Green Synthesis for Carbon Quantum Dots via Opuntia ficus-indica and Agave maximiliana: Surface-Enhanced Raman Scattering Sensing Applications.

In this study, we present an alternative method for synthesizing carbon quantum dots (CQDs) using a green synthesis approach via extracts from Agave maximiliana and Opuntia ficus-indica(Ofi). The extracts from both plants were used as the carbon source for the CQDs. The synthesis method employs mesoporous zeolite 4A as a refractory for the thermal treatment of the samples. Transmission electron microscopy analysis established that the size of the CQDs shows a narrow distribution centered around 2 nm with a maximum size of less than 3 nm for both cases. The CQDs exhibit absorption bands associated with π-π* transitions located around 220 nm. In both cases, photoluminescence (PL) phenomenon was detected by irradiating the samples with a UV wavelength and detecting emissions close to the blue wavelength. Additionally, both kinds of CQDs were tested as surface-enhanced Raman scattering (SERS) substrates against methylene blue (MB), indicating an enhancement associated with ring deformation and stretching modes of the v(C-C) and v(C-N) bonds located around 1400 and 1620 cm-1, respectively. Complementarily, in the framework of density functional theory, H2nC2(2m+1) structures (with n = 3-5 and m = 1-3) were used as a theoretical representation of CQDs in interaction with the MB molecule. It is used for developing the analysis of charge transfer effects between both systems and for specifying elements that generate the SERS effect associated with the chemical enhancement mechanism.

Impact of Delivering a Healthy Lifestyle Intervention: Promotora Findings from Familias Sanas y Activas II.

Background: Community health workers, promotoras, have been identified as effective change agents of their community members' health behaviors and health status. However, few studies have examined the effects of delivering an intervention on the promotoras themselves. Objectives: This study assessed whether promotoras delivering a healthy lifestyle intervention for adults improved their health behaviors and health status from baseline to 6- and 12-months post-baseline. Methods: Volunteer promotoras were trained to promote healthy lifestyles including physical activity through workshops and free group exercise classes throughout their communities. Twenty completed all required trainings and delivered at least one class during the period between baseline and 12-month assessments. The promotoras were measured on the following variables: Systolic and diastolic blood pressure, waist circumference, weight, and height. Additionally, they reported their health behaviors and status including moderate-to-vigorous physical activity, beverage consumption, sleep duration, and depressive symptoms. Results: Repeated measures ANOVAs showed statistically significant decreases from baseline to 6 months for systolic blood pressure (p ≤ 0.05), diastolic blood pressure (p ≤ 0.001) and body mass index (p ≤ 0.05). Changes in self-reported measures were not statistically significant although trends were observed with increases in water consumption. Conclusions: Findings from this study suggest positive effects associated with delivery of a PA intervention. This is one of the first studies to focus on a cohort of promotoras to examine health outcomes from delivering a healthy lifestyle intervention. It is important to further explore these impacts on the community health workers as they have become increasingly essential to the health of some communities.

Facilitators of peer leader retention within a Type 2 diabetes intervention trial for US Latinos/Hispanics of Mexican origin.

Peer support is effective in improving self-management behaviors and health outcomes among individuals with Type 2 diabetes. Volunteer peer support programs offer a cost-effective resource for diabetes self-management support; however, factors affecting the retention of volunteer peer leaders remain understudied. Herein, we examined factors associated with volunteer retention and satisfaction among 34 predominantly Mexican-origin peer leaders who assisted patients from a Federally Qualified Health Center located on the US/Mexico border with their diabetes management. Peer leaders completed surveys with open- and close-ended questions at baseline, 6 months and 12 months. Quantitative and qualitative data analyses were guided by the Volunteer Process Model. Using nonparametric Mann-Whitney U tests, self-efficacy as a peer leader at 6 months was most associated with interest to continue volunteering (P = 0.01), and satisfaction with support from the program at 12 months was most associated with interest to continue volunteering (P = 0.01). The qualitative data indicated that the relationship between the peer leaders and their patients was the primary factor for a satisfying volunteer experience. Future research should focus on increasing peer leaders' self-efficacy and satisfaction with program support and examine how organizations can support the development of the patient-peer relationship. Practitioners should consider appealing to volunteer peers' motivations to promote their retention.

Trace metals and metalloids in Andean flamingos (Phoenicoparrus andinus) and Puna flamingos (P. jamesi) at two wetlands with different risk of exposure in the Bolivian Altiplano.

Birds are widely used as bioindicators in monitoring programs in wetlands. We compare concentrations of seven trace metals and metalloids (TMM) As, Cd, Cu, Fe, Hg, Pb, Znin both feathers and blood in two flamingo species in two high-altitude wetlands in Bolivia, with different levels of anthropogenic point source pollution. Lake Uru Uru (LUU) receives discharges from mining operations, and also effluents from the nearby city of Oruro, while Laguna Colorada (LCo) does not receive contaminants from anthropogenic sources. We sampled water and sediments at each site, as well as flamingos in three age classes in an effort to establish a benchmark for long-term monitoring. Metal concentrations in water did not differ between sites, whereas Zn and Pb concentrations of TMM in sediments were higher at LUU, and Hg higher at LCo. TMM concentrations were highly specific for all separate elements, but results point to differences between Andean flamingo (Phoenicoparrus andinus) chicks and the rest of the classes considered. As flamingo chicks did not molt before sampling, we pose that TMM concentrations in their blood and feathers may respond mainly to local conditions. Eggshells provide additional information, since adults transfer some TMM during egg development. Long-term monitoring in these species should include different age classes and sample both feathers and eggshells to monitor the environmental conditions and bioaccumulation of TMM in these species. Future studies should include sites devoid of natural sources of TMM to help distinguish sources of contamination, since some TMM (As and Pb) may be naturally in high concentrations in remote areas, like Laguna Colorada.

Lactato sérico como factor predictivo de mortalidad en pacientes con sangrado del tubo digestivo alto / Serum lactate as predictive factor of mortality in upper digestive tract bleeding

Resumen ANTECEDENTES: Según el reporte de Upper Gastrointestinal Bleeding de Gastroenterology Clinics of North America, en 2008 se registraron 863,000 admisiones hospitalarias por hemorragia gastrointestinal, con mortalidad reportada de 15 a 20%. En México la mortalidad por sangrado del tubo digestivo alto es de 8.5%, pero aumenta hasta 63% cuando coexiste con otras enfermedades. El lactato se ha validado para el pronóstico de mortalidad en distintas áreas. OBJETIVO: Determinar la utilidad del lactato como pronóstico de mortalidad en pacientes con sangrado del tubo digestivo alto. MATERIAL Y MÉTODO: Estudio de cohorte retrospectivo, ambilectivo, observacional, analítico y unicéntrico, en el que de 2015 a 2016 se midió el lactato de pacientes admitidos por sangrado del tubo digestivo alto al momento del ingreso a la sala de urgencias del Hospital General Xoco, Ciudad de México; posteriormente se correlacionó con el diagnóstico de egreso, se buscó correlación entre sangrado del tubo digestivo alto y egreso por defunción. Se evaluaron como objetivos secundarios la relación entre lactato y hemoderivados transfundidos. RESULTADOS: Se incluyeron 30 pacientes. La media de lactato en hombres fue de 5.33 ± 0.53 mmol/L y en mujeres fue de 1.2 ± 3.84 mmol/L con p < 0.01. El tiempo de hospitalización fue de 6.43 ± 5.13 días. El análisis de supervivencia tomó como referencia la media de lactato de 4.78; 29 pacientes egresaron por mejoría, mientras que un paciente falleció sin encontrar relación entre las concentraciones de lactato y defunción como diagnóstico de egreso; sin embargo, no encontramos relación estadísticamente significativa. CONCLUSIONES: Tras realizar el análisis de nuestra población no encontramos una relación estadísticamente significativa entre las concentraciones de lactato a 4.78 mmol/L y la mortalidad. Se buscó también asociación entre las concentraciones de lactato y las complicaciones durante el internamiento; sin embargo, esto tampoco tuvo relación significativa. A pesar de los resultados obtenidos, consideramos que es necesario replantear el estudio con un enfoque distinto ajustando las características de población y el tamaño de la misma con el fin de aportar datos definitivos respecto a este biomarcador.

Abstract BACKGROUND: According to Upper Gastrointestinal Bleeding of Gastroenterology Clinics of North America, in 2008 there were 863,000 hospital admissions for gastrointestinal bleeding, with reported mortality of 15-20%. In Mexico, mortality from upper digestive tract bleeding represents 8.5%, but increases up to 63% when it coexists with other diseases. Lactate has been validated for the prognosis of mortality in different areas. OBJECTIVE: To determine the usefulness of lactate as prognosis factor of mortality in upper digestive tract bleeding. MATERIAL AND METHOD: A retrospective, ambilective, observational, analytical and unicenter cohort study was done measuring lactate in patients admitted for upper digestive tract bleeding at admission to the emergency room of Hospital General Xoco, Mexico City, from 2015 to 2016 later it was correlated with the diagnosis of discharge, seeking a correlation between upper digestive tract bleeding and discharge due to death. Lactate ratio and blood products transfused were evaluated as secondary objectives. RESULTS: There were included 30 patients. The mean lactate in men was 5.33 ± 0.53 mmol/L and in women were 1.2 ± 3.84 mmol/L with a p < 0.01. The hospitalization time was 6.43 ± 5.13 days. The survival analysis was based on the mean lactate of 4.78; 29 patients graduated for improvement, while one patient died without finding a relation between lactate and death levels as a diagnosis of discharge; however, we did not find statistically significant relationship. CONCLUSION: After analyzing our population we did not find a statistically significant relation between lactate levels at 4.78 mmol/L and mortality. We also looked for an association between lactate levels and complications during hospitalization; however, this either had significant relation. Despite of the obtained results, it is necessary to reconsider the study with a different approach adjusting the population characteristics and its size in order to obtain definitive data about this biomarker.

Eficacia de la profilaxis con haloperidol vs placebo en la prevención de delirio en pacientes con alto riesgo de padecerlo hospitalizados en el servicio de Medicina Interna / Efficacy of prophylaxis with haloperidol vs placebo in the prevention of delirium in patients with risk of suffering it hospitalized in an Internal Medicine service

Resumen ANTECEDENTES: el delirio es un síndrome clínico transitorio y reversible, ocurre frecuentemente en el marco de un proceso de enfermedad aguda, se caracteriza por la alteración de la conciencia que se acompaña de un cambio en las funciones cognoscitivas, sobreviene a lo largo de un breve periodo, habitualmente horas o días, y tiende a fluctuar a lo largo del día. El delirio constituye un problema de salud pública importante, se considera predictor independiente de resultados clínicos negativos con incremento de la mortalidad, la estancia hospitalaria, el costo de la atención y el deterioro cognitivo a largo plazo. La evidencia disponible no apoya la administración de medicamentos para prevenir el delirio en el paciente con enfermedad aguda. OBJETIVO: comprobar la seguridad y eficacia de haloperidol para el tratamiento y profilaxis del delirio. MATERIAL Y MÉTODO: ensayo clínico controlado, prospectivo, transversal, comparativo, en el que se estudiaron pacientes hospitalizados en el servicio de Medicina Interna del Hospital General Xoco de la Secretaría de Salud de la Ciudad de México, se calculó la escala PREDELIRIC al ingreso de los pacientes; se incluyeron en el estudio los pacientes con riesgo alto de delirio (PREDELIRIC >50%). Los pacientes se distribuyeron al azar en dos grupos, en el grupo 1 se aplicaron medidas no farmacológicas de prevención de delirio más la administración de haloperidol profiláctico y el grupo 2 recibió medidas no farmacológicas de prevención de delirio más placebo. RESULTADOS: se incluyeron 84 pacientes, distribuidos en dos grupos, cada uno con 42 pacientes, de los que 33 (40%) eran hombres. El 42% padeció delirio, el tipo mixto fue el más común. La profilaxis con haloperidol no demostró disminuir la incidencia de delirio (54 vs 46%, p=0.51) en comparación con el grupo control. El haloperidol profiláctico no ofreció diferencias significativas comparado con placebo en retrasar el inicio del delirio (media de 6.3 vs 6.8 días, p=0.98), en los días de estancia hospitalaria (mediana 9.5 vs 12 días, p=0.56) o en la duración del delirio (media 3 vs 3.5 días, p=0.32); tampoco tuvo efecto en la mortalidad (20 vs 10%, p=0.21). No se informaron efectos secundarios con la administración de haloperidol. CONCLUSIONES: la administración de haloperidol para la prevención del delirio en pacientes con riesgo alto de padecerlo no demostró diferencia significativa en comparación con el placebo en disminuir la incidencia de delirio, en retrasar el inicio de los síntomas, en la reducción de su duración, en reducir los días de estancia hospitalaria ni en la mortalidad. De acuerdo con nuestros resultados, por el momento no es posible recomendar la administracion de haloperidol en la profilaxis de delirio en pacientes con riesgo alto de padecerlo.

Abstract BACKGROUND: Delirium is a clinical transitory and reversible syndrome, occurs frequently in a setting of an acute disease process, it is characterized by the disorder of the consciousness accompanied by a change in the cognitive functions, it occurs throughout a brief period, usually hours or days and tends to vary during the day. Delirium is an important public health problem and it is considered independent predictor of negative clinical results with increased mortality, hospital stay, attention cost and cognitive damage to long-term. The available evidence does not support the administration of drugs to prevent delirium in patients with acute disease. OBJECTIVE: To prove the safety and efficacy of haloperidol for the treatment and prophylaxis of delirium. MATERIAL AND METHOD: A clinical, controlled, prospective, cross-sectional, comparative study was done, in which patients hospitalized at Internal Medicine service of General Hospital Xoco, Mexico City, were included. Scale PREDELIRIC was calculated at the entering of patients, including in the study those with high risk of delirium (PRE-DELIRIC >50%). Patients were randomly distributed into two groups, in the group 1 non pharmacological measures of delirium prevention were applied plus the administration of prophylactic haloperidol and group 2 was given non pharmacological measures of delirium prevention plus placebo. RESULTS: There were included 84 patients, distributed into two groups, each one with 42 patients, from which 33 (40%) were male; 42% suffer delirium, mix type was the most common. Prophylaxis with haloperidol did not show to reduce the incidence of delirium (54% vs 46%, p=0.51) compared with control group. Prophylactic haloperidol did not show significant differences compared to placebo in delaying the beginning of delirium (mean of 6.3 days vs 6.8 days, p=0.98), in days of hospital stay (mean 9.5 vs 12 days, p=0.56), or in the lasting of delirium (mean 3 vs 3.5 days, p=0.32). Prophylaxis with haloperidol did not show either effect on mortality (20% vs 10%, p=0.21). There were not secondary effects with haloperidol. CONCLUSIONS: Haloperidol administration to prevent delirium in patients with high risk of having it did not show significant difference compared to placebo in reducing delirium incidence, delaying the starting of symptoms, in reducing their lasting, in reducing the hospital stay nor in reducing mortality. According to our results, by now it is not possible to recommend the administration of haloperidol in the prophylaxis of delirium in patients with high risk of having it.

Diferencias en las concentraciones de ácido úrico en pacientes hipertensos, normotensos y prehipertensos / Differences in levels of uric acid in hypertensive, normotensive and prehypertensive patients

Resumen ANTECEDENTES: la prehipertensión es una condición que aumenta el riesgo de padecer hipertensión arterial. Las concentraciones séricas elevadas de ácido úrico se asocian con hipertensión arterial y dificultan su control. OBJETIVO: evaluar las concentraciones circulantes de ácido úrico en pacientes prehipertensos en comparación con las de sujetos normotensos e hipertensos. MATERIAL Y MÉTODO: estudio clínico transversal en el que de enero a junio de 2016 las concentraciones séricas de ácido úrico se determinaron por método enzimático en pacientes con prehipertensión (de acuerdo con los criterios del JNC VII), así como en sujetos normotensos y sujetos hipertensos. Los métodos estadísticos usados fueron ANOVA y prueba exacta de Fisher. RESULTADOS: se incluyeron 90 pacientes con prehipertensión, 90 sujetos normotensos y 90 sujetos hipertensos. Encontramos que el grupo de prehipertensos tuvo valores significativamente mayores de ácido úrico que los normotensos (6.24±1.5 mg/dL vs 5.4±1.2 mg/dL, p=0.000206), mientras que aunque los valores en hipertensos fueron superiores (6.7±2 mg/dL), no alcanzaron significación estadística con los prehipertensos (p=0.99). Encontramos asociación significativa entre hiperuricemia con prehipertensión (p=0.015 IC 95%; 1.18-3.99). CONCLUSIONES: los pacientes prehipertensos mostraron concentraciones de ácido úrico superiores a las de los normotensos y aunque los valores mencionados fueron menores que en los hipertensos, esto no fue significativo. La hiperuricemia puede contribuir, al menos en parte, a mayor progresión hacia hipertensión arterial observada en los prehipertensos.

Abstract BACKGROUND: Prehypertension increases the risk of hypertension, serum uric acid levels are also associated with increased risk of hypertension. Increased levels of resistin and/or decreased levels of adiponectin are associated with cardiovascular mortality and the development of hypertension. OBJECTIVE: To evaluate uric acid serum levels in normotensive, prehypertensive and hypertensive patients. MATERIAL AND METHOD: A clinical, cross-sectional study was made from January to June 2016 in which circulating levels of uric acid were measured (enzymatic method) in normotensive, prehypertensive and hypertensive patients. Statistical analysis was performed with ANOVA and Fisher test. RESULTS: Ninety normotensive, 90 prehypertensive and 90 hypertensive patients were included. Prehypertensive patients have significantly greater levels of uric acid than normotensive subjects (6.24±1.5 mg/dL vs 5.4±1.2 mg/dL, p=0.000206). We also observed that hypertensive patients had increased, although non-significantly, values of uric acid than prehypertensive subjects (6.7±2 mg/dL, p=0.99). We also found a significantly association between hyperuricemia and prehypertension (p=0.015 IC 95%; 1.18-3.99). CONCLUSIONS: Prehypertensive patients had greater levels of uric acid when compared with normotensive subjects, this may explain why prehypertensive patients shown increased risk for hypertension than normotensive patients.

Circulating Adipokine Levels in Non-diabetic Subjects with High Normal Blood Pressure.

OBJECTIVE: This study aimed to evaluate the levels of the adipokines, resistin and adiponectin in normotensive and high normal blood pressure patients. METHODS: Circulating levels of the adipokines, resistin and adiponectin were measured by enzyme-linked immunosorbent assay (ELISA; R'D Systems, Minneapolis) in 20 high normal blood pressure patients and in 20 age-matched normotensive non-diabetic subjects. Statistical analysis was performed with analysis of variance (ANOVA). RESULTS: The control group showed non-significantly decreased levels of resistin when compared with patients with high normal blood pressure [systolic 130-139 mmHg; diastolic 85-89 mmHg] (12.25 vs 14.38 pg/mL, p = 0.40). There were significantly higher levels of adiponectin in the control group when compared with high normal blood pressure patients (11.3 vs 7.51 µg/mL, p = 0.028). CONCLUSIONS: High normal blood pressure patients have increased levels of resistin and lower values of adiponectin when compared with age-matched non-diabetic normotensive subjects. This may explain why those patients showed more progression to hypertension, atherosclerosis and cardiovascular risk than normotensive subjects.

Análisis del nivel de ansiedad en el paciente adulto con cardiopatía congénita en una institución de alta especialidad / Analysis of the anxiety level in adult patients with congenital heart disease in a highly specialized institution", "_i": "

Introducción: Gracias a los adelantos científico-tecnológicos, cada vez son más las personas con algún tipo de cardiopatía congénita que alcanzan la edad adulta, sin embargo, esta condición supone un impacto significativo en la esfera emocional; por ello, en el presente estudio se hace referencia a la ansiedad. Objetivo: Analizar el nivel de ansiedad que presentan los pacientes adultos con cardiopatía congénita en una institución de alta especialidad. Material y métodos: Estudio no experimental, analítico, prospectivo y transversal. Se aplicó previo consentimiento informado, un instrumento validado sobre ansiedad State and Trait Anxiety Inventory. Se determinó una muestra estadística aleatorizada simple (n = 248) con personas mayores de 17 años que tuvieran cardiopatía congénita cianógena o acianógena. Se analizaron los datos sociodemográficos con frecuencias, porcentajes y medidas de tendencia central; se compararon y asociaron variables ordinales con U de Mann Whitney, Pearson y Spearman; se aceptó como significativa p ‹ 0.05. Resultados: Edad media de 26.9 años; 71.4% tienen CC acianógena; a 50% le han realizado cirugía cardiaca; 74% tuvo nivel medio de ansiedad. Existe asociación directa entre ansiedad y escolaridad (rs = -0.163, p = 0.010). Comparación de ansiedad entre cianógena y acianógena (Z = -0.590, p = 0.555), entre mujeres y hombres (Z = -2.603, p = 0.009). Conclusiones: A pesar de que no existe diferencia entre las personas con cardiopatía cianógena y acianógena, la ansiedad está presente con mayores niveles en las mujeres.

Introduction: Thanks to scientific and technological advances, more and more people with some type of congenital heart disease reach adulthood, however, this condition has a significant impact on the emotional sphere. Therefore, in the present study anxiety reference is made. Objective: To analyze the level of anxiety that present adult patients with congenital heart disease in a highly specialized institution. Material and methods: Non-experimental, analytical, prospective cross-sectional study. A validated instrument on State and Trait Anxiety Inventory was applied previous informed consent. A simple random statistical sample (n = 248) in people over 17 who have cyanotic congenital heart disease or acianogena was determined. Sociodemographic data frequencies, percentages and measures of central tendency were analyzed; were compared and ordinal variables associated with a U of Mann Whitney, Pearson and Spearman; was accepted as significant p ‹ 0.05. Results: Mean age of 26.9 years; 71.4% had cyanotic CC; 50% have undergone cardiac surgery; 74% had medium level of anxiety. There is a direct association between anxiety and schooling (rs = -0.163, p = 0.010). Comparison between cyanotic and acyanotic anxiety (Z = -0.590, p = 0.555) between women and men (Z = -2.603, p = 0.009). Conclusions: Although there is no difference between people with a cyanotic and acyanotic heart disease, anxiety is present at higher levels in women

Diagnósticos de enfermería más frecuentes por necesidad en la persona con afección cardiovascular / The most frequent nursing diagnoses by necessity in the person with cardiovascular disease", "_i": "

Introducción: Los diagnósticos de enfermería describen problemas de salud reales, potenciales o de bienestar, son un juicio clínico de la persona, familia o comunidad que se obtiene tras la valoración. Objetivo: Identificar los diagnósticos de enfermería más frecuentes por necesidad en la persona con afección cardiovascular. Material y métodos: Estudio descriptivo, transversal y prospectivo de octubre del 2007 a diciembre del 2008. Muestra por conveniencia de n = 667 valoraciones exhaustivas de enfermería cardiovascular con el enfoque de Virginia Henderson; incluyó valoraciones realizadas a las personas de todas las edades y hospitalizadas en el Instituto Nacional de Cardiología Ignacio Chávez y se eliminaron aquéllas donde no se registró el diagnóstico de enfermería o éste era ilegible. Análisis de datos en Excel 2003 con frecuencias y porcentajes. Resultados: Del total de valoraciones; 54% corresponden al sexo masculino. Necesidad alterada de mayor frecuencia: oxigenación con 68%. Se obtuvieron un total de 113 etiquetas diagnósticas, 81% pertenecen a la taxonomía Nursing Diagnosis: Definitions & Classification (NANDA) y 19% redactadas en formato: Problema, Etiología, Signos y Síntomas (PESS). De manera general, el insomnio, el riesgo de caída y el deterioro de la movilidad física son las etiquetas más frecuentes en el paciente cardiópata. Para la necesidad de oxigenación, las etiquetas más frecuentes son: patrón respiratorio ineficaz (35.7%) y deterioro del intercambio gaseoso (31.8%). Conclusión: Las etiquetas diagnósticas se encuentran directamente relacionadas con las manifestaciones clínicas cardiovasculares y son aplicables para el desarrollo de los planes de cuidado de enfermería. También existe una correspondencia directa de la entidad clínica cardiovascular con el deterioro de la necesidad de oxigenación y seguridad.

Introduction: Nursing diagnoses described problems of health, real, potential or welfare; a clinical trial of the person, family or community, which is obtained after the assessment they are. Objective: Identify the most frequent nursing diagnoses by necessity in the person with cardiovascular condition. Material and methods: descriptive, transversal and prospective study from October 2007 to December 2008. Sample for convenience of n = 667 comprehensive assessments of cardiovascular nursing Virginia Henderson approach; It included all assessment to people of all ages and hospitalized at the National Institute of Cardiology Ignacio Chavez and eliminated those where there was the nursing diagnosis or this was the unreadable. Data analysis in Excel 2003 with frequencies and percentages. Results: Of the total of valuations; 54% are male. Altered more often need: oxygenation with 68%. Were a total of 113 diagnostic labels, 81% belong to the taxonomy Nursing Diagnosis: Definitions & Classification (NANDA) and 19% in format: problem, etiology, signs and symptoms. In general, the insomnia, the risk of falling and the deterioration of physical mobility are more common in the patient with cardiovascular alteration labels. For the need of oxygen, most frequent labels are: ineffective breathing pattern (35.7%) and impairment of gas exchange (31.8%). Conclusion: The diagnostic labels are directly related to cardiovascular clinical manifestations and are applicable for the development of nursing care plans. There is also a direct correspondence of cardiovascular clinical entity with the deterioration of the oxygenation and security need.

Validación de un instrumento de valoración de enfermería cardiovascular con el enfoque de Virginia Henderson / Validation of an instrument for assessing cardiovascular nursing using Virginia Henderson model", "_i": "

La valoración es la base para el cuidado del paciente; a partir de los datos observados se desencadena una toma de decisiones para que las actividades a realizar sean inmediatas y mediatas, constituye entonces un proceso sistemático y dinámico por medio del cual la enfermera a través de la interacción con el paciente, los familiares y otros profesionales de la salud, reúne y analiza datos del enfermo. Objetivo: Validar un instrumento de valoración con el enfoque metodológico de Virginia Henderson, que permita identificar la alteración de las necesidades humanas ante una enfermedad cardiovascular. Material y métodos: Estudio descriptivo, prospectivo y transversal en el cual se diseñó y validó un instrumento de valoración de enfermería en el Instituto Nacional de Cardiología Ignacio Chávez de marzo a junio de 2007. La validación se realizó en base a los resultados, la opinión de expertos y confiabilidad interna por medio del coeficiente Alfa de Cronbach. Resultados: El instrumento de valoración se aplicó a 108 pacientes; en 92.7% de los casos aportó datos al personal para la realización de diagnósticos relacionados. Las necesidades identificadas con alteración correspondieron a oxigenación en 14.5%; alimentación con 13.05% y 12.42% para eliminación. La calificación otorgada al formato por el personal que aplicó el instrumento fue de 8.5, en una escala del 1 al 10; la confiabilidad fue aceptable (α = 0.71). Conclusiones: El instrumento de valoración de enfermería cardiovascular con el enfoque metodológico de Virginia Henderson permitió detectar las necesidades alteradas oportunamente del paciente, elaborar diagnósticos enfermeros y proseguir con el resto de las etapas del proceso de enfermería, asimismo, el personal de enfermería lo consideró factible para su implementación.

The assessment is the basis for patient care. From observed data, a decision making process is triggered in order to activities which must to be performed are immediate. Therefore, it is a dynamic and systematic process whereby the nurse gathers and analyzes patient data through interaction with the patient, his/her family and other health professionals. Objective: To validate an assessment tool using Virginia Henderson model, this assessment tool should identify human needs changed due to a cardiovascular disease. Material and methods: Descriptive, prospective and crossover study, in which a nursing assessment tool was designed and validated at the National Institute of Cardiology Ignacio Chavez, from March to June 2007. The Assessment was performed based on the results, expert opinion and internal reliability using Cronbach’s Alpha coefficient. Results: The assessment tool was applied to 108 patients. In 92.7% of the cases, it provided data which were used by the staff to get a related diagnosis. The needs identified as changed needs were oxygenation in 14.5% of the patients, feeding in 13.05%, and clearance in 12.42%. The format received a rating of 8.5 from the staff who applied the instrument, on a scale of 1 to 10; the reliability was acceptable (α = 0.71). Conclusions: Instrument for assessing cardiovascular nursing using Virginia Henderson model allowed detecting promptly changed patient needs, developing diagnoses, and continuing with the remaining stages of the nursing process; moreover, its implementation was considered possible by the nursing staff.

Antimicrobial resistance and characterization of Helicobacter pylori strains isolated from Mexican adults with clinical outcome.

Eradication of Helicobacter pylori infection in Mexico is of great importance due to the elevated seroprevalence, however, there is yet very little information about antibiotic resistance rates in H. pylori isolates in our country. We analyzed susceptibility to three antimicrobials used in therapy of 49 H. pylori strains isolated from patients with active chronic gastritis, active chronic gastritis with lymphoid follicles, intestinal metaplasia and gastric cancer. All isolated strains were susceptible to amoxicillin, 28 (58%) were resistant to metronidazole and 2 (4%) were resistant to both clarithromycin and metronidazole. Sequence analysis of the 23S rRNA of the two clarithromycin-resistant strains showed the A2142G mutation in one and A2143G and T2182C mutations in the other. Metronidazole resistance was associated with cagA negative strains with a frequency of 82% (9/11). No significant correlation was found between vacA s/m alleles and metronidazole resistance.

Helicobacter pylori: recent advances in the study of its pathogenicity and prevention.

Helicobacter pylori has acquired great importance during the last two decades, after being recognized as an important pathogen that infects a great portion of the human population. This microorganism is recognized as the main causal agent of chronic gastritis and duodenal ulcers, and it is associated with the subsequent development of gastric carcinoma. The pathogenic mechanisms of H. pylori and their relation to gastric ailments have not been clearly defined. However, at present it is well established that urease, vacuolating cytotoxin VacA, and the pathogenicity island (cag PAI) gene products, are the main factors of virulence of this organism. Thus, individuals infected with strains that express these virulence factors probably develop a severe local inflammation that may induce the development of peptic ulcer and gastric cancer. The way the infection spreads throughout the world suggests the possibility that there are multiple pathways of transmission. Due to the importance that H. pylori has acquired as a human pathogen, laboratories worldwide are attempting to develop a vaccine that confers long-term immunological protection against infection by this microorganism. Hence, the objective of this review is to present the most relevant findings of the biology of H. Pylori and its interaction with the human host.

Characterization of the inorganic pyrophosphatase from the pathogenic bacterium Helicobacter pylori.

A cytoplasmic pyrophosphatase [E.C. 3.6.1.1.] was partially purified from Helicobacter pylori. The molecular mass was estimated to be 103 kDa by gel filtration. Results of SDS-PAGE suggested that the enzyme consists of six identical subunits of 19.1 kDa each. The enzyme specifically catalyzed the hydrolysis of pyrophosphate and was very sensitive to NaF, but not to sodium molybdate. The optimal pH for activity was 8.5. Mg2+ was required for maximal activity; Mn2+, Co2+, and Zn2+ poorly supported hydrolytic activity. The pyrophosphatase had an apparent K(m) for Mg-PP(i)2 hydrolysis of 90 microM, and a Vmax estimated at 24.0 micromol P(i) min(-1) mg(-1).

[Management of hypertension emergencies in elderly patients with isosorbide dinitrate aerosol]. / Manejo de las emergenecias hipertensivas en el anciano con dinitrato de isosorbide en nebulizador.

In this clinical trial, we assessed the effectiveness and safety of isosorbide dinitrate spray administered through the oral mucosa in 20 elderly patients (> 60 years old) with a hypertensive emergency (mean arterial pressure > 140 mmHg and target-organ damage). The patents were given a first dose of 1.25 mg of spray when they were admitted; a second dose was administered 15 min. later if the mean arterial pressure had not decreased by > 15%. An electrocardiogram (ECG) was done on every patient immediately prior and 30 min. after administering the medication. Three patients (15%) had a good response with one dose while 17 patients (85%) required a second dose. Thirty patients had a significant reduction in arterial blood pressure (193 +/- 91,123 +/- 5.4 to 154 + 7.1/92.5 + 6.2 mmHg p < 0.005) as well as of the mean arterial pressure (146.8 +/- B to 113 +/- 5 mmHg 23%, p < 0.005 > in a period of 30 min. No adverse effects, rebound hypertension nor severe hypotension were observed. These figures remained under control for 3 h. Both ECG, were normal. A reduction of 13.5% heart rate was obtained (p < 0.005). Our observations suggest that isosorbide dinitrate aerosol is an effective and safe alternative for the treatment of elderly patients with hypertensive emergencies.

TLA-1: a new plasmid-mediated extended-spectrum beta-lactamase from Escherichia coli.

Escherichia coli R170, isolated from the urine of an infected patient, was resistant to expanded-spectrum cephalosporins, aztreonam, ciprofloxacin, and ofloxacin but was susceptible to amikacin, cefotetan, and imipenem. This particular strain contained three different plasmids that encoded two beta-lactamases with pIs of 7.0 and 9.0. Resistance to cefotaxime, ceftazidime, aztreonam, trimethoprim, and sulfamethoxazole was transferred by conjugation from E. coli R170 to E. coli J53-2. The transferred plasmid, RZA92, which encoded a single beta-lactamase, was 150 kb in length. The cefotaxime resistance gene that encodes the TLA-1 beta-lactamase (pI 9.0) was cloned from the transconjugant by transformation to E. coli DH5alpha. Sequencing of the bla(TLA-1) gene revealed an open reading frame of 906 bp, which corresponded to 301 amino acid residues, including motifs common to class A beta-lactamases: (70)SXXK, (130)SDN, and (234)KTG. The amino acid sequence of TLA-1 shared 50% identity with the CME-1 chromosomal class A beta-lactamase from Chryseobacterium (Flavobacterium) meningosepticum; 48.8% identity with the VEB-1 class A beta-lactamase from E. coli; 40 to 42% identity with CblA of Bacteroides uniformis, PER-1 of Pseudomonas aeruginosa, and PER-2 of Salmonella typhimurium; and 39% identity with CepA of Bacteroides fragilis. The partially purified TLA-1 beta-lactamase had a molecular mass of 31.4 kDa and a pI of 9.0 and preferentially hydrolyzed cephaloridine, cefotaxime, cephalothin, benzylpenicillin, and ceftazidime. The enzyme was markedly inhibited by sulbactam, tazobactam, and clavulanic acid. TLA-1 is a new extended-spectrum beta-lactamase of Ambler class A.

Comparison between isosorbide dinitrate in aerosol and in tablet form for the treatment of hypertensive emergencies in the elderly.

BACKGROUND: Isosorbide dinitrate in spray form is an effective and safe option for the treatment of hypertensive emergencies. The aim of this study was to evaluate whether isosorbide dinitrate spray is as effective and safe as treatment in tablet form for the management of hypertensive emergencies in the elderly. METHODS: Forty patients with hypertensive emergencies were randomly divided into two groups of 20 patients each. Group A received 1.25 mg isosorbide dinitrate aerosol upon arrival and a second dose 15 min later when mean systemic arterial pressure (MAP) reduction was <15% . Group B patients received a single 5 mg tablet of sublingual isosorbide dinitrate. RESULTS: Blood pressure in Group A patients decreased from 193 +/- 13/123 +/- 6.6 mmHg to 154 +/- 15/92.5 +/- 7.6 mmHg (p < 0.005), the reduction beginning 10 min after drug administration; no adverse effects were found. Two patients in Group B did not respond but for the other patients in this group blood pressure decreased from 197 +/- 10/121 +/- 7 to 154 +/- 11/90 +/- 4 mmHg, (p < 0.005), the reduction beginning 45 min after receiving the medication; 8 patients suffered headache. CONCLUSION: Our results indicate that isosorbide dinitrate aerosol is more effective than tablets for the treatment of elderly patients with hypertensive emergencies.

Single-step PCR amplification and enzyme restriction analysis of the entire Helicobacter pylori cytotoxin vacA gene for genetic variability studies.

To monitor changes along the entire Helicobacter pylori vac A gene we carried out full-length single-step PCR amplification in 21 gastritis and gastric cancer isolates. HindIII restriction analysis led us to detect a > 400-bp internal insertion in vacA subsequently shown to be a direct 451-bp gene duplication. We found HindIII profiles for 16 genes that allowed their grouping into two restriction patterns that were related to theoretical profiles for previously sequenced Western genes. Comparisons with theoretical HindIII patterns for Japanese isolates appear suggestive of geographical H. pylori clonality. Full-length single-step PCR amplification seems suitable for quick restriction pattern assignment and detection of gene size changes.

Aneurisma fusiforme de la carótida intracraneal / Giant fusiform aneurysm in the intracranial crotid artery

Objetivo. Los aneurismas fusiformes son lesiones que se incluyeron en la categoría de los aneurismas gigantes, siendo mucho menos comunes que las lesiones saculares. Los aneurismas fusiformes se localizan por lo general en la circulación posterior. Presentación clínica. Presentamos un caso de un paciente masculino de 56 años de edad, cuyo cuadro de presentación clínica fue como EITR (episodios Isquemicos Transitorios Reversibles-TIA). Posterior a habérsele realizado una tomografía computada y contrastada de cráneo(TC), se le realizó un ECHO-Doppler de ejes carotídeos, completándose el estudio con una panangiografía cerebral. El manejo quirúrgico del enfermo consistió en un puente arterial (arteria temporal superficial/arteria cerebral media), con reconstrucción microvascular del vaso afectado. Conclusión. Los aneurismas fusiformes de la circulación anterior son raros, teniendo una presentación clínica diferente a la de las lesiones saculares. Este tipo de lesiones son un reto de manejo para el cirujano neurovascular. Tal y como se ejemplifica en el presente reporte, los pacientes se benefician de la intervención quirúrgica, requiriéndose abordajes combinados y teniendo simpre en mente, que cada caso deberá de ser individualizado

Isosorbide aerosol: an option for the treatment of hypertensive crises.

In this study the authors assessed the effectiveness and safety of isosorbide dinitrate aerosol administered through the oral mucosa in 30 adult patients who presented with a hypertensive crisis (mean arterial pressure > 130 mm Hg and evidence of target organ damage). The patients were given a first dose of 1.25 mg of aerosol when they were admitted to the hospital; a second dose was administered 15 minutes later if the mean arterial pressure had not decreased by > 15%. An electrocardiogram (ECG) was obtained for every patient immediately prior to and 30 minutes after administration of the medication. Nine patients (30%) had a good response with one dose, whereas 21 patients (70%) required a second dose. All 30 patients had a significant reduction of the arterial blood pressure (187+/-13 / 121+/-6.6 to 153+/-15.3 / 92.3+/-7.6 mm Hg; p<0.005) as well as of the mean arterial pressure (136.6+/-8 to 109.5+/-7 mm Hg; p<0.005) in a period of 30 minutes. No adverse effects, rebound hypertension, or severe hypotension were observed. These figures remained under control for 6 hours. Two of the patients had angina pectoris at admission and their ECG showed subepicardial ischemia, both of which disappeared with the medication. A second ECG appeared normal. A reduction of 14% in heart rate was obtained (95+/-15 to 82+/-14 beats per minute; p<0.005). These observations suggest that isosorbide dinitrate aerosol is an effective and safe alternative for the treatment of patients with hypertensive crises.