[Frequency of sensitization to shrimp with house dust mite immunotherapy with polymerized extracts]. / Frecuencia de sensibilización a camarón con inmunoterapia a ácaros con extractos polimerizados.

OBJECTIVE: To evaluate the risk of IgE sensitization and symptoms to shrimp in a population that has received AIT with polymerized mite extract. METHODS: Patients with allergic rhinitis sensitized to dust mites (Dermatophogides spp) with an indication for mite AIT were included. Those patients who had not yet received AIT or had received less than 6 doses were included as controls and those who had received more than 24 doses of AIT were included as cases. Sensitization to shrimp was assessed by skin prick test with complete shrimp extract and/or shrimp-specific IgE. RESULTS: A total of 68 patients were included; 47 cases and 21 controls. When calculating the odds ratio of sensitization according to time with immunotherapy we observed that there were no differences between the group of cases and controls (OR 0.76 95% CI 0.26 to 2.22 p 0.7 by MacNemar technique). Factors such as consumption or not of shrimp and frequency of consumption do not seem to be related to the outcome. CONCLUSION: In contrast to what was reported with aqueous extracts, we observed that AIT with polymerized extracts is not a risk factor for shrimp sensitization. It is necessary to reproduce these results with a larger sample size to explore other factors.

OBJETIVO: Evaluar el riesgo de sensibilización IgE y síntomas a camarón en una población que ha recibido AIT con extracto polimerizado para ácaros. MÉTODOS: Se incluyeron pacientes con rinitis alérgica sensibilizados a ácaros del polvo (Dermatophogides spp) con indicación de AIT para ácaros. Aquellos pacientes que no habían aún recibido AIT o llevaban menos de seis dosis, fueron incluidos como controles, y aquellos que llevaban más de 24 dosis de AIT, fueron incluidos como casos. Se evaluó la sensibilización a camarón mediante prueba cutánea con extracto completo de camarón y/o IgE específica a camarón. RESULTADOS: En total, 68 pacientes fueron incluidos; 47 casos y 21 controles. Al calcular el odds ratio de la sensibilización de acuerdo al tiempo con la inmunoterapia, observamos que no había diferencias entre el grupo de casos y controles (OR 0,76 95% IC 0,26 a 2,22 p 0,7 por técnica de MacNemar). Factores como el consumo o no de camarón y la frecuencia de consumo, no parecen estar relacionados con el desenlace. CONCLUSIÓN: A diferencia de lo reportado con extractos acuosos, observamos de AIT con extractos polimerizados para no es un factor de riesgo para la sensibilización a camarón. Es necesario reproducir estos resultados con un mayor tamaño de muestra que permita explorar otros factores.

Open-access database for digital lensless holographic microscopy and its application on the improvement of deep-learning-based autofocusing models.

Among modern optical microscopy techniques, digital lensless holographic microscopy (DLHM) is one of the simplest label-free coherent imaging approaches. However, the hardware simplicity provided by the lensless configuration is often offset by the demanding computational postprocessing required to match the retrieved sample information to the user's expectations. A promising avenue to simplify this stage is the integration of artificial intelligence and machine learning (ML) solutions into the DLHM workflow. The biggest challenge to do so is the preparation of an extensive and high-quality experimental dataset of curated DLHM recordings to train ML models. In this work, a diverse, open-access dataset of DLHM recordings is presented as support for future research, contributing to the data needs of the applied research community. The database comprises 11,760 experimental DLHM holograms of bio and non-bio samples with diversity on the main recording parameters of the DLHM architecture. The database is divided into two datasets of 10 independent imaged samples. The first group, named multi-wavelength dataset, includes 8160 holograms and was recorded using laser diodes emitting at 654 nm, 510 nm, and 405 nm; the second group, named single-wavelength dataset, is composed of 3600 recordings and was acquired using a 633 nm He-Ne laser. All the experimental parameters related to the dataset acquisition, preparation, and calibration are described in this paper. The advantages of this large dataset are validated by re-training an existing autofocusing model for DLHM and as the training set for a simpler architecture that achieves comparable performance, proving its feasibility for improving existing ML-based models and the development of new ones.

Holographic point source for digital lensless holographic microscopy.

A holographic point source (HPS) developed for digital lensless holographic microscopy (HPS-DLHM) is presented. The HPS is an off-axis phase transmission hologram of an experimental micrometer pinhole recorded on a photopolymer holographic film. An amplitude division interferometer, adjusted to operate at maximum diffraction efficiency, has been employed to record the hologram. The results of HPS-DLHM have been contrasted with the results obtained via conventional DLHM, and the two techniques were found to give similar measurements. Compared with conventional pinhole-based DLHM illumination, our cost-effective proposal provides increased mechanical stability, the possibility of wider spherical illumination cones, and shorter reconstruction distances. These superior features pave the way to applying this quantitative phase imaging (QPI) technique in biomedical and telemedicine applications. The imaging capabilities of our HPS-DLHM proposal have been tested by using an intricate sample of a honeybee leg, a low-absorption sample of epithelial cheek cells, a 1951 USAF test target, and smeared human erythrocytes.

Linear diattenuation imaging of biological samples with digital lensless holographic microscopy.

A digital lensless holographic microscope (DLHM) sensitive to the linear diattenuation produced by biological samples is reported. The insertion of a linear polarization-states generator and a linear polarization-states analyzer in a typical DLHM setup allows the proper linear diattenuation imaging of microscopic samples. The proposal has been validated for simulated and experimental biological samples containing calcium oxalate crystals extracted from agave leaves and potato starch grains. The performance of the proposed method is similar to that of a traditional polarimetric microscope to obtain linear diattenuation images of microscopic samples but with the advantages of DLHM, such as numerical refocusing, cost effectiveness, and the possibility of field-portable implementation.

Common-path interferometer for digital holographic Doppler spectroscopy of living biological tissues.

SIGNIFICANCE: Common-path interferometers have the advantage of producing ultrastable interferometric fringes compared with conventional interferometers, such as Michelson or Mach-Zehnder that are sensitive to environmental instabilities. Isolating interferometric measurements from mechanical disturbances is important in biodynamic imaging because Doppler spectroscopy of intracellular dynamics requires extreme stability for phase-sensitive interferometric detection to capture fluctuation frequencies down to 10 mHz. AIM: The aim of this study was to demonstrate that Doppler spectra produced from a common-path interferometer using a grating and a spatial filter (SF) are comparable to, and more stable than, spectra from conventional biodynamic imaging. APPROACH: A common-path interferometer using a holographic diffraction grating and an SF was employed with a low-coherence source. Simulations evaluated the spatial resolution. DLD-1 (human colon adenocarcinoma) spheroids were used as living target tissue samples. Power spectra under external vibrations and drug-response spectrograms were compared between common-path and Fourier-domain holographic systems. RESULTS: The common-path holography configuration shows enhanced interferometric stability against mechanical vibrations through common-mode rejection while maintaining sensitivity to Doppler frequency fluctuations caused by intracellular motions. CONCLUSIONS: A common-path interferometer using a grating and an SF can provide enhanced interferometric stability in tissue-dynamics spectroscopy for drug screening assays.

Classical HLA alleles tag SNP in families from Antioquia with type 1 diabetes mellitus

Introduction: The HLA region strongly associates with autoimmune diseases, such as type 1 diabetes. An alternative way to test classical HLA alleles is by using tag SNP. A set of tag SNP for several classical HLA alleles has been reported as associated with susceptibility or resistance to this disease in Europeans. Objective: We aimed at validating the methodology based on tag SNP focused on the inference of classical HLA alleles, and at evaluating their association with type 1 diabetes mellitus in a sample of 200 families from Antioquia. Materials and methods: We studied a sample of 200 families from Antioquia. Each family had one or two children with T1D. We genotyped 13 SNPs using tetra-primer ARMS-PCR or PCRRFLP. In addition, we tested the validity of the tag SNP reported for Europeans in 60 individuals from a population of Colombians living in Medellín (CLM) from the 1000 Genomes Project database. Statistical analyses included the Hardy-Weinberg equilibrium, the transmission disequilibrium and the linkage disequilibrium tests. Results: The linkage disequilibrium was low in reported tag SNP and classical HLA alleles in this CLM population. Association analyses revealed both risk and protection factors to develop type 1 diabetes mellitus. Appropriate tag SNPs for the CLM population were determined by using the genotype information available in the 1000 Genome Project database. Conclusions: Although linkage disequilibrium patterns in this CLM population were different from those reported in Europeans, we did find strong evidence of the role of HLA in the development of type 1 diabetes mellitus in the study population.

Polimorfismos de un solo nucleótido representativos para los alelos clásicos del antígeno leucocitario humano en familias antioqueñas con diabetes mellitus tipo 1 / Classical HLA alleles tag SNP in families from Antioquia with type 1 diabetes mellitus

Resumen Introducción. La región del antígeno leucocitario humano (Human Leukocyte Antigen, HLA) se ha asociado claramente con enfermedades autoinmunitarias, como la diabetes mellitus de tipo 1. Los polimorfismos representativos de un solo nucleótido (tag Single Nucleotide Polymorphism, tag SNP) constituyen una forma alternativa de evaluar los alelos clásicos del HLA. En la población europea se ha reportado un grupo de tag SNP para múltiples alelos clásicos relacionados con la predisposición o la resistencia frente a dicha enfermedad. Objetivo. Validar la metodología basada en los tag SNP enfocada en la inferencia de alelos HLA clásicos, y evaluar su asociación con la diabetes mellitus de tipo 1 en una muestra de familias antioqueñas. Materiales y métodos. Se estudió una muestra de 200 familias antioqueñas con uno a dos hijos afectados por diabetes mellitus de tipo 1. Se genotipificaron 13 SNP mediante el ARMS-PCR (Amplification Refractory Mutation System-Polymerase Chain Reaction) con cuatro iniciadores, o mediante la PCR-RFLP (PCR-Restriction Fragment Length Polymorphism). Además, se evaluó la validez de los tag SNP de 1.000 genomas reportados en europeos en una muestra de 60 individuos de la población colombiana de Medellín. Se hicieron las pruebas de desequilibrio de la transmisión, de desequilibrio de ligamiento y de equilibrio de Hardy-Weinberg. Resultados. En la población de estudio no se encontró suficiente desequilibrio de ligamiento entre los SNP y los alelos clásicos evaluados, por lo cual no fue posible inferir los alelos clásicos del HLA para el conjunto de familias con diabetes mellitus de tipo 1. El estudio de asociación evidenció que esta región aporta factores tanto de riesgo como de protección para el desarrollo de la enfermedad. Los tag SNP apropiados para la muestra de estudio se determinaron usando los SNP ubicados en la región HLA en la base de datos del 1000 Genomes Project en la mencionada población. Conclusiones. Los patrones de desequilibrio de ligamiento en la población estudiada fueron diferentes a los reportados para la población europea. A pesar de esto, se encontró evidencia clara sobre el papel de la región HLA en el riesgo de padecer diabetes mellitus de tipo 1 en la población de estudio.

abstract Introduction: The HLA region strongly associates with autoimmune diseases, such as type 1 diabetes. An alternative way to test classical HLA alleles is by using tag SNP. A set of tag SNP for several classical HLA alleles has been reported as associated with susceptibility or resistance to this disease in Europeans. Objective: We aimed at validating the methodology based on tag SNP focused on the inference of classical HLA alleles, and at evaluating their association with type 1 diabetes mellitus in a sample of 200 families from Antioquia. Materials and methods: We studied a sample of 200 families from Antioquia. Each family had one or two children with T1D. We genotyped 13 SNPs using tetra-primer ARMS-PCR or PCRRFLP. In addition, we tested the validity of the tag SNP reported for Europeans in 60 individuals from a population of Colombians living in Medellín (CLM) from the 1000 Genomes Project database. Statistical analyses included the Hardy-Weinberg equilibrium, the transmission disequilibrium and the linkage disequilibrium tests. Results: The linkage disequilibrium was low in reported tag SNP and classical HLA alleles in this CLM population. Association analyses revealed both risk and protection factors to develop type 1 diabetes mellitus. Appropriate tag SNPs for the CLM population were determined by using the genotype information available in the 1000 Genome Project database. Conclusions: Although linkage disequilibrium patterns in this CLM population were different from those reported in Europeans, we did find strong evidence of the role of HLA in the development of type 1 diabetes mellitus in the study population.

Final report: impact evaluation of community-led total sanitation (CLTS) in rural Mali

Globally 2.5 billion people lack access to an improved sanitation facility; in Mali, only 15% of rural households use improved sanitation (JMP 2014). Community-led total sanitation (CLTS) uses participatory approaches to facilitate sustained behavior change to eliminate open defecation by mobilizing communities in order to achieve that goal. Although CLTS has been implemented in over 50 countries, there is a lack of rigorous and objective data on its outcomes in terms of sanitation and hygiene behavior, and on health impact such as diarrhea and child growth. This report covers the main findings of the impact evaluation of a community-led total sanitation (CLTS) campaign implemented by the government of Mali (Direction Nationale de l'Assainissement) with the technical and financial support of UNICEF. We conducted a cluster-randomized controlled trial among 121 villages randomly selected in the region of Koulikoro in order to evaluate health and non-health program impacts. Baseline data was collected during April-June 2011, the CLTS intervention program was implemented in 60 villages between September 2011 and June 2012, and follow-up data was collected in April-June 2013. A total of 4,532 households were enrolled at baseline and 5,206 were visited at follow up; 89% of baseline households (N=4,031) were successfully matched to a household at follow up. The primary outcomes and impacts presented in this report are reported for those households present at both baseline and follow up. The CLTS campaign was highly successful in increasing access to private latrines, improving the quality of latrines, and reducing self-reported open defecation. Access to a private latrine almost doubled among households in CLTS villages (coverage increased to 65% in CLTS villages compared to 35% in control villages). Self-reported open defecation rates fell by 70% among adult women and men, by 46% among older children (age 5-10), and by 50% among children under five. Children too young to use latrines were also more likely to use a child potty in CLTS villages. The program also increased perceived privacy and safety during defecation among women. These results were sustained over time. Observations by field staff support respondent-reported reductions in open defecation, use of cleaner latrines, and improved hygiene in CLTS villages. Latrines in the CLTS households were 3 times more likely to have soap present (PR: 3.17, 95% CI: 2.18-4.61) and 5 times more likely to have water present (PR: 5.3, 95% CI: 3.49-8.05). Latrines at CLTS households were more than twice as likely to have a cover over the hole of the pit (PR: 2.78, 95% CI: 2.24-3.44), and 31% less likely to have flies observed inside the latrine (PR: 0.79, 95% CI: 0.68-0.93). CLTS households were also half as likely to have piles of human feces observed in the courtyard (PR: 0.54, 95% CI: 0.37-0.79). Statistically significant impacts on child diarrheal or respiratory illness were not observed among children under five years of age when analyzing follow-up data only. It should be noted that even though randomization occurred after baseline data collection was complete and socio-economic characteristics were balanced across groups, most symptoms of diarrheal and respiratory illness were more prevalent in CLTS villages at baseline.

Niveles de hemoglobina en pacientes en hemodiálisis a nivel del mar y a mayor altitud, y su relación con la calidad de vida / Hemoglobin levels in hemodialysis patients at sea level and high altitude, and its relation with the quality of life

Objetivo. Determinar si los niveles de hemoglobina se relacionan con la calidad de vida a diferentes altitudes en pacientes en hemodiálisis (HD) crónica. Pacientes y Métodos. Se seleccionó pacientes con enfermedad renal crónica (ERC) en HD crónica que vivían a nivel del mar (Lima, 150 metros sobre el nivel del mar ûmsnmû; Chiclayo, 27 msnm) y a mayor altitud (Arequipa, 2 327 msnm; Puno, 3 827 msnm). Los pacientes fueron reevaluados a los tres y seis meses, se registró el nivel de hemoglobina, la presión arterial y las dosis de eritropoyetina y de fierro. A los seis meses, se seleccionó a los pacientes que tuvieron hemoglobina que no varió más de 1,5 g/dL entre el primer, tercero y sexto mes del estudio y se aplicó el test SF-36de calidad de vida. Resultados. Se evaluó 54 pacientes de nivel del mar y 48 de mayor altitud. Los primeros tuvieron mayor edad, menor prevalencia de hipertensión arterial, menores niveles de hemoglobina y de hematócrito, mayor promedio de KT/V y menor uso de medicamentos que interfieren con angiotensina. No hubo diferencia en la dosis semanal de eritropoyetina ni en la mensual de hierro. Los resultados del test SF-36 no mostraron diferencia entre los dos grupos; y, en pacientes de nivel del mar se encontró correlación entre el resultado del test SF-36 y el nivel de hemoglobina, no así en pacientes de mayor altitud. Conclusiones. Los pacientes en HD que viven a mayor altitud tienen un mayor nivel de hemoglobina. Hubo correlación entre el nivel de hemoglobina y la calidad de vida en los pacientes en HD que viven a nivel del mar, pero no en los pacientes en HD que viven a mayor altitud.

Objective. To determine whether hemoglobin levels are related to the quality of life at different altitudes in hemo- dyalisis (HD) patients. Material and MethOds. We selected patients with chronic kidney disease (CKD) in chronicHD who were living at sea level (Lima at 150 meters above sea level (masl) and Chiclayo 27 masl) and at high altitude (Arequipa 2 327 masl and Puno 3 827 masl). The patients were re-evaluated at 3 and 6 months recording: hemoglobin, blood pressure, doses of erythropoietin and iron levels. Six months later, patients who had hemoglobin which did not vary more than 1,5 g/dL among the first, third and sixth month of the study were selected; and the quality of life Test SF-36 was applied. results. We assessed 54 HD patients at sea level and 48 at high altitude. Sea level HD patients were older, had a lower prevalence of arterial hypertension, lower levels of hemoglobin and hematocrit, higher KT/V average and less use of medicines that interfere with angiotensin. There was no difference in the weekly dose of erythropoietin or monthly dose of iron. SF-36 test results showed no difference between the two groups. In sea level HD patients, a correlation was found between the SF-36 test result and their hemoglobin level. This was not found among high altitude HD patients. Conclusion. Higher hemoglobin levels are found in HD patients living at high altitude; and, in HD patients from sea level, there was a correlation between the hemoglobin level and the quality of life, which was not found in HD patients who live at high altitude. Key wOrds. Anemia, hemodialysis, high altitude, chronic kidney disease, quality of life.

Guía de práctica clínica basada en la evidencia para el diagnóstico de disfagia en niños / Evidence-based practice guidelines for the diagnosis of dysphagia in children

Se presenta una guía basada en la evidencia para el diagnóstico de disfagia en niños. Se llevó a cabo una búsqueda de artículos indexados entre enero de 1996 y diciembre de 2007 en las bases de datos Medline, Lilacs y el registro Cochrane. Se hizo restricción por idioma a publicaciones en inglés y español y, por edad, solo se incluyó a la población pediátrica. Se complementó la exploración con artículos incluidos en la bibliografía de artículos primarios y citados en revisiones no sistemáticas. La estrategia de búsqueda produjo 605 artículos de los cuales se seleccionaron 58. El análisis de la validez de los artículos y el grado de recomendación se hicieron por consenso entre los investigadores. El desarrollo de la guía se basó en el instrumento AGREE (Appraisal of Guidelines Research and Evaluation) y en el modelo GRADE del Colegio Americano de Médicos del Tórax (Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines). El enfoque diagnóstico del niño con disfagia debe partir de la sospecha clínica. La anamnesis y el examen físico deben preceder a cualquier actividad diagnóstica. Se encontró que en niños con alta sospecha clínica de disfagia debe complementarse la evaluación clínica con la videofluoroscopia (Recomendación 1C), que es el estándar de oro para confirmar la presencia de aspiración o penetración de la vía aérea (Recomendación 1A). El ultrasonido es el método de elección en niños con disfagia asociada a anormalidades de la lengua. (Recomendación 1C). La electromiografía se puede utilizar como una prueba de tamizaje para niños mayores de cinco años con alteración de la musculatura facial (Recomendación 2B). La resonancia magnética nuclear es útil en pacientes con sospecha de lesiones cervicales que alteran la dinámica de la deglución (Recomendación 1C). Se concluye que los estudios diagnósticos disponibles tienen deficiencias metodológicas que no permiten hacer recomendaciones de mayor grado de validez.

We present an evidence-based guideline for the diagnosis of dysphagia in children. The articles included were retrieved by electronic search in Medline, Lilacs, and Cochrane databases. The search was restricted to those published between January 1996 and December 2007, in English or Spanish, and only to those including children (0-18 years). Manual search of papers cited by primary articles and non-systematic reviews was also done. The search strategy identified 605 articles and 58 were chosen for further analysis. Evaluation of the papers was carried out by all the authors and recommendations were done by consensus. The guideline was developed by using the AGREE instrument (Appraisal of Guidelines Research and Evaluation) and the GRADE model (Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines) from the American College of Chest Physicians. The diagnostic approach to children with dysphagia begins with clinical suspicion, and thorough clinical history and physical examination should precede any diagnostic test. We found that in children with clinical features that suggest dysphagia, videofluoroscopy is the recommended imaging technique to confirm this condition (Recommendation 1C). This test is considered to be the gold standard to demonstrate aspiration and/or penetration of contrast material into the airway (Recommendation 1A). Ultrasound is considered as the best diagnostic imaging technique in children with dysphagia associated with tongue abnormalities (Recommendation 1C). On the other hand, electromyography might be used as a screening test in children aged 5 years or more with disorders of the facial muscles (Recommendation 2B). Finally, magnetic resonance imaging seems to provide the best diagnostic yield in those children with cervical lesions responsible for disrupting deglutition dynamics (Recommendation 1C). In conclusion, available articles on diagnostic tests for dysphagia have serious methodological deficiencies and do not allow recommendations with better levels of evidence.

Significado del cuidado de enfermería para el paciente en estado de cronicidad / Meaning of nursing care for chronically ill patient

Las respuestas a "¿Qué significa el cuidado de enfermería para los pacientes en estados de cronicidad?", permitieron encontrar esencias procedentes de la interacción entre los pacientes y las enfermeras que los cuidaban; en esta investigación se consideró pertinente centrarse en lo común, permanente e invariante de los discursos de los participantes. El propósito fue acercar la brecha entre teoría y práctica, academia y ejercicio profesional y aportar al conocimiento de enfermería derivado de la práctica. Mediante método fenomenológico y abordaje de Colaizzi se definió del fenómeno de interés, recolección de datos sobre éste, lectura de los datos, relectura de las transcripciones, interpretaciones mediante códigos vivos y sustantivos, asociación por grupos de temas, descripciones exhaustivas de experiencias y validación. Se mantuvo el respeto por las personas en su decisión de participar. Resultados: Los participantes asignaron significados a la enfermera como un ser espiritual, que tiene vocación para la ayuda a los demás y que es el alma del hospital. El significado principal estuvo en el apoyo especialmente en aspectos de las interrelaciones humanas, lo cual les permitió sentirse confortados con la amabilidad y familiaridad en los momentos de hospitalización y bien cuidados, y mantener la expectativa de la recuperación (AU)

The answers to "¿What means the nursing for the patients in chronical states?", allowed to find essences coming from the interaction between the patients and the nurses who took care of them; in this investigation it was considered pertinent to be centered in common, permanent and invariant aspects of the participants speeches. The aim was to approach the breach between theory and practice, academy and professional exercise and to contribute to the nursing knowledge derived from the practice. By phenomenology method and boarding of Colaizzi it was defined of the interest phenomenon, data collection, data reading, transcriptions reading, interpretations by means of codes alive and nouns, association by groups of subjects, exhaustive descriptions of experiences and validation. The investigator had respect by the people in their decision stayed to participate. Results: The participants assigned meaning to the nurse like a spiritual being, who has vocation for the aid to the others and she is the hospital soul. The chief meaning was in the support specially in aspects of the human interrelations, which allowed them to feel comforted with the kindness and familiarity when they were hospitalized and maintaining the expectation of the recovery (AU)

Factores de riesgo para el melasma. Medellín-2005 / Melasma risk factors: Medellín 2005

El melasma es una hipermelanosis principalmente de la cara frecuente en las mujeres del trópico cuya causa es desconocida. Se han implicado factorescomo el embarazo, la exposición a la luz ultravioleta y los anticonceptivos orales, pero no se conoce el nivel de asociación. Este estudio pretendeencontrar el grado de asociación de los factores etiológicos del melasma con el desarrollo de la enfermedad en mujeres mayores de dieciocho años dela ciudad de Medellín.Metodología: Se realizó un estudio de casos y controles. Se ingresaron 101 mujeres adultas que asistieron a la consulta de alguno de los investigadores,67 casos con diagnóstico clínico de melasma al momento del estudio y 34 controles, que no hubieran tenido anteriormente esta patología. Todosaceptaron voluntariamente participar en el estudio y firmaron el formato de consentimiento informado.El tamaño muestral se calculó basados en la exposición solar como factor principal de riesgo con una frecuencia teórica del 99% para los casos y del80% para los controles por experiencia clínica, con una confianza del 95%. La relación caso control fue 2 a 1. El instrumento de recolección de informaciónfue una encuesta diseñada para el estudio. La lectura de los datos se hizo a través del sistema teleform. Se realizó un análisis bivariado calculandolas diferencias de proporciones y el valor OR con intervalos de confianza y el valor de p, con una confianza del 95%.Resultados: La edad promedio fue de 38,3 años con un rango de 21-57 años.Casos: El tiempo de evolución del melasma varío de 1-20 años, 32 tenían un patrón homogéneo (47,7%) y 35 reticular (52,2%). La distribución centro-facial fue la más frecuente (52,2%) seguida de malar (35,8%) y en tercer lugar, mandibular (11,9%). El 80,5% aumentaban con la luz de Wood, el16,4% no cambiaban y el 3% disminuían.Factores de riesgo: Al analizar los factores de riesgo, los siguientes no tuvieron asociación significativa con el melasma: el fototipo, la paridad, el usoactual de anticonceptivos u otros fármacos no hormonales, la terapia hormonal diferente a las hormonas femeninas, el antecedente de enfermedadtiroidea y el antecedente de exposición solar.Se pudo comprobar una razón de disparidad mayor para sufrir la enfermedad en quienes tenían familiares en primer grado de consanguinidad conmelasma, con un OR 2,58 (intervalos 1,08-6,73) y p = 0,029, y el uso de maquillaje cosmético (tipo polvo o base) OR 3,69 (1,36-10,12) p = 0,0036.El consumo de bebidas colas fue un factor protector OR 0,021 (0,06-0,67) y p = 0,0026.Conclusión: De este estudio podemos concluir que de los múltiples factores implicados en la etiología del melasma, por estudios científicos o creenciapopular, solo el antecedente familiar de la enfermedad y el uso de cosméticos fueron factores de riesgo en mujeres de 18 años con melasma en la ciudadde Medellín. El hallazgo de que el consumo de bebidas colas actuó como un factor protector, amerita posteriores estudios

Melasma is a hiperpigmentation of unknown cause primarily of the face. Is common in women of the tropics. Pregancy, UV light and oral contraceptiveshave been implicated, but the level of association is unknown. This study pretends to find the degree association between the ethilogical factors ofmelasma with the development of the disease in women older then 18 years, in Medellín.Methods: A case and control study was carried out, including 101 adulta women; 67 of them had a diagnosis of melasma, and the other 34 werehealthy controls. The size of the sample was calculated based on solar exposure as main risk factor with a theoretical frequency of 99% for cases and88% for controls, by clinical experience with a confiability of 95%. The case control ratio was 2 to 1. The instrument for collecting of information wasa questionaire designed for the study. The data was obtained by telefom. A bivariated analysis was performed done, calculating the differences of proportionsand the OR value, with confiability intervals and p value, with a confiability of 95%.Results: Median age was 38.3 years with a range between 21 and 57.Cases: Duration of disorder varied from 1 to 20 years, 32 had an homogeneous pattern (47.7%) 35 reticular (52.2%); centrofacial distribution wasthe most common (52.2%) followed by malar (35.8%) and in third place, mandibular (11.9%). Eigthy for cent 80.5% were more visible with Wood’slight, 16.4% didn’t show any difference and 3% were less visible.Risk factors: Risk factors, didn’t show significant association with melasma: skin phototype, number of pregnancies, actual use of contraceptives orother non hormonal drugs, hormonal therapy different from femenine hormones, history of thyroid disease and history of sola rexposure. A biggerdisparity reason for suffering the disease was confirmed for those with first degree relatives with melasma, with an OR 2.58 (1.08-6.73 intervals) and p= 0.029 and use of cosmetic makeup (powder or foundation) OR 3.69 (1.36-10.12) p = 0.0036. The intake of cola drinks was a protective factor OR0.021 (0.06-0.07) and p = 0.0026.Conclusions: We can conclude that of the many implicated factors for the development of melasma, by scientific studies of popular belief, only thefamily history of disease and the use of makeup were risks in women older then 18 years in the city of Medellin. The fact that colas intake acted as aprotective factor requires further studies

Reflexiones sobre la relación interpersonal enfermera-paciente en el ámbito del cuidado clínico / Reflections on the interpersonal relation nurse - patient in the field the clinical care

La tesis central de este artículo presenta a la enfermería como una relación humana entre un paciente y una enfermera, mediante la cual es posible reconocer y responder a la necesidad de ayuda y al problema del paciente. La reflexión está fundamentada en el pensamiento de Hildegard Peplau, quien construyó un modelo de cuidado para enfermería que plantea cómo en las relaciones interpersonales con los pacientes, la enfermera puede acercarse a los significados que éstos asignan a la enfermedad, a los comportamientos y a los sentimientos, para incorporarlos al cuidado y ayudarlos a dirigir sus potencialidades hacia formas útiles para sobrellevar sus dolencias. En la práctica profesional, la autora del artículo ha observado la forma en que los estados de inconciencia, la sedación obligatoria o la intubación endotraqueal, llevan a muchos pacientes hospitalizados en la unidad de cuidados intensivos, a tener interferencias en la comunicación con el entorno; esto suprime los símbolos para interpretar el ambiente y para actuar en consecuencia. Tanto la propuesta teórica como la experiencia profesional, permiten concluir que si los pacientes no tienen una interrelación eficaz con el entorno y con los enfermeros, se requiere que éstos los valoren integralmente para proponer alternativas de cuidado sustentadas en conocimientos científicos sólidos, habilidades prácticas y alto grado de sensibilidad humana para alcanzar la interpretación de la condición del paciente y ayudarlo a satisfacer sus necesidades básicas de bienestar

The aim of this article displays the nursing like a human relation between a patient and a nurse, by means of which it is possible to recognize and to respond to the necessity of aid and to the problem of the patient.The reflection is based on the thought of Hildegard Peplau, who constructed a model of nursing care about the interpersonal relations with the patients, which the nurse can approach the meaning that patients assign to the disease, to the behaviors and the feelings, in order to incorporate them to the care and to help them to lead their potentialities towards useful forms to bear its illness. At the professional practice, the author of this article has observed the form in which the unconsciousness, the obligatory sedation or the endotraqueal intubations, take to many patients hospitalized in the intensive cares units, to have interferences in the communication with the surroundings; this aspects suppresses the symbols to interpret the atmosphere and to act consequently. The theoretical proposal like the professional experience, they allow to conclude that if the patients do not have an effective interrelation with the surroundings and the nurses, it is required that the nurses value them integrally to propose sustained alternatives of care in solid scientific knowledge, abilities practical and stop degree of human sensitivity to reach the interpretation of the condition of the patient and for helping it to satisfy its basic necessities with well-being

Cambios con el acondicionamiento físico, en la PO2, la PCO2 y el Grado de Disnea en Pacientes con Enfermedad Pulmonar Obstructiva Crónica,del Hospital Universitario San Vicente de Paúl / Changes with Fitness in PO2, PCO2 and the Degree of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease, University Hospital San Vicente de Paul

Objetivo: estudiar los cambios en los gases arteriales (PaO2, PaCO2), la disnea y la tolerancia al ejercicio, en pacientes con EPOC, luego de un programa de rehabilitación pulmonar con acondicionamiento físico. Método: 24 pacientes con EPOC, divididos en grupo experimental (GE) y grupo control (GC) de 12 pacientes cada uno. A ambos, se les sometió a terapia respiratoria, se tomaron gases arteriales, espirometría y se realizó el índice de disnea basal (BDI) al inicio; y al terminar, el índice de disnea de transición (TDI) y se repitieron las mismas pruebas. El GE se sometió adicionalmente a un acondicionamiento físico por 12 semanas, previa prueba de esfuerzo en cicloergómetro y prueba de caminata de 6 minutos, que se repitieron al final. Resultados: se encontró un promedio significativamente más bajo (p<0.05) en las concentraciones de PaCO2 en el GE, comparado con el GC, al finalizar el programa (31.87±1.47mmHg vs 36.38±1.19mmHg). Se encontró mejoría estadísticamente significativa en la disnea demostrada con el TDI en el GE, comparado con el GC (0.45±0.81 vs +6.08±0.35). El coeficiente de determinación mostró que la variación del TDI, es explicado por la PO2, PaCO2 y VO2max en un 47% en el GE. Se observó incremento estadísticamente significativo en el GE en la tolerancia al ejercicio demostrada por aumento en: la distancia recorrida en la prueba de caminata de 6 minutos (Antes: 471.30±30.05 m; Después: 558.92±28.33 m), en la carga máxima movilizada (vatios); en la prueba de esfuerzo (Antes: 45.90±6.83W; Después: 59.54±7.14W); en el VO2max indirecto (antes: 15.09±2.14ml/kg/min; después: 17.80±1.93 ml/kg/min). Conclusión: este estudio sugiere que la capacidad funcional y la disnea mejoran en pacientes con EPOC, luego de un acondicionamiento físico

Objective: to study the changes in the arterial blood gases (PaO2, PaCO2), the dyspnea and the exercise tolerance, in patients with COPD, after a pulmonary rehabilitation program with physical fitness. Method: 24 patients with COPD, separated as experimental group (EG) and control group (CG) of 12 patients each one. Both groups were submitted to respiratory therapy, arterial blood gases test, spirometry and the basal dyspnea index (BDI) were taken at the beginning; and at the end, the transitional dyspnea index (TDI) was evaluated, and the same test were repeated. The EG underwent a program of physical fitness additionally for 12 weeks, previous they had an exercise test on a cycle ergometer and a 6-minute walking test, which were repeated at the end of the study. Results: we found one significantly lower average (p<0.05) in the level of PaCO2 obtained in the EG compared with the CG, at the end of the study (31.87±1.47mmHg vs. 36.38±1.19mmHg). Also, we finded improvement in the dyspnea with in the TDI in the EG, when comparing it with the CG (0.45±0.81 vs +6.08±0.35). The determination coefficient showed that the variation the TDI, is explained for the PO2, PaCO2 y VO2max in 47% in the EG.. We observed significant statistically increased in the exercise tolerance demostrated by: rise in reaching long the six-minute walking test in the EG (before: 471.30±30.05 m; after: 558.92±28.33 m), in the maximum work load (Watts) in the exercise test (before: 45.90±6.83W; after: 59.54±7.14W), in the indirect VO2max (before: 15.09±2.14ml/kg/min; after: 17.80±1.93ml/kg/min). Conclusion: this study suggests that functional capacity and the dyspnea can improve in the patients with COPD, after physical fitness

Cistoureterografía Miccional Seriada Pediátrica / A Series of Urinal Tract Retrograde Cystography (CUMS) in Pediatrics

Se exponen las causas que originan la realización del estudio radiológico CUMS en el niño y se argumentan razones que justifican la elaboración de un protocolo de cuidados de enfermería y los procedimientos correspondientes a la atención del niño/a. Protocolizar una actividad favorece y facilita su ejecución. Los cuidados de enfermería, como cualquier otra actividad, también son susceptibles de protocolizarse y con ello mejorar su calidad. En la unidad de enfermería de radiodiagnóstico pediátrico del H. U. Reina Sofía de Córdoba estamos elaborando protocolos de cuidados en cada uno de los estudios radiológicos, para la atención del niño que acude a este servicio y que precisa de cuidados de enfermería. En este trabajo se comentan algunos protocolos y procedimientos y las razones que justifican su elaboración (AU)

[Pediatric serial urinary cystoureterography. Needs, nursing diagnosis, and care protocol]. / Cistoureterografía miccional seriada pediátrica. Necesidades, diagnósticos de enfermería y potocolo de cuidados.

The authors present the causes which lead to carrying out a Series of Urinal Tract Retrograde Cystography (CUMS) study in a child and they discuss some reasons which justify the elaboration of a nursing treatment protocol and the corresponding procedures in order to care for the child. To make a protocol for a procedure facilitates and enhances its execution. Nursing treatments, like any other activity, are susceptible to having a protocol and therefore can improve their quality. Nurses in the radio-diagnostic pediatrics ward at the University Hospital Reina Sofía in Cordoba are elaborating treatment protocols for every one of their radiological studies for the care of every child to whom we attend whom requires nursing care. In this article some protocols and procedures are commented on along with the reasons which justify their elaboration.