Role of Incretins in Muscle Functionality, Metabolism, and Body Composition in Breast Cancer: A Metabolic Approach to Understanding This Pathology.

A poorly studied issue in women with breast cancer is the role of incretins (GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1)) in the quantity and quality of muscle mass in lean and obese individuals. The current report aims to analyze the patterns of association and the role of incretin in muscle functionality and body composition in women with cancer compared with healthy women (mammography BI-RADS I or II) to elucidate whether GIP and GLP-1 can be used to estimate the risk, in conjunction with overweight or obesity, for breast cancer. We designed a case-control study in women with a breast cancer diagnosis confirmed by biopsy in different clinical stages (CS; n = 87) and healthy women with a mastography BI-RADS I or II within the last year (n = 69). The women were grouped according to body mass index (BMI): lean (<25 kg/m2BS), overweight (≥25-<30 kg/m2BS), and obese (≥30 kg/m2BS). We found that GLP-1 and GIP levels over 18 pg/mL were associated with a risk of breast cancer (GIP OR = 36.5 and GLP-1 OR = 4.16, for the entire sample), particularly in obese women (GIP OR = 8.8 and GLP-1 OR = 6.5), and coincidentally with low muscle quality indexes, showed an association between obesity, cancer, incretin defects, and loss of muscle functionality.

Evaluation of the Renal Angina Index to Predict the Development of Acute Kidney Injury in Children With Sepsis Who Live in Middle-Income Countries.

OBJECTIVE: The renal angina index (RAI) provides a clinically feasible and applicable tool to identify critically ill children at risk of severe acute kidney injury (AKI) in high-income countries. Our objective was to evaluate the performance of the RAI as a predictor of the development of AKI in children with sepsis in a middle-income country and its association with unfavorable outcomes. METHODS: This is a retrospective cohort study in children with sepsis hospitalized in the pediatric intensive care unit (PICU) between January 2016 and January 2020. The RAI was calculated 12 hours after admission to predict the development of AKI and at 72 hours to explore its association with mortality, the need for renal support therapy, and PICU stay. RESULTS: We included 209 PICU patients with sepsis with a median age of 23 months (interquartile range, 7-60). We found that 41.1% of the cases (86/209) developed de novo AKI on the third day of admission (KDIGO 1, 24.9%; KDIGO 2, 12.9%; and KDIGO 3, 3.3%).Overall mortality was 8.1% (17/209), higher in patients with AKI (7.7% vs 0.5%, P < 0.01). The RAI on admission was able to predict the presence of AKI on day 3 (area under the curve (AUC), 0.87; sensitivity, 94.2%; specificity, 100%; P < 0.01), with a negative predictive value greater than 95%. An RAI greater than 8 at 72 hours was associated with a greater risk of mortality (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 2.0-3.2; P < 0.01), a need for renal support therapy (aOR, 2.9; 95% CI, 2.3-3.6; P < 0.01), and a PICU stay of more than 10 days (aOR, 1.54; 95% CI, 1.1-2.1; P < 0.01). CONCLUSIONS: The RAI on the day of admission is a reliable and accurate tool for predicting the risk of developing AKI on day 3, in critically ill children with sepsis in a limited resource context. A score greater than eight 72 hours after admission is associated with a higher risk of death, the need for renal support therapy, and PICU stay.

Association between bacterial resistance profile and the development of intra-abdominal abscesses in pediatric patients with perforated appendicitis: cohort study.

PURPOSE: The objective of this study was to determine the association between the presence of a microorganism resistant to the antibiotic used in empirical therapy and the development of intra-abdominal abscesses in children with perforated appendicitis. METHODS: A prospective cohort study was conducted in patients under 18 years of age who underwent laparoscopic appendectomy between November 1, 2019, and September 30, 2020, in whom perforated appendicitis was documented intraoperatively. Peritoneal fluid samples were taken for bacteria culture purposes, and clinical and microbiological data were collected from all patients. RESULTS: A total of 232 patients were included in the study. The most isolated microorganisms were Escherichia coli (80.14%) and Pseudomonas aeruginosa (7.45%). In addition, 5.31% of E. coli isolates were classified as ESBL-producing organisms. No association was found between a germ resistant to empiric antimicrobial therapy and the development of a postoperative intra-abdominal abscess. Multivariate analysis showed that being a high-risk patient on admission (OR 2.89 (p = 0.01)) was associated with the development of intra-abdominal abscesses postoperatively. CONCLUSION: E. coli was the most commonly isolated microorganism, with a low rate of ESBL-producing isolates. No association between resistance and risk of postoperative intra-abdominal abscess was found. However, it was identified that being a high-risk patient on admission was associated with this complication. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level I.

Prognostic Significance of Amino Acid and Biogenic Amines Profiling in Chronic Kidney Disease.

There is a pressing need for more precise biomarkers of chronic kidney disease (CKD). Plasma samples from 820 subjects [231 with CKD, 325 with end-stage kidney disease (ESKD) and 264 controls] were analyzed by liquid chromatography with tandem mass spectrometry (LC-MS/MS) to determine a metabolic profile of 28 amino acids (AAs) and biogenic amines to test their value as markers of CKD risk and progression. The kynurenine/tryptophan ratio showed the strongest correlation with estimated glomerular filtration rate values (coefficient = -0.731, p < 0.0001). Models created with orthogonal partial least squares-discriminant analysis (OPLS-DA) containing the metabolic signature showed a high goodness of fit and predictability for controls/CKD (R2X:0.73:R2Y:0.92:Q2:0.92, p < 0.0001) and lower values for CKD/ESKD (R2X:0.56:R2Y:0.59:Q2:0.55, p < 0.0001). Based on generated VIP scores, the most relevant markers for segregating samples into control/CKD and CKD/ESKD groups were citrulline (1.63) and tryptophan (1.47), respectively. ROC analysis showed that the addition of the metabolic profile to a model including CKD classic risk factors improved the AUC from 86.7% (83.6-89.9) to 100% (100-100) for CKD risk (p < 0.0001) and from 63.0% (58.2-67.8) to 96.5% (95.3-97.8) for the risk of progression from CKD to ESKD (p < 0.0001). Plasma concentrations of AAs and related amines may be useful as diagnostic biomarkers of kidney disease, both for CKD risk and for progression of CKD patients to ESKD.

Phase Angle in Head and Neck Cancer: A Sex-Differential Analysis from Biological and Clinical Behavior to Health-Related Quality of Life.

Head and neck cancer (H&NC) is a diverse category of tumors related to malignancies in the common aerodigestive pathway, with high metabolic rate, poor nutritional and treatment outcomes, and elevated mortality despite the best standard treatment. Herein, we focus on determining how the phase angle (PA) differs across sex as a predictor of poor prognosis, low quality-of-life (QoL) scores, and mortality in patients with head and neck cancer. This follow-up study presents a sex-differential analysis in a prospective cohort of 139 head and neck cancer patients categorized by sex as male (n = 107) and female (n = 32). Patients were compared in terms of nutritional, biochemical, and quality-of-life indicators between low and normal PA in women (<3.9° (n = 14, 43.75%) and ≥3.9°) and men (<4.5° (n = 62, 57.9%) and ≥4.5°). Our results show that most patients were in locally advanced clinical stages (women: n = 21 (65.7%); men: n = 67 (62.6%)) and that patients with low PA had a lower punctuation in parameters such as handgrip strength, four-meter walking speed, albumin, C-reactive protein (CRP), and CRP/albumin ratio (CAR), as well as the worst QoL scores in functional and symptomatic scales in both the male and female groups. A comparison between sexes revealed significant disparities; malnourishment and tumor cachexia related to an inflammatory state was more evident in the women's group.

Effects of Socio-educational Interventions on the Quality of Life of People with a Digestive Ostomy.

Introduction: The creation of digestive stomata is associated with a change in people's lives. Causing a strong impact that influences all dimensions of life. This paper reports on the effects of socio-educational interventions on the quality of life (QOL) of people with a digestive ostomy. Objective: To describe the effect of a nursing intervention on the QOL of people with a digestive ostomy. Methods: A quasiexperimental study was conducted whose sample consisted of 12 people who were ostomized in a public hospital in Colombia. Participants were selected through convenience sampling and randomly assigned to the intervention group and the control group. For the control group, an educational process was carried out through a theoretical session with virtual mediation (educational video). The QOL was evaluated before and after the interventions through the Montreux questionnaire. Results: The average age was 57(+7) years. No statistical differences were found between the groups in the QOL index or for any of the dimensions that make up QOL. Pretest and post-test analysis for each intervention separately showed improvement in two dimensions of QOL for each group; in the intervention group body image dimension (p = .017) and the positive coping dimension (p = .027). In the control group, the physical well-being dimension (p = .037) and social concerns dimension (p = .034). Conclusions: The personalized educational intervention or carried out through virtual pedagogical mediation, generated a clinically significant increase in the dimensions of QOL, without statistical differences. The study adds knowledge about the impact that digestive stomata have on the QOL, which is why it is necessary to establish specialized interdisciplinary teams to care for the person's new condition at home during the following months.

Phase Angle and Nutritional Status: The Impact on Survival and Health-Related Quality of Life in Locally Advanced Uterine Cervical Cancer.

The phase angle, an indicator of muscle mass status and membrane cell integrity, has been associated with low survival, poorer clinical outcomes, and worse quality of life among cancer patients, but information on women with uterine cervical cancer (UCCa) is scarce. In this prospective study, we used a bioelectrical impedance analyzer to obtain the PA of 65 women with UCCa. We compared the health-related quality of life and inflammatory and nutritional indicators between low PA and normal PA. The mean age was 52 ± 13. The low PA and normal PA groups differed in terms of the C-reactive protein (15.8 ± 19.6 versus 6.82 ± 5.02, p = 0.022), glucose (125.39 ± 88.19 versus 88.78 ± 23.08, p = 0.021), albumin (3.9 ± 0.39 versus 4.37 ± 0.30, p = 0.000), EORTC QLQ-C30 loss of appetite symptom scale score (33.33 (0.0-100.00) versus 0.0 (0.0-0.0), p = 0.005), and EORTC QLQ-CX24 menopausal symptoms scale score (0.0 (0.0-33.33) versus 0.0 (0.0-100.0), p = 0.03). The main finding of the present study is the interaction between PA and obesity as critical cofactors in the UCCa adeno and adenosquamous histologic variants, to a greater extent than cervical squamous cell carcinoma.

Influence of variability in the cyclooxygenase pathway on cardiovascular outcomes of nephrosclerosis patients.

Nephrosclerosis patients are at an exceptionally high cardiovascular (CV) risk. We aimed to determine whether genetic variability represented by 38 tag-SNPs in genes of the cyclooxygenase pathway (PTGS1, PTGS2, PTGES, PTGES2 and PTGES3) leading to prostaglandin E2 (PGE2) synthesis, modified CV traits and events in 493 nephrosclerosis patients. Additionally, we genotyped 716 controls to identify nephrosclerosis risk associations. The addition of three variants, namely PTGS2 rs4648268, PTGES3 rs2958155 and PTGES3 rs11300958, to a predictive model for CV events containing classic risk factors in nephrosclerosis patients, significantly enhanced its statistical power (AUC value increased from 78.6 to 87.4%, p = 0.0003). Such increase remained significant after correcting for multiple testing. In addition, two tag-SNPs (rs11790782 and rs2241270) in PTGES were linked to higher systolic and diastolic pressure [carriers vs. non-carriers = 5.23 (1.87-9.93), p = 0.03 and 5.9 (1.87-9.93), p = 0.004]. PTGS1(COX1) rs10306194 was associated with higher common carotid intima media thickness (ccIMT) progression [OR 1.90 (1.07-3.36), p = 0.029], presence of carotid plaque [OR 1.79 (1.06-3.01), p = 0.026] and atherosclerosis severity (p = 0.041). These associations, however, did not survive Bonferroni correction of the data. Our findings highlight the importance of the route leading to PGE2 synthesis in the CV risk experienced by nephrosclerosis patients and add to the growing body of evidence pointing out the PGE2 synthesis/activity axis as a promising therapeutic target in this field.

Sofropedagogía como estrategia de regulación motivacional para el aprendizaje de capacidades en Educación Física / Sophropedagogy as a motivational regulation strategy for learning skills in Physical Education

En un contexto de incertidumbre, estrés, incorporación de tecnología y procesos formativos híbridos se requiere de alternativas innovadoras sencillas y eficientes con posibilidades de mejorar la actuación y compromiso académico de los estudiantes en los procesos de enseñanza-aprendizaje del área de Educación Física (EF). El estudio tuvo por objetivo determinar el efecto de la sofropedagogía como estrategia de regulación motivacional para el aprendizaje de capacidades referidas al desarrollo de conciencia del esquema corporal y activación mental positiva en el área curricular de EF. Es una investigación cuasiexperimental con pre y post prueba sin grupo control, desarrollada en procesos formativos presenciales y no presenciales durante dos semestres académicos, con 150 estudiantes del ciclo inicial, intermedio y superior de la Escuela Profesional de Educación Física/Universidad Nacional del Altiplano, Puno-Perú. Los resultados destacan la factibilidad de incluir la sofropedagogía como un entrenamiento motivacional-inductor en los procesos formativos híbridos de enseñanza-aprendizaje, cuyos efectos en el aprendizaje de capacidades en EF fueron significativos: 0.000 menor a 0.05 según la prueba de rangos con signo de Wilconxon. Se concluye que la sofropedagogía ha mostrado otorgar opciones de autonomía-flexibilidad para planificar, ejecutar y monitorear acciones en relación a objetivos propuestos en el área de EF y se adapta fácilmente a calendarios, espacios y ritmos de aprendizaje individual-colectivo de los estudiantes de EF. (AU)

In a context of uncertainty, stress, incorporation of technology and hybrid training processes, simple and efficient innovative alternatives are required with the possibility of improving the performance and academic commitment of students in the teaching-learning processes in the area of Physical Education (PE). The study aimed to determine the effect of sophropedagogy as a motivational regulation strategy for learning skills related to the development of body schema awareness and positive mental activation in the PE curriculum area. It is a quasi-experimental research with pre and post test without control group, developed in face-to-face and non-face-to-face training processes during two academic semesters, with 150 students of the initial, intermediate and superior cycle of the Professional School of Physical Education / National University of the Altiplano, Puno. -Peru. The results highlight the feasibility of including sophropedagogy as a motivational-inducing training in hybrid teaching-learning training processes, whose effects on learning skills in PE were significant: 0.000 less than 0.05 according to the Wilconxon signed-rank test. It is concluded that sophropedagogy has shown to grant autonomy-flexibility options to plan, execute and monitor actions in relation to proposed objectives in the PE area and easily adapts to calendars, spaces and individual-collective learning rhythms of PE students. (AU)

Ansiedad, depresión, soledad y adopción del rol del cuidador de la persona en cuidado paliativo / Anxiety, depression, loneliness and role-taking in the caregiver of a person in palliative care

Introducción: Los cuidadores familiares de personas en cuidado paliativo (CP) se exponen continuamente a altas demandas de cuidado y a situaciones de angustia, lo que puede afectar su adopción del rol, ansiedad, depresión y percepción de soledad. Objetivo: Describir y correlacionar la ansiedad, depresión, soledad y adopción del rol en una muestra de cuidadores de personas en CP de Bogotá, Colombia.Materiales y métodos: Estudio cuantitativo transversal conducido en el primer semestre de 2021 con una muestra de 220 cuidadores familiares principales de personas en CP. Se usaron los instrumentos ROL, HADS y UCLA para medir la adopción del rol del cuidador, ansiedad y depresión, y soledad respectivamente. Fueron usados coeficientes de correlación de Pearson y modelos de regresión lineal para analizar la relación entre las variables. Resultados: El 75 % de las personas en CP tenían cáncer, el 63,2 % con índice de Karnofsky de 30 y con una edad promedio de 69,4 años. El 81,8 % de los cuidadores fueron mujeres, con edad promedio de 47,7 años, el 85,5 % cuida a la persona desde el momento del diagnóstico con una dedicación promedio de 20 h diarias de cuidado; además el 34,2 % se autorreportó enfermo. Los cuidadores que tuvieron menores puntajes de adopción del rol tendieron a presentar mayores niveles de ansiedad, depresión y soledad (p < 0,05). Conclusión: Se requieren intervenciones de cuidado transicional de cuidador familiar de la persona en CP dado su mayor riesgo de presentar soledad, ansiedad y depresión, que promuevan una adopción del rol satisfactoria y que, con ello, mejore los resultados en estos. (AU)

Introduction: Family caregivers of people in palliative care (PC) are continually exposed to high demands for care and situations of distress, which can affect their adoption of the role, causing anxiety, depression, and a perception of loneliness. Aim: To describe and correlate anxiety, depression, loneliness, and role adoption in a sample of caregivers of people in PC in Bogotá, Colombia. Materials and methods: A cross-sectional quantitative study was conducted in the first half of 2021 with a sample of 220 main family caregivers of people in PC. The ROL, HADS, and UCLA instruments were used to measure role-taking, anxiety, depression, and loneliness, respectively. Pearson’s correlation coefficients and linear regression models were used to analyze the relationship between variables. Results: 75 % of people in PC had cancer, 63.2 % with a Karnofsky index of 30 and a mean age of 69.4 years; 81.8 % of the caregivers were women, with an average age of 47.7 years; 85.5 % cared for the patient from the time of diagnosis, with an average dedication of 20 hours of care per day. In addition, 34.2 % self-reported illness. Caregivers who had lower role-adoption scores tended to have higher levels of anxiety, depression, and loneliness (p < 0.05). Conclusion: Transitional care interventions are needed for the family caregivers of people in PC given their greater risk of having loneliness, anxiety, and depression, to promote satisfactory role-taking and thus improve their results. (AU)

Polymorphisms in glucose homeostasis genes are associated with cardiovascular and renal parameters in patients with diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) has become the major cause of end-stage kidney disease and is associated to an extremely high cardiovascular (CV) risk. METHODS: We screened 318 DN patients for 23 SNPs in four glucose transporters (SLC2A1, SLC2A2, SLC5A1 and SLC5A2) and in KCNJ11 and ABCC8, which participate in insulin secretion. Regression models were utilised to identify associations with renal parameters, atherosclerosis measurements and CV events. In addition, 506 individuals with normal renal function were also genotyped as a control group. RESULTS: In the patient's cohort, common carotid intima media thickness values were higher in carriers of ABCC8 rs3758953 and rs2188966 vs. non-carriers [0.78(0.25) vs. 0.72(0.22) mm, p < 0.05 and 0.79(0.26) vs. 0.72(0.22) mm, p < 0.05], respectively. Furthermore, ABCC8 rs1799859 was linked to presence of plaque in these patients [1.89(1.03-3.46), p < 0.05]. Two variants, SLC2A2 rs8192675 and SLC5A2 rs9924771, were associated with better [OR = 0.49 (0.30-0.81), p < 0.01] and worse [OR = 1.92 (1.15-3.21), p < 0.05] CV event-free survival, respectively. With regard to renal variables, rs841848 and rs710218 in SLC2A1, as well as rs3813008 in SLC5A2, significantly altered estimated glomerular filtration rate values [carriers vs. non-carriers: 30.41(22.57) vs. 28.25(20.10), p < 0.05; 28.95(21.11) vs. 29.52(21.66), p < 0.05 and 32.03(18.06) vs. 28.14(23.06) ml/min/1.73 m2, p < 0.05]. In addition, ABCC8 rs3758947 was associated with higher albumin-to-creatinine ratios [193.5(1139.91) vs. 160(652.90) mg/g, p < 0.05]. The epistasis analysis of SNP-pairs interactions showed that ABCC8 rs3758947 interacted with several SNPs in SLC2A2 to significantly affect CV events (p < 0.01). No SNPs were associated with DN risk. CONCLUSIONS: Polymorphisms in genes determining glucose homeostasis may play a relevant role in renal parameters and CV-related outcomes of DN patients.

[How do patients on dialysis experience their disease? A qualitative approach]. / ¿Como viven su enfermedad las personas en diálisis?: una mirada cualitativa a la experiencia del paciente.

BACKGROUND: End-stage chronic kidney disease is a severe public health problem due to the poor quality of life of patients on dialysis and the costs associated with renal replacement treatment. AIM: To understand the social representations of kidney disease of people on dialysis. MATERIAL AND METHODS: In a qualitative study under the post-positivist paradigm, eighteen patients in peritoneal or hemodialysis participated in an in-depth interview. The analysis was performed using content analysis. RESULTS: Eight categories were identified: Friends, Health Care Team, Spirituality and Disease, Family, Health Support System, Physical Consequences, Psychosocial Consequences, Self-Care of Continuous Health-Disease. CONCLUSIONS: Health care of people on dialysis should take into consideration the experience of kidney disease from the perspective of the patient, including his beliefs and feelings and involving the family, community, and the state.

Effectiveness of a case management model for people with multimorbidity: Mixed methods study.

AIMS: The aim was to determine the impact of a case management model on indicators of health service utilization, polypharmacy, quality of life and dependency of patients with multimorbidity, and family caregiver overload in a group of patients insured with two insurance companies in the city of Bogotá (Colombia). DESIGN: This was a mixed methods study, which integrated a quantitative and qualitative component. METHODS: The study was conducted between July 2019 and March 2020. A quantitative component is based on a pre-experimental study with a single group and pre- and post-test measurements. Patients with multimorbidity with a medium or high level of complexity were included in the study. A sample of 317 patients and their caregivers was estimated. Following the completion of the intervention, a descriptive study that explored the perspective of nurses, patients and caregivers was developed to better understand the process and results from their own words and experience. A total of 17 dyads of patients and caregivers were interviewed, as well as six nurse managers. The integration strategy was developed based on a comparison made from the perspective of multiple stakeholders. RESULTS: The model's impact on quality of life, particularly in terms of social functioning and mental health, has been documented. Caregiver overload was reduced and an improvement in the adoption of the role was observed, aspects that converge with the experience of the dyads and the caregivers in the support and backing provided by the model. CONCLUSION: The intervention was structured in five modules: case detection, complexity screening, comprehensive assessment with various instruments, individualized care and follow-up plan, and plan assessment. The nurse manager role is confirmed as that of a professional with the leadership capacity to articulate disciplines and actors, whilst also dealing with the day-to-day needs of people with complex health conditions. IMPACT: A comprehensive and integrated approach to patients with multiple diseases in a health insurance context marked by access barriers and fragmentation of health services. The study provides quantitative and qualitative evidence of the benefits of the case management model in Colombia for patients with multiple diseases and their family caregivers, particularly in terms of the psychosocial dimensions of health-related quality of life and dependence assessment. A significant impact on the caregiver role, as well as an improvement in perception and trust in the health system, was observed as a result of the overcoming of administrative barriers achieved by the nurse case manager. The findings are considered to be extremely useful for decision-makers and insurers in developing a case management model focused on comprehensive and individualized care plans, as well as for individuals with multiple diseases and their caregivers.

Análisis del impacto presupuestal en Colombia de la prueba de HPV con genotipificación comparada con la citología / Budget impact analysis of primary screening with the HPV test and genotyping against conventional cytology in Colombia

Introducción. La detección del virus del papiloma humano mediante la combinación de la prueba de HPV y otras técnicas como la citología, ha demostrado su eficacia en el diagnóstico y tratamiento oportuno de lesiones asociadas con el cáncer de cuello uterino. Objetivo. Estimar el impacto presupuestal de la estrategia de detección temprana del HPV mediante la prueba de genotipificación combinada con la citología en comparación con la citología convencional, en mujeres de 30 a 65 años participantes en el programa de tamizaje de cáncer de cuello uterino en una Entidad Administradora del Plan de Beneficios en salud (EAPB) en Colombia. Materiales y métodos. Utilizando un árbol de decisiones y un modelo de Markov, se estimaron las implicaciones clínicas y los costos directos anuales de dos ciclos de tamizaje, diagnóstico y tratamiento, en una cohorte de mujeres. Las prevalencias de los resultados clínicos y los costos se tomaron de la base de datos de una EAPB y la información de la progresión, persistencia y regresión de los estados de salud provinieron del estudio ATHENA. Resultados. El esquema de tamizaje con la prueba de HPV, la genotipificación y la citología resultó en un ahorro de costos comparado con la citología convencional. El costo promedio por ciclo de tamizaje con la prueba de HPV se estimó en COP $129'201.363 y con la citología en COP $186'309.952, es decir, un ahorro de COP $57'108.589 (30,7 %). Conclusión. La implementación de la estrategia de tamizaje evaluada sugiere que habría ahorros derivados de la detección temprana de los estados de salud asociados con el desarrollo de cáncer de cuello uterino.

Introduction: The detection of the human papillomavirus (HPV) through the combination of the HPV test and other techniques such as cytology has impacted the detection and timely treatment of lesions associated with cervical cancer. Objective: To estimate the budgetary impact of the strategy of early detection of HPV with DNA test genotyping with reflex cytology versus conventional cytology in women aged 30 to 65 years attending the cervical cancer screening program at a health benefit managing entity in Colombia. Materials and methods: Using a decision tree and a Markov model, the clinical implications and direct costs of screening, diagnosis, and treatment were estimated in a cohort of women. The analysis considered two screening cycles and their annual costs. The data on the prevalence of clinical results and the costs were taken from the health managing entity. The information on the progression, persistence, and regression of the health states were taken from the ATHENA study. Results: The screening scheme with the HPV test, genotyping, and reflex cytology compared to conventional cytology was cost-saving. The average cost per screening cycle with the HPV test was estimated at COP $ 129,201,363 and with cytology at COP $ 186,309,952, i.e., a saving of COP $ 57,108,589 (30.7%). Conclusion: The implementation of the screening strategy under evaluation suggests prospective savings derived from the early detection of health states associated with the development of cervical cancer.

Tag-SNPs in Phospholipase-Related Genes Modify the Susceptibility to Nephrosclerosis and its Associated Cardiovascular Risk.

Nephrosclerosis patients have a high cardiovascular (CV) risk that is very often of more concern than the renal disease itself. We aimed to determine whether variants in phospholipase-related genes, associated with atherosclerosis and CV outcomes in the general population, could constitute biomarkers of nephrosclerosis and/or its associated CV risk. We screened 1,209 nephrosclerosis patients and controls for 86 tag-SNPs that were identified in the SCARB1, PLA2G4A, and PLA2G7 gene loci. Regression models were utilized to evaluate their effect on several clinical parameters. Most notably, rs10846744 and rs838880 in SCARB1 showed significant odds ratios (OR) of 0.66 (0.51-0.87), p = 0.003 and 1.48 (1.11-1.96), p = 0.007 for nephrosclerosis risk. PLA2G4A and PLA2G7 harboured several SNPs associated with atherosclerosis measurements in the patients, namely common carotid intima media thickness (ccIMT), presence of plaques, number of plaques detected and 2-years ccIMT progression (significant p-values ranging from 0.0004 to 0.047). Eight SNPs in PLA2G4A were independent risk factors for CV events in nephrosclerosis patients. Their addition to a ROC model containing classic risk factors significantly improved its predictive power from AUC = 69.1% (61.4-76.9) to AUC = 79.1% (73.1-85.1%), p = 0.047. Finally, PLA2G4A rs932476AA and rs6683619AA genotypes were associated with lower CV event-free survival after controlling for confounding variables [49.59 (47.97-51.21) vs. 51.81 (49.93-51.78) months, p = 0.041 and 46.46 (41.00-51.92) vs. 51.17 (50.25-52.08) months, p = 0.022, respectively]. Variability in phospholipase-related genes play a relevant role in nephrosclerosis and associated atherosclerosis measurements and CV events.

Body Fat Distribution, Adipocytokines Levels and Variability in Associated Genes and Kidney Transplant Outcomes.

Introduction: Body fat distribution is known to contribute to a variety of pathologies. Research Questions: We aimed to assess whether this distribution is associated with clinical outcomes in renal transplant recipients (RTR) and to examine its relationship with leptin and adiponectin gene variants and plasma concentrations. Design: Bioelectrical impedance analyses were performed in 236 RTR. Leptin/adiponectin levels were measured by immunoassay and relevant polymorphisms in the leptin receptor (LEPR) and adiponectin (ADIPOQ) genes were identified. Associations were assessed by logistic regression modeling. Results: The waist-to-height ratio (WHr) displayed a significant association with delayed graft function, acute rejection and post-transplant diabetes mellitus, with OR values of 2.04 (1.02-4.08) p = 0.045; 3.08 (1.22-7.79) p = 0.017 and 2.79 (1.16-6.74) p = 0.022, respectively. Waist circumference was linked to delayed graft function [OR = 1.03 (1.01-1.05), p = 0.025] and AR [OR = 1.041 (1.01-1.07), p = 0.009]. Leptin levels were significantly higher in patients who experienced rejection [19.91 ± 23.72 versus 11.22 ± 16.42 ng/ml; OR = 1.021 (1.01-1.04), p = 0.017]. The ADIPOQ rs1501299TT genotype showed a significant association with higher WHr (0.63 ± 0.11 vs 0.59 ± 0.87 for GG/GT genotypes; p = 0.015) and WC values (102.3 ± 14.12 vs 96.38 ± 14.65 for GG/GT genotypes; p = 0.021). Conclusion: WC, and especially WHr, are associated with adverse outcomes in renal transplantation and are affected by variability in the ADIPOQ gene.

¿Como viven su enfermedad las personas en diálisis?: una mirada cualitativa a la experiencia del paciente

Background: End-stage chronic kidney disease is a severe public health problem due to the poor quality of life of patients on dialysis and the costs associated with renal replacement treatment. Aim: To understand the social representations of kidney disease of people on dialysis. Material and Methods: In a qualitative study under the post-positivist paradigm, eighteen patients in peritoneal or hemodialysis participated in an in-depth interview. The analysis was performed using content analysis. Results: Eight categories were identified: Friends, Health Care Team, Spirituality and Disease, Family, Health Support System, Physical Consequences, Psychosocial Consequences, Self-Care of Continuous Health-Disease. Conclusions: Health care of people on dialysis should take into consideration the experience of kidney disease from the perspective of the patient, including his beliefs and feelings and involving the family, community, and the state.

Adhesivos y dispositivos médicos: lesiones en piel / Adhesives and medical devices: skin injuries

Objetivo Analizar información bibliográfica relacionada con las principales lesiones ocasionadas por los adhesivos tisulares, y el manejo de los dispositivos médicos. Metodología Revisión documental durante los meses de mayo, junio y julio de 2018 búsqueda exhaustiva de 68 artículos en diferentes bases de datos como PubMed, Scielo, Elsevier, Scient Direct, FECYT, Embase, Ovid Nursing y Medline. Con criterios de búsqueda como lesiones cutáneas y lesiones por dispositivos médicos de los cuales se tomaron 50 artículos teniendo en cuenta como método de inclusión el año (no mayor a 6 años de publicado) y la pertinencia en el tema de lesiones en piel por adhesivos y dispositivos clínicos. Resultados Las lesiones cutáneas más comunes son: reacciones alérgicas y las lesiones derivadas de los actos inseguros que alteran seguridad y bienestar del paciente, derivados de las prácticas por parte del personal médico y de enfermería. Conclusiones El uso de adhesivos tisulares y dispositivos de uso clínico prevé una problemática, que debe ser tratada con educación y estrategias de prevención.

Objective To analyze bibliographic information related to the main injuries caused by tissue adhesives, and the management of medical devices. Methodology Documentary review during the months of May, June and July of 2018 exhaustive search of 68 articles in different databases such as PubMed, Scielo, elsevier, Direct, FECYT, Embase, Ovid Nursing and Medline, with search criteria such as skin lesions and injuries by medical devices of which 50 were taken into account as inclusion method the year (no more than 6 years of publication) and the pertinence in the topic of skin lesions by adhesives and clinical devices. Results The most common skin lesions are: allergic reactions and injuries derived from unsafe acts that alter the safety and well-being of the patient, derived from the practices by medical and nursing staff. Conclusions the use of tissue adhesives and devices for clinical use, foresees a problem that must be treated with education and prevention strategies.

Indicadores de un programa de gestión en cuidado paliativoen Colombia: seguimiento retrospectivo / Indicators of a palliative care management program in Colombia: a retrospective follow-up

Objetivo: Comparar el seguimiento a indicadores de cuidado paliativo (CP) de un programaimplementado en Bogotá, Colombia, entre marzo de 2019 y febrero de 2020.Materiales y métodos: Estudio descriptivo, comparativo, retrospectivo desarrollado con baseen los indicadores de un programa de CP. La muestra correspondió a una cohorte de 391 personas. Fueron considerados indicadores: la frecuencia de eventos hospitalarios, días de estanciahospitalaria, admisiones a unidad de cuidado intensivo (UCI), consulta a urgencias, consumode opioides, frecuencia de uso de servicios profesionales, dolor, bienestar, calidad de vida,satisfacción y uso de recursos financieros.Resultados: Se reportó menor frecuencia de eventos hospitalarios, uso de cuidados intensivos,consulta a urgencias (p < 0,01), mayor consumo de opioides en el último mes de vida (p < 0,01)y menor gasto de recursos financieros (p < 0,01) en los usuarios del programa de CP comparadoscon los usuarios susceptibles de CP. Se reportó una frecuencia de uso de servicios profesionalespor paciente y por mes entre 0,86 y 3,6, siendo la consulta por terapia respiratoria y enfermeríalos más frecuentes. Se observaron indicadores de satisfacción y bienestar por encima del 80 %,mientras que el control del dolor estuvo en el 74,1 %.Conclusión: Existen efectos potenciales de la inclusión de pacientes en un programa de CPsobre la percepción del bienestar, control del dolor y satisfacción del paciente con efectos quese extienden al uso de recursos en salud y su consecuente contención del gasto financiero. Serequieren estudios futuros que permitan establecer relaciones causales entre el programa conlos resultados financieros y los de los pacientes. (AU)

Aim: To compare follow-up among palliative care (PC) indicators of a program implemented inBogotá, Colombia, between March 2019 and February 2020.Materials and methods: A descriptive, retrospective study was developed based on the indicatorsof a PC program. The sample involved a cohort of 391 people. Considered indicators includedfrequency of in-hospital events, days of hospital stay, admissions to the Intensive Care Unit(ICU), emergency room visits, opioid use, frequency of professional services, pain, well-being,quality of life, satisfaction, and use of financial resources.Results: A lower frequency was reported for in-hospital events, use of ICU, emergency roomvisits (p < 0.01), higher use of opioids in the last month of life (p < 0.01), and lower financialexpenses (p < 0.01) among users of the PC program compared with the those susceptible ofPC. The frequency of professional service usage per patient and by month was reported to bebetween 0.86 and 3.6, with respiratory therapy and nursing visits being most common. Satisfaction and well-being indicators were observed above 80 %, whilst pain management was 74.1 %.Conclusion: There are potential effects of the inclusion of patients in a PC program on well-beingperception, pain management, and patient satisfaction, with effects that extend to usage of healthresources and consequent financial expense contention. Future studies are required that will allowestablishing causal relations between a PC program with positive financial results and patients. (AU)

A Custom Target Next-Generation Sequencing 70-Gene Panel and Replication Study to Identify Genetic Markers of Diabetic Kidney Disease.

Diabetic kidney disease (DKD) has been pointed out as a prominent cause of chronic and end-stage renal disease (ESRD). There is a genetic predisposition to DKD, although clinically relevant loci are yet to be identified. We utilized a custom target next-generation sequencing 70-gene panel to screen a discovery cohort of 150 controls, DKD and DKD-ESRD patients. Relevant SNPs for the susceptibility and clinical evolution of DKD were replicated in an independent validation cohort of 824 controls and patients. A network analysis aiming to assess the impact of variability along specific pathways was also conducted. Forty-eight SNPs displayed significantly different frequencies in the study groups. Of these, 28 with p-values lower than 0.01 were selected for replication. MYH9 rs710181 was inversely associated with the risk of DKD (OR = 0.52 (0.28-0.97), p = 0.033), whilst SOWAHB rs13140552 and CNDP1 rs4891564 were not carried by cases or controls, respectively (p = 0.044 and 0.023). In addition, the RGMA rs1969589 CC genotype was significantly correlated with lower albumin-to-creatinine ratios in the DKD patients (711.8 ± 113.0 vs. 1375.9 ± 474.1 mg/g for TC/TT; mean difference = 823.5 (84.46-1563.0); p = 0.030). No biological pathway stood out as more significantly affected by genetic variability. Our findings reveal new variants that could be useful as biomarkers of DKD onset and/or evolution.