Next generation sequencing characterizes HLA diversity in a registry population from the Netherlands.

Next generation DNA sequencing is used to determine the HLA-A, -B, -C, -DRB1, -DRB3/4/5, and -DQB1 assignments of 1009 unrelated volunteers for the unrelated donor registry in The Netherlands. The analysis characterizes all HLA exons and introns for class I alleles; at least exons 2 to 3 for HLA-DRB1; and exons 2 to 6 for HLA-DQB1. Of the distinct alleles present, there are 229 class I and 71 class II; 36 of these alleles are novel. The majority (approximately 98%) of the cumulative allele frequency at each locus is contributed by alleles that appear three or more times. Alleles encoding protein variation outside of the antigen recognition domains are 0.6% of the class I assignments and 5.3% of the class II assignments.

Ethnic differences in fat and muscle mass and their implication for interpretation of bioelectrical impedance vector analysis.

According to the World Health Organization Expert Consultation, current body mass index (BMI) cut-offs should be retained as an international classification. However, there are ethnic differences in BMI-associated health risks that may be caused by differences in body fat or skeletal muscle mass and these may affect the interpretation of phase angle and bioelectrical impedance vector analysis (BIVA). Therefore, the aim of this study was to compare body composition measured by bioelectrical impedance analysis among 1048 German, 1026 Mexican, and 995 Japanese adults encompassing a wide range of ages and BMIs (18-78 years; BMI, 13.9-44.3 kg/m2). Regression analyses between body composition parameters and BMI were used to predict ethnic-specific reference values at the standard BMI cut-offs of 18.5, 25, and 30 kg/m2. German men and women had a higher fat-free mass per fat mass compared with Mexicans. Normal-weight Japanese were similar to Mexicans but approached the German phenotype with increasing BMI. The skeletal muscle index (SMI, kg/m2) was highest in Germans, whereas in BIVA, the Mexican group had the longest vector, and the Japanese group had the lowest phase angle and the highest extracellular/total body water ratio. Ethnic differences in regional partitioning of fat and muscle mass at the trunk and the extremities contribute to differences in BIVA and phase angle. In conclusion, not only the relationship between BMI and adiposity is ethnic specific; in addition, fat distribution, SMI, and muscle mass distribution vary at the same BMI. These results emphasize the need for ethnic-specific normal values in the diagnosis of obesity and sarcopenia.

Full gene HLA class I sequences of 79 novel and 519 mostly uncommon alleles from a large United States registry population.

HLA class I assignments were obtained at single genotype, G-level resolution from 98 855 volunteers for an unrelated donor registry in the United States. In spite of the diverse ancestry of the volunteers, over 99% of the assignments at each locus are common. Within this population, 52 novel alleles differing in exons 2 and 3 are identified and characterized. Previously reported alleles with incomplete sequences in the IPD-IMGT/HLA database (n = 519) were selected for full gene sequencing and, from this sampling, another 27 novel alleles are described.

[Health care team and parents' opinion about pediatric patients identification]. / Evaluación de la opinión del equipo de salud y padres sobre la identificación de los pacientes pediátricos.

INTRODUCTION: Patient misidentification continues to be a quality and safety significant issue. The Joint Commission International listed patient identification as the first of ten life-saving patient-safety solutions. Identification wrist bands are the goal in the identification strategy. At the Hospital Nacional de Pediatría "Prof. Dr. J.P. Garrahan" we inquired about perception and agreement of this practice within hospital staff and parents. METHOD: A short questionnaire was used with; in the first part a four point Lickert scale, and in the second one an open unstructured response. The questionnaire was distributed among health care workers and parent's patients. For families, the third question was not administrated. The survey explored about purpose and opportunity regarding the use of wrist band identification. A one day cutoff was made to obtain baseline data for properly use of identification bands. RESULTS: A total of 300 questionnaires were analyzed, 100 for each cluster (physicians, nurses, and parents); 82% responded that the wrist band should stay along the whole hospitalizing period. A range of 64% to 74% within the groups responded that it is helpful to prevent errors. There was no statistical difference between parents and physicians. Overall, percentage of patient with correct identification band in the hospital was 34%. CONCLUSIONS: We concluded that the wrist band identification is not a health care workers priority behavior yet. Initiatives on safety patient identifications, including families and healthcare workers, must be developed in the near future.

Evaluación de la opinión del equipo de salud y padres sobre la identificación delos pacientes pediátricos / Health care team and parents opinion about pediatric patients identification

Introducción. La correcta identificación del paciente es esencial para la seguridad de la atención:la pulsera identificadora del paciente internado es una estrategia en la prevención del error médico.Sin embargo, en la realidad, la identificación de la totalidad de los pacientes es un tema pendiente.Objetivo. Conocer la opinión del equipo de salud y los padres respecto al procedimiento de identificaciónde los pacientes en el Hospital Nacionalde Pediatría “Prof. Dr. Juan P. Garrahan” y medir la adhesión a esta práctica.Método. Se realizó una encuesta al equipo de salud en una semana, autoadministrada y anónima, de tres preguntas sencillas con respuesta cerrada (4 ítems con escala de Likert), acerca de la opinión sobre la identificación de los pacientes, conun espacio abierto para observaciones. El mismo cuestionario, con excepción de la tercera pregunta, fue administrado a los padres de los pacientes. Serealizó un corte de un día evaluando porcentaje de pacientes correctamente identificados.Resultados. Se realizaron 300 encuestas a médicos (100), enfermeros (100) y padres (100). El 82 por cientocontestó que los pacientes debían tener pulsera identificadora en todo momento durante la internación.Un 64-74 por ciento contestó que era útil para prevenir errores. No se encontraron diferencias significativas entre padres y médicos. Sin embargo,sólo el 34 por ciento de los pacientes se encontraban correctamente dentificados. Conclusiones. La discrepancia entre la opinión y la práctica indica que la identificación de los pacientes no representa aún un eslabón prioritarioen la seguridad y la calidad de la atención.Por lo tanto, es necesario desarrollar estrategias para mejorar la cultura de la seguridad.

Introduction. Patient misidentification continues to be a quality and safety significant issue. The Joint Commission International listed patient identification as the first of ten life-saving patient-safety solutions. Identification wrist bands are the goal in the identification strategy. At the Hospital Nacional de Pediatría "Prof. Dr. J.P. Garrahan" we inquired about perception and agreement of this practice within hospital staff and parents.Method. A short questionnaire was used with; in the first part a four point Lickert scale, and in the second one an open unstructured response. The questionnaire was distributed among health care workers and parent's patients. For families, the third question was not administrated. The survey explored about purpose and opportunity regarding the use of wrist band identification. A one day cutoff was made to obtain baseline data for properly use of identification bands.Results. A total of 300 questionnaires were analyzed, 100 for each cluster (physicians, nurses, and parents); 82% responded that the wrist band should stay along the whole hospitalizing period. A range of 64% to 74% within the groups responded that it is helpful to prevent errors. There was not statistical difference between parents and physicians. Overall, percentage of patient with correct identification band in the hospital was 34%.Conclusions. We concluded that the wrist band identification is not a health care workers priority behavior yet. Initiatives on safety patient identifications, including families and health care workers, must be developed in the near future.

Evaluación de la opinión del equipo de salud y padres sobre la identificación delos pacientes pediátricos / Health care team and parents opinion about pediatric patients identification

Introducción. La correcta identificación del paciente es esencial para la seguridad de la atención:la pulsera identificadora del paciente internado es una estrategia en la prevención del error médico.Sin embargo, en la realidad, la identificación de la totalidad de los pacientes es un tema pendiente.Objetivo. Conocer la opinión del equipo de salud y los padres respecto al procedimiento de identificaciónde los pacientes en el Hospital Nacionalde Pediatría ¶Prof. Dr. Juan P. Garrahan÷ y medir la adhesión a esta práctica.Método. Se realizó una encuesta al equipo de salud en una semana, autoadministrada y anónima, de tres preguntas sencillas con respuesta cerrada (4 ítems con escala de Likert), acerca de la opinión sobre la identificación de los pacientes, conun espacio abierto para observaciones. El mismo cuestionario, con excepción de la tercera pregunta, fue administrado a los padres de los pacientes. Serealizó un corte de un día evaluando porcentaje de pacientes correctamente identificados.Resultados. Se realizaron 300 encuestas a médicos (100), enfermeros (100) y padres (100). El 82 por cientocontestó que los pacientes debían tener pulsera identificadora en todo momento durante la internación.Un 64-74 por ciento contestó que era útil para prevenir errores. No se encontraron diferencias significativas entre padres y médicos. Sin embargo,sólo el 34 por ciento de los pacientes se encontraban correctamente dentificados. Conclusiones. La discrepancia entre la opinión y la práctica indica que la identificación de los pacientes no representa aún un eslabón prioritarioen la seguridad y la calidad de la atención.Por lo tanto, es necesario desarrollar estrategias para mejorar la cultura de la seguridad.(AU)

Introduction. Patient misidentification continues to be a quality and safety significant issue. The Joint Commission International listed patient identification as the first of ten life-saving patient-safety solutions. Identification wrist bands are the goal in the identification strategy. At the Hospital Nacional de Pediatría "Prof. Dr. J.P. Garrahan" we inquired about perception and agreement of this practice within hospital staff and parents.Method. A short questionnaire was used with; in the first part a four point Lickert scale, and in the second one an open unstructured response. The questionnaire was distributed among health care workers and parents patients. For families, the third question was not administrated. The survey explored about purpose and opportunity regarding the use of wrist band identification. A one day cutoff was made to obtain baseline data for properly use of identification bands.Results. A total of 300 questionnaires were analyzed, 100 for each cluster (physicians, nurses, and parents); 82% responded that the wrist band should stay along the whole hospitalizing period. A range of 64% to 74% within the groups responded that it is helpful to prevent errors. There was not statistical difference between parents and physicians. Overall, percentage of patient with correct identification band in the hospital was 34%.Conclusions. We concluded that the wrist band identification is not a health care workers priority behavior yet. Initiatives on safety patient identifications, including families and health care workers, must be developed in the near future.(AU)

A nursing analysis of the causes of and approaches for urinary incontinence among elderly women in nursing homes.

Urinary incontinence is a widespread but often ignored problem among elderly women residing in nursing homes. Despite numerous research studies performed within this setting, few have been able to demonstrate lasting change in the care of and enduring outcomes in this population. However, neither the most commonly used definitions of incontinence nor current management approaches are meeting the needs of institutionalized frail elderly, particularly women, who are twice as likely as men to demonstrate symptoms of the condition. Costs in terms of quality of life and expense of care are staggering. Because many believe that a holistic approach may provide direction for management of urinary incontinence, and because nursing is a holistic profession, a solution to the challenges involved in treating incontinence among the elderly potentially lies in utilizing a nursing as opposed to medical framework for the analysis of factors and care. Specifically, the complexities of testing necessary to differentiate current diagnoses might be simplified by classifying incontinence in a different way, such as using nurse-identified levels of need as opposed to physiologically-based factors. The use of nursing theory to guide patient assessment and an evaluation of systems of care provides a fresh approach to this long-standing problem.

Maternal adherence to the zidovudine regimen for HIV-exposed infants to prevent HIV infection: a preliminary study.

OBJECTIVE: To describe the extent of adherence to the recommended neonatal zidovudine (ZDV) regimen administered to infants who have been exposed to the human immunodeficiency virus (HIV) to prevent mother-to-child transmission of HIV and to determine which maternal factors are associated with compliance. METHODS: HIV-infected women (n = 87) who were participating in a larger study of perinatal transmission at 3 inner-city New York City hospitals were interviewed 2 to 6 weeks' postpartum to assess adherence to neonatal prophylaxis, social support, social network factors, and depression. In addition, plasma samples of 45 of their infants were assayed for ZDV levels. RESULTS: A majority of women (71%) administered all of the prescribed 4 daily doses in the previous week, as measured by interview; self-reported adherence was not associated with any maternal characteristics. In contrast, poor adherence, as measured by lower infant ZDV plasma levels, was associated with asymptomatic HIV illness in the mother and having 2 or more other children; good adherence, as indicated by higher ZDV levels, was associated with the presence of a maternal social support network, disclosure of HIV infection, and mothers' adherence to their own ZDV regimens during pregnancy. In multivariate regression analyses, maternal asymptomatic status (beta = -0.40) was associated with lower infant ZDV levels, and maternal adherence during pregnancy (beta = 0.37) was associated with higher levels. CONCLUSIONS: Women who are HIV asymptomatic and lack a social support network are more likely not to comply with the recommended neonatal prophylactic regimen of antiretroviral therapy. Future studies should address the prenatal period and social network factors, such as disclosure of serostatus, and the custody of other children.

Ergotismo por automedicación / Ergotism by automedication

Los autores informan sobre 7 casos clínicos de ergotismo gangrenoso (6 mujeres y 1 hombre) provocado por la ingestión inmoderada de ergotamina ministrada para aliviar las crisis de migraña. En todos los enfermos estaban presentes síntomas y signos clínicos, ecográficos y angiográficos de constricción arterial severa y ninguno sufrió alucinaciones. El ergotismo fue tratado con la suspensión de la ergotamina, la ministración de vasodilatadores y la simpatectomía. Después del tratamiento, la mejoría de los 7 pacientes fue evidente por la desaparición de los síntomas y signos de isquemia distal y aumento significativo (P < 0.05) del índice pletismográfico de perfusión sanguínea, medido por medio de la ecografía Doppler. Estos cambios fueron observados aún en un paciente que perdió 2 dedos del pie derecho, secundariamente al ergotismo gangrenoso. Si bien, ninguno de los enfermos manifestó alucinaciones, los autores hacen referencia al primer uso del cornezuelo de centeno, reconocido históricamente, en las ceremonias mágico religiosas de Eleusis de la Grecia clásica; así, como al caso de brujería de Salem, Nueva Inglaterra, en 1692. La migraña no puede ser considerada banal; frecuentemente, causa desesperación del enfermo, que se intoxica con la ergotamina, cuando es sólo este medicamento el recomendado por su médico tratante. En consecuencia, el médico especialista, familiar, general o rural, debe conocer perfectamente la terapia profiláctica de las crisis de migraña con medicamentos vasodilatadores y así, reducir la posibilidad de ergotismo.

Paraganglioma vagal: reporte de caso y revisión de la literatura / Vagal paraganglioma: a case report and review of the literature

Objetivo: Reportar un caso de paraganglioma vagal, diagnosticado y tratado en el Servicio de Angiología del Hospital de Especialidades del Centro Médico "La Raza" y realizar revisión de la incidencia del mismo. Método: Se presenta el caso de una paciente con paraganglioma vagal sometida a resección quirúrgica y radioterapia. Se analizan las manifestaciones clínicas y parámetros utilizados para el diagnóstico de los paragangliomas vagales, así como los criterios de malignidad. Se discute el rol de la radioterapia y secreción hormonal, realizando análisis de la incidencia en el servicio y revisión bibliográfica sobre el tema. Resultados: El caso reportado es de una paciente de 53 años con paraganglioma vagal derecho de hallazgo casual. Sometida a cirugía, se realizó resección parcial y luego radioterapia. La incidencia fue de 1.25 por ciento de todos los paragangliomas tratados en el Servicio de Angiología en un periodo de cuatro años. En la literatura existen reportados 190 casos. Conclusión: El paraganglioma es un muy raro tumor de la base de cráneo generalmente benigno, la presencia de metástasis es el único criterio indiscutible de malignidad, el tratamiento ideal es la resección quirúrgica total.