Prevalencia de los factores de riesgo de pie diabético y nivel de conocimiento sobre autocuidados en personas con diabetes. Estudio PIEDIFAC / Prevalence of diabetic foot risk factors and level of knowledge about self-care in people with diabetes. PIEDIFAC study

OBJETIVO: Conocer la prevalencia de los factores de riesgo de pie diabético, el nivel de conocimientos, la capacidad y la realización de autocuidados de las personas con diabetes. Evaluar las intervenciones farmacéuticas.MATERIAL Y MÉTODOS: Diseño: Estudio observacional descriptivo y transversal a realizar en farmacias comunitarias españolas del 15 al 30 de noviembre de 2021. Aprobado por el Comité de Ética de la Investigación (CEICA) de Zaragoza. Inclusión: Usuarios mayores de edad, con tratamiento hipoglucemiante superior a un año, con autonomía y consienten participar. Variable principal: la puntuación del cuestionario adhoc (media±DS) y categorización(N+%), agrupado en los ítems: información sobre la revisión de los pies; adecuación de calzado y calcetines; capacidad física de autoexploración correcta y de detección de alteraciones; Inspección e información por farmacéutico. Recogida de datos: SEFAC e-XPERT. Procedimiento: 1.Diseño de un cuestionario de conocimientos y autocuidados del pie diabético. 2. Ofrecimiento, selección y aleatorización de los usuarios. 3. Cumplimentación de los datos sociodemográficos y la primera parte del cuestionario: conocimiento de autocontroles del pie. 4. Exploración del pie por el farmacéutico. 5. Intervención. (AU)

Cytokines and growth factors in a biologic product obtained from patients' urine as immune-modulators to treat autoimmune and allergic diseases.

At "Instituto de Alergias y Autoinmunidad Dr. Maximiliano Ruiz Castañeda, A.C." in Mexico City, a non-traditional health care center focused on the treatment of autoimmune and allergic diseases using personalized medicine, an alternative treatment referred to as an "immune-modulator" has been developed. In this study, we will refer to this treatment substance as the "immune-modulator." In brief, a urine sample is collected from the patient and processed to obtain the peptide fraction, which is conditioned and then administered sublingually to the patient. Sample processing involves multiple steps aimed at the removal of toxic compounds and enrichment for cytokines, growth factors, and other immune peptides that may contribute to the function of the immune-modulator. This treatment has been administered for many years, and patients testify that it is useful and reliable. Despite the benefits of this treatment, the molecular mechanisms underlying its effects have not been thoroughly investigated. Therefore, this study aims to identify immunoregulatory peptides, such as cytokines and growth factors, in the immune-modulator. Urine and immune-modulator concentrations of cytokines and growth factors were assessed using a Luminex assay. Twenty-one cytokines and growth factors were identified in immune-modulator samples. MCP-1 was identified in 100% of the samples; MIP-1ß, IL-8, RANTES, INF-γ, and IP-10 were identified in approximately 65-70% of samples; IL5, IL-1B, and IL-17 in 50-60%; eotaxin, VEGF, IL-6, and FGF in about 40%; MIP-1α, IL-9, GM-CSF, G-CSF, IL-12, and IL-15 in about 20-30%; and IL-13 and PDGF-bb were identified in <6% of samples. Additionally, patients exhibited significant changes in IL-1ß, IFN-γ, and MCP-1 concentrations after treatment with the immune-modulator, whereas healthy individuals showed no significant change in response to the treatment. The immune-modulator is an alternative treatment based on the administration of cytokines and growth factors obtained from the urine of patients. In this study, its composition was characterized. The isolated products could be responsible for the effects of the immune-modulator. Further trials are required to evaluate the effective delivery of these molecules by the administration route described.

Comparison of the Effects of Endotracheal Intubation of Wistar Rats Using the Conventional Technique vs. a New Modified Technique Using a 3D Mouth-Piece.

AIMS: Endotracheal intubation in rats is challenging due to the difficult anatomical characteristics of the airway. The success rate at first attempt is low and airway damage is a common complication. We aimed to compare and evaluate the conventional intubation method with a modified procedure using an inclined plate, headlamp (700-Lumen), and 3D mouth-piece designed with a 20° curvature. Both techniques were conducted by laboratory personnel with and without previous experience in airway management of laboratory rats. MATERIAL AND METHODS: In this study, we used 36 Wistar rats of both genders. Three groups of laboratory personnel (anesthesiologists, medical students, and laboratory technicians) performed both endotracheal intubation techniques, i.e., blind intubation at supine position and endotracheal intubation at 70° supine position with a 3D mouth-piece and direct illumination of the glottis. RESULTS: The modified technique had a significantly higher success rate and shorter procedure duration. Moreover, there was no significant difference in the procedure duration between personnel with and without previous training in airway management. CONCLUSION: Previous knowledge and experience in airway management are required when performing conventional endotracheal intubation; moreover, its success rate is low. Contrastingly, using proper instruments and the 3D mouth-piece facilitated easier and quicker airway management regardless of previous experience.

Effect and associated factors of a clinical pharmacy model in the incidence of medication errors (EACPharModel) in the Hospital Pablo Tobón Uribe: study protocol for a stepped wedge randomized controlled trial (NCT03338725).

BACKGROUND: According to WHO, medication error (ME) is a subject that requires attention at all levels of care to reduce severe and preventable damage related to medication use. Clinical pharmacy practice standards have been proposed around the world so that the pharmacist, as part of a multidisciplinary health team, can help improve patient safety; however, further evidence derived from adequate studies is needed to demonstrate this. This study aims to assess the effect of a clinical pharmacy practice model (CPPM) in preventing MEs associated with the medication use process. METHODS: A prospective, stepped-wedge, cluster-randomized, controlled trial with a duration of 14 months will be performed to compare the effect of a CPPM along with the usual care process of patients in the Pablo Tobón Uribe Hospital (Medellin, Colombia). The study is designed as a cluster-randomized controlled trial, involving five hospital wards (clusters) and 720 patients. Medical wards are allocated to interventions using a stepped-wedge design. Clusters are initially assigned to the control group. After a 2-month observation period, hospital clusters were randomly allocated to the intervention group. Study outcomes will be assessed at baseline and at 2, 4, 6, 8, 10, and 12 months after randomization. The primary outcome will be to assess the effect of a CPPM on the incidence of medication errors associated with the medication use process. Drug-related problems and factors that contribute to the occurrence of MEs will be assessed as secondary outcomes. Statistical analyses will be performed using a mixed model, with the treatment group and time as fixed effects and the clustering structure as a random effect. Statistical analysis will be performed using Pearson chi-square tests and Student's t-tests, and a P value < 0.05 will be considered statistically significant. DISCUSSION: As far as we know, this is the first stepped-wedge, cluster-randomized, controlled trial designed to assess the change of a CPPM on the incidence of medication errors in a hospital in Colombia, and it could generate valuable information about a standardized and patient-centered clinical pharmacy model to improve the safety of inpatient care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03338725. Registered on 9 November 2017. The first patient was randomized on 2 February 2018. PROTOCOL VERSION: 0010112018JG.

Pseudoquilotórax en artritis reumatoide de corta evolución y sin engrosamiento pleural: reconsiderando una teoría fisiopatológica / Pseudochylothorax in short-duration rheumatoid arthritis without pleural thickening: reconsidering a physiopathological theory

El pseudoquilotórax ha sido relacionado clásicamente con un defecto en la reabsorción de líquido en el contexto de un engrosamiento pleural que aparece tras largo tiempo de evolución de la etiología subyacente. Sin embargo, durante los últimos años se han reportado en diversos países, aunque muy pocos, casos de pacientes con este tipo de derrame en los que no existía una causa de larga evolución ni engrosamiento o calcificaciones pleurales. A nivel mundial, se han comunicado menos de 10 casos de estas características. En este manuscrito presentamos el caso de una mujer de 40 años con artritis reumatoide de corta evolución que desarrolló un pseudoquilotórax sin engrosamiento pleural

Pseudochylothorax has conventionally been associated with a deficit in the reabsorption of liquid in the context of pleural thickening, which appears over a long period of underlying etiology. However, in recent years, there have been reports in different countries, though very few, of patients with this type of effusion in which there is no long-standing cause nor plural thickening or calcification. Worldwide, fewer than 10 cases with these characteristics have been reported. In this study, we present the case of a 40-yearold woman with short-duration rheumatoid arthritis who developed a pseudochylothorax without pleural thickening

Educational inequalities in traffic deaths during fluctuations of the economy in four Argentinian provinces, 1999-2013.

OBJECTIVES: The objective of this study is to analyse how educational differentials in traffic mortality changed during economic fluctuations in four Argentinian provinces. STUDY DESIGN: Retrospective quantitative analysis of secondary data. METHODS: Data on fatalities due to traffic injuries (all traffic injuries, pedestrians/cyclists, motorcyclists, car users and unspecified road users) in four Argentinian provinces between 1999 and 2013 were linked to population data and information on the educational level of the deceased to compute mortality rates by educational level. Negative binomial models were estimated using age, sex, year, province of residence, year of economic expansion or recession and educational level as explanatory variables. RESULTS: Annual traffic mortality differentials by educational level were lower during the period of economic crisis. An absolute increase in traffic mortality was observed in individuals of low educational level during economic expansions, but here, there were no traffic mortality differences for individuals of medium to high educational level. The educational gap in motorcyclist mortality widened during the period of quick economic expansion between 2005 and 2013. CONCLUSIONS: We found less educational inequality in traffic mortality during an economic crisis in a developing country. However, the educational inequalities for different subtypes of traffic mortality show different patterns of evolution during the cycle of economic expansion and recession. Considering deaths due to traffic injuries, economic growth seems to be riskier for individuals of lower educational level compared with those of medium-high educational level.

High prevalence and intensity of Stephanurus dentatus in a population of wild boar (Sus scrofa) in south western Spain.

In the period from October 2016 to February 2017, the urinary tracts of 390 wild boar (Sus scrofa) from four areas of south central Spain (102 from Doñana National Park; 150 from Sierra Morena and the Toledo Mountains; 84 from Sierra Nevada; 54 from Sierra de Cazorla, Segura y Las Villas Natural Park) were examined for the presence of adult specimens of Stephanurus dentatus (Nematoda: Strongyloidea). This parasite was only detected in the wild boar population of Doñana National Park, with high prevalence (76.5±4.2%; 78/102), mean intensity (43.2±4.4) and mean abundance (33.1±3.8). Juvenile wild boar had significantly lower prevalence and abundance than subadult and adult wild boar. The intensity of infestation was significantly higher in male than in female wild boar. The detection of a focus of S. dentatus infestation in the wild boar population in Doñana National Park will provide further opportunities for understanding the epidemiology of this parasite.

Is celiac disease better identified through HLA-DQ8 than through HLA-DQ2 in Mexican subjects? / ¿Es posible una mejor identificación de la enfermedad celiaca en sujetos mexicanos por medio de HLA-DQ8 que de HLA-DQ2?

INTRODUCTION AND AIMS: A strong genetic association between celiac disease (CD) and the human leukocyte antigen (HLA) has been widely demonstrated. In Europe, the HLA-DQ2 allele is predominant. However, studies in Latin America indicate that HLA-DQ8 could be more frequent. In Mexico, the frequency of those alleles has not been reported in subjects with CD. Therefore, the aim of the present study was to evaluate the distribution of HLA-DQ2 and HLA-DQ8 in Mexican individuals with CD. MATERIAL AND METHODS: An exploratory study was conducted on a cohort of 49 subjects with chronic diarrhea. Autoantibodies for CD, duodenal atrophy, and HLA haplotypes were determined. RESULTS: Thirty individuals had CD (23 women, mean age 54.2 ± 15.5 years), 24 (80%) of whom expressed HLA-DQ8, 15 (50%) expressed HLA-DQ2, and 11 (37%) presented with both alleles. However, neither the HLA-DQ2 nor the HLA-DQ8 allele was found in 5 (10%) individuals. In subjects with chronic diarrhea that did not have CD, 12 (63%) presented with HLA-DQ2, and 7 (37%) with HLA-DQ8. Individuals with CD expressed the combinations of the HLA-DQ8/DQ2 alleles (37 vs. 5%) and the HLA-DR4/DQ8 alleles (60 vs. 26%) more frequently than the subjects without CD. CONCLUSIONS: In Mexican subjects with CD, HLA-DQ8 distribution was more frequent than that of HLA-DQ2, indicating a possible similarity to the frequency reported in other Latin American countries. However, given the nature of the present study and its sample size, further conclusions could not be reached.

Susceptibility background for type 2 diabetes in eleven Mexican Indigenous populations: HNF4A gene analysis.

The genetic risk of developing type 2 diabetes (T2D) increases in parallel with the proportion of Native American ancestry. Mestizo Mexicans have a 70% Native Amerindian genetic background. The T130I polymorphism in the HNF4A gene has been associated with early-onset T2D in mestizo Mexicans. Thus, the aim of the present study was to evaluate the frequency and relationship of the T130I variant in the HNF4A gene with risk factors for developing T2D in eleven indigenous groups from Mexico. In two groups, all exons of the HNF4A gene were directly sequenced; in the remaining the T130I polymorphism was analyzed by restriction fragment length polymorphism. Ancestry informative markers were assessed to confirm the Amerindian component. An additional analysis of EHH was carried out. Interestingly, HNF4A gene screening revealed only the presence of the T130I polymorphism. The range frequency of the risk allele (T) in the indigenous groups was from 2.7 to 16%. Genotypic frequencies (T130I/I130I) were higher and significantly different from those of all of the populations included in the HapMap Project (P < 0.005). EHH scores suggest a positive selection for T130I polymorphism. Metabolic traits indicate a relationship between the T130I/I130I genotypes with high triglyceride concentrations in the indigenous groups (P < 0.005). These results strongly suggest that the high frequency of the T130I polymorphism and its biological relationship with dysfunction in lipid metabolism in Mexican indigenous groups is a risk factor for the developing of T2D in Mexicans.

Duplicación de arteria femoral superficial en paciente con claudicación intermitente / Duplication of superficial femoral artery in a patient with intermittent claudication

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Hemorragia recidivante por fístula carótido-faríngea tras tratamiento endovascular / Recurrent haemorrhage due to a carotid-pharyngeal fistula after endovascular treatment

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[Presentation, staging, and outcome of patients with hepatocellular carcinoma at a center in Veracruz, Mexico]. / Presentación, clasificación y evolución de los pacientes con carcinoma hepatocelular en un centro de Veracruz, México.

BACKGROUND: Hepatocellular carcinoma (HCC) staging provides a basis for calculating disease prognosis and therapeutic guidance. Liver resection and transplantation are curative options, and ablation therapies are applied to patients that are not candidates for curative treatment. Survival after liver resection or ablation therapies varies. AIMS: To describe the presentation, staging, management, and outcome in patients with HCC in our center. PATIENTS AND METHODS: Forty-two patients had a 7-year prospective follow-up. Survival was calculated with the Kaplan-Meier analysis and the log-rank test was used for its comparison between the staging systems (Okuda, BCLC, and CLIP) and types of treatment (liver resection, radiofrequency ablation, and no surgical treatment). RESULTS: The mean age of the patients was 68.9 ± 9.5 years; 57% were women. A total of 54% of the patients presented with cirrhosis and 31% were infected with hepatitis C virus (HCV). The mean tumor size was 6.48 ± 2.52cm. The CLIP 0, Okuda I, and BCLC A stages had better survival rates than the other stages (P<0.05). Survival with resection was superior (median of 32 months and survival at 1, 3, and 5 years of 83, 39, and 19.7%, respectively) to that of both radiofrequency ablation (median of 25 months and survival at 1 and 3 years of 90 and 17.2%, respectively) and no surgical treatment (1 year < 5%) (P<0.05). CONCLUSION: The patients at our center were diagnosed at late stages of HCC, as is the case in other Mexican populations. Outcome in relation to CLIP and BCLC was similar to the prognoses reported in the literature. The best results were observed in the patients with early stage disease and those that underwent HCC resection surgery.

Expression of interleukin (IL)-19 and IL-24 in inflammatory bowel disease patients: a cross-sectional study.

Interleukin (IL)-19 and IL-24 belong to the IL-20 subfamily, and are involved in host defence against bacteria and fungi, tissue remodelling and wound healing. Nevertheless, no previous studies have explored their expression in Mexican mestizo patients with inflammatory bowel disease (IBD). The aim of the study was to characterize and to enumerate peripheral and tissue IL-19- and IL-24-producing cells, as well as gene expression in patients with IBD with regard to its clinical activity. We studied a total of 77 patients with ulcerative colitis (UC), 36 Crohn's disease (CD) and 33 patients as control group (without endoscopic evidence of intestinal inflammation). Gene expression was measured by real-time-polymerase chain reaction (RT-PCR). Protein expression was detected in biopsies by immunohistochemistry and in freshly isolated peripheral blood mononuclear cells by flow cytometry. IL-19 and IL-24 gene expression was elevated significantly in patients with active IBD versus the inactive disease and non-inflammatory control groups (P < 0·05). However, IL-19- and IL-24-producing cells were only increased in active CD versus active UC and non-inflammatory tissues (P < 0·05). IL-19 was produced conspicuously by circulating B cells and monocytes in patients with inactive disease (P < 0·05). Conversely, IL-24 was noticeably synthesized by peripheral B cells, CD4(+) T cells, CD8(+) T cells and monocytes in patients with active disease. In conclusion, IL-19- and IL-24-producing cells in active CD patients were increased compared with active UC and non-inflammatory tissues. These cytokines could significantly shape and differentiate inflammatory process, severity and tolerance loss between UC and CD pathophysiology.

Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: immediate and long-term effects using a blind randomized controlled trial.

Recent guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) have claimed the possible benefits of psychoeducational techniques in the comprehensive management of ADHD. To evaluate the efficacy of a psychoeducation programme for parents of children and adolescents with ADHD in a clinical setting using a blind randomized trial. 81 children/adolescents with ADHD were randomly assigned for their families to receive either a well-structured psychoeducation programme (intervention group, n = 44), or a parent counselling and support intervention (control group, n = 37). Measures of child ADHD symptoms, psychopathology, quality of life and family stress were taken before and after intervention and after a year follow-up. Parents and evaluators were unaware of the condition received. Compared to the support control group, the psychoeducation group showed ADHD Index and cognitive/inattention levels significantly reduced after the intervention ended (Mann-Whitney U = 3.34; p = 0.001; Mann-Whitney U = 3.47; p = 0.001). An improvement in the pro-social domain was also observed after 1 year follow-up (Mann-Whitney U = -2.37; p = 0.018), and clinical global impression found a statistically significant effect for severity over the time. Differences were initially found for the impact of the disorder in the family in different domains, including emotional and social functioning; these differences were no longer significant after alpha correction. No significant differences in quality of life or family stress were found in comparison with the control group. This psychoeducation programme is a valuable treatment for parents/carers of children/adolescents with ADHD, which needs to be considered when evaluating different non-pharmacological treatment options. Psychoeducation and other kind of non-pharmacological approaches need to be regarded not as a substitute, but as a complementary treatment to medications; these approaches might help other very crucial aspects of ADHD including social and familiar outcomes.

Metabolic syndrome and nutrition in a Granada's tropical coast population.

BACKGROUND: The metabolic syndrome (MS) is described as an association of health problems that a given person may simultaneously or successively develop, and it is considered a serious condition because it is related to a significantly increased risk of suffering diabetes, coronary disease and brain damage. Nutrition, along with other factors such as physical activity and genetic inheritance, has an influence on preventing MS. OBJECTIVE: The aim of this research is to demonstrate important aspects concerning the diagnosis, the prevalence, and the prevention of metabolic syndrome among the population of the tropical coast of Granada. METHODS: 119 individuals from the tropical coast of Granada were studied to collect personal data such as their body mass index, body fat percentage, glycaemia, total cholesterol, HDL cholesterol, LDL cholesterol, and food intake (through nutritional survey). RESULTS: As a result of this research, a metabolic syndrome prevalence of 20,2% was obtained, 58,3% of which was related to women. The results obtained show significant statistical differences between individuals having metabolic syndrome and the control group. Particularly, these differences can be noted in parameters such as the BMI or the % of body fat. Nevertheless, there are no significant differences between the two groups concerning parameters related to nutrition such as % of fat, carbohydrates, proteins and kcal/day. CONCLUSION: As a conclusion from the research, we can state that the metabolic syndrome prevalence among the population of the tropical coast of Granada is similar to the figure obtained for the population in the US and in other areas of Spain. In addition, this research shows that metabolic syndrome is more frequent among individuals whose BMI and % of body fat is higher than 30.

Antecedentes: El síndrome metabólico (SM) es una asociación de problemas de salud que pueden aparecer de forma simultánea o secuencial en un mismo individuo, y es importante porque se relaciona con un incremento significativo de riesgo de diabetes, enfermedad coronaria y enfermedad cerebrovascular. La nutrición junto a otros factores como es el ejercicio físico y la genetica del individuo, influyen en la prevención del SM. Objetivo: Conocer aspectos importantes como el diagnostico, prevalencia y prevención del síndrome metabólico en población de la Costa Tropical Granadina. Métodos: Se estudiaron en 119 individuos de la Costa Granadina parámetros como el indice de masa corporal, el porcentaje de grasa corporal, análisis clínicos de glucosa, colesterol total, colesterol HDL, colesterol LDL y estudiaron valores nutricionales mediante encuesta. Resultados: En el estudio se obtuvo una prevalencia el Síndrome metabólico del 20,2%, del que el 58,3% correspondía a mujeres. Los resultados obtenidos reflejan diferencias estadísticas significativas entre los individuos con síndrome metabólico y el grupo control, observándose dichas diferencias en parámetros tales como IMC o el porcentaje de grasa corporal. Sin embargo en parámetros como porcentaje de lípidos, porcentaje de hidratos de carbono, porcentaje de proteínas y kcal/día no hay diferencias significativas entre los individuos con SM y los individuos control. Conclusión: De esta manera podemos deducir del estudio que la prevalencia de síndrome metabólico en la población de la Costa Tropical Granadina se asemeja a la obtenida en EE.UU y a la obtenida en algunas zonas estudiadas en España. Igualmente, se puede apreciar en este estudio como el síndrome metabólico es más frecuente en personas con IMC y % de grasa corporal superior a 30.

Tumoración cervical y disfonía / Cervical tumor and dysphonia

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Fístula arteriovenosa ilio-ilíaca iatrogénica / Iatrogenic ilio-iliac arteriovenous fistula

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Complicación tras acceso vascular para hemodiálisis. Aneurisma de la arteria humeral / Complications after vascular access for hemodialysis: humeral artery aneurysm

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