In vitro, ex vivo and in vivo antihypertensive evaluation of enzymatic hydrolysates of Californian red worm (Eisenia fetida) proteins.

Hypertension is an important risk factor concomitant with cardiovascular disease (CVD) states, which is why we set out to evaluate Californian red worm hydrolysates on antihypertensive activity both in vitro, ex vivo, using rabbit aortic rings and in vivo using hypertensive induced rats. The worms were manually separated, washed with water, purged for 4 h with 4 % sodium bicarbonate, sacrificed with 7 % saline, and finally washed with drinking water. The in vitro antihypertensive capacity was performed by measuring angiotensin-converting enzyme inhibition; for the ex vivo assays, rabbit aorta was used to measure relaxation; for the in vivo assays, rats with induced hypertension were used to perform acute (hypotension) and chronic assays, using captopril as a control in all assays. With respect to angiotensin-converting enzyme (ACE) inhibition, the EC50 value of the worm hydrolysate was found to be 358 ppm; with respect to the analysis in aortic rings, it was found that the mechanisms of action of the hydrolysate are endothelium-dependent, presenting a maximum relaxation of 35 %. With respect to the in vivo assays, the hypotensive test showed that the hydrolysate can reduce blood pressure by up to 32 % in only 2 h, while the chronic analysis showed that the hydrolysate at 150 ppm did not present statistically significant differences with the control (captopril) during the 15 days of analysis. The Red Californian earthworm hydrolysate presents bioactive compounds identified with antihypertensive activities in vitro, ex vivo and in vivo in different isolated and animal models. The study demonstrates the efficacy of the hydrolysate to be used as an alternative in the treatment and prevention of hypertension, and it can be implemented in functional foods or nutraceutical foods. Antihypertensive peptides, particularly those that inhibit angiotensin-converting enzyme (ACE), hold significant importance in medical research, specifically in the context of cardiovascular disease treatment, particularly hypertension. The focus on these peptides and the potential implications of their results in medical research can be summarized through several key points: 1) Mechanisms of Action-Antihypertensive peptides function by inhibiting ACE or renin, crucial enzymes in blood pressure regulation. 2)Alternatives to Synthetic Drugs, 3) Additional Health Benefits, and various other factors.

Sustainable use of giant reed to produce industrialized enzymes.

The giant reed (Arundo donax) is a fast-growing plant adapted to different climatic and soil conditions; although its origin is Asian, the species has spread throughout the world. During its development, it consumes three times more water than typical native vegetation and is responsible for changing the landscape of riparian areas; the high biomass productivity and the annual harvest period make this crop an alternative to produce and/or extract industrial bioproducts. The main objective of this research was to evaluate the feasibility of using giant reed in a bioprocess that produces enzymes by a solid-state fermentation experiment, four fungal species were tested (Aspergillus niger GH1, Aspergillus niger PSH, Trichoderma harzianum, and Rhizopus oryzae); enzyme activities were performed using reported methodologies varying only reaction volumes. The A. niger GH1 and PSH strains were the best adapted to the plant material, A. niger GH1 was capable to produce 4 of the 5 evaluated enzymes (cellulase-endoglucanase (174.39 ± 19.62 U/L), xylanase (1313.31 ± 39.25 U/L), invertase (642.22 ± 23.55 U/L), and polyphenol oxidase (6094.01 ± 306.54) while A. niger PSH was able to produce 3 of the 5 evaluated enzymes (cellulase-endoglucanase (147.09 ± 13.88 U/L), xylanase (1307.76 ± 31.40 U/L), and invertase (603.92 ± 3.14 U/L).

Optimization and scale up of the enzymatic hydrolysis of Californian red worm protein (Eiseniafoetida).

Although the best-known use of the different species of earthworm is the production of organic fertilizer, they can also be considered a rich source of biologically and pharmacologically-active compounds, for use in the treatment of various diseases. In recent decades, with the development of biochemical technologies, research on the pharmaceutical effects of compounds extracted from different species of earthworms has begun. Enzymatic hydrolysis is the most common and widely used technique for producing bioactive hydrolysates, because it uses moderate operating conditions, with a certain specificity for the substrate. In the present study, the objective was to optimize and scale up the enzymatic hydrolysis of Eisenia foetida protein to obtain peptides with biological activity. The substrate characterization was carried out according to AOAC, a response surface design was performed for the optimization of the enzymatic hydrolysis and then the scaling was performed by means of dimensional analysis. The results show that the major component of the paste is protein, 65% of which is albumin, and the absence of pathogenic microorganisms was also found. Regarding optimization, it was found that the optimal hydrolysis conditions are achieved with pH = 8.5; temperature = 45 °C; amount of substrate = 125 g and volume of enzyme = 1245µL. For the scaling, 4 dimensionless pi-numbers were calculated which describe the process with no statistically significant differences between the model and the prototype; it can be concluded that the enzymatic hydrolysate of Eisenia foetida presents high values of antioxidant activity evaluated by different methodologies.

Thrombectomy with embed aspiration in acute ischaemic stroke.

BACKGROUND: In addition to stent retrievers, direct aspiration has become a reasonable thrombectomy strategy. OBJECTIVES: We carried out the thrombectomy by guiding the aspiration catheter fully over the clot and performing immediate manual aspiration; we call this procedure "embed aspiration". METHODS: In this prospective, non-randomised, single-centre study, we included all patients treated at a high volume-of-care stroke centre between 2017 and 2018 for the TRIANA (Thrombectomy in Andalusia using Aspiration) registry. Thrombectomy was carried out by embed aspiration. Patients were classified according to the success (eTICI 2b67-2c-3) or failure (eTICI 0-1-2a-2b50) of the procedure. Baseline clinical data and outcomes were compared, and multivariate analysis was performed. RESULTS: The embed aspiration technique was used in 370 patients. Treatment was successful in 90.3% of patients. Mean puncture-to-recanalisation time was 25 minutes. The overall rate of good outcomes (mRS 0-2) at 3 months was 64%. CONCLUSIONS: This study supports real-life evidence that standardised embed aspiration may be an alternative to stent retrievers for thrombectomy.

Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

Quality of life and cost-effectiveness analysis of topical tranexamic acid and fibrin glue in femur fracture surgery.

BACKGROUND: We assessed quality of life (QoL) of patients undergoing surgery for proximal femur fracture and performed a cost-effectiveness analysis of haemostatic drugs for reducing postoperative bleeding. METHODS: We analysed data from an open, multicentre, parallel, randomized controlled clinical trial (RCT) that assessed the efficacy and safety of tranexamic acid (TXA group) and fibrin glue (FG group) administered topically prior to surgical closure, compared with usual haemostasis methods (control group). For this study we conducted a cost-effectiveness analysis of these interventions from the Spanish Health System perspective, using a time horizon of 12 months. The cost was reported in $US purchasing power parity (USPPP). We calculated the incremental cost-effectiveness ratio (ICER) per QALY (quality-adjusted life-year). RESULTS: We included 134 consecutive patients from February 2013 to March 2015: 42 patients in the TXA group, 46 in the FG group, and 46 in the control group. Before the fracture, EuroQol visual analogue scale (EQ-VAS) health questionnaire score was 68.6. During the 12 months post-surgery, the intragroup EQ-VAS improved, but without reaching pre-fracture values. There were no differences between groups for EQ-VAS and EuroQol 5 dimensions 5 levels (EQ-5D-5L) health questionnaire score, nor in hospital stay costs or medical complication costs. Nevertheless, the cost of one FG treatment was significantly higher (399.1 $USPPP) than the cost of TXA (12.9 $USPPP) or usual haemostasis (0 $USPPP). When comparing the cost-effectiveness of the interventions, FG was ruled out by simple dominance since it was more costly (13,314.7 $USPPP) than TXA (13,295.2 $USPPP) and less effective (utilities of 0.0532 vs. 0.0734, respectively). TXA compared to usual haemostasis had an ICER of 15,289.6 $USPPP per QALY). CONCLUSIONS: There were no significant differences between the intervention groups in terms of postoperative changes in QoL. However, topical TXA was more cost-effective than FG or usual haemostasis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02150720. Date of registration 30/05/2014. Retrospectively registered.

Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope.

PURPOSE: To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3-1.0 Gy) radiotherapy to the lungs. MATERIALS AND METHODS: PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations. RESULTS: Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover âˆ¼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were -0.1% (range -3% to +4%) for the PA treatment and 0.3% (range -10.3% to +15.2%) for the 4-field treatment. CONCLUSION: A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs.

[Parental perceptions of increased child-to-parent violence of Spanish adolescents during covid-19 lockdown.] / Percepciones parentales de incremento de violencia filioparental de los adolescentes españoles durante el confinamiento por COVID-19.

OBJECTIVE: Internationally, there was a warning of the risk of increased domestic violence during lockdown due to the COVID-19 pandemic, including child-to-parent violence. The objective of our study was to assess the prevalence of different violent behaviors from children to parents during pre-lockdown, lockdown and immediately after, between March 14 and June 20, 2020, and to assess differences in behaviors between pre-lockdown and lockdown and between pre-lockdown and post-lockdown. METHODS: The researchers developed a survey with closed questions about different violent behaviors of the children (poor responses, insults and physical aggression). This was distributed with the CAWI methodology during the months of August and September 2020 to a sample of Spanish parents stratified by autonomous communities. 1,500 families with 1,927 adolescents aged 12 to 18 years participated. The frequency of responses obtained between the pre-lockdown and lockdown and between pre-lockdown and post-lockdown was compared through the Mac Nemar test for comparison of related samples. RESULTS: The prevalences of poor responses, insults and aggressions in a pre-lockdown setting were 30.1%, 3.8% and 0.6%, respectively. Poor responses and insults increased significantly between pre-lockdown and lockdown (p<0.001) and between pre-lockdown and post-lockdown (p<0.001) in all autonomous communities, age groups, genders, occupation type of the adolescent and type of household. No statistically significant differences were found in physical aggression for the periods evaluated. Single-parent families, adolescents residing in subsidized housing and those without an occupation or education ("NEET") exhibited more violent behavior in the three periods. CONCLUSIONS: Lockdown led to an increase in nonphysical violent behaviors, which were maintained to the end, warning of the potentially persistent risks of lockdown in this age group, especially in vulnerable families.

OBJETIVO: A nivel internacional se alertó de riesgo de aumento de violencia doméstica, durante el confinamiento debido a la pandemia por COVID-19, incluyendo violencia filioparental. El objetivo de nuestro estudio fue valorar la prevalencia de diferentes conductas violentas de hijos adolescentes a padres en los periodos pre-confinamiento, confinamiento e inmediatamente después del confinamiento producido entre el 14 de marzo y el 20 de junio de 2020, y valorar diferencias en las conductas entre pre y confinamiento, y entre pre y post-confinamiento. METODOS: Los investigadores elaboraron una encuesta con preguntas cerradas acerca de diferentes conductas violentas (malas respuestas, insultos y agresión física) de los hijos. Esta fue distribuida con metodología CAWI durante los meses de agosto y septiembre de 2020 a una muestra de padres españoles estratificada por comunidades autónomas. Participaron 1.500 familias con 1.927 hijos entre 14 y 18 años. Se comparó la frecuencia de respuestas obtenidas entre el momento pre-confinamiento y durante el confinamiento, y entre pre y post confinamiento, a través de la prueba de Mc Nemar para comparación de muestras relacionadas. RESULTADOS: Las prevalencias encontradas de malas respuestas, insultos y agresiones en situación previa al confinamiento fueron del 30,1%, 3,8% y 0,6% respectivamente. Las malas respuestas e insultos aumentaron de forma altamente significativa entre el pre y el confinamiento (p<0,001), y entre el pre y post-confinamiento (p<0,001), en todas las comunidades autónomas, franjas de edad, sexo, tipo de ocupación del adolescente y tipo de vivienda. No se hallaron diferencias estadísticamente significativas en las agresiones físicas en los periodos evaluados. Las familias monoparentales, los adolescentes residentes en viviendas cedidas y aquellos sin ocupación ni estudios ("ninis") presentaban valores porcentualmente más elevados de conductas violentas en los tres periodos. CONCLUSIONES: El confinamiento supuso un incremento de conductas violentas no físicas, que se mantuvieron al cesar el mismo, alertando de los riesgos del confinamiento en esta franja de edad, potencialmente persistente, en especial en familias vulnerables.

A characterization of the molecular phenotype and inflammatory response of schizophrenia patient-derived microglia-like cells.

Different lines of evidence support a causal role for microglia in the pathogenesis of schizophrenia. However, how schizophrenia patient-derived microglia are affected at the phenotypic and functional level is still largely unknown. We used a recently described model to induce patient-derived microglia-like cells and used this to analyze changes in the molecular phenotype and function of myeloid cells in schizophrenia. We isolated monocytes from twenty recent-onset schizophrenia patients and twenty non-psychiatric controls. We cultured the cells towards an induced microglia-like phenotype (iMG), analyzed the phenotype of the cells by RNA sequencing and mass cytometry, and their response to LPS. Mass cytometry showed a high heterogeneity of iMG in cells derived from patients as well as controls. The prevalence of two iMG clusters was significantly higher in schizophrenia patients (adjusted p-value < 0.001). These subsets are characterized by expression of ApoE, Ccr2, CD18, CD44, and CD95, as well as IRF8, P2Y12, Cx3cr1 and HLA-DR. In addition, we found that patient-derived iMG show an enhanced response to LPS, with increased secretion of TNF-α. Further studies are needed to replicate these findings, to determine whether similar subclusters are present in schizophrenia patients in vivo, and to address how these subclusters are related to the increased response to LPS, as well as other microglial functions.

The Effect of Lifestyle Intervention on Pregnancy and Birth Outcomes on Obese Infertile Women: A Systematic Review and Meta-Analysis.

Obesity has been associated with negative effects on natural fertility and poor prognosis when assisted reproductive technologies (ART) are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve the outcomes. There is lack of enough information on how weight-loss would be effective for improving fertility in women who are overweight or obese. We conducted a systematic review to evaluate whether weight-loss achieved by lifestyle program improves natural or assisted reproduction in obese infertile women. We searched CENTRAL, MEDLINE, and EMBASE up to March 2018. Two reviews were selected as randomised trials assessing a lifestyle intervention in women with obesity before receiving treatments for infertility and appraised their risk of bias. We extracted data on pregnancy, birth, and miscarriage rates as the primary outcomes and pooled effect estimates using a random effects model. The primary outcome was the live birth rate. We reported summary measures as the relative risk (RR), 95% confidence interval (CI), and percentage of heterogeneity (I2). We included eight randomised trials with 1175 women. Lifestyle programmes, improved pregnancy rates (RR: 1.43, CI: 95% 1.02 to 2.01; I2=60%; 8 RCTs; N=1098) but had no impact on live births (RR: 1.39, CI: 95% 0.90 to 2.14; I2=64%; 7RCTs; N=1034). Our findings suggest that women participating in lifestyle interventions had an increased risk of miscarriage (RR: 1.50, CI: 95% 1.04 to 2.16; I2=0; 6RCTs; N=543). We rated the quality of evidence for these outcomes as the moderate-to-low. Lifestyle interventions slightly increased the pregnancy rate, while it would be uncertain whether it can improve the live birth. Lifestyle interventions can increase the risk of miscarriage. More research is needed to further explore lifestyle interventions on reproductive outcomes in obese infertile women.

Effects of chemical silage of red tilapia viscera (Oreochromis spp.) as a source of protein on the productive and hematological parameters in isa-brown laying hens (Gallus gallus domesticus).

This paper evaluates the inclusion of chemical silage from viscera of red tilapia (Oreochromis spp.) in diets of Isa-Brown laying hens (Gallus gallus domesticus), and its influence on productive variables and hematological parameters. A total of 56, 16-week-old laying hens were randomly divided into two groups (one per diet), which in turn were subdivided into 7 replicates of 4 birds each. All test groups were fed for 16 weeks. During this period, the evaluation of the productive variables was carried out, and at the end, random blood samples were taken from 3 birds per diet. The results indicated that the inclusion of chemical silage from red tilapia viscera with a proportion of 17.18% dry matter, does not present statistically significant differences in the productive variables which were evaluated (p > 0.05) with respect to the control. Moreover, the chemical silage did not modify the hematological parameters and blood the chemistry in the hens. This allowed us to conclude that silage can be used as a substitute for conventional protein raw materials such as fishmeal and soybean meal in the preparation of diets for laying hens, without altering their productive performance.

Adoption Factors Related to Electronic Vaccine Record in the Public Primary Care Network of Buenos Aires City.

The Electronic Health Record used in the public primary care network of Buenos Aires City has a specific module for the vaccines registration. The present study explores the factors of EHR adoption by nurses. We found 5 barriers and one facilitator for adoption. Barriers are related with organize the flow of patients especially during vaccine campaigns, adapt the work stations and integrate the records with the vaccine central program.

Anticoagulantes orales directos frente a antagonistas de la vitamina K en pacientes con fibrilación auricular de la práctica clínica: revisión sistemática y metanálisis / Direct oral anticoagulants versus vitamin K antagonists in real-life patients with atrial fibrillation. A systematic review and meta-analysis

Introducción y objetivos: Determinar la efectividad de los anticoagulantes orales directos frente a los antagonistas de la vitamina K en pacientes con fibrilación auricular de la práctica clínica. Métodos: Se realizó una revisión sistemática acorde con los estándares metodológicos de Cochrane. Los resultados de la revisión se publicaron según la declaración PRISMA. Se empleó la herramienta ROBINS-I para determinar el riesgo de sesgos. Resultados: Se incluyeron datos de 27 estudios diferentes provenientes de 30 publicaciones. En los estudios con seguimiento hasta 1 año, el apixabán (HR = 0,93; IC95%, 0,71-1,20) y dabigatrán (HR = 0,95; IC95%, 0,80-1,13) no se redujo significativamente el riesgo de ictus isquémico frente a la warfarina, pero sí el rivaroxabán (HR = 0,83; IC95%, 0,73-0,94). Con respecto al riesgo de hemorragias mayores, el apixabán (HR = 0,66; IC95%, 0,55-0,80) y el dabigatrán (HR = 0,83; IC95%, 0,70-0,97) lo redujeron significativamente frente a la warfarina, pero no el rivaroxabán (HR = 1,02, IC95%, 0,95-1,10), aunque con heterogeneidad entre los estudios. El apixabán (HR = 0,56; IC95%, 0,42-0,73), el dabigatrán (HR = 0,45; IC95%, 0,39-0,51) y el rivaroxabán (HR = 0,66; IC95%, 0,49-0,88) redujeron significativamente el riesgo de hemorragia intracraneal frente a la warfarina. El empleo de dosis bajas de anticoagulantes orales directos se asoció con una ligera mejoría del perfil de seguridad, pero con una marcada reducción de la efectividad en la prevención de ictus. Conclusiones: Los resultados de este metanálisis indican que, en comparación con la warfarina, la efectividad para prevenir el riesgo de ictus y de hemorragias de los anticoagulantes orales directos en los pacientes con fibrilación auricular de la práctica clínica real puede ser diferente

Introduction and objectives: To assess the effectiveness of direct oral anticoagulants vs vitamin K antagonists in real-life patients with atrial fibrillation. Methods: A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA statement. The ROBINS-I tool was used to assess risk of bias. Results: A total of 27 different studies publishing data in 30 publications were included. In the studies with a follow-up up to 1 year, apixaban (HR, 0.93; 95%CI, 0.71-1.20) and dabigatran (HR, 0.95; 95%CI, 0.80-1.13) did not significantly reduce the risk of ischemic stroke vs warfarin, whereas rivaroxaban significantly reduced this risk (HR, 0.83; 95%CI, 0.73-0.94). Apixaban (HR, 0.66; 95%CI, 0.55-0.80) and dabigatran (HR, 0.83; 95%CI, 0.70-0.97) significantly reduced the major bleeding risk vs warfarin, but not rivaroxaban (HR, 1.02; 95%CI, 0.95-1.10), although with a high statistical heterogeneity among studies. Apixaban (HR, 0.56; 95%CI, 0.42-0.73), dabigatran (HR, 0.45; 95%CI, 0.39-0.51), and rivaroxaban (HR, 0.66; 95%CI, 0.49-0.88) significantly reduced the risk of intracranial bleeding vs warfarin. Reduced doses of direct oral anticoagulants were associated with a slightly better safety profile, but with a marked reduction in stroke prevention effectiveness. Conclusions: Data from this meta-analysis suggest that, vs warfarin, the stroke prevention effectiveness and bleeding risk of direct oral anticoagulants may differ in real-life patients with atrial fibrillation

Prevalencia de los factores de riesgo cardiovascular y autoevaluación de conocimientos acerca de la prevención de la enfermedad y promoción de la salud en estudiantes de pregrado de la Facultad de Medicina de la Universidad Pontificia Bolivariana, 2016 / Prevalence of cardiovascular risk factors and self-evaluation of knowledge about the prevention of disease and health promotion in undergraduate students of the faculty of medicine of the Universidad Pontificia Bolivariana, 2016 / Prevalência dos fatores de risco cardiovascular e auto avaliação de conhecimentos sobre a prevenção da doença e promoção da saúde em estudantes de graduação da Faculdade de Medicina da Universidad Pontificia Bolivariana, 2016

Objetivo: identificar la prevalencia de factores de riesgo cardiovascular y realizar la autoevaluación de conocimientos acerca de la prevención de la enfermedad y promoción de la salud en estudiantes de la Facultad de Medicina de la Universidad Pontificia Bolivariana (UPB), 2016. Metodología: estudio de tipo descriptivo de prevalencia, se realizó mediante encuestas que evaluaban variables sociodemográficas y el cuestionario Healthy Doctor=Healthy Patient. Resultados: fueron encuestados 347 de 527 estudiantes, lo que corresponde a un 65.8% de la población total. La edad promedio fue de 20.3 ± 2.38 años y 236 estudiantes (68.0%) de sexo femenino. El 50% de los encuestados califica como "media" la actividad física que realiza diariamente, siendo de mayor intensidad en los niveles básicos (valor p 0.40). En lo atinente al consumo de alcohol, el resultado fue 50% para cada una de las categorías de consumidores y no consumidores, fue mayor en estudiantes de clínicas con diferencias significativas (valor p <0.01). En cuanto al consumo de cigarrillo, fue mayor la proporción de estudiantes que no consumen (93.3% vs. 6.3%), sin diferencias entre básicas y clínicas (valor p 0.07). En cuanto a la encuesta de conocimientos básicos en prevención y promoción, los resultados fueron bajos en el tema de nutrición, el mejor desempeño se obtuvo en tabaquismo. Conclusiones: los estudiantes de la Facultad de Medicina de la UPB presentaron como principal factor de riesgo cardiovascular, en las áreas básicas, el sedentarismo y, en las clínicas, el consumo de alcohol con diferencias estadísticas significativas. Además, se demostró que el consumo de tabaco no es un hábito prevalente, sin diferencia significativa entre niveles universitarios, coincidiendo con el resultado de la encuesta de conocimientos acerca de promoción de la salud y prevención de la enfermedad cardiovascular en la que los estudiantes demostraron mayores conocimientos acerca del tabaquismo como factor de riesgo cardiovascular.

Objective: to identify the prevalence of cardiovascular risk factors and self-assessment of knowledge about the prevention of the disease and the promotion of health in students of the Faculty of Medicine of the Universidad Pontificia Bolivariana (UPB), 2016. Methods: a descriptive prevalence type study was carried out through surveys that evaluated the sociodemographic variables and the questionnaire Healthy Doctor = Healthy Patient. Results: 347 out of 527 students were surveyed, where the average age was 20.3 ± 2.38 years, and 236 students (68.01%) were female. 50% qualified their daily physical activity as "average", which was of greater intensity in the basic levels (p value 0.40). Alcohol consumption was 50%, which was increased in clinical-level students with statistically significant differences (p value <0.01). The majority of students were non-smoking (93.3%), without differences between basic and clinical-level students (p value = 0.07). Regarding the survey of basic knowledge in prevention and promotion, results were low regarding nutrition; the best performance was obtained in smoking. Conclusions: At the Faculty of Medicine of the UPB, sedentary lifestyle was the main cardiovascular risk factor in basic-level students, while alcohol consumption was the main risk factor for clinical-level students. In addition, it was demonstrated that tobacco consumption is not a prevalent habit, without significant difference between the university levels. This coincides with the result of the survey of knowledge on health promotion and prevention of cardiovascular disease, where students demonstrated greater knowledge about smoking as a cardiovascular risk factor.

Objetivo: identificar a prevalência de fatores de risco cardiovascular e realizar a auto avaliação de conhecimentos sobre a prevenção da doença e promoção da saúde em estudantes da Faculdade de Medicina da Universidad Pontificia Bolivariana (UPB), 2016. Metodologia: estudo de tipo descritivo de prevalência, se realizou mediante enquetes que avaliavam variáveis sócio-demográficas e o questionário Healthy Doctor=Healthy Patient. Resultados: foram entrevistados 347 de 527 estudantes, o que corresponde a um 65.8% da população total. A idade média foi de 20.3 ± 2.38 anos e 236 estudantes (68.0%) de sexo feminino. 50% dos entrevistados qualifica como "média" a atividade física que realiza diariamente, sendo de maior intensidade nos níveis básicos (valor p 0.40). No referente ao consumo de bebidas alcoólicas, o resultado foi 50% para cada uma das categorias de consumidores e não consumidores, foi maior em estudantes de clínicas com diferencias significativas (valor p <0.01). Em quanto ao consumo de cigarro, foi maior a proporção de estudantes que não consume (93.3% vs. 6.3%), sem diferenças entre básicas e clínicas (valor p 0.07). Em quanto à enquete de conhecimentos básicos em prevenção e promoção, os resultados foram baixos no tema de nutrição, o melhor desempenho se obteve em tabaquismo. Conclusões: os estudantes da Faculdade de Medicina da UPB apresentaram como principal fator de risco cardiovascular, nas áreas básicas, o sedentarismo e, nas clínicas, o consumo de bebidas alcoólicas com diferencias estatísticas significativas. Ademais, se demostrou que o consumo de tabaco não é um hábito prevalente, sem diferencia significativa entre níveis universitários, coincidindo com o resultado da enquete de conhecimentos sobre de promoção da saúde e prevenção da doença cardiovascular na que os estudantes demostraram maiores conhecimentos sobre o tabaquismo como fator de risco cardiovascular.

Direct Oral Anticoagulants Versus Vitamin K Antagonists in Real-life Patients With Atrial Fibrillation. A Systematic Review and Meta-analysis.

INTRODUCTION AND OBJECTIVES: To assess the effectiveness of direct oral anticoagulants vs vitamin K antagonists in real-life patients with atrial fibrillation. METHODS: A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA statement. The ROBINS-I tool was used to assess risk of bias. RESULTS: A total of 27 different studies publishing data in 30 publications were included. In the studies with a follow-up up to 1 year, apixaban (HR, 0.93; 95%CI, 0.71-1.20) and dabigatran (HR, 0.95; 95%CI, 0.80-1.13) did not significantly reduce the risk of ischemic stroke vs warfarin, whereas rivaroxaban significantly reduced this risk (HR, 0.83; 95%CI, 0.73-0.94). Apixaban (HR, 0.66; 95%CI, 0.55-0.80) and dabigatran (HR, 0.83; 95%CI, 0.70-0.97) significantly reduced the major bleeding risk vs warfarin, but not rivaroxaban (HR, 1.02; 95%CI, 0.95-1.10), although with a high statistical heterogeneity among studies. Apixaban (HR, 0.56; 95%CI, 0.42-0.73), dabigatran (HR, 0.45; 95%CI, 0.39-0.51), and rivaroxaban (HR, 0.66; 95%CI, 0.49-0.88) significantly reduced the risk of intracranial bleeding vs warfarin. Reduced doses of direct oral anticoagulants were associated with a slightly better safety profile, but with a marked reduction in stroke prevention effectiveness. CONCLUSIONS: Data from this meta-analysis suggest that, vs warfarin, the stroke prevention effectiveness and bleeding risk of direct oral anticoagulants may differ in real-life patients with atrial fibrillation.

La Escuela Médica de Quito: origen y trayectoria de tres siglos / The Medical School of Quito: origin and trajectory of three centuries

Contexto: la cátedra de Medicina o Escuela Médica Quiteña, constituye la más antigua del país, y una de las primeras de la América hispana. Objetivo: describir la Escuela Médica de Quito, su origen y trayectoria a lo largo de tres siglos. Discusión: en la Audiencia de Quito, la noble ciudad de las iglesias, empieza a fisgonearse la obra monumental de los albores de la educación médica nacional. Los conventos abren sus puertas al surgimiento de los espacios de las letras, del arte y del conocimiento venido desde Europa. Las deplorables condiciones de vida de la población, junto a las reiteradas epidemias, demandaron de ese esfuerzo fenomenal de los religiosos de Santo Domingo, quienes fundaron la primera Cátedra de Medicina en 1693. La figura protagónica de Eugenio Espejo, marca el despertar del humanismo en el siglo XVIII. Su lucha en todos los órdenes, reivindica a los grupos sociales marginados. Su aporte crítico al sistema de enseñanza universitario, particularmente al de medicina, significan una nueva y anticipada visión sobre la verdadera forma de instrumentar el arte de curar y enseñar. Esta Cátedra de Medicina o Escuela Médica Quiteña, constituye la más antigua del país, y una de las primeras de la América hispana. El Plan de Estudios de la Cátedra de Medicina de Quito se estableció en tres años con las asignaturas de Anatomía y Fisiología (a cargo del catedrático de Prima), Patología, Método y Terapéutica (a cargo del catedrático de Vísperas). Los espíritus ilustrados, erguidos con la independencia americana, inician el renacimiento nacional, impulsan la ciencia y combaten la relajación opresiva en que se hallaba sumido el pueblo ecuatoriano e infunden un afán de ilustración y progreso que se manifiesta por el resurgimiento y la creación de los planteles de enseñanza y la formación de academias científicas en varias ciudades de la naciente República. Cinco años después de la gesta libertaria, la labor del protomedicato declina sus atribuciones ante la Facultad de Medicina, que escribe el 26 de octubre de 1827 la primera página de sus anales, cuando la Universidad Central crea la Facultad Médica del Departamento del Ecuador y Distrito del Sur, en reemplazo de la antigua Escuela Médica Quiteña. Lo estatuido en la Ley sobre las Escuelas de Medicina, fija las cátedras correspondientes yse manda que haya en cada una, biblioteca, anfiteatro y gabinete anatómico, laboratorios, etc. Conclusión: el advenimiento de las ideas libertarias y la instauración de la República, la formación médica ecuatoriana se cobija de la influencia europea, particularmente francesa y posteriormente anglosajona. (AU)

Context: the Chair of Medicine or Medical School of Quito is the oldest in the country, and one of the first in Hispanic America. Objective: to describe the Medical School of Quito, its origin and trajectory over three centuries. Discussion: at the Audiencia of Quito, the noble city of the churches, the monumental work of the dawn of national medical education begins to be snooped. The convents open their doors to the emergence of spaces of letters, art and knowledge from Europe. The deplorable conditions of life of the population, together with the repeated epidemics, demanded of that phenomenal effort of the religious of Santo Domingo, who founded the first Chair of Medicine in 1693. The leading figure of Eugenio Espejo marks the awakening of humanism in the eighteenth century. His struggle in all orders vindicates marginalized social groups. His critical contribution to the system of university education, particularly saying that medicine means a new and anticipated vision of the true way to implement the art of healing and teaching. This Chair of Medicine or Medical School of Quito is the oldest in the country, and one of the first in Hispanic America. The curriculum of the Chair of Medicine of Quito was establishe in three years with the subjects of Anatomy and Physiology (in charge of the professor of Prima), Pathology, Method and Therapeutics (under the charge of the professor of Vespers). The enlightened spirits, erected with American independence, initiate the national revival, promote science and combat the oppressive relaxation in which the Ecuadorian people were immerse and infuse an eagerness for illustration and progress that is manifested by the resurgence and creation of the teaching facilities and the formation of scientific academies in several cities of the nascent Republic. Five years after the libertarian deed, the work of the protomedicato declines its attributions before the Faculty of Medicine, which writes on October 26, 1827 the first page of its annals, when the Central University creates the Medical Faculty of the Department of Ecuador and District of the South, replacing the old Medical School of Quito. Conclusion: the advent of libertarian ideas and the establishment of the Republic, the Ecuadorian medical training is sheltered from European influence, particularly French and later Anglo-Saxon influence. (AU)

Tinzaparin for Long-Term Treatment of Venous Thromboembolism in Patients With Cancer: A Systematic Review and Meta-Analysis.

Patients with cancer are at increased risk of recurrent venous thromboembolism (VTE) and bleeding. Thus, long-term treatment with anticoagulants for secondary prevention is challenging. The objective of this review was to evaluate current evidence on the safety and efficacy of tinzaparin compared with other anticoagulants for long-term VTE treatment in patients with cancer. Based on a preregistered protocol, we identified randomized controlled trials (RCTs) comparing long-term tinzaparin (therapeutic dose: 175 IU/kg) versus other anticoagulants for at least 3 months after an acute episode of VTE that included adult patients with underlying malignancy. We extracted predefined, clinically relevant outcomes of patients with cancer and, using standard methodology, pooled available data and assessed risk of bias and quality of evidence for each study. Three open-label RCTs evaluating 1169 patients with cancer were included in the analysis. Tinzaparin was associated with a significantly lower risk of recurrent VTE at the end of treatment (relative risk [RR], [95% confidence interval] 0.67 [0.46-0.99]) and at longest follow-up (RR: 0.58 [0.39-0.88]) and showed a lower risk of clinically relevant non-major bleeding at the end of treatment (RR: 0.71 [0.51-1.00]). No significant between-treatment differences were found for all-cause mortality (RR: 1.09 [0.91-1.30]) or fatal and non-fatal major bleeding events (RR: 1.06 [0.56-1.99]). The overall quality of evidence was deemed moderate, mainly due to small sample size in 2 of the studies and limited number of events in the meta-analyses. In conclusion, both short- and long-term treatments with tinzaparin were found to be superior to vitamin K antagonists for avoiding recurrences of VTE.