Effect of Triple Therapy with Budesonide-Formoterol-Tiotropium Versus Placebo-Tiotropium on Sleep Quality in Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Factors responsible for poor sleep quality in patients with chronic obstructive pulmonary disease (COPD) includes the effects of medications. This study evaluates the effect of the inhaled triple therapy of budesonide-formoterol-tiotropium versus placebo-tiotropium on sleep quality in COPD patients. METHODS: Twenty-three patients (11 [48%] males; age 55 [51-60, 48--5] years; body mass index [BMI] 25 [22-30, 18-40] kg/m2; forced expiratory volume in 1 second [FEV1]1.10 [0.80 -1.90, 0.60-2.80] L, 42 [31-62, 24-75] % predicted) were studied. Ten patients were randomized to budesonide-formoterol-tiotropium and 13 patients to placebo-tiotropium. At baseline and after 28 days, patients completed spirometry, polysomnography, an Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), COPD-specific St George's Respiratory Questionnaire (SGRQ-C) and short form 36 (SF 36). RESULTS: After 28 days, there was a significant 29% increase in the bedtime FEV1 in the budesonide-formoterol-tiotropium group (from 0.75 [0.55-1.30, 0.50-2.40] L to 1.00 [0.75-1.55, 0.50-3.00] L, p=0.031), with no change in the placebo-tiotropium group (from 1.20 [0.80-1.50, 0.60-1.90] L to 1.15 [0.75-1.55, 0.50-1.80] L, p=0.91). No significant change was found post treatment in sleep efficiency or total sleep time in both the budesonide-formoterol-tiotropium group (from 78 [72-92, 62-98]% to 88 [77-92, 40-98]%, p=0.70 and 290 [268-358, 252-382] min to 342 [303-358, 157-372] min, p=0.77, respectively) and the placebo-tiotropium group (from 82 [75-88, 46-93]% to 84 [77-87, 62-94]%, p=0.96 and 320 [292-350, 180-378] min to 339 [303-349, 241-366] min, p=0.79, respectively). While there was no significant change in the arousal index in the budesonide-formoterol-tiotropium group (9 [5-16, 0-48] arousals/hour to 14 [9-17, 2-36] arousals/hour, p=0.43), a significant increase was seen in the placebo-tiotropium group (11 [4-13, 3--2] arousals/hour to 17 [11-21, 2-33] arousals/hour, p=0.027). Similarly, there was no change in the ESS in the budesonide-formoterol-tiotropium group (6 [3-8, 0-11] to 6 [5-8, 0-1]), p=0.44), but a marginally significant increase in the placebo-tiotropium group (8 [5-12, 2-18] to 10 [7-13, 5-18], p=0.07), with a significant difference in the ESS 28 days post treatment between the 2 groups (6 [5-8, 0-11] versus 10 [7-13, 5-18], p=0.043). There was no significant change in nocturnal oxygenation, sleep architecture, PSQI, SGRQ-C, or SF 36 in both groups. CONCLUSION: In patients with COPD, inhaled triple therapy with budesonide-formoterol-tiotropium as compared to placebo-tiotropium improves pulmonary function while preserving sleep quality and architecture.

Regulatory T cell phenotype and anti-osteoclastogenic function in experimental periodontitis.

The alveolar bone resorption is a distinctive feature of periodontitis progression and determinant for tooth loss. Regulatory T lymphocytes (Tregs) display immuno-suppressive mechanisms and tissue repairing functions, which are critical to support periodontal health. Tregs may become unstable and dysfunctional under inflammatory conditions, which can even accelerate tissue destruction. In this study, experimental periodontitis was associated with the progressive and increased presence of Th17 and Treg-related mediators in the gingiva (IL-6, IL-17A, IL-17F, RANKL, IL-10, TGF-ß and GITR; P < 0.05), and the proliferation of both Treg and Th17 cells in cervical lymph nodes. Tregs from cervical lymph nodes had reduced Foxp3 expression (> 25% MFI loss) and increased IL-17A expression (> 15%), compared with Tregs from spleen and healthy controls. Tregs gene expression analysis showed a differential signature between health and disease, with increased expression of Th17-associated factors in periodontitis-derived Tregs. The ex vivo suppression capacity of Tregs on osteoclastic differentiation was significantly lower in Tregs obtained from periodontally diseased animals compared to controls (P < 0.05), as identified by the increased number of TRAP+ osteoclasts (P < 0.01) in the Tregs/pre-osteoclast co-cultures. Taken together, these results demonstrate that Tregs become phenotypically unstable and lose anti-osteoclastogenic properties during experimental periodontitis; thus, further promoting the Th17-driven bone loss.

Personal narratives of nurses who care for patients at the end of life.

BACKGROUND: Little attention has been paid to the ways in which nurses personally experience, understand and assign meaning to providing palliative care. AIM: A qualitative study of four nurses working with patients in the terminal phase in a hospital in Mexico was conducted to understand their lived professional experiences and relationships with death. METHODS: Four interviews were analysed using the Greimasian actantial-semiotic model. Actants were categorised by narrative role and their actions were analysed. The grammatical features of the narration were also examined. FINDINGS: Nurses sought a good death for the patient, which they typically achieved, and spiritual peace for themselves, which they often did not. Nurses placed a high value on personal, social and professional recognition for their work. The philosophical themes affecting nursing as a vocation that emerged included life and death, truth and honesty and the role of God and the family. These professional values were often contradictory, and these dilemmas should be addressed in professional training and support.

Use of positional therapy when incorporated into a diagnosis-treatment algorithm for obstructive sleep apnea.

PURPOSE: Positional obstructive sleep apnea (OSA) is prevalent. We hypothesized that by incorporating positional therapy into a diagnosis-treatment algorithm for OSA it would frequently be prescribed as an appropriate first-line therapy. METHODS: Fifty-nine members (45 males, 49±9 yrs, BMI 35.2±5.6 kg/m2) of the Law Enforcement Health Benefits (LEHB), Inc. of Philadelphia with clinically suspected OSA were evaluated. Patients completed an Epworth Sleepiness Scale (ESS) questionnaire and a home sleep test (HST). Patients diagnosed with positional OSA (non-supine apnea-hypopnea index [AHI] < 5 events/hr) were offered positional therapy. A cost comparison to continuous positive airway pressure (CPAP) therapy was performed. RESULTS: Fifty-four (92%) of the patients (43 males, 49±9 yrs, BMI 35.2±5.3 kg/m2) had OSA on their HST (AHI 24.2±20.1 events/hr). Sixteen (30%) patients had positional OSA. Compared to non-positional patients, patients with positional OSA were less heavy (32.4±5.1 vs. 36.4±5.1 kg/m2, respectively [p=0.009]), less sleepy (ESS 8±5 vs. 12±5, respectively [p=0.009]), and had less severe OSA (AHI 10.4±4.3 vs. 30.0±21.3 events/hr, respectively [p<0.001]). Thirteen of the 16 patients with positional OSA agreed to positional therapy and 31 non-positional OSA patients agreed to CPAP therapy. Based on initial costs, incorporating positional therapy ($189.95/device compared to CPAP therapy at $962.49/device) into the treatment algorithm resulted in a 24% cost savings compared to if all the patients were initiated on CPAP therapy. CONCLUSION: With the high prevalence of positional OSA, using a diagnosis-treatment algorithm that incorporates positional therapy allows it to be more frequently considered as a cost effective first-line therapy for OSA.

Cuidar deseando paz espiritual: análisis cualitativo actancial de narrativas personales de enfermeras que atienden a pacientes en fase terminal / Caring desiring spiritual peace: actancial qualitative analysis of personal narratives of nurses attending terminal phase / Cuidar desejando paz espiritual: análise qualitativa actancial de narrativas pessoais de enfermeiras que cuidam de pacientes em fase terminal

INTRODUCCIÓN: El constructo "morir" y el proceso de la muerte, son vistos como un proceso de tránsito que está determinado socioculturalmente y que tiene implicaciones tanto en el paciente en fase terminal y su familia como en el personal de enfermería que lo atiende. Hasta la fecha, no existen investigaciones con enfoque cualitativo fenomenológico acerca de la experiencia vivida por parte del personal de enfermería. OBJETIVO: Conocer y comprender la estructura narrativa de la experiencia vivida por parte del personal de enfermería que atiende a pacientes en fase terminal. Materiales y MÉTODOS: Estudio cualitativo mediante el análisis semiótico actancial greimasiano de narrativas. Éticamente sin riesgo, consentimiento informado y respetando principios éticos. Materiales y MÉTODOS: Estudio cualitativo mediante el análisis semiótico actancial greimasiano de narrativas. Éticamente sin riesgo, consentimiento informado y respetando principios éticos. RESULTADOS: Se identificó en la estructura argumentativa el "drama trágico". Los actantes (entes o fuerzas que juegan un rol en la narrativa) más importantes fueron: enfermera, Dios, muerte y paciente. Las categorías centrales que definen el ser enfermera son: saber, ser y hacer. Se elaboró esquema actancial según roles o funciones: Objeto, Oponente, Auxiliar, Destinador y Destinatario. DISCUSIÓN: Los hallazgos permiten establecer que el objeto deseado "bien morir" del paciente es alcanzado, pero no el de la "propia paz espiritual". En el personal de enfermería, existen carencias formativas en tanatología, habiendo dilemas filosóficos en definición y formación profesional y tampoco obtienen reconocimiento ni apoyo institucional para afrontar y cumplir con esta misión de manera saludable. CONCLUSIÓN: Urgente análisis y reformulación de los principios de la enfermería, incorporar la tanatología en los programas de capacitación y propiciar tanto el reconocimiento del valor que tienen los cuidados de enfermería en los pacientes en etapa terminal como el apoyo por parte de los servicios de salud

INTRODUCTION: The facing of death and the dying process is seen as a transit process, socioculturally determined. To die has implications for the patient and his/her family, but also for the nursery personnel and there is not any investigation approaching the experience of this, from a phenomenological qualitative focus. OBJECTIVE: To know and understand the narrative structure by the description of their experience when they provide care to final stage PATIENTS: MATERIAL AND METHODS: Qualitative study, by means of semiotic actantial greimasian analysis from narratives obtained by deep interviews from 4 bachelor nurses from a second level hospital in Tampico, Tamaulipas, Mexico. From the ethic perspective the study was without any risk, informed consent was sought and it was developed according to the ethical principles. RESULTS: Argumentative structure of a "tragic drama" from the existence was identified. The most important actants (entities or forces that play a role in the narrative): nurse, God, death and patient. The core categories that defines the being as nurse were to know, to be and to do. An actantial scheme was made according to the roles or functions: Object (what is sought), Opponent (which blocks to find the object), Auxiliary (that facilitate to find what is sought), Receiver (who owns or which oversees the acquisition of the object), and Addressee (who bears the benefit of the object). DISCUSSION: The traces allow to establish that the desired object of the patient "good death" is actually obtained, but not the one of the own spiritual peace. There are lacks in knowledge about thanatological and philosophical dilemma and of values in definition and job training. They do not get recognition nor support in the face of the compliance of the mission to confront this in a healthy way. CONCLUSIONS: Urgent analysis and infirmary principles reformulation, to incorporate thanatology in curricula and recognition of the value an importance of the nursery care in the final stage for continuous improvement in health services

INTRODUÇÃO: A definição da morteé vista como um processo de transição, que é determinada de uma maneira sociocultural e que tem implicações tanto no paciente em fase terminal e sua família, assim como na equipe de enfermagem que o atende. Até o momento, não existem investigações com enfoque qualitativo sobre a experiência vivenciada por parte da equipe de enfermagem. OBJETIVO: Conhecer e compreender a estrutura narrativa das experiências vividas por parte da equipe de enfermagem que cuidam a pacientes em fase terminal. METODOLOGIA: Estudo qualitativo através de análise semiótica actancial greimasiana de narrativas. Eticamente seguro, consentimento informado e respeitando princípios éticos. RESULTADOS: Na estrutura argumentativa o "drama trágico" foi identificado. Os atuantes (entes ou forças que desempenham um papel na narrativa) mais importantes foram: enfermeira, Deus, a morte e paciente. As categorias centrais que definem o ser enfermeira são: saber, ser e fazer. O esquema actancial foi desenvolvido conforme papéis ou funções: Objeto, Adversário, Auxiliar, Emissor e Receptor. Discussão: Os resultados estabelecem que o objeto desejado "boa morte" do paciente foi atingido, mas não o da "própria paz espiritual". Na equipe de enfermagem, existem carências formativas em tanatologia, havendo dilemas filosóficos na definição e na formação profissional e tampouco obtém reconhecimento e apoio da instituição para confrontar e cumprir com esta missão de maneira saudável. CONCLUSÃO: A análise urgente e reformulação dos princípios de enfermagem, incorporar a tanatologia nos programas de treinamento e fomentar tanto o reconhecimento do valor dos cuidados de enfermagem nos pacientesna fase terminal,assim como fornecer suporte por parte dos serviços de saúde

Intervención educativa para el manejo del dolor en personal de enfermería / Educational intervention study in the management of pain in nursing staff

Resumen En la actualidad, el dolor es considerado co-то el quinto signo vital. El objetivo del trabajo fue determinar la efectividad de un programa educativo para el personal de enfermería sobre manejo de dolor en pacientes con problemas crónicos degenerativos y quirúrgicos. El método usado fue el diseño pre-experimental con pretest-postest. La población de estudio estuvo integrada por personal de enfermería (42) de dos instituciones de salud de segundo nivel de atención, del sector público. Se utilizó el cuestionario Conocimiento y Actitudes Respecto al Dolor. La media de respuestas correctas del conocimiento pretest fue de 50.9 (DE = 9.65), valor mínimo de 28.1 y máximo 78.1; y en el postest la media fue de 70.4 (DE = 10.9) valor mínimo de 40.6 y máximo 90.6. Posterior a la intervención educativa, se encontró mayor conocimiento en el personal de enfermeria (t (41)= - 12.98; p < 0.001). El estudio de intervención educativa del personal de enfermería fue efectivo para mejorar el conocimiento sobre el manejo del dolor en los pacientes, ya que los primeros brindaron una mejor atención y cuidados, posteriores a la intervención educativa, no obstante, este fue insuficiente para la mayoría del personal participante.

Abstract Pain is currently considered as the fifth vital sign. The objective of the study was to determine the effectiveness of an educational program for nurses on pain management for patients with chronic degenerative and surgical problems. The employed method was a pre-experimental design with a pre-test and a posttest. The research population was made up of 42 nurses from two secondary health care institutions in the public sector. The Nurse's Knowledge and Attitudes Survey Regarding Pain was used. Results showed that the pre-test mean knowledge of correct answers was 50.9 (SD = 9.65), with a minimum value of 28.1 and a maximum value of 78.1. The post-test mean was 70.4 (SD = 10.9) with a minimum value of 40.6 and a maximum value of 90.6. After the educational intervention, nurses demonstrated an increased level of knowledge regarding pain management (t (41) = -12.98; p < 0.001). The educational intervention study for nurses was effective in improving their knowledge regarding pain management in patients, since the participating nurses provided better attention and care after the educational intervention. This, however, was insufficient for most of the participating personnel.

Impacto psicosocial en enfermeras que brindan cuidados en fase terminal / Impacto psicossocial em enfermeiras que oferecem cuidados em fase terminal / Psychosocial impact on nurses providing care in terminal phase

Introducción: La vivencia y significación del proceso de morir dependen de construcción sociocultural, cosmovisión de la vida, conocimientos y experiencias personales. En México, como en otros países, la muerte es algo contradictorio, temido, evadido y venerado. El personal de enfermería está inmerso en esta cultura y desde ahí ejerce su profesión, pretendiendo contribuir en la promoción, mantenimiento, recuperación de la salud y asistencia de enfermos terminales. Existen múltiples investigaciones sobre actuación y actitudes ante la muerte en enfermería, pero vacíos sobre impacto emocional ante el desempeño del cuidado. Objetivo: Caracterizar cualitativamente el impacto psicosocial en enfermeras que prestan cuidados paliativos hospitalarios a pacientes en etapa final de la vida. Materiales y Métodos: Estudio cualitativo, método fenomenológico, técnica entrevista en profundidad, como informantes 4 licenciadas en enfermería, análisis semiótico centrado en narrativas. Resultados: Conceptualización: ser humano, muerte, fase terminal, enfermería-enfermera; hallazgos: autopercepción como seres escindidos entre lo personal y lo profesional; significación de muerte como pérdida-ganancia; contexto hospitalario desfavorable a bien morir; impacto psicosocial y factores que lo intensifican; carencia de formación y apoyo. Discusión: Concordancia con investigaciones previas en conceptualización y significación de muerte, el aporte radica en describir o impacto psicosocial y sus razones. Conclusiones: Impacto psicosocial asociado a múltiples factores: afrontamiento cultural de la muerte, divergencias entre actuación personal y profesional, contexto hospitalario, enfoque tanatológico ausente. Urgente generar líneas de acción que retomen estos hallazgos, lo que repercutiría en menor impacto psicosocial del personal de enfermería y ello en mejoras en desempeño hospitalario, calidad de atención y condición de pacientes.

Introdução: A experiência e significado do processo de morrer dependem da construção sociocultural cosmovisão da vida, conhecimento e experiências pessoais. No México, como em outros países, a morte é algo contraditório, temido, evadido e reverenciado. A equipe de enfermagem está imersa nessa cultura e espaço onde pratica sua profissão, pretendendo contribuir para a promoção, manutenção, recuperação da saúde e assistência de doentes terminais. Existem muitas pesquisas sobre o desempenho e atitudes em relação à morte em enfermagem, mas vazios sobre o impacto emocional para o desempenho do cuidado. Objetivo: Caracterizar qualitativamente o impacto psicossocial em enfermeiros que prestam cuidados paliativos hospitalários a pacientes em fase final da vida. Materiais e Métodos: Estudo qualitativo, método fenomenológico, técnica entrevista em profundidade, como informantes quatro enfermeiras, análise semiótica focado em narrativas. Resultados: Conceituação: ser humano, morte, fase terminal, enfermagem-enfermeira; achados: auto-percepção como seres divididos entre o pessoal e o profissional; significado de morte como perda-ganho; contexto hospitalário desfavorável para o bom morrer; impacto psicossocial e fatores que o intensificam; falta de treinamento e suporte. Discussão: Resultados parecidos com outras pesquisas prévias em conceituação e significado da morte, o aporte radica em descrever o impacto psicossocial e suas razões. Conclusões: Impacto psicossocial associado a vários fatores: lidar com a cultura da morte, diferenças entre o desempenho pessoal e profissional, ambiente hospitalar, o foco na tanatologia ausente. Urgente gerar linhas de ação para retomar esses achados, afetando em menos impacto psicossocial no pessoal de enfermagem e melhorias no desempenho hospitalar, qualidade da atenção e condição dos pacientes.

Introduction: The experience and significance of the process of dying depend on sociocultural construction worldview of life, knowledge and personal experiences. In Mexico, as in other countries, death is something contradictory, feared and revered evaded. The nursing staff is immersed in this culture and from there his practice, aiming to contribute to the promotion, maintenance, recovery of health and hospice care. There are many research on performance and attitudes to death in nursing, but empty of emotional impact to the performance of care. Objective: To characterize qualitatively psychosocial impact on nurses who provide palliative care hospital patients in the end stage of life. Materials and Methods: A qualitative study, phenomenological method, in-depth interview technique, as informants four registered nurses, semiotic analysis focused on narratives. Results: Conceptualization: human, death, terminal phase, nurse-nursing; findings: self-perception as being split between the personal and the professional; significance of death as loss-gain; unfavorable hospital setting to die well; psychosocial impact and factors that intensify it; lack of training and support. Discussion: Conceptualization and significance of death reviewed in previous investigations, describing the psychosocial impact and its causes. Conclusions: Psychosocial impact related to multiple factors: address the social stigma of death, the divergence between taking professional vs. personal actions, what pertains to the hospital and a lack of a thanatological approach. Urgently develop a plan that accounts for these findings. This plan would result in less psychosocial impact on nurses and consequently improve hospital performance and improve quality of care and patient conditions.

Effect of Emphysema Severity on the Apnea-Hypopnea Index in Smokers with Obstructive Sleep Apnea.

RATIONALE: The presence of obstructive sleep apnea (OSA) in patients with chronic obstructive pulmonary disease (COPD) is referred to as the OSA-COPD overlap syndrome. While lung inflation has been shown to be an important factor in determining upper airway stability, its role in determining OSA severity in smokers, including those with emphysema, has not been evaluated. OBJECTIVES: To evaluate the importance of lung inflation on OSA severity (apnea-hypopnea index [AHI]) in smokers with suspected OSA. METHODS: Fifty-one smokers (18 males; mean [±SD] age, 59 ± 9 yr; body mass index [BMI], 32 ± 9 kg/m(2)) who were part of the Genetic Epidemiology of COPD (COPDGene) project were studied. Patients underwent a full-night polysomnography for suspected OSA. Other testing included spirometry and volumetric chest computed tomography (CT) for quantitative measurement of CT-derived percent emphysema and CT-derived percent gas trapping. MEASUREMENTS AND MAIN RESULTS: For the group overall, there was evidence of obstructive airway disease by spirometry (FEV1, 1.4 ± 0.5 L, 58 ± 14% predicted) and emphysema by quantitative CT (CT-derived percent emphysema, 11 ± 13%; CT-derived percent gas trapping, 31.6 ± 24.1%). Twenty-nine (57%) of the patients had OSA (AHI, 18 ± 12 events/h). Patients with OSA had a higher BMI but were younger than those without OSA (BMI, 35 ± 9 kg/m(2) vs. 29 ± 7 kg/m(2), respectively [P = 0.007]; age, 56 ± 8 yr vs. 62 ± 9 yr, respectively [P = 0.01]). There was an inverse correlation between the AHI and the CT-derived percent emphysema and CT-derived percent gas trapping, both for the entire group (r = -0.41 [P < 0.01] and r = -0.44 [P < 0.01], respectively) and when just those patients with OSA were evaluated (r = -0.43 [P = 0.04] and r = -0.49 [P = 0.03], respectively). Multiple linear regression revealed that, in addition to CT-derived percent emphysema and CT-derived percent gas trapping, sex and BMI were important in determining the AHI in these patients. CONCLUSIONS: In smokers with OSA, increased gas trapping and emphysema as assessed by CT are associated with a decreased AHI. Along with sex and BMI, these measurements may be important in determining the severity of OSA in patients with COPD and may offer a protective mechanism in patients with more advanced disease.

Cuidado de enfermería en paciente postoperada de mastectomía: estudio de caso / Nursing care in postoperative mastectomy patient: a case study

Introducción: El cáncer de mama es una de las neoplasias más frecuentes en mujeres a nivel mundial y causan más muertes cada año. El diagnóstico oportuno es muy importante ya que es de relevancia en la elección y eficacia del tratamiento, teniendo mayor éxito cuando se detecta temprano. La mejor estrategia para la detección temprana es a través de la prevención primaria mediante información, orientación y educación a la población femenina acerca de los factores de riesgo y la promoción de conductas favorables a la salud. El objetivo del estudio fue identificar dominios y clases afectadas en paciente postoperada de mastectomía. Materiales y Métodos: Estudio de caso en paciente femenina de 47 años de edad diagnosticada con cáncer de mama izquierda, realizándole mastectomía radical izquierda en una institución de salud del sector privado de Tampico, Tamaulipas, México. Se aplicó el proceso enfermero, realizando la valoración de enfermería con la Taxonomía II de Diagnósticos de enfermería, se describen los dominios y clases afectadas en el periodo posoperatorio, implementándose el plan de cuidados de enfermería con las interrelaciones diagnósticos, intervenciones y resultados. Resultados: La paciente evolucionó favorablemente, egresando al tercer día de la intervención quirúrgica, se proporcionó educación para sus cuidados en el domicilio. Discusión y Conclusiones: Al finalizar la investigación del caso, se observó la importancia de llevar a cabo el plan de cuidados de enfermería con las respectivas interrelaciones para brindar atención de calidad.

Introduction: Breast cancer is one of the most common cancers in women worldwide and causes more deaths each year. Early diagnosis is very important because it is relevant in the choice and treatment efficacy, with greater success when caught early. The best strategy for early detection is through primary prevention through information, guidance and education to the female population about risk factors and promoting positive health behaviors. The aim of the study was to identify domains and affected classes in a postoperative mastectomy patient. Materials and Methods: A case study in female patients of 47 years of age diagnosed with left breast cancer, performing left radical mastectomy in a private health institution in Tampico, Tamaulipas, Mexico. The nursing process was applied, making the nursing assessment with Taxonomy II Nursing Diagnoses, domains and affected classes in the postoperative period are described, implementing the nursing care plan with interrelationships, diagnoses, interventions and outcomes. Results: The patient improved, egressing the third day after surgery, education was provided for care at home. Discussion and Conclusions: After investigating the case, the importance of carrying out the plan of nursing care with the respective relationships to provide quality care was observed.

Assays for the in vitro establishment of Swietenia macrophylla and Cedrela odorata / Ensayos para el establecimiento in vitro de Swietenia macrophyllay Cedrela odorata

Recalcitrance and contamination in Mahogany (Swietenia macrophylla King) and Spanish cedar (Cedrela odorata L.) stem tissues are the main causes of its ineffective in vitro propagation. The objectives of this research were: a) to evaluate sodium hypochlorite (NaOCl) and plant preservative mixture (PPM®) as surface disinfectants and/or added to the culture medium for the in vitro establishment of nodal explants taken from 10-year-old Mahogany and Spanish cedar plants, and b) to evaluate the in vitro response of such explants treated with N6-benzylaminopurine (BAP) (0, 2.2, 4.4, 8.8, 17.7 μM), silver nitrate (AgNO3) (0, 3 mg l-1), activated charcoal (0, 1 g l-1) and vented caps. All the experiments were arranged in a completely randomized design. The NaOCl at 15%, for 20 min, as a surface sterilization or PPM® at 2 ml l-1 into the culture medium, were the best treatments to reduce contamination for both species. For Mahogany explants, BAP at 17.7 μM resulted in higher percentages of bud breaks than Spanish cedar (64% and 25%, respectively). Leaves on elongated shoots dropped off by 20 days after starting the explants in culture and neither the activated charcoal nor the AgNO3 alone or combined prevented leaf abscission. The AgNO3 decreased contamination, but also increased leaf abscission. Bud breaks was two-fold higher for nodal explants established in vessels with vented caps than with normal caps. Mahogany nodal explants were easier to surface sterilize and more buds broke from BAP treated explants than Spanish cedar treated explants in the in vitro establishment.

La contaminación y la recalcitrancia de tejidos de tallo de Caoba (Swietenia macrophylla King) y Cedro español (Cedrela odorata L.) son las causas principales de su inefectiva micro-propagación. Los objetivos de la investigación fueron: a) evaluar el hipoclorito de sodio (NaClO) y una mezcal preservadora de plantas (PPM®) como desinfectantes superficiales y/o agregados al medio de cultivo para el establecimiento in vitro de explantes nodales de Caoba y Cedro español de 10 años de edad; b) evaluar la respuesta in vitro de tales explantes tratados con N6-benzylaminopurine (BAP) (0, 2.2, 4.4, 8.8, 17.7 μM), nitrato de plata (AgNO3) (0, 3 mg l-1), carbón activado (0, 1 g l-1) y tapas porosas. Los experimentos fueron establecidos bajo un diseño completamente al azar. La contaminación se redujo en ambas especies con NaOCl al 15% durante 20 min como desinfección superficial o con PPM® (2 ml l-1) agregado al medio de cultivo. El mayor porcentaje de brotación de explantes se obtuvo con BAP a 17.7 μM en caoba (64%) comparado con cedro (25%). Los brotes se defoliaron a los 20 días de cultivo y ni el carbón activado ni el AgNO3, solos o combinados evitaron la defoliación. El AgNO3 disminuyó la contaminación, pero incrementó la defoliación. La brotación fue dos veces mayor en los explantes nodales establecidos en recipientes con tapas porosas que cuando se utilizaron tapas normales. Los explantes nodales de Caoba respondieron mejor a la desinfección superficial y a los tratamientos de BAP comparados con los de Cedro español en el establecimiento in vitro.

Perspectiva de la enfermera ante el paciente oncológico en fase terminal en Tampico, Tamaulipas, México / Perspectiva do enfermeiro ao paciente com câncer terminal em Tampico, Tamaulipas, México / Perspective from the nurse to the terminal cancer patient in Tampico, Tamaulipas, Mexico

En este trabajo se muestran los resultados de una investigación cualitativa que se realizó en tres hospitales de Tampico, Tamaulipas, en México. En ella se detalla una perspectiva distinta respecto a la última etapa de la vida humana. Específicamente, la labor de la enfermera en el cuidado del paciente oncológico terminal y su relación con él y su familia cuando se acerca el momento de la muerte. Dentro de la práctica de enfermería existe un asunto al que se le debe dar un énfasis especial: el cuidado de pacientes con enfermedades terminales. Durante esta fase, el enfermo experimenta diversos síntomas, que son complejos y cambiantes, por ello necesita tener una atención integral y ética para mejorar su calidad de vida dentro de lo posible. No obstante, los resultados de esta investigación mostraron que las enfermeras viven el proceso de muerte con dolor, tristeza e impotencia. El dolor y la tristeza se relacionan con lo que les significa el paciente y por el tiempo de convivencia mutua. La impotencia la experimentan al sentir que no pudieron hacer más por él o que no sirvieron de mucho todo el esfuerzo, tiempo y recursos dedicados a su atención (AU)

Este artigo apresenta os resultados de uma pesquisa qualitativa foi realizada em três hospitais de Tampico, Tamaulipas, México. Ele detalha uma perspectiva diferente da última etapa da vida humana. Especificamente, o trabalho do enfermeiro no cuidado de pacientes terminais de câncer e sua relação com ele e sua família quando o tempo está se aproximando da morte. Dentro da prática de enfermagem não é uma questão que deve ser dada ênfase especial: o cuidado de doentes terminais. Durante esta fase, o paciente experimenta sintomas diferentes, que são complexas e em mudança, então você precisa de uma atenção integral e ética para melhorar sua qualidade de vida sempre que possível. No entanto, os resultados desta pesquisa mostram que as enfermeiras vivem o processo de morrer de tristeza, dor e desamparo. A dor ea tristeza que lhes estão associados significa que o paciente eo tempo de convivência mútua. A sensação de impotência experiência que poderia fazer mais por ele ou não serve muito de todos os tempo, esforço e recursos destinados a sua atenção (AU)

This paper presents the results of a qualitative study conducted in three hospitals in Tampico, Mexico. It details a different perspective from the last stage of human life, specifically, the work of the nurse in the care of terminal cancer patient, and her relationship with him and his families when he dies. Within nursing practice, it must be given special emphasis to the care of terminally ill patients. During this phase, the patient experience different symptoms, which are complex and changing, therefore he needs to have a holistic and ethical care to improve their quality of life wherever possible. However, the results of this inquiry showed that nurses experience the process of dying with pain, sadness and powerlessness. The pain and sadness are associated with the importance that nurses give the patient, also by their mutual relations. They experience impotence, feeling they could not do more for him, and believe that the effort, time and resources devoted for his attention were vain (AU)

Frecuencias alélicas de los polimorfismos del gen del retinoblastoma en pacientes ecuatorianos / Alélicas frequencies of the polymorphisms of the gene of retinoblastoma in Ecuadorian patients

El gen del retinoblastoma (Rb1) fue el primer gen supresor de tumor identificado y ha sido ampliamente analizado a nivel mundial en la población ecuatoriana no existen reportes sobre este gen y en otros países de América Latina se han realizado pocos estudios. En este estudio presentamos la frecuencia alélica de 28 polimorfismos del gen Rb1 en nuestra población y describimos tres nuevos polimorfismos, de los cuales uno se localiza en el intrón 26 donde nunca se han descrito alteraciones anteriormente. Al comparara nuestras frecuencias alélicas con las de otros autores encontramos diferencias estadísticamente significativas lo que sugiere que los mecanismos mutacionales involucrados en el desarrollo de esta enfermedad difieren de otras poblaciones.

Dos nuevas mutaciones y tres nuevos polimorfismos en el gen del retinoblastoma en población ecuatoriana / Two new mutations and three new polymorphisms in the gene of retinoblastoma in Ecuadorian population

El cáncer es una enfermedad de origen genético y para comprender mejor los diferentes mecanismos que conllevan a su desarrollo es necesario el estudio de los genes y mutaciones. El retinoblastoma es el tumor de ojo más frecuente de la infancia y se desarrolla a partir de mutaciones en el gen Rb1; estas mutaciones pueden ser de origen hereditario en el 40 por ciento de los casos y espontáneo en el 60 por ciento de los casos. En la actualidad, se dispone de análisis moleculares para determinar origen y así poder brindar un mejor asesoramiento genético. En el presente estudio se analizaron muestras de 31 pacientes de diferentes regiones del Ecuador. Se realizaron 840 reacciones de PCR (reacción en cadena de la polimerasa)...

Two new mutations and three novel polymorphisms in the RB1 gene in Ecuadorian patients.

RB1 is the gene responsible for retinoblastoma, the most common malignant intraocular tumor of infancy and early childhood. There are no reports about this gene in Ecuadorian populations, and only a few studies have been published in Latin America about this subject. There is a spectrum of more than 370 mutations described in the RB1 gene mutation database (http://www.d-lohmann.de/Rb/mutations.html), and alterations have been found in 25 of the 27 exons. During the exon-by-exon analysis of 31 tumor and blood samples from Ecuadorian patients, we found two new mutations and three novel polymorphisms. One of the polymorphisms is located in intron 26 where no alterations of the gene have been described previously. The polymorphisms were found in all of the patients' tumor samples, but not in normal population, suggesting there might be a relationship between these polymorphisms and the development of retinoblastoma in the Ecuadorian population.