Resilience in Caregivers: A Systematic Review.

BACKGROUND: Resilience is a multidimensional construct that explains why people facing the consequences of adversity and stress can have a positive outcome, emphasizing adjustment to experiences that are perceived as threatening. OBJECTIVE: The aim of this study is to review the construct of resilience and associated variables in caregivers of patients with chronic, advanced illness and at the end of life. METHODS: The review included studies published between January 2009 and January 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide reporting. The Medline, ScienceDirect, HINARI, PsychINFO, and SciELO databases were used for bibliographic exploration to identify research studies that examined the impact of resilience on adaptation and overall well-being in caregivers of patients with chronic and advanced illness. RESULTS: A total of 23 quantitative and qualitative studies were identified whose aim was to describe the role of resilience in adaptation and coping in caregivers. In these studies, resilience was associated with a positive impact on the quality of life and emotional distress. Communication and social support increase resilient coping strategies. In most selected articles, the sampling strategy used was convenience sampling. Data collection used evaluation scales related to resilience and associated variables for quantitative studies, and semistructured interviews were used for qualitative studies. CONCLUSION: Promoting a resilient coping style in caregivers reduces the distress that normally results from illness-related changes in the biopsychosocial and spiritual dimensions. A resilient coping style can diminish the risk of stress and burden, and promote adaptation in the caregiver.

Different sodium salts cause different solute accumulation in the halophyte Prosopis strombulifera.

The success of Prosopis strombulifera in growing under high NaCl concentrations involves a carefully controlled balance among different processes, including compartmentation of Cl(-) and Na(+) in leaf vacuoles, exclusion of Na(+) in roots, osmotic adjustment and low transpiration. In contrast, Na(2) SO(4) causes growth inhibition and toxicity. We propose that protection of the cytoplasm can be achieved through production of high endogenous levels of specific compatible solutes. To test our hypothesis, we examined endogenous levels of compatible solutes in roots and leaves of 29-, 40- and 48-day-old P. strombulifera plants grown in media containing various concentrations of NaCl, Na(2) SO(4) or in mixtures of both, with osmotic potentials of -1.0,-1.9 and -2.6 MPa, as correlated with changes in hydric parameters. At 24 h after the last pulse plants grown in high NaCl concentrations had higher relative water content and relatively higher osmotic potential than plants grown in Na(2) SO(4) (at 49 days). These plants also had increased synthesis of proline, pinitol and mannitol in the cytoplasm, accompanied by normal carbon metabolism. When the sulphate anion is present in the medium, the capacities for ion compartmentalisation and osmotic adjustment are reduced, resulting in water imbalance and symptoms of toxicity due to altered carbon metabolism, e.g. synthesis of sorbitol instead of mannitol, reduced sucrose production and protein content. This inhibition was partially mitigated when both anions were present together in the solution, demonstrating a detrimental effect of the sulphate ion on plant growth.

La experiencia de sufrimiento en cuidadores principales de pacientes con dolor oncológico y no oncológico / The experience of suffering in main care takers of patients with cancer-pain and non-cancer pain / A experiência de sofrimento em cuidadores principais de pacientes com dor oncológica e não oncológica

El objetivo de la investigación es describir la experiencia de sufrimiento de los cuidadores informales de pacientes con dolor oncológico y no oncológico de tres instituciones de salud de Medellín. Es una investigación cualitativa de tipo fenomenológico. La muestra estuvo conformada por 16 cuidadores de pacientes con dolor oncológico y no oncológico. La información se recolectó a través de una entrevista semiestructurada y se cuantificó el nivel de sufrimiento por medio del termómetro emocional como complemento al enfoque cualitativo. Los datos obtenidos se analizaron por medio de categorías y perfiles previamente definidos, lo cual dio cuenta del significado, el nivel y los factores de sufrimiento más comunes en los cuidadores entrevistados.Los resultados evidenciaron que la mayoría de los cuidadores experimentaron altos niveles de sufrimiento. Reportaron sentimientos de tristeza y satisfacción contradictoriamente. En la esfera cognitiva, asociaron el sufrimiento con dolor y con el hacer bien su actividad; y en el área conductual, refirieron que el sufrimiento se relacionaba con la dificultad para el control de los síntomas físicos del paciente, y con el aplazamiento de actividades propias de su vida.En conclusión, el apoyo psicosocial recibido por los cuidadores no fue percibido como factor protector para la disminución del sufrimiento; el tipo de dolor estaba relacionado con la experiencia de sufrimiento y el rol de cuidadores, quienes en su mayoría eran mujeres cuidadoras de pacientes con dolor oncológico. Los cuidadores entrevistados estaban en riesgo de presentar Burnout debido a las múltiples demandas propias de su rol.

The purpose of the study is to describe the experience of suffering among informal care takers of patients with cancer-pain and non-cancer pain at three health institutions of Medellín-Colombia.It is a qualitative study of phenomenological type. The sample consisted of 16 care takers of patients who suffered cancer-pain and non-cancer pain. The information was gathered through a semi-structured interview, the level of suffering was quantified through the emotional thermometer as a complementing element to the qualitative approach. The data obtained were analyzed through categories and profiles previously defined which showed the most common meaning, level and factors of suffering among the interviewed care takers.The results showed that the majority of care takers experienced high levels of suffering. They reported feelings of sadness and satisfaction in a contradictory manner. In the cognitive realm, they associated suffering with pain and the good execution of their activity; in the behavioral field, they expressed that suffering was related to the difficulty in controling the patient’s physical symptoms, and with the deferral of their own life activities.In conclusion, the psychological support received by the care takers was perceived as a protecting factor to reduce suffering; the type of pain was related to the experience of suffering and the care taker’s role, who were mostly female care takers of patients with cancer pain. The interviewed care takers were at risk of presenting Burnout due to the multiple demands inherent to their role.

A pesquisa visa descrever a experiência de sofrimentos dos cuidadores informais de pacientes com oncológica e não oncológica em três instituições de saúde em Medellín.É uma pesquisa qualitativa de tipo fenomenológico. A amostra esteve conformada por 16 cuidadores de pacientes com dor oncológica e não oncológica. A informação foi coletada através de uma entrevista semi-estruturada e se quantificou o nível de sofrimento por meio do termômetro emocional como complemento à abordagem qualitativa. Os dados obtidos foram analisados mediante categorias e perfis previamente definidos que dão conta do significado, do nível e dos fatores de sofrimento mais comuns nos cuidadores entrevistados.Os resultados evidenciaram que os níveis de sofrimento na maioria dos cuidadores eram altos. Também, observaram-se sentimentos contraditórios de tristeza e satisfação. No âmbito cognitivo, associaram o sofrimento com dor e com o fato de fazerem bem sua atividade; e na parte comportamental apontaram que o sofrimento estava ligado à dificuldade para controlar os sintomas físicos do paciente, e com o adiamento de atividades próprias de sua vida.Em conclusão, o apoio psicossocial recebido pelos cuidadores não foi percebido como fator protetor para a diminuição do sofrimento; o tipo de dor estava relacionado com a experiência de sofrimento e o papel de cuidadores, que eram maiormente pacientes com dor oncológica. Os cuidadores entrevistados estavam em risco de apresentar Burnout por causa das múltiples demandas de sua função.

Surveillance of toxigenic fungi and ochratoxin A in feedstuffs from Córdoba Province, Argentina.

The aim of this work was to evaluate the incidence of potential ochratoxigenic mycoflora and ochratoxin A (OA) in poultry, pig and rabbit feeds. Eighty poultry, pig and rabbit feed samples were taken at random from factories located from Córdoba province, Argentina, over a period of 8 months. Isolation and quantitative enumeration of fungal propagules were done on DRBC and DG18 media. The predominant species were A. candidus, A. flavus, A. terreus, A. parasiticus, P. implicatum, P. minioluteum, P. crustosum and P. citrionigrum. The distribution of section Nigri species varied according to the feedstuffs analysed. The frequency of A. niger var. niger was noticeably high in poultry feed samples on DRBC medium. The Nigri section species was present at moderate mean colony counts (CFU/g) from three feeds. Mycotoxin analysis of these samples showed that OA was detected in 15%, 10% and 12% of pig, poultry and rabbit feed samples, respectively. The mean levels detected ranged between 15 and 25 ng/g from three feeds. The presence of ochratoxigenic species of Nigri section and OA in feeds indicates the risk of potential exposure of poultry, pigs and rabbits through the ingestion of feeds.

Survey of mycoflora and ochratoxin A in dried vine fruits from Argentina markets.

AIMS: The aims of this work were to identify the mycoflora and to evaluate the natural occurrence of OA in dried vine fruits. Likewise, the capacity to produce OA by Aspergillus section Nigri was studied. MATERIALS AND METHODS: Fifty samples of dried vine fruits were obtained from Mendoza and San Juan provinces. The surface disinfection method was used for mycoflora determination using the medium dichloran 18% glycerol agar (DG18) and dichloran Rose Bengal chloramphenicol agar (DRBC). RESULTS: Statistical analysis demonstrated that the species A. niger var. niger and Aspergillus niger var. awamori were isolated in higher frequency from black dried vine fruits from DRBC and DG18 media (P < 0.01). OA was found in 74% of the dried vine fruits samples. Sixty-two strains (28%) of Aspergillus section Nigri, were OA producers. In the species A. carbonarius the highest percentages of ochratoxigenic strains were detected (82.6%). CONCLUSIONS: The presence of ochratoxigenic strains of Nigri section in dried vine fruits suggests that they may be an important source of OA in this substrate. Dried vine fruits can also be an important source of OA people who consume large amounts. SIGNIFICANCE AND IMPACT OF THE STUDY: The dried vine fruits contamination with Aspergillus section Nigri and OA was significant.

Mycoflora and ochratoxin-producing strains of Aspergillus section Nigri in wine grapes in Argentina.

AIMS: The aims of this work were to evaluate the mycoflora and to identify the species of Aspergillus with the potential to produce ochratoxin A (OA) from different wine grape varieties from Mendoza, Argentina. Likewise, the capacity to produce OA by Aspergillus section Nigri was studied. METHODS AND RESULTS: Fifty samples of wine grapes were obtained from a winery of Mendoza province, Argentina. The surface-disinfection method was used for mycoflora determination using the medium dichloran 18% glycerol agar (DG18). Alternaria, Aspergillus and Penicillium were identified at species level. OA production was tested in 63 strains belonging to section Nigri. Alternaria genus was the most frequent (80% of the samples) followed by Aspergillus (70%). Alternaria alternata was the only specie identified from the Alternaria genus, followed by A. niger var. niger, A. flavus among others. From Penicillium genus, P. crysogenum was the most frequent specie. From 63 strains of Aspergillus section Nigri, 41.3% were OA producers. The levels of produced toxin ranged from 2 to 24.5 ng ml-1 of culture medium. CONCLUSIONS: The presence of ochratoxigenic strains of Nigri section in this substrate suggests that they may be an important source of OA in grapes from tropical and subtropical zones. Therefore, the industry should work further to diminish the growth of these fungi and mycotoxins formation in grapes, with the aim to reduce OA content in wine products. SIGNIFICANCE AND IMPACT OF THE STUDY: The wine grape contamination with A. alternata and Aspergillus section Nigri was significant.

Detection of ochratoxin A in animal feeds and capacity to produce this mycotoxin by Aspergillus section Nigri in Argentina.

Ochratoxin A (OA) is a mycotoxin detected in a variety of food and feeds mostly from countries with a temperate climate because of the fungi that produce it, mainly Aspergillus ochraceus and Penicillium verrucosum. In Argentina, there is no available information about the natural occurrence of OA and ochratoxigenic fungi from feedstuffs. The aim was to evaluate the natural occurrence of OA in poultry, pig and rabbit feeds over 8 months. Likewise, the capacity to produce OA by Aspergillus section Nigri was investigated. Mycotoxin analysis showed that in some months of sampling, OA was detected in three feeds. OA was found in 38% of the poultry feed samples tested with levels ranging from 25 to 30 ng g(-1). From rabbit feed samples, 25% contained OA and the levels ranged from 18.5 to 25 ng g(-1). Only 13% of the pig feed samples were contaminated with similar levels of toxins. Ninety-four black Aspergillus strains from feedstuffs were tested for OA production. Among these, the tested species were A. niger var. niger, A. niger var. awamori, A. japonicus var. japonicus, A. japonicus var. aculeatus and A. foetidus. For the detection of OA, three methodologies were applied: the two TLC methods used for the fast screening of the filamentous fungi for the production of OA were not sensitive enough to detect OA in any of the black Aspergillus strains. When an HPLC methodology was used, the results showed that 46% of the black Aspergillus strains were producers of OA, with levels ranging from 13 to 25 ng ml(-1) culture medium. The highest percentage of ochratoxicogenic strains was isolated from rabbit feeds with 100 and 78% of A. niger var. niger and A. niger var. awamori, with mean levels of 15.5 and 14.6 ng ml(-1), respectively. From pig feeds, 61% of the A. niger var. awamori were producers of this toxin with mean levels of 16 ng ml(-1). In poultry feeds, the lowest percentage of OA producer strains was detected. The results for the occurrence of OA in feeds from different sampling months depended on storage and humidity-temperature conditions. Therefore, a good storage practice becomes very important to prevent OA production

The mycoflora and toxicity of feedstuffs from a production plant in córdoba, Argentina.

Feedstuffs used for poultry nutrition in Argentina were analyzed for fungal flora and natural incidence of mycotoxins. Survey of 120 samples of poultry feeds, taken from May 1998 to April 1999, showed the presence of 15 genera of filamentous fungi. The predominant genera wereFusarium spp. andPenicillium ssp., isolated in 67.5 % of the samples, followed byAspergillus spp. (57.5 %). Yeast, were significantly isolated from most of the samples. Species identification was carried down for the toxigenic genera. Fungal total counts of poultry feeds ranged from 2.0 × 10(3) to 3.0 × 10(5) CFU g(-1) The fungal total counts during two months of sampling, were slightly over the limit value of 1 × 105 CFU g(-1), which ensure the hygienic quality of the feed. Potentially toxicogenic species presented moderate mean colony counts. Many of the fungi isolated from poultry feeds are mycotoxin producers. Fumonisins had the highest incidence, and were found in 97 % of the analyzed samples followed by aflatoxin B1 (46 %), zearalenone (18 %) and deoxynivalenol (6 %). On the co-occurrence of both carcinogenic mycotoxins, all of the FBs contaminated feed samples were co-contaminated with AFB1. The results show the relevance of the samples screening for viable fungi propagules and the surveillance of their associated mycotoxins in poultry feeds.

Efficacy of synthetic zeolite to reduce the toxicity of aflatoxin in broiler chicks.

Synthetic zeolites (NaX, NaY, NaA, and CaA) were evaluated in vitro for their ability to sorb aflatoxin (AF) B1 from an aqueous solution. Zeolite NaA (ZN) was selected to be tested in vivo because of its high affinity and its stable association with AFB1. This sorbent was incorporated into diets (1%) containing 2.5 mg/kg AFB1. Male broiler chicks from 21 to 42 d of age received ad libitum access to their respective diets and water. When compared with controls, BW gains were lower (P < 0.05) for broilers that were fed AF in their diets. No differences were found between the BW gains of chicks fed diets without AF and those of chicks fed AF + ZN, indicating almost total protection against the effects caused by AF. Liver weights were considerably higher in chicks fed a diet containing AF, compared with those of controls, nevertheless, no significant differences were found in feed:gain ratio among the groups. The findings of this research suggest that ZN can counteract some of the toxic effects of AF in growing broiler chicks.

Multiple sclerosis: association to HLA DQalpha in a tropical population.

Studies performed in subtropical populations have found significant association between the phenotype multiple sclerosis (MS) and the major histocompatibility complex (MHC). We present the results of a case-control study conducted on a tropical population (Antioquia, Colombia) in order to detect a possible association between MS and HLA DQalpha (HLA DQA1*) alleles. Forty chromosomes belonging to MS patients were compared to two sets of controls (40 and 910 chromosomes, respectively). The HLA DQA1*0101 and DQA1*0102 alleles were found in a significantly higher proportion among the cases than among the controls, whereas the HLA DQA1*0103 allele was found in a significantly lower proportion of the cases. These results suggest that the association of HLA DQA1*0101, DQA1*0102 and DQA1*0103 to the MS phenotype found in Caucasian subtropical populations remains in individuals with MS inhabiting the tropics. This finding could mean that the major genetic component associated to the MHC in subtropical populations is the same in the tropics.

Mycoflora and naturally occurring mycotoxins in poultry feeds in Argentina.

The purpose of this work was to determine the mycoflora and mycotoxins natural incidence in poultry feeds from 2 factories in Río Cuarto, Córdoba. One hundred and thirty samples were taken from May/1996 to May/1997. The most dominant species isolated of poultry feed samples belonged to the genera Aspergillus spp 85% and Fusarium spp 70%. From Aspergillus genus eleven species were identified and A. flavus was the most frequent. Nine species were identified from the Fusarium genus and the predominant was F. moniliforme. Penicillium ranked third in the number of isolated cases. From this genus twelve species were collected of which P. brevicompactum (15%), P. restrictum (14%) and P. purpurogenum (12%) were the most common. The most significant mycotoxin from poultry feeds was aflatoxin B1 (AFB1) found in 48% of the samples, with levels ranging from 10 to 123 ng/g. For zearalenone (ZEA) the levels were 327 to 5, 850 ng/g and DON was not detected from the samples. Due to the fact that in Argentina there is little information about this topic, these data on poultry feeds in our region would be of worldwide interest.

Status epiléptico en una unidad de terapia intensiva pediátrica / Status epilepticus in an unit of pediatric intensive care

Objetivo: Analizar retrospectivamente la epidemiología de pacientes con Status Epiléptico. Diseño: Trabajo retrospectivo y descriptivo. Lugar: Unidad de Cuidados Intensivos Pediátricos. Pacientes: Los comprendidos entre 1 mes y 16 años (n = 54). Mediciones y principales resultados: Edad media: 37 meses, n mediana: 22 meses. El 54,7 por ciento fueron menores de 2 años, con leve predominio masculino. La etiología fue febril en un 11 por ciento, injuria aguda: 48 por ciento; injuria remota: 32 por ciento e idiopática en un 7 por ciento. Como forma de presentación fueron generalizadas en un 56 por ciento; focales en un 27,8 por ciento y secundariamente generalizadas en un 16,7 por ciento. Las complicaciones se presentaron en 11 pacientes (20 por ciento), entre ellas sepsis 45 por ciento; NAR en un 27 por ciento y SDRA en un 9 por ciento. La mortalidad global fue de un 22,5 por ciento (12 pacientes). Tuvieron mayor riesgo de muerte los pacientes con altos valores de PRISM (OR 1,23 p < 0,018) y los que presentaban complicaciones (OR 19,4 p = 0,0041). El uso de Tiopental se asoció significativamente a mayor mortalidad (p = 0,0031). Conclusión: La mortalidad de nuestra serie fue alta, probablemente debido a la gravedad de los pacientes estudiados. El PRISM alto, las complicaciones, el uso de Tiopental, y el uso de ARM, son variables que influyen negativamente en la evolución de los pacientes con Status Epiléptico (AU)

Status epiléptico en una unidad de terapia intensiva pediátrica / Status epilepticus in an unit of pediatric intensive care

Objetivo: Analizar retrospectivamente la epidemiología de pacientes con Status Epiléptico. Diseño: Trabajo retrospectivo y descriptivo. Lugar: Unidad de Cuidados Intensivos Pediátricos. Pacientes: Los comprendidos entre 1 mes y 16 años (n = 54). Mediciones y principales resultados: Edad media: 37 meses, n mediana: 22 meses. El 54,7 por ciento fueron menores de 2 años, con leve predominio masculino. La etiología fue febril en un 11 por ciento, injuria aguda: 48 por ciento; injuria remota: 32 por ciento e idiopática en un 7 por ciento. Como forma de presentación fueron generalizadas en un 56 por ciento; focales en un 27,8 por ciento y secundariamente generalizadas en un 16,7 por ciento. Las complicaciones se presentaron en 11 pacientes (20 por ciento), entre ellas sepsis 45 por ciento; NAR en un 27 por ciento y SDRA en un 9 por ciento. La mortalidad global fue de un 22,5 por ciento (12 pacientes). Tuvieron mayor riesgo de muerte los pacientes con altos valores de PRISM (OR 1,23 p < 0,018) y los que presentaban complicaciones (OR 19,4 p = 0,0041). El uso de Tiopental se asoció significativamente a mayor mortalidad (p = 0,0031). Conclusión: La mortalidad de nuestra serie fue alta, probablemente debido a la gravedad de los pacientes estudiados. El PRISM alto, las complicaciones, el uso de Tiopental, y el uso de ARM, son variables que influyen negativamente en la evolución de los pacientes con Status Epiléptico

[Prevalence of neurocysticercosis in individuals affected by epilepsy]. / Prevalencia de neurocisticercosis en individuos afectados de epilepsia.

INTRODUCTION: In this investigations, was carried out a neurocysticercosis (NC) prevalence study during seven months in the Instituto Neurológico de Antioquia with the purpose of known neurocysticercosis frequency as cause of epilepsy in patients older than ten years that we attended in our institute. MATERIAL AND METHODS: Computerized tomographies (CT) were made to 503 patients, with epilepsy, 24.7% of them were CT positive for NC. Cysticercosis enzyme linked immunoelectrotransfer blot (EITB) and enzyme linked immunoabsorbent assay (ELISA) test were made to 178 patients, 19.6% were EITB positive for NC and 5% ELISA positive for NC. Results. From this result it is possible to infer that about 8% of the 503 patients with epilepsy had cysticercosis, according to EITB that is the golden assay for NC. The CT and ELISA test had 94.3% and 27.7% sensitivity, respectively, according to EITB. The specificity of the CT for NC was 49.2% and specificity for ELISA test was 100% as compared to EITB. The multivariate analysis with logistic regression allowed to establish association of positive EITB with factors such as male sex, eating pork, headaches and multiple lesions in CT. CONCLUSIONS: Prevention and education actions are necessary for the interruption of the neurocysticercosis transmission chain in order to diminish the high prevalence of epilepsy in the country and its complication and consequences.