Trends in Parkinson's mortality in Mexico 2000-2020.

OBJECTIVE: To describe the recent trends in Parkinson's disease mortality in Mexico during 2000-2020. METHOD: The adjusted mortality rate per 100,000 inhabitants was calculated using the direct method and the world standard population. Trend analysis was performed with the Joinpoint software. RESULTS: The average mortality rate was 1.26/100,000 inhabitants (SD: 0.09), and males showed higher mortality than females (M/F ratio=1.60). Older individuals ≥70 years old showed higher mortality rates than the rest of the age groups. During the period of study, a significant increase in mortality was observed from 2000 to 2005, while from 2005 to 2020 no significant trend was observed in all the studied groups. CONCLUSIONS: In Mexico, males and older individuals showed the highest mortality rates. The socioeconomic regions with high levels of wellness showed the highest mortality rates levels. Parkinson's mortality rate has remained constant since 2005 in Mexico.

Trends in Parkinson's mortality in Mexico 2000–2020 / Tendencias de la mortalidad por Parkinson en México 2000-2020

Objective: To describe the recent trends in Parkinson's disease mortality in Mexico during 2000-2020. Method: The adjusted mortality rate per 100,000 inhabitants was calculated using the direct method and the world standard population. Trend analysis was performed with the Joinpoint software. Results: The average mortality rate was 1.26/100,000 inhabitants (SD: 0.09), and males showed higher mortality than females (M/F ratio = 1.60). Older individuals ≥ 70 years old showed higher mortality rates than the rest of the age groups. During the period of study, a significant increase in mortality was observed from 2000 to 2005, while from 2005 to 2020 no significant trend was observed in all the studied groups. Conclusions: In Mexico, males and older individuals showed the highest mortality rates. The socioeconomic regions with high levels of wellness showed the highest mortality rates levels. Parkinson's mortality rate has remained constant since 2005 in Mexico.(AU)

Objetivo: Describir las tendencias recientes de la mortalidad por enfermedad de Parkinson en México durante 2000-2020. Método: La tasa de mortalidad ajustada por 100.000 habitantes se calculó mediante el método directo y usando población estándar mundial. El análisis de tendencias se realizó con el programa Joinpoint. Resultados: La tasa de mortalidad promedio fue de 1,26/100.000 habitantes (DE: 0,09) y los hombres presentaron mayor mortalidad que las mujeres (relación H/M = 1,60). Los individuos ≥70 años presentaron las mayores tasas de mortalidad que el resto de los grupos de edad. Durante el periodo de estudio se observó un aumento significativo de la mortalidad de 2000 a 2005, mientras que de 2005 a 2020 no se observó una tendencia significativa. Conclusiones: Los hombres y de mayor edad mostraron las tasas más altas de mortalidad. Las regiones socioeconómicas con mayor nivel de bienestar presentaron las tasas más altas de mortalidad. La tasa de mortalidad por enfermedad de Parkinson se mantuvo constante desde 2005 en México.(AU)

End of life in patients under the care of paediatric palliative care teams. Multicentre observational study.

INTRODUCTION: Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain. PATIENTS AND METHODS: Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated. RESULTS: Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home. CONCLUSIONS: There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution.

El final de vida en pacientes atendidos por equipos de cuidados paliativos pediátricos. Estudio observacional multicéntrico / End of life in patients under the care of paediatric palliative care teams. Multicentre observational study

Introducción:Cada año fallecen en España alrededor de 2000 niños y adolescentes; sin embargo, conocemos poco las particularidades que envuelven a la muerte en pediatría. El objetivo de este estudio es documentar las características de los pacientes que fallecen a cargo de los equipos de cuidados paliativos pediátricos en España. Pacientes y métodos:Estudio retrospectivo, descriptivo y multicéntrico. Participaron 14 equipos de todo el territorio nacional.Resultados:Se obtuvieron datos de 164 pacientes. En la mayoría la enfermedad de base eran procesos oncológicos, neurológicos y neuromusculares. La mediana de edad al fallecimiento fue de 6,9 años (RIC: 11,2). La mediana de tiempo de seguimiento por el equipo fue de 0,3 años (RIC: 0,8 años). Los síntomas más frecuentes en la última semana de vida fueron disnea, dolor, aumento de secreciones y trastornos del sueño. El número de fármacos que se administraban a cada paciente una semana previa al fallecimiento tuvo una mediana de 6 (RIC: 4). El lugar de fallecimiento de 95 de los pacientes (57,9%) fue el hospital y de 67 (40,9%) fue su domicilio.Conclusiones:Los pacientes presentaban un amplio rango de edad y una exposición sustancial a la polifarmacia. El tiempo de seguimiento nos muestra el acceso tardío a los programas de cuidados paliativos, deberíamos hacer un esfuerzo para la introducción temprana de estos cuidados y que no quede relegada al final de vida. En España existe una distribución desigual de recursos, sin que todos los equipos tengan la posibilidad de atención domiciliaria, por lo que el lugar de fallecimiento debemos interpretarlo con cautela. (AU)

Introduction:Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain.Patients and methods:Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated.Results:Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home.Conclusions:There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution. (AU)

[End of life in patients under the care of paediatric palliative care teams. Multicentre observational study]. / El final de vida en pacientes atendidos por equipos de cuidados paliativos pediátricos. Estudio observacional multicéntrico.

INTRODUCTION: Around 2000 children and adolescents die each year in Spain, however, we know little about the particularities of deaths in paediatrics. The purpose of this study is to document the characteristics of patients who die in the care of paediatric palliative care teams in Spain. PATIENTS AND METHODS: Retrospective, descriptive, multicentre study. Fourteen teams from all over the country participated. RESULTS: Data were obtained from 164 patients. In most cases the underlying disease stemmed from oncological, neurological or neuromuscular processes. The median age at death was 6.9 years (RIC 11.2). The median follow-up time by the team was 0.3 years (RIC 0.8 years). The most frequent symptoms in the last week of life were dyspnoea, pain, increased secretions and sleep disorders. The median number of drugs administered to each patient one week prior to death was 6 (RIC 4). The place of death for 95 of the patients (57.9%) was hospital while 67 (40.9%) died at home. CONCLUSIONS: There was a wide age range of patients and they had substantial exposure to polypharmacy. The follow-up time shows that patients have late access to palliative care programmes. An effort should be made to introduce this care earlier rather than relegating it to the end of life. In Spain there is an unequal distribution of resources and not all teams can provide care at home. The place of death should be interpreted with caution.

Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. ¿Es útil la consulta telefónica en ORL? / Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?

Objetivo: Describir cómo se gestionaron las consultas de los servicios de Otorrinolaringología y Cirugía de Cabeza y Cuello (ORLCCC) del Hospital Morales Meseguer (HMM) de Murcia y del Hospital Virgen del Castillo (HVC) de Yecla durante el periodo de estado de alarma debido a la COVID-19 y analizar los resultados obtenidos para valorar la utilidad de la consulta telefónica en nuestra especialidad.Material y métodosDesde el día 16 de marzo en los servicios de ORLCCC de los hospitales HMM y HVC comenzamos a realizar la consulta de forma telefónica. Debido a la disparidad de actuación de los diferentes miembros de los servicios se decidió realizar un protocolo para la gestión de dichas consultas que se comenzó a aplicar el 23 de marzo.ResultadosDurante el periodo de estudio en las consultas de ambos servicios se atendieron 1.054 pacientes, de los cuales 663 (62,9%) fueron primeras visitas y 391 (37,10%) fueron visitas sucesivas. El 21,73% (229) de las consultas se pudieron resolver de forma telefónica, el 10,82% (114) precisaron atención de forma presencial, al 57,40% (605) se les indicó revisión a demanda según la evolución de su patología y el 10,05% (106) de los pacientes no se pudieron localizar de forma telefónica.DiscusiónLa situación de estado de alarma ocasionada por la COVID-19 ha supuesto un condicionante en el desempeño de nuestra labor asistencial. En los servicios ORLCCC de los hospitales HMM y HVC decidimos realizar la consulta de forma telefónica como alternativa a la consulta tradicional. Durante este periodo hemos observado que hasta el 21,73% de las consultas se pudieron solventar de forma telefónica.ConclusiónLa consulta telefónica parece una herramienta muy útil para atender a nuestros pacientes evitando el riesgo de contagio por COVID-19 durante el estado de alarma. Además, según los datos analizados y los diferentes estudios, parece una buena alternativa a la consulta tradicional en pacientes seleccionados. (AU)

Objective: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty.Material and methodsFrom March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23.ResultsDuring the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone.DiscussionThe state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone.ConclusionThe telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients. (AU)

Enhanced in vitro anticancer activity of yeast expressed recombinant glucose oxidase versus commercial enzyme.

Cancer treatments continue to have many disadvantages. Reactive oxygen species, such as H2O2, in high concentrations, can cause cytotoxicity to cells, being even greater in cancer cells. One of the H2O2-producing enzymes is glucose oxidase; its application in cancer treatment should be explored. In this work, the extracellular expression of the mutated recombinant enzyme glucose oxidase was carried out in the eukaryotic expression system Pichia pastoris SMD1168, through the modification and optimization of the gox gene of Aspergillus niger to improve its expression in yeast and its purification. Also, the secretion signal of the alpha-mating factor from Saccharomyces cerevisiae was added to the gene for extracellular expression, and it was inserted into the expression vector pPIC3.5k. The extracellular expression of the enzyme facilitated purification by anion exchange chromatography; the purification was corroborated by SDS-PAGE, with a molecular weight of its subunit between 63 kDa and 100 kDa. The mutated recombinant enzyme glucose oxidase showed greater anticancer activity compared to the commercial glucose oxidase and could have potential for cancer treatment. KEY POINTS: • Pichia pastoris is an excellent eukaryotic expression system for proteins that need post-translational modifications. • Extracellular expression facilitates protein purification. • Glucose oxidase has potential application in cancer treatment.

Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful? / Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. ¿Es útil la consulta telefónica en ORL?

OBJECTIVE: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. MATERIAL AND METHODS: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. RESULTS: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. DISCUSSION: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. CONCLUSION: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.

[Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?] / Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. ¿Es útil la consulta telefónica en ORL?

Objective: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. Material and methods: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. Results: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. Discussion: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. Conclusion: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.

Confiabilidad y vigencia de un instrumento que mide el emprendimiento en comerciantes del centro de México / Reliability and validity of an instrument that measures entrepreneurship of merchants in central mexico

ABSTRACT The objective of this study is to contribute to the validity and reliability of the Garcia Coffee Entrepreneurship Scale (2016). A non-experimental, cross-sectional, and exploratory study was conducted with a non-random selection of 300 coffee merchants. The results confirm the original report, although the incidence of another factor, that the literature identifies as cooperativism, is noted. The extension of the work to other scenarios and samples of micro entrepreneurs is suggested, in order to confirm the dimensions of the undertaking.

RESUMEN El objetivo de este estudio fue contribuir a la validez y confiabilidad de la Escala de Emprendimiento Cafetero de García (2016). Se realizó un estudio no experimental, transversal y exploratorio con una selección no aleatoria de 300 comerciantes de café. Los resultados confirman el informe original, aunque se nota la incidencia de otro factor que la literatura identifica como cooperativismo. Se sugiere la extensión del trabajo a otros escenarios y muestras de microempresarios con el fin de confirmar las dimensiones del emprendimiento.

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients-A Scoping Review.

Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on the impact of organizational conditions on TBC and diabetic patient outcomes.

Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. Es útil la consulta telefónica en ORL? / Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?

OBJETIVO: Describir cómo se gestionaron las consultas de los servicios de Otorrinolaringología y Cirugía de Cabeza y Cuello (ORLCCC) del Hospital Morales Meseguer (HMM) de Murcia y del Hospital Virgen del Castillo (HVC) de Yecla durante el periodo de estado de alarma debido a la COVID-19 y analizar los resultados obtenidos para valorar la utilidad de la consulta telefónica en nuestra especialidad. MATERIAL Y MÉTODOS: Desde el día 16 de marzo en los servicios de ORLCCC de los hospitales HMM y HVC comenzamos a realizar la consulta de forma telefónica. Debido a la disparidad de actuación de los diferentes miembros de los servicios se decidió realizar un protocolo para la gestión de dichas consultas que se comenzó a aplicar el 23 de marzo. RESULTADOS: Durante el periodo de estudio en las consultas de ambos servicios se atendieron 1.054 pacientes, de los cuales 663 (62,9%) fueron primeras visitas y 391 (37,10%) fueron visitas sucesivas. El 21,73% (229) de las consultas se pudieron resolver de forma telefónica, el 10,82% (114) precisaron atención de forma presencial, al 57,40% (605) se les indicó revisión a demanda según la evolución de su patología y el 10,05% (106) de los pacientes no se pudieron localizar de forma telefónica. DISCUSIÓN: La situación de estado de alarma ocasionada por la COVID-19 ha supuesto un condicionante en el desempeño de nuestra labor asistencial. En los servicios ORLCCC de los hospitales HMM y HVC decidimos realizar la consulta de forma telefónica como alternativa a la consulta tradicional. Durante este periodo hemos observado que hasta el 21,73% de las consultas se pudieron solventar de forma telefónica. CONCLUSIÓN: La consulta telefónica parece una herramienta muy útil para atender a nuestros pacientes evitando el riesgo de contagio por COVID-19 durante el estado de alarma. Además, según los datos analizados y los diferentes estudios, parece una buena alternativa a la consulta tradicional en pacientes seleccionados

OBJECTIVE: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. MATERIAL AND METHODS: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. RESULTS: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. DISCUSSION: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. CONCLUSION: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients

Caracterización de los cuidadores de adultos mayores hemipléjicos a causa de enfermedad cerebrovascular / Characterization of caregivers of hemiplegic aged patients with cerebrovascular illness

Se realizó un estudio descriptivo y transversal de 45 cuidadores de adultos mayores hemipléjicos a causa de enfermedad cerebrovascular, atendidos en la Sala de Rehabilitación Integral del Policlínico Universitario Luis Augusto Turcios Lima del municipio y provincia de Pinar del Río, desde julio hasta diciembre de 2015, con vistas a caracterizar a dichos cuidadores según variables de interés para la investigación. En la serie prevalecieron los cuidadores de 50-59 años de edad (53,3 por ciento), del sexo femenino (44,4 por ciento), con nivel educacional preuniversitario (37,8 por ciento), con lazos de parentesco (71,1 por ciento) y con un tiempo en esta labor entre 7-9 meses (40,0 por ciento). El parentesco existente entre el cuidador y la persona cuidada es un factor importante que influye en gran medida en la experiencia del cuidado(AU)

A descriptive and cross-sectional study of 45 caregivers of aged hemiplegic adults with cerebrovascular disease, assisted in the Comprehensive Rehabilitation room of "Luis Augusto Turcios Lima" University Polyclinic in Pinar del Río municipality and province, was carried out from July to December of 2015, with the aim of characterizing this caretakers, according to variables of interest for the investigation. In the series the caregivers of 50-59 years of age (53,3 percent), the female sex (44,4 percent), preuniversity educational level (37,8 percent), family relationship (71,1 percent) and with a period in this activity among 7-9 months (40,0 percent) prevailed. The existent family relationship between the caregiver and the sick elderly is an important factor that influences greatly in the experience of the care(AU)

Caracterización de los cuidadores de adultos mayores hemipléjicos a causa de enfermedad cerebrovascular / Characterization of caregivers of hemiplegic aged patients with cerebrovascular illness

Se realizó un estudio descriptivo y transversal de 45 cuidadores de adultos mayores hemipléjicos a causa de enfermedad cerebrovascular, atendidos en la Sala de Rehabilitación Integral del Policlínico Universitario Luis Augusto Turcios Lima del municipio y provincia de Pinar del Río, desde julio hasta diciembre de 2015, con vistas a caracterizar a dichos cuidadores según variables de interés para la investigación. En la serie prevalecieron los cuidadores de 50-59 años de edad (53,3 por ciento), del sexo femenino (44,4 por ciento), con nivel educacional preuniversitario (37,8 por ciento), con lazos de parentesco (71,1 por ciento) y con un tiempo en esta labor entre 7-9 meses (40,0 por ciento). El parentesco existente entre el cuidador y la persona cuidada es un factor importante que influye en gran medida en la experiencia del cuidado

A descriptive and cross-sectional study of 45 caregivers of aged hemiplegic adults with cerebrovascular disease, assisted in the Comprehensive Rehabilitation room of Luis Augusto Turcios Lima University Polyclinic in Pinar del Río municipality and province, was carried out from July to December of 2015, with the aim of characterizing this caretakers, according to variables of interest for the investigation. In the series the caregivers of 50-59 years of age (53,3 percent), the female sex (44,4 percent), preuniversity educational level (37,8 percent), family relationship (71,1 percent) and with a period in this activity among 7-9 months (40,0 percent) prevailed. The existent family relationship between the caregiver and the sick elderly is an important factor that influences greatly in the experience of the care

Stroke penumbra defined by an MRI-based oxygen challenge technique: 2. Validation based on the consequences of reperfusion.

Magnetic resonance imaging (MRI) with oxygen challenge (T(2)(*) OC) uses oxygen as a metabolic biotracer to define penumbral tissue based on CMRO(2) and oxygen extraction fraction. Penumbra displays a greater T(2)(*) signal change during OC than surrounding tissue. Since timely restoration of cerebral blood flow (CBF) should salvage penumbra, T(2)(*) OC was tested by examining the consequences of reperfusion on T(2)(*) OC-defined penumbra. Transient ischemia (109 ± 20 minutes) was induced in male Sprague-Dawley rats (n=8). Penumbra was identified on T(2)(*)-weighted MRI during OC. Ischemia and ischemic injury were identified on CBF and apparent diffusion coefficient maps, respectively. Reperfusion was induced and scans repeated. T(2) for final infarct and T(2)(*) OC were run on day 7. T(2)(*) signal increase to OC was 3.4% in contralateral cortex and caudate nucleus and was unaffected by reperfusion. In OC-defined penumbra, T(2)(*) signal increased by 8.4% ± 4.1% during ischemia and returned to 3.25% ± 0.8% following reperfusion. Ischemic core T(2)(*) signal increase was 0.39% ± 0.47% during ischemia and 0.84% ± 1.8% on reperfusion. Penumbral CBF increased from 41.94 ± 13 to 116.5 ± 25 mL per 100 g per minute on reperfusion. On day 7, OC-defined penumbra gave a normal OC response and was located outside the infarct. T(2)(*) OC-defined penumbra recovered when CBF was restored, providing further validation of the utility of T(2)(*) OC for acute stroke management.

Stroke penumbra defined by an MRI-based oxygen challenge technique: 1. Validation using [14C]2-deoxyglucose autoradiography.

Accurate identification of ischemic penumbra will improve stroke patient selection for reperfusion therapies and clinical trials. Current magnetic resonance imaging (MRI) techniques have limitations and lack validation. Oxygen challenge T(2)(*) MRI (T(2)(*) OC) uses oxygen as a biotracer to detect tissue metabolism, with penumbra displaying the greatest T(2)(*) signal change during OC. [(14)C]2-deoxyglucose (2-DG) autoradiography was combined with T(2)(*) OC to determine metabolic status of T(2)(*)-defined penumbra. Permanent middle cerebral artery occlusion was induced in anesthetized male Sprague-Dawley rats (n=6). Ischemic injury and perfusion deficit were determined by diffusion- and perfusion-weighted imaging, respectively. At 147 ± 32 minutes after stroke, T(2)(*) signal change was measured during a 5-minute 100% OC, immediately followed by 125 µCi/kg 2-DG, intravenously. Magnetic resonance images were coregistered with the corresponding autoradiograms. Regions of interest were located within ischemic core, T(2)(*)-defined penumbra, equivalent contralateral structures, and a region of hyperglycolysis. A T(2)(*) signal increase of 9.22% ± 3.9% (mean ± s.d.) was recorded in presumed penumbra, which displayed local cerebral glucose utilization values equivalent to contralateral cortex. T(2)(*) signal change was negligible in ischemic core, 3.2% ± 0.78% in contralateral regions, and 1.41% ± 0.62% in hyperglycolytic tissue, located outside OC-defined penumbra and within the diffusion abnormality. The results support the utility of OC-MRI to detect viable penumbral tissue following stroke.

Influencia de la comunicación del diagnóstico y el pronóstico en el sufrimiento del enfermo terminal / Influence of communicating the diagnosis and the prognosis on the suffering of the terminal patient

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Prevalencia de la infección por el virus del papiloma humano en mujeres con citologías anormales del cérvix uterino y factores de riesgo asociados a la infección / Prevalence of human papillomavirus infection in women with abnormal pap-smears of the uterine cervix and risk factors associated to the infection

Objetivo: Conocer la prevalencia de la infección por el virus del papiloma humano (VPH) en mujeres con citologías anormales del cérvix uterino y determinar los factores de riesgo asociados a la infección. Sujetos y métodos: Ochenta y una mujeres, que presentaron una citología con el diagnóstico de atipia de significado incierto (ASCUS), lesión escamosa intraepitelial de bajo grado (L-SIL) o de alto grado (H-SIL), se sometieron a un cuestionario epidemiológico, detección del VPH mediante la prueba Hybrid Capture II®, estudio histológico y análisis de otras enfermedades de transmisión sexual. Resultados: Se estudiaron 16 mujeres con citologías con resultado de ASCUS, 44 con L-SIL y 21 con H-SIL. La prevalencia global de la infección por el VPH fue del 67,9% (55 casos). Se detectó el VPH de alto riesgo (VPH-AR) en 50 (61,8%). Los porcentajes de infección por el VPH-AR en las mujeres con citologías con ASCUS, L-SIL y H-SIL fueron del 31,2, 63,6 y 80,9%, respectivamente. La infección por el VPH se asoció de forma significativa con el número de parejas sexuales a lo largo de la vida (χ2 de tendencia: 4,187; p = 0,0407). Conclusiones: Las mujeres con citologías con resultado de ASCUS son las que más pueden beneficiarse de las técnicas que detectan el VPH-AR, debido a la menor prevalencia de la infección. El principal factor de riesgo asociado a la infección por el VPH fue el número de parejas sexuales a lo largo de la vida

Objectives: To determine the prevalence of human papillomavirus (HPV) infection in women with an abnormal pap smear of the uterine cervix and to determine the risk factors associated with HPV infection. Subjects and methods: Eighty-one women with a cytological result of atypical cells of unknown origin (ASCUS), low-grade squamous intraepithelial lesions (LG-SIL) or high-grade squamous intraepithelial lesions (HG-SIL) were referred for epidemiological questionnaire, HPV detection performed using the Hybrid Capture II® test, histological study, and analysis of other sexually-transmitted diseases. Results: Cytologic study identified 16 women with ASCUS, 44 with LG-SIL and 21 with HG-SIL. The global prevalence of HPV infection was 67.9% (55 patients) and high-risk HPV (HR-HPV) infection was detected in 50 patients (61.8%). The percentages of HR-HPV infection in women with ASCUS, L-SIL and H-SIL were 31.2%, 63.6% and 80.9%, respectively. The number of sexual partners over a woman's lifetime was significantly associated with HPV infection (χ2 for trend: 4.187; p = 0.0407). Conclusions: Women with ASCUS detected by cytology are those who could most benefit from HR-HPV detection techniques, because of the lower prevalence of the infection. The main risk factor associated with HPV infection was the number of sexual partners over a woman's lifetime