Enfermedad de Parkinson: abordaje enfermero desde atención primaria / Parkinson's disease: Nursing approach from primary health care

Introducción: La enfermedad de Parkinson es un trastorno crónico neurodegenerativo de inicio insidioso y de curso prolongado. Tiene una mayor incidencia en las personas de edad avanzada; la edad media de inicio es de 57 años. Los cuidados que reciben los pacientes influyen en su calidad de vida. Se ha realizado una revisión bibliográfica de los datos publicados hasta el momento sobre qué necesidades tienen los enfermos de párkinson en fases iniciales y qué cuidados requieren. El objetivo principal del estudio ha sido determinar los cuidados de enfermería en los pacientes de párkinson recién diagnosticados en atención primaria. Resultados: Las necesidades más demandadas en la fase inicial de la enfermedad se relacionan con la movilidad, la eliminación y el sueño/reposo. Las intervenciones se programan según la necesidad de cada paciente. Conclusiones: La detención precoz del diagnóstico de la enfermedad de Parkinson mejorará la eficacia de la intervención y dará lugar a un enlentecimiento del progreso de la enfermedad. La importancia de informar y educar al paciente sobre los aspectos fundamentales y el pronóstico evolutivo de la enfermedad de Parkinson son fundamentales para mejorar la capacidad de afrontamiento del individuo

Introduction: Parkinson's disease is a chronic neurodegenerative disorder with insidious beginning and prolonged course. It has a higher impact in elderly people; the average age of onset is 57 years. The care that patients receive affect their quality of life. A literature review of the published data so far has been made to know which kind of needs the Parkinson's patients have in the early stages and which type of care they require. The main objective of this study has been to establish the nursing care for newly diagnosed Parkinson's patients at primary health care. Results: The most requested needs in the early stage of Parkinson's disease are related to mobility, elimination and sleep/rest. The interventions are programmed according to the needs of each patient. Conclusions: The early diagnosis of Parkinson's disease will improve the efficiency of the intervention and it will result in a slower progression of the disease. The importance of informing and educating the patient about the fundamental aspects and the evolution of the prognosis of Parkinson's disease are fundamental to improve the individual's ability of coping

Los enfermos de Alzheimer y sus cuidadores: intervenciones de enfermería / Alzheimer's patients and their caregivers: nursing interventions

Introducción: La enfermedad de Alzheimer es una demencia que afecta a un número cada vez mayor de personas. Estos pacientes precisan de una atención continua, prestada habitualmente por sus familiares. El cuidador informal es la persona encargada de realizar el cuidado no profesional de los pacientes dependientes, lo que puede conllevar en ellos repercusiones físicas, sociales y psíquicas, susceptibles de intervención profesional. El objetivo es analizar las necesidades más demandadas por familiares de pacientes de Alzheimer, estudiar los recursos sociosanitarios ofertados y concretar las competencias enfermeras en el abordaje del paciente y su familia. Material y métodos: Revisión bibliográfica en Cuiden, Elsevier, Dialnet, SciELO y Google Academic, de aquellos trabajos que analizan las necesidades, recursos sociosanitarios y competencias de enfermería sobre la enfermedad de Alzheimer. En total se analizaron 40 artículos. Resultados: Las necesidades más demandadas por los cuidadores son las de información, formación, ayuda física, atención al duelo y apoyo social. Los recursos sociosanitarios disponibles para facilitar la atención de estos son la atención a domicilio y diurna de no internamiento entre otros. Los cuidadores perciben que no se utilizan todos los recursos sociosanitarios disponibles. Los enfermeros aportan apoyo y cuidado, y destacan sobre todo las intervenciones de tipo psicoeducativo. Conclusión: Las necesidades de los cuidadores abarcan las dimensiones física, psíquica y social. Los recursos sociosanitarios a disposición de los cuidadores se encuentran infrautilizados y las intervenciones enfermeras más valoradas son las estrategias de educación sanitaria. Es preciso seguir investigando para ampliar los conocimientos que permitan ofrecer cuidados de calidad

Introduction: Alzheimer disease is a dementia which affects an increasing number of people. Those patients require continued assistance which is usually given by their relatives. The informal carer is the person in charge of the non-professional care of the dependent patients. This can imply physical, social and psychic repercussions, susceptible to professional intervention. The goal is analysing the most demanding necessities by the relatives of Alzheimer’s patients, studying the offered socio-health resources and concreting the nursing competencies in the approach of the patient and his family. Material and methods: Bibliographic revision in Cuiden, Elsevier, Dialnet, SciELO and Google Academic, of those works which analyse the necessities, sociohealth resources and nursing competences about Alzheimer disease. Overall forty articles were analysed. Results: The most demanding necessities by the cares are related with the information, formation, physical help, grief attention and social support. The available socio-health resources to ease their attention are for instance, the home care and the daytime and non-hospitalized attention. The cares observe that the available socio-health resources are not completely used. The nurses give support and care, especially in the psychoeducational interventions. Conclusion: The necessities of the cares cover physical, psychic and social dimensions. Their available socio-health resources are untapped and the most valued nursing interventions are the health education strategies. It is necessary to carry out more research in order to broaden the knowledge which allows us to provide good quality cares

Asociación de familiares de enfermos de Alzheimer cubriendo un vacío / Association of relatives of Alzheimer patients filling a gap

Introducción: Existe una alta prevalencia de adultos mayores diagnosticados de demencia que generan una importante demanda de cuidados y recursos sociosanitarios. Los centros de día atienden a las personas en situaciones de dependencia y facilitan la integración familiar. Nuestras preguntas iniciales son acerca de las asociaciones de enfermos y familiares. ¿Cómo surgen y se organizan? ¿Qué servicios ofrecen? ¿Qué competencias desarrollan los profesionales de enfermería? Objetivo: Analizar la percepción que tienen los miembros del equipo de una asociación de familiares de enfermos de Alzheimer y otras demencias sobre el funcionamiento y el servicio que ofrecen a la sociedad. Material y métodos: Estudio cualitativo descriptivo, realizado en una asociación de familiares de enfermos de Alzheimer. Se realizan tres entrevistas semiestructuradas respetando las consideraciones éticas establecidas para los trabajos de investigación con personas. Resultados: Surgen tres categorías en el análisis de los relatos, la historia de la asociación, la estructura y organización del equipo interdisciplinar, destacando las competencias del profesional de enfermería y la oferta de servicios que ha desarrollado. Conclusiones: La asociación surge ante las necesidades de atención sentidas por parte de las familias y que no obtienen respuesta en otras instituciones. Se ha consolidado como un recurso imprescindible cuyo objetivo es mantener a la persona dependiente en su medio habitual y proporcionar apoyo a sus cuidadores. Atiende desde un equipo interdisciplinar que contribuye al desarrollo de unos fines comunes, donde la enfermería desarrolla las competencias propias de la profesión

Introduction: There is a high prevalence of elderly diagnosed of dementia that generates an important demand of well-taken care of and socio-sanitary resources. The day care centers take care of the people in dependency situations and facilitate familiar integration. Our initial questions are about the Associations of patients and relatives. How arises and how they are organized? What services do they offer? What competences develop the nurse professionals? Aim: To analyze the perception which the members of the equipment have of an Alzheimer´s patients relatives Association and other dementias on the operation and the service that offer to the society. Material and methods: Descriptive qualitative study, made in an Alzheimer´s Relatives Association. Three semi structured interviews are made respecting the established ethical considerations for the investigation works with people. Results: Three categories in the analysis arise from the stories, the history of the Association, the structure and organization of the multidisciplinary equipment, emphasizing the competitions of the nurse professional and the supply of services that it has developed. Conclusions: The Association arises from the needs of heartfelt attention from families and that do not obtain answer in other institutions. It has established as an essential resource whose aim is to maintain to the disabled person in its usual means and to provide support to its caretakers. It takes care of from a multidisciplinary equipment that contributes to the development of common aims, where nursing develops the own competitions of the profession

Gastroenteritis eosinofílica y obstrucción intestinal, ¿es la cirugía evitable? / Eosinophilic gastroenteritis and bowel obstruction. Can surgery be avoided?

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Uso directo de identificación cromogénica y antibiograma directo (E-test) sobre muestra clínica para la identificación y estudio de sensibilidad de uropatógenos / Direct use of chromogenic identification and antibiogram (E-test) on clinical samples in order to perform identification and susceptibility tests on urinary pathogens

La obtención rápida y asequible de resultados es prioritaria. Para ello propusimos la realización de identificación y antibiograma sobre muestras de orina directa, mediante placa cromogénica CPS® y E-test (BioMérieux, Francia). Se evaluó la concordancia con los procedimientos standard, estableciendo un protocolo paralelo a la rutina haciendo lecturas de identificación y antibiograma a las 6 y 24 horas sobre 54 muestras clínicas de orina. La identificación concordó en un 88,88% a las 6 horas y en un 100% a las 24. El antibiograma solo detectó errores menores en amoxicilina-clavulánico y cefuroxima en la lectura a las 6 horas. Concluimos que en el caso de infecciones urinarias causadas por bacilos Gram negativos no Pseudomonas spp. la lectura a las 6 h del E-test sobre muestra directa es muy fiable como antibiograma presuntivo y para la detección de BLEE (AU)

Getting fast and affordable laboratory results is a priority. A method for the direct identification and susceptibility testing on direct urine samples by chromogenic plate CPS ® and E-test (BioMérieux, France) is presented. Tests were performed in parallel in order to compare the direct identification and susceptibility results at 6 h and 24 h on 54 samples of urine with the standard procedure. Identification agreement was 88.88% (6 h) and 100% (24 h). Antimicrobial susceptibility testing detected only minor errors in amoxicillin-clavulanate and cefuroxime (6 h). It is concluded that six hours testing is a very reliable susceptibility and extended-spectrum beta-lactamase (ESBL) detection method for urinary tract infection caused by non-Pseudomonas spp Gram negative bacteria (AU)

Antifolates as antimycotics? Connection between the folic acid cycle and the ergosterol biosynthesis pathway in Candida albicans.

The increased incidence of invasive mycoses and the emerging problem of antifungal drug resistance have encouraged the search for new antifungal agents or effective combinations of existing drugs. Infections due to Candida albicans are usually treated with azole antifungals such as fluconazole, ketoconazole or itraconazole. Whilst azoles may have little or no toxicity, they generally offer rather poor fungicidal activity. Even in the absence of resistance, treatment failures or recurrent infections are not uncommon, especially in immunocompromised individuals. Here we demonstrate that the non-classical antifolate pyrimethamine shows synergy with azole antifungal compounds and interferes with the ergosterol biosynthesis pathway in C. albicans. By disturbing folate metabolism in this fungus, pyrimethamine can inhibit ergosterol production. The molecular connection between the folic acid cycle and the ergosterol biosynthesis pathway is discussed and we show that the filamentous form of this fungus is more susceptible to methotrexate than the yeast form because the drug is more effectively transported through the membrane of the filamentous form. When used to treat the hyphal form, methotrexate showed synergy with other antifungals such as azoles and terbinafine. This finding could have important clinical applications, as a combination of azoles with antifolates and/or inhibitors of folic acid synthesis could represent an attractive alternative for the treatment of C. albicans infections.

Tea polyphenol epigallocatechin-3-gallate inhibits ergosterol synthesis by disturbing folic acid metabolism in Candida albicans.

OBJECTIVES: Elucidation of the mechanism of action of epigallocatechin-3-gallate (EGCG) against Candida albicans and demonstration of the connection between its antifolate activity and other metabolic pathways involved in C. albicans survival are the major objectives of this study. METHODS: C. albicans ATCC 10231 and 12 clinical isolates were used. MICs of EGCG against C. albicans were determined according to NCCLS. C. albicans dihydrofolate reductase (DHFR) was purified using methotrexate-affinity chromatography and its inhibition by EGCG studied by spectroscopic techniques. Synergy experiments were performed by chequerboard tests by combining eight doubling concentrations of EGCG with another eight dilutions of azole compounds or terbinafine. Reversion experiments with leucovorin or S-adenosylmethionine were carried out, and the content of ergosterol was determined by a spectrophotometric method. RESULTS: EGCG is an efficient inhibitor of C. albicans DHFR (K(i) = 0.7 microM). As with other antifolates, the effects of EGCG on C. albicans can be highly attenuated by growing the cells in the presence of leucovorin. EGCG showed synergy with inhibitors of the ergosterol biosynthesis pathway in C. albicans such as azole antifungals and terbinafine. We demonstrate that by disturbing the folate metabolism, EGCG can inhibit ergosterol production. The molecular connection between the pathways is discussed. CONCLUSIONS: EGCG acts as an antifolate compound on C. albicans, disturbing its folic acid metabolism. This effect could explain the molecular mechanism for the synergy between EGCG and azole antifungals, and could represent a starting point for therapies involving antifolates and azoles used as an alternative for the treatment of C. albicans infections.

Antifolate activity of epigallocatechin gallate against Stenotrophomonas maltophilia.

The catechin epigallocatechin gallate, one of the main constituents of green tea, showed strong antibiotic activity against 18 isolates of Stenotrophomonas maltophilia (MIC range, 4 to 256 microg/ml). In elucidating its mechanism of action, we have shown that epigallocatechin gallate is an efficient inhibitor of S. maltophilia dihydrofolate reductase, a strategic enzyme that is considered an attractive target for the development of antibacterial agents. The inhibition of S. maltophilia dihydrofolate reductase by this tea compound was studied and compared with the mechanism of a nonclassical antifolate compound, trimethoprim. Investigation of dihydrofolate reductase was undertaken with both a trimethoprim-susceptible S. maltophilia isolate and an isolate with a high level of resistance. The enzymes were purified using ammonium sulfate precipitation, gel filtration, and methotrexate affinity chromatography. The two isolates showed similar levels of dihydrofolate reductase expression and similar substrate kinetics. However, the dihydrofolate reductase from the trimethoprim-resistant isolate demonstrated decreased susceptibility to inhibition by trimethoprim and epigallocatechin gallate. As with other antifolates, the action of epigallocatechin gallate was synergistic with that of sulfamethoxazole, a drug that blocks folic acid metabolism in bacteria, and the inhibition of bacterial growth was attenuated by including leucovorin in the growth medium. We conclude that the mechanism of action of epigallocatechin gallate on S. maltophilia is related to its antifolate activity.

Molecular properties and prebiotic effect of inulin obtained from artichoke (Cynara scolymus L.).

A high molecular weight inulin has been prepared from artichoke (Cynara scolymus L.) agroindustrial wastes using environmentally benign aqueous extraction procedures. Physico-chemical analysis of the properties of artichoke inulin was carried out. Its average degree of polymerization was 46, which is higher than for Jerusalem artichoke, chicory, and dahlia inulins. GC-MS confirmed that the main constituent monosaccharide in artichoke inulin was fructose and its degradation by inulinase indicated that it contained the expected beta-2,1-fructan bonds. The FT-IR spectrum was identical to that of chicory inulin. These data indicate that artichoke inulin will be suitable for use in a wide range of food applications. The health-promoting prebiotic effects of artichoke inulin were demonstrated in an extensive microbiological study showing a long lasting bifidogenic effect on Bifidobacterium bifidum ATCC 29521 cultures and also in mixed cultures of colonic bacteria.