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1.
Trials ; 22(1): 595, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488845

RESUMO

BACKGROUND: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. Diabetes remains the main cause of lower-extremity non-traumatic amputations. Current medical treatment, based on antiplatelet therapy and statins, has demonstrated deficient improvement of the disease. In recent years, research has shown that it is possible to improve tissue perfusion through therapeutic angiogenesis. Both in animal models and humans, it has been shown that cell therapy can induce therapeutic angiogenesis, making mesenchymal stromal cell-based therapy one of the most promising therapeutic alternatives. The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. METHODS: A multicenter, randomized double-blind, placebo-controlled trial has been designed. Ninety eligible patients will be randomly assigned at a ratio 1:1:1 to one of the following: control group (n = 30), low-cell dose treatment group (n = 30), and high-cell dose treatment group (n = 30). Treatment will be administered in a single-dose way and patients will be followed for 12 months. Primary outcome (safety) will be evaluated by measuring the rate of adverse events within the study period. Secondary outcomes (efficacy) will be measured by assessing clinical, analytical, and imaging-test parameters. Tertiary outcome (quality of life) will be evaluated with SF-12 and VascuQol-6 scales. DISCUSSION: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. Given that the current treatment is not established in daily clinical practice, it is essential to provide evidence-based data that allow taking a step forward in its clinical development. Also, the multidisciplinary coordination exercise needed to develop this clinical trial protocol will undoubtfully be useful to conduct academic clinical trials in the field of cell therapy in the near future. TRIAL REGISTRATION: ClinicalTrials.gov NCT04466007 . Registered on January 07, 2020. All items from the World Health Organization Trial Registration Data Set are included within the body of the protocol.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais , Noma , Tecido Adiposo , Animais , Ensaios Clínicos Fase II como Assunto , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Método Duplo-Cego , Humanos , Isquemia/diagnóstico , Isquemia/terapia , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
3.
Front Immunol ; 10: 1151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231366

RESUMO

Cell therapy is a progressively growing field that is rapidly moving from preclinical model development to clinical application. Outcomes obtained from clinical trials reveal the therapeutic potential of stem cell-based therapy to deal with unmet medical treatment needs for several disorders with no therapeutic options. Among adult stem cells, mesenchymal stem cells (MSCs) are the leading cell type used in advanced therapies for the treatment of autoimmune, inflammatory and vascular diseases. To date, the safety and feasibility of autologous MSC-based therapy has been established; however, their indiscriminate use has resulted in mixed outcomes in preclinical and clinical studies. While MSCs derived from diverse tissues share common properties depending on the type of clinical application, they markedly differ within clinical trials in terms of efficacy, resulting in many unanswered questions regarding the application of MSCs. Additionally, our experience in clinical trials related to critical limb ischemia pathology (CLI) shows that the therapeutic efficacy of these cells in different animal models has only been partially reproduced in humans through clinical trials. Therefore, it is crucial to develop new research to identify pitfalls, to optimize procedures and to clarify the repair mechanisms used by these cells, as well as to be able to offer a next generation of stem cell that can be routinely used in a cost-effective and safe manner in stem cell-based therapies targeting CLI.

4.
J Wound Care ; 27(12): 806-815, 2018 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-30557111

RESUMO

OBJECTIVE: The amniotic membrane (AM) is a tissue with low immunogenity and high therapeutic potential due to its anti-inflammatory, anti-fibrotic and antimicrobial effects. This paper describes the use of cryopreserved amniotic membrane allografts to treat diabetic foot ulcers (DFUs) in patients with diabetes. METHOD: In this case series, AM was processed to obtain a final medicinal product: cryopreserved amniotic membrane. cryopreserved AM was applied every 7-10 days until total epithelialisation of the DFUs. RESULTS: A total of 14 patients with DFUs (median size: 12.30cm, (range: 0.52-42.5cm2) were treated and followed up until complete closure (median time: 20 weeks, range: 7-56 weeks). Patients received 4-40 AM applications. All patients in this study achieved complete epithelialisation of the wound. No adverse events were observed. CONCLUSION: AM is a feasible and safe treatment in complex DFUs. Furthermore, the treatment is successful in achieving epithelialisation of long-evolution, unhealed wounds resistant to conventional therapies.


Assuntos
Aloenxertos/transplante , Âmnio/transplante , Criopreservação/métodos , Pé Diabético/cirurgia , Cicatrização/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Resultado do Tratamento , Adulto Jovem
5.
Surg Endosc ; 32(9): 3989-4002, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29777353

RESUMO

BACKGROUND: Low splanchnic perfusion is an immediate effect of pneumoperitoneum-induced intra-abdominal hypertension (IAH). Anatomical structure results in the intestinal mucosa being the area most sensitive to hypoperfusion. The relationship between intestinal injury and clinical parameters of tissue perfusion [abdominal perfusion pressure (APP), gastric intramucosal pH (pHi) and lactic acid (Lc)] has not been previously studied. This study aimed to monitorize intestinal pathogenesis through sequential ileal biopsies and to measure APP, pHi, and Lc levels at different pneumoperitoneum-induced intra-abdominal pressures (20, 30, and 40 mmHg) to evaluate the potential relationships between them. MATERIALS AND METHODS: Fifty pigs were divided into four groups; a control group (C) and three experimental groups with different pneumoperitoneum-induced levels [20 mmHg (G20), 30 mmHg (G30), and 40 mmHg (G40)], that were maintained for 3 and 5 h. APP, pHi, and Lc were measured and ileal biopsies taken laparoscopically every 30 min. The mucosal damage was graded using the standardized Park's Score and animals were classified as injured (I+) or uninjured (I-). RESULTS: Different histopathological lesions were observed in groups G20, G30, and G40 but no damage observed in group C. A 33.3% of animals in G20 and G30 were I+ after 3 h, while 93.3% were injured in G40. After 5 h, histopathological lesions were no longer seen in some animals in G20 and only 10% were I+. Conversely, in G30 I+ pigs increased to 80% while those in G40 remained at 93.3% I+. The I+ animals had significantly lower APP and pHi than those I-. Lc was the clinical parameter that showed the earliest differences, with significantly higher figures in I+ animals. CONCLUSIONS: The evolution of intestinal injuries from pneumoperitoneum-induced IAH depends on the degree of IAP. These damages may be associated with decreases in APP and pHi, and increases in Lc.


Assuntos
Íleo/patologia , Hipertensão Intra-Abdominal/patologia , Pneumoperitônio Artificial/efeitos adversos , Cavidade Abdominal/fisiologia , Animais , Biópsia , Pressão Sanguínea/fisiologia , Mucosa Gástrica/química , Concentração de Íons de Hidrogênio , Hipertensão Intra-Abdominal/etiologia , Ácido Láctico/metabolismo , Modelos Animais , Suínos
6.
PLoS One ; 13(1): e0191420, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29357386

RESUMO

BACKGROUND: A mechanical intestinal obstruction (MIO) can generate intraabdominal hypertension (IAH) that is life threatening. The intestines are very sensitive to IAH since the low splanchnic perfusion causes intestinal hypoxia, local acidosis and bacterial translocations. This may lead to acute intestinal distress syndrome (AIDS). The identification of intestinal injuries during IAH and its correlation with clinical parameters as the abdominal perfusion pressure (APP), the gastric intramucosal pH (pHi) and lactic acid (Lc) are still unknown. This study aimed to evaluate the sequence of intestinal histopathological findings in an MIO model and to analyze potential relationships with parameters currently used in clinical practice (APP, pHi and Lc). MATERIAL AND METHODS: Twenty pigs were divided into three groups: a control group (n = 5) and two experimental groups with 20 mmHg (G1, n = 10) and 30 mmHg (G2, n = 5) of IAH by MIO. The pressures were maintained for 3 hours, except in 5 animals in G1 where it was maintained for 5 hours. The APP, pHi and LA were recorded and biopsies of the terminal ileum were taken every 30 minutes in all groups. The intestinal damage was graded according to the Park Score. RESULTS: Intestinal injuries were found in 42.9% of pigs in the experimental groups. The lesions were independent of the level and duration of IAH. Although APP and pHi were slightly lower in injured animals (I +) of G1 and G2, there were no significant differences among those uninjured (I-). Lc was significantly increased in all I+ pigs from the onset of IAH. CONCLUSION: The IAH by MIO causes intestinal lesions from the first 30 minutes with concurrent decreases in APP and pHi and increases in Lc. Lc could be the best clinical parameter related to intestinal damages with a clear difference between I + and I- animals.


Assuntos
Obstrução Intestinal/complicações , Intestinos/patologia , Hipertensão Intra-Abdominal/complicações , Hipertensão Intra-Abdominal/patologia , Fenômenos Mecânicos , Animais , Modelos Animais de Doenças , Feminino , Suínos , Fatores de Tempo
7.
J Tissue Eng Regen Med ; 12(3): 808-820, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28621502

RESUMO

Keratinocyte migration is a mandatory aspect of wound healing. We have previously shown that amniotic membrane (AM) applied to chronic wounds assists healing through a process resulting in the overexpression of c-Jun at the wound's leading edge. We have also demonstrated that AM modifies the genetic programme induced by transforming growth factor-ß (TGF-ß) in chronic wounds. Here we used a scratch assay of mink lung epithelial cells (Mv1Lu) and a spontaneously immortalized human keratinocyte cell line (HaCaT) cells to examine the influence of AM application on the underlying signalling during scratch closure. AM application induced c-Jun phosphorylation at the leading edge of scratch wounds in a process dependent on MAPK and JNK signalling. Strikingly, when the TGF-ß-dependent Smad-activation inhibitor SB431542 was used together with AM, migration improvement was partially restrained, whereas the addition of TGF-ß had a synergistic effect on the AM-induced cell migration. Moreover, antagonizing TGF-ß with specific antibodies in both cell lines or knocking out TGF-ß receptors in Mv1Lu cells had similar effects on cell migration as using SB431542. Furthermore, we found that AM was able to attenuate TGF-ß-Smad signalling specifically at the migrating edge; AM treatment abated Smad2 and Smad3 nuclear localization in response to TGF-ß in a process dependent on mitogen-activated protein kinase kinase 1 (MEK1) activation but independent of EGF receptor or JNK activation. The involvement of Smad signalling on AM effects on HaCaT keratinocytes was further corroborated by overexpression of either Smad2 or Smad3 and the use of Smad phosphorylation-specific inhibitors, revealing a differential influence on AM-induced migration for each Smad. Thus, AM TGF-ß-Smad signalling abating is essential for optimal cell migration and wound closure.


Assuntos
Âmnio/metabolismo , Movimento Celular , Transdução de Sinais , Fator de Crescimento Transformador beta/metabolismo , Animais , Linhagem Celular , Núcleo Celular/metabolismo , Humanos , Queratinócitos/citologia , Queratinócitos/metabolismo , Vison , Fosforilação , Proteínas Proto-Oncogênicas c-jun/metabolismo , Proteína Smad2/metabolismo , Proteína Smad3/metabolismo , Cicatrização
8.
Sci Rep ; 7(1): 15262, 2017 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-29127427

RESUMO

During wound healing, the migration of keratinocytes onto newly restored extracellular matrix aims to reestablish continuity of the epidermis. The application of amniotic membrane (AM) to chronic, deep traumatic, non-healing wounds has proven successful at stimulating re-epithelialization. When applied on epithelial cell cultures, AM activates extracellular signal-regulated kinases 1/2 (ERK1/2) and c-Jun N-terminal kinases 1/2 (JNK1/2), with the overexpression and phosphorylation of c-Jun along the wound edge. The effect of AM on the migration of cells was investigated by studying critical proteins involved in the focal adhesions turn-over: Focal Adhesion Kinase (FAK), Paxillin and Vinculin. In Mv1Lu and HaCaT cells, validated models for cell migration and wound healing, AM affected the expression and activation of Paxillin, but did not affect Vinculin expression, both factors which integrate into focal adhesions. Moreover, AM regulation also affected FAK activity through phosphorylation. Finally, we have determined that AM regulation of focal adhesions involves both JNK and MEK MAP kinase signaling pathways. This data provides a molecular background to understand how AM regulates critical cell and molecular aspects of cell migration, organizing and directing the movement of cells by the continuous formation, maturation, and turnover of focal adhesion structures at the migration leading edge.


Assuntos
Âmnio/química , Movimento Celular , Células Epiteliais/metabolismo , Adesões Focais/metabolismo , Sistema de Sinalização das MAP Quinases , Cicatrização , Animais , Linhagem Celular , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Proteína-Tirosina Quinases de Adesão Focal/metabolismo , Humanos , Vison , Paxilina/metabolismo , Vinculina/metabolismo
9.
Placenta ; 59: 146-153, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28413063

RESUMO

Wound healing usually follows a predictable sequence and prognosis of events. Its evolutionary process is the result of a complicated interaction between patient-related factors, the wound, the treatment used and the skills and knowledge of the professionals who treat them. Only through a meticulous initial assessment of the wound is it possible to identify the factors that contribute to its complexity. The challenge for professionals will be to implement efficient therapies at the right time and in the most cost-efficient way in order to reduce associated problems, treat the symptoms and expectations of the patients and achieve adequate wound healing whenever possible. This is particularly evident in big chronic wounds with considerable tissue loss, which become senescent in the process of inflammation or proliferation losing the ability to epithelialize. Generally, chronic wounds do not respond to current treatments, therefore they need special interventions. AM is a tissue of particular interest as a biological dressing and it has well-documented reepithelialization effects which are in part related to its capacity to synthesize and release biological active factors. Our studies have demonstrated that amniotic membrane (AM) is able to induce epithelialization in chronic wounds that were unable to epithelialize. AM induces several signaling pathways that are involved in cell migration and/or proliferation. Additionally, AM is able to selectively antagonize the anti-proliferative effect of transforming growth factor-ß (TGF-ß) by modifying the genetic program that TGF-ß induces on keratinocytes. The combined effect of AM on keratinocytes, promoting cell proliferation/migration and antagonizing the effect of TGF-ß is the perfect combination, allowing chronic wounds to move out of their non-healing state and progress into epithelialization.


Assuntos
Âmnio , Curativos Biológicos , Úlcera Cutânea/terapia , Cicatrização , Humanos
11.
PLoS One ; 10(8): e0135324, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26284363

RESUMO

BACKGROUND: Post-traumatic large-surface or deep wounds often cannot progress to reepithelialisation because they become irresponsive in the inflammatory stage, so intervention is necessary to provide the final sealing epidermis. Previously we have shown that Amniotic Membrane (AM) induced a robust epithelialisation in deep traumatic wounds. METHODS AND FINDINGS: To better understand this phenomenon, we used keratinocytes to investigate the effect of AM on chronic wounds. Using keratinocytes, we saw that AM treatment is able to exert an attenuating effect upon Smad2 and Smad3 TGFß-induced phosphorylation while triggering the activation of several MAPK signalling pathways, including ERK and JNK1, 2. This also has a consequence for TGFß-induced regulation on cell cycle control key players CDK1A (p21) and CDK2B (p15). The study of a wider set of TGFß regulated genes showed that the effect of AM was not wide but very concrete for some genes. TGFß exerted a powerful cell cycle arrest; the presence of AM however prevented TGFß-induced cell cycle arrest. Moreover, AM induced a powerful cell migration response that correlates well with the expression of c-Jun protein at the border of the healing assay. Consistently, the treatment with AM of human chronic wounds induced a robust expression of c-Jun at the wound border. CONCLUSIONS: The effect of AM on the modulation of TGFß responses in keratinocytes that favours proliferation together with AM-induced keratinocyte migration is the perfect match that allows chronic wounds to move on from their non-healing state and progress into epithelialization. Our results may explain why the application of AM on chronic wounds is able to promote epithelialisation.


Assuntos
Âmnio/citologia , Proliferação de Células/efeitos dos fármacos , Queratinócitos/citologia , Fator de Crescimento Transformador beta/farmacologia , Cicatrização/fisiologia , Ferimentos Penetrantes/terapia , Âmnio/metabolismo , Animais , Ciclo Celular/efeitos dos fármacos , Células Cultivadas , Células Epiteliais/citologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Humanos , Queratinócitos/efeitos dos fármacos , Queratinócitos/metabolismo , Pulmão/citologia , Pulmão/efeitos dos fármacos , Pulmão/metabolismo , Sistema de Sinalização das MAP Quinases , Vison , Fosforilação , Proteínas Proto-Oncogênicas c-jun/metabolismo , Reepitelização , Proteína Smad2/metabolismo , Cicatrização/efeitos dos fármacos , Ferimentos Penetrantes/patologia
12.
Stem Cells Cloning ; 7: 53-63, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24744610

RESUMO

Epithelial and mesenchymal cells isolated from the amniotic membrane (AM) possess stem cell characteristics, differentiation potential toward lineages of different germ layers, and immunomodulatory properties. While their expansion and differentiation potential have been well studied and characterized, knowledge about their immunomodulatory properties and the mechanisms involved is still incomplete. These mechanisms have been evaluated on various target cells of the innate and the adaptive system and in animal models of different inflammatory diseases. Some results have evidenced that the immunomodulatory effect of AM-derived cells is dependent on cell-cell contact, but many of them have demonstrated that these properties are mediated through the secretion of suppressive molecules. In this review, we present an update on the described immunomodulatory properties of the derived amniotic cells and some of the proposed involved mechanisms. Furthermore, we describe some assays in animal models of different inflammatory diseases which reveal the potential use of these cells to treat such diseases.

13.
Gastroenterol. hepatol. (Ed. impr.) ; 37(2): 51-57, feb. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-119515

RESUMO

INTRODUCCIÓN: La hipertensión intraabdominal se define como una elevación de la presión intraabdominal que da lugar a una disfunción progresiva de los órganos intraabdominales. Objetivo Estudiar las consecuencias de la hipertensión intraabdominal a nivel esplácnico en un modelo porcino determinando la medida indirecta de elección. Material y métodos Se utilizaron 10 cerdos divididos en un grupo control y en un grupo de presión de 20 mmHg con un modelo de ascitis. Se registraron las presiones intraabdominal transvesical y transperitoneal, calculándose el grado de correlación entre ambas. Se obtuvo el ácido láctico, la alanina aminotransferasa, la glucosa y el pH intramucoso gástrico. Se determinó la presión arterial media y la presión de perfusión abdominal, observando la correlación de esta con el pH intramucoso gástrico y el ácido láctico. Los parámetros se registraron durante 3 h. Resultados Hubo una alta correlación entre ambas presiones (R2 = 0,98). A 20 mmHg el ácido láctico aumentó significativamente entre grupos a los 180 min (p < 0,011). El pH intramucoso gástrico mostró diferencias significativas entre grupos desde el inicio (p = 0,004) descendiendo significativamente a partir de los 120 min. La presión arterial media y la perfusión abdominal disminuyeron progresivamente apreciándose cambios significativos más precoces en la presión de perfusión abdominal (p = 0,001) mostrando una buena correlación con los parámetros estudiados. No hubo afectación significativa de los parámetros hepáticos. Conclusiones Consideramos la presión intraabdominal transvesical como la técnica de elección, siendo la presión de perfusión abdominal un marcador sensitivo de la hipertensión intraabdominal y el pH intramucoso gástrico el parámetro más precozmente afectado


INTRODUCTION: Intra-abdominal hypertension is defined as a rise in intra-abdominal pressure leading to progressive dysfunction of the abdominal organs. OBJECTIVE: To evaluate the effects of intra-abdominal hypertension on the splanchnic circulation in a porcine animal model with a view to determining the diagnostic method of choice. MATERIAL AND METHODS: A total of 10 swine were divided into 2 groups: a control group and a group with an ascites pressure of 20 mmHg. Transvesical and transperitoneal intra-abdominal pressures were registered, and the correlation between the measurements obtained was determined. Concentrations of lactic acid, alanine aminotransferase, glucose and gastric mucosal pH were also obtained. We registered the mean arterial and abdominal perfusion pressures, and the correlation of the latter with gastric mucosal pH and lactic acid concentrations. The parameters were registered for a total of 3 hours. RESULTS: We observed a high correlation between transvesical and transperitoneal measurements of intra-abdominal pressure (R2 = 0.98). In the 20 mmHg pressure group, lactic acid concentrations increased significantly at 180 min (p < 0.011). Gastric mucosal pH differed significantly between the 2 groups from the beginning of the study (p = 0.004) and significantly decreased from 120 min onward. Mean arterial and abdominal perfusion pressures gradually decreased during the trial, with early significant changes in the abdominal perfusion pressure (p = 0.001), and a good correlation with the remaining study parameters. There were no significant changes in hepatic indicators. CONCLUSIONS: We believe the transvesical approach to be the technique of choice to determine intra-abdominal pressure. Abdominal perfusion pressure is a sensitive marker of intra-abdominal hypertension, and gastric mucosal pH is the first parameter to be affected


Assuntos
Animais , Hipertensão Intra-Abdominal/complicações , Baço/irrigação sanguínea , Ascite/fisiopatologia , Modelos Animais de Doenças , Concentração de Íons de Hidrogênio
14.
Gastroenterol Hepatol ; 37(2): 51-7, 2014 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-24238726

RESUMO

INTRODUCTION: Intra-abdominal hypertension is defined as a rise in intra-abdominal pressure leading to progressive dysfunction of the abdominal organs. OBJECTIVE: To evaluate the effects of intra-abdominal hypertension on the splanchnic circulation in a porcine animal model with a view to determining the diagnostic method of choice. MATERIAL AND METHODS: A total of 10 swine were divided into 2 groups: a control group and a group with an ascites pressure of 20mmHg. Transvesical and transperitoneal intra-abdominal pressures were registered, and the correlation between the measurements obtained was determined. Concentrations of lactic acid, alanine aminotransferase, glucose and gastric mucosal pH were also obtained. We registered the mean arterial and abdominal perfusion pressures, and the correlation of the latter with gastric mucosal pH and lactic acid concentrations. The parameters were registered for a total of 3hours. RESULTS: We observed a high correlation between transvesical and transperitoneal measurements of intra-abdominal pressure (R(2)=0.98). In the 20mmHg pressure group, lactic acid concentrations increased significantly at 180min (p<0.011). Gastric mucosal pH differed significantly between the 2 groups from the beginning of the study (p=0.004) and significantly decreased from 120min onward. Mean arterial and abdominal perfusion pressures gradually decreased during the trial, with early significant changes in the abdominal perfusion pressure (p=0.001), and a good correlation with the remaining study parameters. There were no significant changes in hepatic indicators. CONCLUSIONS: We believe the transvesical approach to be the technique of choice to determine intra-abdominal pressure. Abdominal perfusion pressure is a sensitive marker of intra-abdominal hypertension, and gastric mucosal pH is the first parameter to be affected.


Assuntos
Ascite/fisiopatologia , Hipertensão Intra-Abdominal/fisiopatologia , Manometria/métodos , Circulação Esplâncnica/fisiologia , Alanina Transaminase/sangue , Animais , Glicemia/análise , Modelos Animais de Doenças , Feminino , Determinação da Acidez Gástrica , Hipertensão Intra-Abdominal/sangue , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Lactatos/sangue , Cavidade Peritoneal , Distribuição Aleatória , Sus scrofa , Suínos , Bexiga Urinária , Cateterismo Urinário
15.
Correo Cient Med Holguín ; 17(4)oct.-.-dic. 2013. tab
Artigo em Espanhol | CUMED | ID: cum-60245

RESUMO

Introducción: la relación médico paciente es el eslabón más sensible y humano de la práctica médica de todos los tiempos y el interrogatorio su principal instrumento; es evidente el deterioro en la aplicación del método clínico y ello compromete la formación de los estudiantes.Objetivo: evaluar la aplicación del método clínico en los estudiantes del tercer año de medicina posterior a aplicación de la estrategia de vinculación básico-clínica en la asignatura de Medicina Comunitaria del segundo año de la carrera, a partir de los resultados de sus exámenes prácticos de la asignatura de Medicina Interna. Métodos: se estudió la efectividad de la aplicación de una estrategia utilizada en la asignatura de Medicina Comunitaria del segundo año de la carrera) para elevar el conocimiento y aplicación del método clínico en los estudiantes del tercer año de la carrera de Medicina de la Facultad de Ciencias Médicas Mariana Grajales Coello de la Universidad Ciencias Médicas de Holguín, en el curso 2011-2012. El universo estuvo constituido por todos los estudiantes de este año de la carrera que se presentaron al examen práctico y se conformó una muestra intencional donde estuvieron incluidas las áreas de salud con mejores resultados en los exámenes y se consultaron los resultados de la promoción según áreas en las dos cursos para proceder a su comparación.Resultados: el 50 por ciento de los estudiantes obtuvieron mejores resultados en los exámenes prácticos y las deficiencias descendieron desde 95 por ciento en el interrogatorio en el curso anterior a 18,9 por ciento en el curso actual, mientras que en el examen físico de 92 por ciento descendió a 24,5 por ciento. El 46,7 por ciento de los profesores identificaron un mejor accionar en los estudiantes contra el 20 por ciento antes antes de aplicar la estrategia evaluada(AU)...


Introduction: the doctor-patient relationship is the most sensitive and human one in the medical practice of all time and questionnaire is its main instrument, it is obvious on the lack of the use of clinical method and it influence on the students´ formation.Objective: to evaluate the clinical method application in third year students of medicine after implementation of the strategy of basic clinical link in the subject of Community Medicine of the second year of this career, considering the results obtained by these students in the practical examination in Internal Medicine subject.Methods: the effectiveness of the implementation of a strategy used in the subject of Community Medicine of the second year of the career to improve the clinical method knowledge and its application in the third year students at Mariana Grajales Coello Faculty of Medical Science of Medical University of Holguín in ,2011-2012, The universe consisted of all students of the third year of the career that passed the practical examination, and the sample comprised those who obtained the better results in this examination considering the health areas in order to establish comparison among them.Results: ,50 percent, of students achieved better results in practical examination and the previous deficiencies decreased from 95% to ,18.9 percent, in the current year, while in the physical examination it decreased from ,92 percent, to ,24.5 percent, 46.7 percent, of teachers observed better results in students before the strategy was applied.Conclusions: the strategy improved clinical method application by the students. The teachers noted an improvement in the relationship between the different stages of implementation, although the promotion results were similar in both courses(AU)...


Assuntos
Humanos , Adulto Jovem , Relações Médico-Paciente , Medicina Comunitária
16.
J Surg Res ; 184(2): 1028-34, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23688792

RESUMO

BACKGROUND: The gastrointestinal system is the most sensitive to the presence of intra-abdominal hypertension. We aimed to assess the early prognostic value of gastric air tonometry as a predictor of inadequate splanchnic perfusion and determine its relation with abdominal perfusion pressure (APP). METHODS: Twenty-five Large White swine were used for this study. A control group and two study groups were included, in which intra-abdominal pressure (IAP) was elevated with Co2 to 20 and 30 mmHg during 5 h. We measured the intramucosal gastric pH (pHim) and determined gastric luminal PCO2 (PgCO2) and PgCO2gap (gastric luminal CO2-arterial CO2) to evaluate gastric acidity. APP was indirectly obtained through IAP and mean arterial pressure. Additionally, histopathologic samples of small intestine were obtained and analyzed. RESULTS: pHim showed a decrease in IAP groups, with statistical significance in the 30 mmHg group, 90 min after stabilization period (P < 0.01). Serum lactate showed delayed alteration when compared with pHim, with significant increase, 180 min after stabilization (P < 0.05). The values of PgCO2 and PCO2gap were increased in IAP groups, being statistically significant in the 30 mmHg group, 120 and 150 min, respectively, after stabilization. In increased IAP groups, there was a time progressive decrease of APP, with statistically significant differences observed between groups at 20 min (P < 0.001). The histopathology study revealed parenchymal injury of the intestine at 30 mmHg. CONCLUSIONS: Tonometry is sensitive to the increase in IAP and relates to the reduction of APP generated by splanchnic hypoperfusion.


Assuntos
Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/fisiopatologia , Manometria/métodos , Circulação Esplâncnica/fisiologia , Animais , Pressão Sanguínea/fisiologia , Modelos Animais de Doenças , Feminino , Hemodinâmica/fisiologia , Intestino Delgado/irrigação sanguínea , Intestino Delgado/patologia , Valor Preditivo dos Testes , Suínos
17.
Correo Cient Méd Holguín ; 17(1)ene.-mar. 2013.
Artigo em Espanhol | CUMED | ID: cum-55823

RESUMO

Se valoró el deterioro acelerado que experimenta la aplicación del método clínico en la actualidad. Se identificaron los aspectos en relación con la aplicación del método clínico en el ejercicio de la práctica médica. Se trataron de manera crítica los aspectos humanos y éticos de la profesión, asociados con la relación médico-paciente, las nuevas tecnologías y su uso. Se expuso la crisis actual del método clínico y sus implicaciones para el futuro de la Medicina(AU)...


An assessment of the implementation of the clinical method was performed. The aspectsrelated to its implementation in the medical practice, considering human and ethicalaspects of medicine profession that involve the doctor-patient relationship and new technology use were identified. The authors also considered the current crisis of the clinical method and its implications for the future of Medicine(AU)...


Assuntos
Humanos , Diagnóstico Clínico , Relações Médico-Paciente
18.
Correo Cient Méd Holguín ; 17(1)ene.-mar. 2013.
Artigo em Espanhol | CUMED | ID: cum-55818

RESUMO

Introducción: la crisis del método clínico es una preocupación constante para los profesionales de la salud porque esta comprende aspectos muy sensibles de la práctica médica y la preparación para su empleo se produce tempranamente en la formación de los estudiantes.Objetivo: determinar el desempeño en la aplicación del método clínico de los estudiantes de tercer año de la carrera de Medicina en la provincia Holguín. Métodos: se realizó un estudio descriptivo con los estudiantes del tercer año de la carrera de Medicina de la Universidad de Ciencias Médicas de Holguín en el curso escolar 2009- 2010. La muestra estuvo integrada por 439 estudiantes, el 66,6 por ciento de la población estudiada. Se consideraron los resultados obtenidos por los estudiantes en los exámenes prácticos de la asignatura de Medicina Interna. Resultados: el 95 por ciento de los alumnos presentaron dificultades en el interrogatorio del paciente, el 92 por ciento en el examen físico y el 93,6 por ciento no pudieron realizar el diagnóstico correcto. En cuanto a los criterios de los profesores sobre la interrelación interrogatorio-examen físico, análisis complementarios, diagnóstico y conducta, el 46,7 por ciento lo consideró regular y el 23,3 por ciento , malo. Conclusiones: los estudiantes del tercer año de la carrera de Medicina carecieron del dominio y aplicaron de manera deficiente el método clínico durante los exámenes prácticos de Medicina Interna(AU)...


Introduction: the crisis of the clinical method is a constant concern for all the health professionals as it turns around many sensitive aspects of the medical practice and takes place at an early stage in their formation as doctors. Objective: to determine the role of clinical method application by t hird- year students of Medicine Career of Holguín province. Methods: a descriptive study in the third- year medical students from the University of Medical Sciences in Holguín was conducted during the school year ,2009- 2010, The sample comprised ,439, students representing ,66.6 percent, of the studied population. The results obt ained in the practical examinations of Internal Medicine Subject were considered. Results: ninety - five percent of the students had difficulties in interviewing the patients,92 percent, had problems in the physical examination and ,93.6 percent, had troubles in making theaccurate diagnosis. As for the professors' assessment of the interrelation between interview - physical examinations, routine tests, diagnosis and treatment: ,46.7 percent, considered it fair and, 23.3 percent, bad. Conclusions: the mastery and the application of the clinical method during the practical examinations of Internal Medicine are deficient, since the students were unable, through the interview and the physical exam, to make a correct diagnosis or develop a logical reasoning of diagnosis -treatment(au)...


Assuntos
Humanos , Estudantes de Medicina , Diagnóstico Clínico , Epidemiologia Descritiva
19.
CCH, Correo cient. Holguín ; 17(1): 27-37, ene.-mar. 2013.
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-681769

RESUMO

Introducción: la crisis del método clínico es una preocupación constante para los profesionales de la salud porque esta comprende aspectos muy sensibles de la práctica médica y la preparación para su empleo se produce tempranamente en la formación de los estudiantes. Objetivo: determinar el desempeño en la aplicación del método clínico de los estudiantes de tercer año de la carrera de Medicina en la provincia Holguín. Métodos: se realizó un estudio descriptivo con los estudiantes del tercer año de la carrera de Medicina de la Universidad de Ciencias Médicas de Holguín en el curso escolar 2009-2010. La muestra estuvo integrada por 439 estudiantes, el 66,6% de la población estudiada. Se consideraron los resultados obtenidos por los estudiantes en los exámenes prácticos de la asignatura de Medicina Interna. Resultados: el 95% de los alumnos presentaron dificultades en el interrogatorio del paciente, el 92% en el examen físico y el 93,6% no pudieron realizar el diagnóstico correcto. En cuanto a los criterios de los profesores sobre la interrelación interrogatorio-examen físico, análisis complementarios, diagnóstico y conducta, el 46,7% lo consideró regular y el 23,3%, malo. Conclusiones: Los estudiantes del tercer año de la carrera de Medicina carecieron del dominio y aplicaron de manera deficiente el método clínico durante los exámenes prácticos de Medicina Interna.


Introduction: the crisis of the clinical method is a constant concern for all the health professionals as it turns around many sensitive aspects of the medical practice and takes place at an early stage in their formation as doctors. Objective: to determine the role of clinical method application by third-year students of Medicine Career of Holguín province. Methods: A descriptive study in the third-year medical students from the University of Medical Sciences in Holguín was conducted during the school year 2009-2010. The sample comprised 439 students representing 66.6% of the studied population. The results obtained in the practical examinations of Internal Medicine Subject were considered. Results: Ninety-five percent of the students had difficulties in interviewing the patients; 92% had problems in the physical examination and 93.6% had troubles in making the accurate diagnosis. As for the professors' assessment of the interrelation between interview-physical examinations, routine tests, diagnosis and treatment: 46.7% considered it fair and 23.3%, bad. Conclusions: the mastery and the application of the clinical method during the practical examinations of Internal Medicine are deficient, since the students were unable, through the interview and the physical exam, to make a correct diagnosis or develop a logical reasoning of diagnosis-treatment.

20.
CCH, Correo cient. Holguín ; 17(1): 64-69, ene.-mar. 2013.
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-681773

RESUMO

Se valora el deterioro acelerado que experimenta la aplicación del método clínico en la actualidad. Se identifican los aspectos en relación con la aplicación del método clínico en el ejercicio de la práctica médica. Se tratan de manera crítica los aspectos humanos y éticos de la profesión, asociados con la relación médico-paciente, las nuevas tecnologías y su uso. Se expone la crisis actual del método clínico y sus implicaciones para el futuro de la Medicina.


An assessment of the implementation of the clinical method it was performed. The aspects related to its implementation in the medical practice, considering human and ethical aspects of medicine profession that involucrate the doctor-patient relationship and new technology use were identifies. The authors also considered the current crisis of the clinical method and its implications for the future of Medicine.

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