaron los factores relacionados con la fragilidad. Resultados: la prevalencia fue del 35.4 %. En el análisis bivariado, las variables asociadas con la fragilidad fueron edad mayor de 80 años (or: 2.07; ic95 %: 1.40-3.20; p = 0.001), sexo femenino (or: 1.40; ic95 %: 0.99-2.02; p = 0.03), multimorbilidad (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) y malnutrición (or: 2.23; ic95 %: 1.22-4.07; p = 0.009). En el análisis multivariado, la multimor-bilidad (or: 2.46; ic95 %: 1.62-3.75; p = 0.001), la velocidad de la marcha lenta (or: 5.15; ic95 %: 3.0-8.60; p = 0.001) y el perímetro de pantorrilla bajo (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) se vincularon con la fragilidad. Conclusión: la prevalencia de fragilidad en el servicio de geriatría del husies mayor a la de los referentes nacionales; adicionalmente, las variables analizadas coinciden con las encontradas en la literatura; todo esto respecto a la gran complejidad clínica de los pacientes. Es clave la detección de los factores que se asocian con fragilidad, a fin de intervenirlos y prevenir desenlaces adversos

Introduction: Frailty, understood as a pre-disability state, increases vulnerability to external stressors and contributes to negative outcomes such as falls, hospitalization, disability, and mortality. This study aims to identify the prevalence of frailty and assess the associated factors in patients attending the geriatric outpatient service of the Hospital Universitario San Ignacio (husi). Materials and methods: A cross-sectional study involving 689 patients treated at the husigeriatric outpatient clinic between August 2016 and March 2020. Logistic regressions were conducted to identify factors associated with frailty. Results: The prevalence of frailty was 35.4 %. In bivariate analysis, variables associated with frailty included age over 80 years (or: 2.07; ci95 %: 1.40-3.20; p = 0.001), female sex (or: 1.40; ci95 %:0.99-2.02; p= 0.03), multimorbidity (or: 2.13; ci95 %:1.40-2.90; p < 0.001) and malnutrition (or: 2.23; ci95 %: 1.22-4.07; p = 0.009). In multivariate analysis, multimorbidity (or: 2.46; ci95 %: 1.62-3.75; p = 0.001), slow walking speed (or: 5.15; ci95 %: 3.0-8.60; p = 0.001) and low calf perimeter (or: 1.60; ci95 %: 1.03-2.50; p = 0.06) were associated with frailty. Conclusion: The prevalence of frailty in our center exceeds national references; and the identified variables align with those reported in the literature; reflecting the considerable clin-ical complexity of our patients. Detecting factors associated with frailty is crucial for intervention and prevention of adverse outcomes

ntrodução: a fragilidade, entendida como um estado anterior à incapacidade, confere maior vulnerabi-lidade a estressores externos e contribui para desfechos negativos como quedas, hospitalização, incapa-cidade e mortalidade. O objetivo deste estudo foi identificar a prevalência e avaliar os fatores associados à fragilidade em pacientes do ambulatório de geriatria do Hospital Universitário San Ignacio (husi) de Bogotá, Colômbia. Materiais e métodos: estudo transversal com 689 pacientes atendidos no ambulatório de geriatria do husi entre agosto de 2016 e março de 2020. Foram realizadas regressões logísticas para identificar fatores associados à fragilidade. Resultados: a prevalência de fragilidade foi de 35.4 %. Na análise bivariada, as variáveis associadas à fragilidade foram: idade acima de 80 anos (or:2.07; ic95 %:1.40-3,20; p = 0.001), gênero feminino (or:1.40; ic95 %:0.99-2.02; p = 0.03), multimorbidade (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) e desnutrição (or:2.23; ic95 %:1.22-4.07; p = 0.009). Na análise multivariada, multimorbidade (or:2.46; ic95 %: 1.62-3.75; p = 0.001), velocidade lenta de caminhada (or:5.15; ic95 %:3.0-8.60; p = 0.001) e baixa circunferência da panturrilha (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) foram associados à fragilidade. Conclusão: a prevalência de fragilidade no husi é superior à das referências nacionais; adicionalmente, as variáveis associadas coincidem com as encontradas na literatura; tudo isso em relação à grande complexidade clínica dos nossos pacientes. É fundamental detectar os fatores associados à fragilidade para intervir e prevenir resultados adversos

Muscular Function as an Alternative to Identify Cognitive Impairment: A Secondary Analysis From SABE Colombia.

BACKGROUND: Identification of cognitive impairment is based traditionally on the neuropsychological tests and biomarkers that are not available widely. This study aimed to establish the association between motor function (gait speed and handgrip strength) and cognitive performance in the Mini-Mental State Examination, globally and by domains. A secondary goal was calculating a cut-off point for gait speed and handgrip strength to classify older adults as cognitively impaired. METHODS: This is a secondary analysis of SABE Colombia (Salud, Bienestar & Envejecimiento), a survey that was conducted in 2015 on health, wellbeing, and aging in Colombia. This study used linear regression models to search for an association between motor function and cognitive performance. The accuracy of motor function measurements in identifying cognitive impairment was assessed with receiver operating characteristic (ROC) curves. This study also analyzed other clinical and sociodemographical variables. RESULTS: Gait speed was associated with orientation (r 2 = 0.16), language (r 2 = 0.15), recall memory (r 2 = 0.14), and counting (r 2 = 0.08). Similarly, handgrip strength was associated with orientation (r 2 = 0.175), language (r 2 = 0.164), recall memory (r 2 = 0.137), and counting (r 2 = 0.08). To differentiate older adults with and without cognitive impairment, a gait speed cut-off point of 0.59 m/s had an area under the curve (AUC) of 0.629 (0.613-0.646), and a weak handgrip (strength below 17.5 kg) had an AUC of 0.653 (0.645-0.661). The cut-off points for handgrip strength and gait speed were significantly higher in male participants. CONCLUSIONS: Gait speed and handgrip strength are similarly associated with the cognitive performance, exhibiting the most extensive association with orientation and language domains of the Mini-Mental State Examination. Gait speed and handgrip strength can easily be measured by any clinician, and they prove to be useful screening tools to detect cognitive impairment.

Autoimmune anti-DNA and anti-phosphatidylserine antibodies predict development of severe COVID-19.

High levels of autoimmune antibodies are observed in COVID-19 patients but their specific contribution to disease severity and clinical manifestations remains poorly understood. We performed a retrospective study of 115 COVID-19 hospitalized patients with different degrees of severity to analyze the generation of autoimmune antibodies to common antigens: a lysate of erythrocytes, the lipid phosphatidylserine (PS) and DNA. High levels of IgG autoantibodies against erythrocyte lysates were observed in a large percentage (up to 36%) of patients. Anti-DNA and anti-PS antibodies determined upon hospital admission correlated strongly with later development of severe disease, showing a positive predictive value of 85.7% and 92.8%, respectively. Patients with positive values for at least one of the two autoantibodies accounted for 24% of total severe cases. Statistical analysis identified strong correlations between anti-DNA antibodies and markers of cell injury, coagulation, neutrophil levels and erythrocyte size. Anti-DNA and anti-PS autoantibodies may play an important role in the pathogenesis of COVID-19 and could be developed as predictive biomarkers for disease severity and specific clinical manifestations.

The Search of a Malaria Vaccine: The Time for Modified Immuno-Potentiating Probes.

Malaria is a deadly disease that takes the lives of more than 420,000 people a year and is responsible for more than 229 million clinical cases globally. In 2019, 95% of malaria morbidity occurred in African countries. The development of a highly protective vaccine is an urgent task that remains to be solved. Many vaccine candidates have been developed, from the use of the entire attenuated and irradiated pre-erythrocytic parasite forms (or recombinantly expressed antigens thereof) to synthetic candidates formulated in a variety of adjuvants and delivery systems, however these have unfortunately proven a limited efficacy. At present, some vaccine candidates are finishing safety and protective efficacy trials, such as the PfSPZ and the RTS,S/AS01 which are being introduced in Africa. We propose a strategy for introducing non-natural elements into target antigens representing key epitopes of Plasmodium spp. Accordingly, chemical strategies and knowledge of host immunity to Plasmodium spp. have served as the basis. Evidence is obtained after being tested in experimental rodent models for malaria infection and recognized for human sera from malaria-endemic regions. This encourages us to propose such an immune-potentiating strategy to be further considered in the search for new vaccine candidates.

Liver and kidney dysfunction, hypoglycemia, and thrombocytopenia in Plasmodium vivax malaria patients at a Colombian Northwest region.

Plasmodium vivax has high morbidity, it is the Plasmodium species with the greatest worldwide distribution, and its ability to trigger severe symptoms is currently recognized. The present study aims to compare the clinical and epidemiological characteristics of patients with P. vivax malaria, with and without complication criteria, in an endemic area for malaria transmission in northwest Colombia. A descriptive cross-sectional study was carried out between 2017 and 2019, patients with P.vivax severe malaria (n = 50), non-severe malaria (n = 56) and healthy controls (n = 50) were included. Sociodemographic, clinical, hematological, and biochemical characteristics were analyzed. Clinical follow-up was carried out in a group of patients with severe malaria. The statistical analysis was carried out in GraphPad Prism; the Chi-square test analyzed categorical variables, comparisons of variables for the three groups were carried out by the Kruskal-Wallis test and comparison between two groups by the Mann-Whitney test. A multiple correspondence analysis described the relationship between variables, which was carried out through the R software. One hundred fifty-six individuals were linked to the study, 76 women and 80 men, between 3 and 71 years old. For 50% of the patients, it was their first malaria episode; 42% of the patients classified with severe malaria required hospitalization, compared to 7.1% of the patients with non-severe malaria. Parasitaemia was similar in both clinical groups; however, 10% of severe patients presented high parasitemia, between 20,000-135,000. The most frequent clinical characteristics in patients with severe malaria were severe thrombocytopenia in 54%, hypoglycemia in 48%, and liver and kidney failure in 30%. Biochemical and hematological parameters returned to normal in 90% of the patients with severe malaria on the third day after starting treatment. Thrombocytopenia, hypoglycemia, and liver and kidney dysfunctions were the most frequent P. vivax malaria complications in this study. Hemoglobin concentration and parasite count were not related to the clinical condition of patients. Thrombocytopenia was the most frequent finding in patients with malaria, and its severity presented an inverse relationship with the number of previous malaria episodes.

Atypical memory B-cells and autoantibodies correlate with anemia during Plasmodium vivax complicated infections.

Malaria caused by Plasmodium vivax is a highly prevalent infection world-wide, that was previously considered mild, but complications such as anemia have been highly reported in the past years. In mice models of malaria, anti-phosphatidylserine (anti-PS) autoantibodies, produced by atypical B-cells, bind to uninfected erythrocytes and contribute to anemia. In human patients with P. falciparum malaria, the levels of anti-PS, atypical B-cells and anemia are strongly correlated to each other. In this study, we focused on assessing the relationship between autoantibodies, different B-cell populations and hemoglobin levels in two different cohorts of P. vivax patients from Colombia, South America. In a first longitudinal cohort, our results show a strong inverse correlation between different IgG autoantibodies tested (anti-PS, anti-DNA and anti-erythrocyte) and atypical memory B-cells (atMBCs) with hemoglobin in both P. vivax and P. falciparum patients over time. In a second cross-sectional cohort, we observed a stronger relation between hemoglobin levels, atMBCs and autoantibodies in complicated P. vivax patients compared to uncomplicated ones. Altogether, these data constitute the first evidence of autoimmunity associating with anemia and complicated P. vivax infections, suggesting a role for its etiology through the expansion of autoantibody-secreting atMBCs.

Intervención de enfermería para la disminución de la ansiedad ante el parto vaginal / Efficacy of nursing intervention management of anxiety before vaginal delivery

El parto vaginal, se conoce como el comienzo espontáneo, o ciclo natural, que permite llegar al final exitoso de la gestación en la mujer. Objetivo: determinar la eficacia de la intervención de enfermería manejo de la ansiedad en mujeres gestantes frente al parto, en el Hospital de segundo nivel en San Gil, Santander. Materiales y métodos: es un estudio cuasi-experimental, con un solo grupo la muestra estuvo conformada 29 mujeres gestantes que cumplieran con los criterios de inclusión, la información se obtuvo a través del cuestionario de ansiedad estado rasgo STAI "State-Trait Anxiety Inventory (Self Evaluation Questionnaire)". Resultados: Se encontró que el promedio de la edad de las gestantes que participaron en el estudio fue de 24 años, el estado civil de más de la mitad de las gestantes es unión libre con un 65,5%. La diferencia de medias entre las puntuaciones pre y post obtuvieron una significación estadística. La media de las puntuaciones de la variable ansiedad estado disminuyo antes (x = 22,3) después de la intervención (x = 20). Conclusión: Se logró describir el nivel la ansiedad en las gestantes y al realizar la comparación de la prueba pre y post se evidenció una disminución en el nivel de ansiedad, por tanto, se debe trabajar en un plan de cuidados, tal como en la teoría de cuidados de Swanson, debe ser un trabajo humanístico hacia las personas a nuestro cuidado. (AU)

Vaginal birth is known as the spontaneous onset, or natural cycle, which allows the successful end of pregnancy in women. Objective: to determine the effectiveness of the nursing intervention anxiety management in pregnant women against childbirth, in the second level Hospital in San Gil, Santander. Materials and methods: is a quasi-experimental study, with a single group the sample consisted of 29 pregnant women who met the inclusion criteria, the information was obtained through the STAI state anxiety trait questionnaire "State-Trait Anxiety Inventory (Self Evaluation Questionnaire)" Results: It was found that the average age of the pregnant women who participated in the study was 24 years, the marital status of more than half of the pregnant women is free union with 65.5%. The difference in means between the pre and post scores obtained a statistical significance. The mean scores of the state anxiety variable decreased before (x = 22.3) after the intervention (x = 20). Conclusions: It was possible to describe the level of anxiety in pregnant women and when comparing the pre and post test, a decrease in the level of anxiety was evidenced, therefore it is necessary to work in a care plan, such as in the theory of care from Swanson, it must be a humanistic work towards the people in our care. (AU)

Parafunctional oral habits and primary dentition characteristics in a group of preschool children from Tlaquepaque, Jalisco, Mexico / Hábitos orales parafuncionales y características de la dentición primaria en un grupo de preescolares de Tlaquepaque, Jalisco, México

The aim of this study was to evaluate the relationship between some characteristics of primary dentition, and the frequency of parafunctional oral habits, with age and sex. Material and Methods: A cross-sectional study was carried out in a sample of 227 preschool children. Subjects' parents or guardians were asked to sign an informed consent form. The epidemiological survey consisted of an oral examination and the application of a questionnaire (Cronbach's alpha=0.881), after calibration of a dentist (Kappa=0.932). To measure the reliability of the questionnaire, Cronbach's alpha was calculated, and for the associations, Mantel and Haenszel Square Chi-square test and likelihood ratio for contingency tables greater than 2x2 values were calculated. Results: Type 2 arch (72.7%), mouth breathing (26.0%) and onychophagia (17.2%) were the risk factors observed more frequently in the group under study. The type of arch was the only variable that was associated with sex (X2MH=4.443, p=0.035). Conclusion: A significant proportion of the subjects had at least one risk factor that may alter the development of dental occlusion; consequently, the implementation of preventive actions in this population must be considered.

Objetivo. Evaluar algunas características de la dentición primaria, así como la frecuencia de hábitos orales parafuncionales y su asociación con la edad y el sexo. Material y Métodos: Se llevó a cabo un estudio transversal en una muestra de 227 preescolares bajo autorización expresa de sus padres. La encuesta epidemiológica estuvo conformada por el examen bucal y la aplicación de un cuestionario (alfa de Cronbach=0,881), previa estandarización de una Cirujana Dentista (Kappa=0,932). Para medir la fiabilidad del cuestionario se calculó el valor del alfa de Cronbach y para las asociaciones la Chi cuadrada de Mantel y Haenszel y el valor de Razón de verosimilitud para tablas de contingencia mayores de 2X2. Resultados. La arcada tipo 2 (72,7%), la respiración bucal (26,0%) y la onicofagia (17,2%) fueron los factores de riesgo que fueron observados con mayor frecuencia en los niños. El tipo de arcada fue la única variable que estuvo asociada con el sexo (X2MH=4,443, p=0,035). Conclusiones. Una proporción alta de los niños encuestados presentó al menos un factor de riesgo para alterar el desarrollo de la oclusión dental, razón por la cual debe considerarse la necesidad de aplicar acciones de carácter preventivo en esta población.

Clinical prognosis and biological factors associated with survival in canines affected by breast neoplasms / Pronóstico clínico y factores biológicos asociados a la supervivencia en caninos afectados por neoplasias mamarias / Prognóstico clínico e fatores biológicos associados a supervivência em caninos afetados por neoplasias mamarias

Introduction: After the skin, breast glands are the location most commonly affected by tumors in bitches. Objectives: to evaluate the survival rate in canines affected by breast neoplasms submitted to surgery, relating the histopathological diagnosis with clinical factors of prognosis. Methodology: 52 bitches were included. The treatment established included mastectomy, previous blood and chest radiographic analysis in order to rule out metastasis. In 13 individuals, euthanasia was performed due to the advanced state of the disease. The variables analyzed were: frequency of presentation, age, reproductive history, diet, previous hormonal treatment, clinical stage, recurrence and survival. Statistical analysis of the variables was performed through analysis of variance and contingency tables based on chi-square tests (Χ²). Results: The effect of type of diagnosis on survival, age and pseudopregnancy showed significant differences (p<0.05). Opposite to this, no significant differences of the type of diagnosis on hormonal treatment, diet, early neutering and recurrence were observed. Conclusions: the determinant prognostic factor on survival was tumoral histopathological pattern (type of diagnosis). Animals with pseudopregnancy showed a higher susceptibility to suffer breast neoplasms. Benign tumors were observed in later ages than malignant.

Introducción: después de la piel, las glándulas mamarias son el sitio más común de afectación tumoral en las perras. Objetivos: evaluar la supervivencia en caninos afectados por neoplasias de la glándula mamaria que fueron sometidos a cirugía, relacionando el diagnóstico histopatológico con factores clínicos de pronóstico. Metodología: se incluyeron 52 perras. El tratamiento instaurado fue mastectomía, previo análisis sanguíneo y radiográfico del tórax con el fin de descartar metástasis. En 13 individuos se realizó la eutanasia debido al avanzado estado de la enfermedad. Las variables analizadas fueron: frecuencia de presentación, edad, historia reproductiva, dieta, tratamientos hormonales previos, estadificación clínica, recidivas y supervivencia. El análisis estadístico de las variables se realizó mediante el análisis de varianza y tablas de contingencia asociadas a la prueba de chi cuadrado (Χ²). Resultados: El efecto del tipo de diagnóstico sobre las variables supervivencia, edad y pseudogestación evidenciaron diferencias significativas (p<0,05), contrario a esto, no se encontraron diferencias significativas en el tipo de diagnóstico para las variables tratamiento hormonal, dieta, esterilización temprana y recidivas. Conclusiones: el factor pronóstico determinante en la sobrevida fue el patrón histopatológico tumoral (tipo de diagnóstico), los animales con pseudogestación evidenciaron una mayor susceptibilidad a padecer cáncer mamario. Los tumores benignos se manifestaron en edades más tardías que los malignos.

Introdução: depois da pele, as glâdulas mamarias são o sitio mais comum de afetação tumoral nas cadelas. Objetivo: avaliar a supervivência em cadelas afetados por neoplasias na glândula mamaria e que foram submetidas a cirurgia, relacionando além o diagnóstico histopatológico com fatores clínicos de prognóstico. Metodologia: incluíramse 52 cadelas. O tratamento instaurado foi mastectomia, prévio analise sanguíneo e radiográfico do tórax com o fim de descartar metástase. Em 13 indivíduos realizou-se a eutanásia devido ao avançado estado da doença. As variáveis analisadas foram: frequência de apresentação, idade, história reprodutiva, dieta, tratamentos hormonais prévios, estadificação clínica, recidiva e sobrevivência. O analise estatístico das variáveis realizou-se mediante o analise de variância e tabelas de contingência associadas ao teste chi quadrado (X2). Resultados: O efeito do tipo de diagnóstico sobre as variáveis supervivência, idade e pseudogestação evidenciaram diferenças significativas (p<0.05), contrário a isto, não se encontraram diferenças significativas no tipo de diagnostico para as variáveis tratamento hormonal, dieta, esterilização juvenil e recidivas. Conclusões: o fator prognóstico determinante na sobrevida foi o padrão histopatológico tumoral (tipo de diagnostico), os animais com pseudogestação evidenciaram uma maior susceptibilidade a padecer câncer mamário. Os tumores benignos manifestaram-se em idades mais tardias que os malignos.

[Eating behavior disorders. Prevalence and clinical features in adolescents in the city of Maracaibo, Zulia State, Venezuela]. / Trastornos de la conducta alimentaria. Prevalencia y características clínicas en adolescentes de la ciudad de Maracaibo, Estado Zulia, Venezuela.

The purpose of this study was to identify the prevalence and clinical characterization related to eating disorders in adolescents from both sexes. In order to do so, the diagnostic criteria and psychological symptoms described by the DSM-IV were used. The sample for this study was constituted by 1,363 adolescents, taken from a population of 23,831 students, who were randomly selected. The sample was stratified taking into account whether they came from a public or a private school and the school levels (middle and high school). The A.B.A checklist was administered to the subjects. This checklist was designed to identify the symptoms that characterize each of the disorders that are the main focus of this study, using DSM-IV criteria. Results from this study show a prevalence of 0% for anorexia nervosa, 1.58% for bulimia nervosa, and .66% for binge eating disorder. Clinical characterization and psychological symptoms related to these disorders show distinguishing features that give distinctive traits to the subjects of this study.

Trastornos de la conducta alimentaria: prevalencia y características clínicas en adolescentes de la ciudad de Maracaibo: estado Zulia-Venezuela / Eating disorders: prevalence and clinical characteristics in adolescents from Zulia-Venezuela

Este estudio tuvo como objetivo determinar la prevalencia y las características clínicas asociadas a los trastornos de la conducta alimentaria en sujetos masculinos y femeninos en etapa de adolescencia. Para esto, se consideró como base los criterios diagnósticos descritos en el DSM-IV. Este estudio tomó 1.363 adolescentes de una población conformada por 23.831 estudiantes, los cuales seleccionados de manera aleatoria y estratificada, de acuerdo al tipo de institución (públicas o privadas) y los grados correspondientes a la tercera etapa de educación básica y ciclo diversificado. Para recolectar los datos se aplicó la lista de chequeo A.B.A., desarrollada por los autores, la cual fue creada para identificar la presencia de los síntomas que caracterizan a cada uno de los trastornos incluidos en este estudio, según los criterios propuestos en el DSM-IV. Los resultados obtenidos muestran una prevalencia del 0 por ciento en Anorexia nerviosa 1,58 por ciento en Bulimia nerviosa y 0,66 por ciento correspondiente al Trastorno por Atracón. Las características clínicas asociadas a estos trastornos muestran singularidad que otorgan rasgos distintivos a los sujetos del estudio.