Food and time: dietary plasticity of different sources of a generalist insect herbivore.

Painted lady butterflies (Vanessa cardui L., Nymphalidae) are generalist herbivores and serve as a model system across several fields of biology. While it has been demonstrated that V. cardui caterpillars can develop on different host plants, much of this work has been done on commercially sourced caterpillars, which could limit our understanding of wild V. cardui populations. In this study, we sought to explore possible differences in how commercial and wild V. cardui caterpillars may respond to feeding on different host plants, and subsequently, how their diet impacts immune response and survival. Here, we analyzed performance, survival, and immune response of wild and commercially sourced V. cardui caterpillars over several generations on diets that consisted of either 1 of 4 different host plant species or a mixed diet including all 4 species. Qualitatively, we observed that wild larvae had a better larval performance and hemocyte counts compared to the commercial larvae. The results demonstrate that both wild and commercially sourced caterpillars grew and survived best on the same diet treatments (mallow, narrowleaf plantain, and a mixed diet) during development across generations. Immune responses showed similar patterns across host plants between wild and commercial populations, with individuals showing lowered immune responses on dandelion and lupine and higher ones on mallow, plantain and the mixed diet; although the relative rankings on those 3 diets varied. Survival also demonstrated similar patterns, in that individuals reared on dandelion and lupine had the lowest survival.

COVID-19, HIV, and Syphilis Contact Tracing: What Have We Learned and Where Are We Headed?

ABSTRACT: Contact tracing is a core public health intervention for a range of communicable diseases, in which the primary goal is to interrupt disease transmission and decrease morbidity. In this article, we present lessons learned from COVID-19, HIV, and syphilis in San Francisco to illustrate factors that shape the effectiveness of contact tracing programs and to highlight the value of investing in a robust disease intervention workforce with capacity to pivot rapidly in response to a range of emerging disease trends and outbreak response needs.

Contact-Tracing Outcomes Among Household Contacts of Fully Vaccinated Coronavirus Disease 2019 (COVID-19) Patients: San Francisco, California, 29 January-2 July 2021.

BACKGROUND: The extent to which vaccinated persons diagnosed with coronavirus disease 2019 (COVID-19) can transmit to other vaccinated and unvaccinated persons is unclear. METHODS: Using data from the San Francisco Department of Public Health, this report describes outcomes of household contact tracing during 29 January-2 July 2021, where fully vaccinated patients with COVID-19 were the index case in the household. RESULTS: Among 248 fully vaccinated patients with breakthrough infections, 203 (82%) were symptomatic and 105 were identified as the index patient within their household. Among 179 named household contacts, 71 (40%) contacts tested, over half (56%) were fully vaccinated and the secondary attack rate was 28%. Overall transmission from a symptomatic fully vaccinated patient with breakthrough infection to household contacts was suspected in 14 of 105 (13%) of households. Viral genomic sequencing of samples from 44% of fully vaccinated patients showed that 82% of those sequenced were infected by a variant of concern or interest and 77% by a variant carrying mutation(s) associated with resistance to neutralizing antibodies. CONCLUSIONS: Transmission from fully vaccinated symptomatic index patients to vaccinated and unvaccinated household contacts can occur. Indoor face masking and timely testing of all household contacts should be considered when a household member receives a positive test result in order to identify and interrupt transmission chains.

Neuropsychological Function in Migraine Headaches: An Expanded Comprehensive Multidomain Meta-Analysis

BACKGROUND AND OBJECTIVES: A sizable literature has studied neuropsychologic function in persons with migraine (PwM), but despite this, few quantitative syntheses exist. These focused on circumscribed areas of the literature. In this study, we conducted an expanded comprehensive meta-analysis comparing performance on clinical measures of neuropsychological function both within and across domains, between samples of PwM and healthy controls (HCs). METHODS: For this Meta-analyses Of Observational Studies in Epidemiology-compliant meta-analysis, a unified search strategy was applied to OneSearch (a comprehensive collection of electronic databases) to identify peer-reviewed original research published across all years up until August 1, 2023. Using random-effects modeling, we examined aggregated effect sizes (Hedges' g), between-study heterogeneity (Cochran Q and I2), moderating variables (meta-regression and subgroup analyses), and publication bias (Egger regression intercept and Duval and Tweedie Trim-and-Fill procedure). Study bias was also coded using the NIH Study Quality Assessment Tools. RESULTS: Omnibus meta-analysis from the 58 studies included (PwM n = 5,452, HC n = 16,647; 612 effect sizes extracted) indicated lower overall cognitive performance in PwM vs HCs (g = -0.37; 95% CI -0.47 to -0.28; p < 0.001), and high between-study heterogeneity (Q = 311.25, I2 = 81.69). Significant domain-specific negative effects were observed in global cognition (g = -0.46, p < 0.001), executive function (g = -0.45, p < 0.001), processing speed (g = -0.42, p < 0.001), visuospatial/construction (g = -0.39, p = 0.006), simple/complex attention (g = -0.38, p < 0.001), learning/memory (g = -0.25, p < 0.001), and language (g = -0.24, p < 0.001). Orientation (p = 0.146), motor (p = 0.102), and intelligence (p = 0.899) were not significant. Moderator analyses indicated that age (particularly younger HCs), samples drawn from health care facility settings (e.g., tertiary headache centers) vs community-based populations, and higher attack duration were associated with larger (negative) effects and accounted for a significant proportion of between-study heterogeneity in effects. Notably, PwM without aura yielded stronger (negative) effects (omnibus g = -0.37) vs those with aura (omnibus g = -0.10), though aura status did not account for heterogeneity observed between studies. DISCUSSION: Relative to HCs, PwM demonstrate worse neurocognition, as detected by neuropsychological tests, especially on cognitive screeners and tests within executive functioning and processing speed domains. Effects were generally small to moderate in magnitude and evident only in clinic (vs community) samples. Aura was not meaningfully associated with neurocognitive impairment.

NKX2­1 copy number alterations are associated with oncogenic, immunological and prognostic remodeling in non­small cell lung cancer.

NK2 homeobox 1 (NKX2-1) copy number alterations (CNAs) are frequently observed in lung cancer. However, little is known about the complete landscape of focal alterations in NKX2-1 copy number (CN), their clinical significance and their therapeutic implications in non-small cell lung cancer (NSCLC). The correlations between NKX2-1 expression and EGFR driver mutations and programmed death ligand 1 (PD-L1) co-expression were studied using immunohistochemistry and PCR from the tumors of recruited Filipino patients (n=45). Clinical features of NSCLC with NKX2-1 CNAs were resolved at the tumor and clonal levels using the molecular profiles of patients with lung adenocarcinoma and lung squamous cell carcinoma from The Cancer Genome Atlas (n=1,130), and deconvoluted single-cell RNA-seq data from the Bivona project (n=1,654), respectively. Despite a significant and positive correlation between expression and CN (r=0.264; P<0.001), NKX2-1 CNAs exerted a stronger influence on the combined EGFR and PD-L1 status of NSCLC tumors than expression. NKX2-1 CN gain was prognostic of favorable survival (P=0.018) and a better response to targeted therapy. NKX2-1 CN loss predicted a worse survival (P=0.041). Mutational architecture in the Y-chromosome differentiated the two prognostic groups. There were 19,941 synonymous mutations and 1,408 genome-wide CN perturbations associated with NKX2-1 CNAs. Tumors with NKX2-1 CN gain expressed lymphocyte markers more heterogeneously than those with CN loss. Higher expression of tumor-infiltrating lymphocyte gene signatures in CN gain was prognostic of longer disease-free survival (P=0.005). Tumors with NKX2-1 CN gain had higher B-cell (P<0.001) and total T-cell estimates (P=0.003). NKX2-1 CN loss was associated with immunologically colder tumors due to higher M2 macrophage infiltrates (P=0.011) and higher expression of immune checkpoint proteins, CD274 (P=0.025), VTCN1 (P<0.001) and LGALS9 (P=0.002). In conclusion, NKX2-1 CNAs are associated with tumors that exhibit clinically diverse characteristics, and with unique oncogenic, immunological and prognostic signatures.

What foods are US supermarkets promoting? A content analysis of supermarket sales circulars.

This study compared the types of foods advertised in supermarket newspaper circulars across geographic region (US Census regions: northeast [n=9], midwest [n=15], south [n=14], and west [n=13]), obesity-rate region (i.e., states with CDC adult obesity rates of <25% [n=14], 25 to <30% [n=24], and ≥ 30% [n=13]), and with MyPlate recommendations. All food advertisements on the first page of each circular were measured (±0.12-in.) to determine the proportion of space occupied and categorized according to food group. Overall, ≥ 50% of the front page of supermarket sales circulars was devoted to protein foods and grains; fruits, vegetables, and dairy, combined, were allocated only about 25% of the front page. The southern geographic region and the highest obesity-rate region both devoted significantly more advertising space to sweets, particularly sugar-sweetened beverages. The lowest obesity-rate region and western geographic region allocated the most space to fruits. Vegetables were allocated the least space in the western geographic region. Grains were the only food group represented in ads in proportions approximately equal to amounts depicted in the MyPlate icon. Protein foods exceeded and fruits, dairy, and vegetables fell below comparable MyPlate proportional areas. Findings suggest supermarket ads do not consistently emphasize foods that support healthy weight and MyPlate recommendations. More research is needed to determine how supermarket newspaper circulars can be used to promote healthy dietary patterns.

Hyperacute immune responses associate with immediate neuropathology and motor dysfunction in large vessel occlusions.

OBJECTIVE: Despite successful endovascular therapy, a proportion of stroke patients exhibit long-term functional decline, regardless of the cortical reperfusion. Our objective was to evaluate the early activation of the adaptive immune response and its impact on neurological recovery in patients with large vessel occlusion (LVO). METHODS: Nineteen (13 females, 6 males) patients with acute LVO were enrolled in a single-arm prospective cohort study. During endovascular therapy (EVT), blood samples were collected from pre and post-occlusion, distal femoral artery, and median cubital vein (controls). Cytokines, chemokines, cellular and functional profiles were evaluated with immediate and follow-up clinical and radiographic parameters, including cognitive performance and functional recovery. RESULTS: In the hyperacute phase (within hours), adaptive immune activation was observed in the post-occlusion intra-arterial environment (post). Ischemic vascular tissue had a significant increase in T-cell-related cytokines, including IFN-γ and MMP-9, while GM-CSF, IL-17, TNF-α, IL-6, MIP-1a, and MIP-1b were decreased. Cellularity analysis revealed an increase in inflammatory IL-17+ and GM-CSF+ helper T-cells, while natural killer (NK), monocytes and B-cells were decreased. A correlation was observed between hypoperfused tissue, infarct volume, inflammatory helper, and cytotoxic T-cells. Moreover, helper and cytotoxic T-cells were also significantly increased in patients with improved motor function at 3 months. INTERPRETATION: We provide evidence of the activation of the inflammatory adaptive immune response during the hyperacute phase and the association of pro-inflammatory cytokines with greater ischemic tissue and worsening recovery after successful reperfusion. Further characterization of these immune pathways is warranted to test selective immunomodulators during the early stages of stroke rehabilitation.

Expression landscapes in non-small cell lung cancer shaped by the thyroid transcription factor 1.

TTF-1-expressing non-small cell lung cancer (NSCLC) is one of the most prevalent lung cancer types worldwide. However, theparadoxical activity of TTF-1 in both lung carcinogenesis and tumor suppression is believed to be context-dependentwhich calls for a deeper understanding about the pathological expression of TTF-1. In addition, the expression circuitry of TTF-1-target genes in NSCLC has not been well examined which necessitates to revisit the involvement of TTF-1- in a multitude of oncologic pathways. We used RNA-seq and clinical data of patients from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx), including ChIP-seq data from different NSCLC cell lines, and mapped the proteome of NSCLC tumor. Our analysis showed significant variability in TTF-1 expression among NSCLC,and further clarified that this variability is orchestrated at the transcriptional level. We also found that high TTF-1 expression could negatively influence the survival outcomes of stage 1 LUAD which may be attributed to growth factor receptor-driven activation of mitogenic and angiogenic pathways. Mechanistically, TTF-1 may also control the genes associated with pathways involved in acquired TKI drug resistance or response to immune checkpoint inhibitors. Lastly, proteome-based biomarker discovery in stage 1 LUAD showed that TTF-1 positivity is potentially associated with the upregulation of several oncogenes which includes interferon proteins, MUC1, STAT3, and EIF2AK2. Collectively, this study highlights the potential involvement of TTF-1 in cell proliferation, immune evasion, and angiogenesis in early-stage NSCLC.

Investigating the Roles of Active Site Residues in Mycobacterium tuberculosis Indole-3-glycerol Phosphate Synthase, a Potential Target for Antitubercular Agents.

Mycobacterium tuberculosis drug resistance is emerging and new drug targets are needed. Tryptophan biosynthesis is necessary for M. tuberculosis replication and virulence. Indole-3-glycerol phosphate synthase (IGPS) catalyzes a step in M. tuberculosis tryptophan biosynthesis and has been suggested as a potential anti-infective target, but our understanding of this enzyme is limited. To aid in inhibitor design and gain a greater mechanistic picture of this enzyme, there is a need to understand the roles of active site amino acids in ligand binding and catalysis. In this work, we explored the roles of conserved active site amino acids Glu57, Lys59, Lys119, Glu168, and Glu219. Mutation of each to Ala results in loss of all detectable activity. The Glu57Gln, Lys59Arg, Lys119Arg, Glu168Gln, and Glu219Asp mutations result in large activity losses, while Glu219Gln has enhanced activity. Analysis of the enzymatic data yields the following main conclusions: (A) Lys119 is the likely catalytic acid in the CdRP ring closure step. (B) Glu168 stabilizes a charged reaction intermediate and may also be the catalytic base. (C) Glu57, Glu219, and Lys119 form a closely arranged triad in which Glu57 and Glu219 modulate the pKa of Lys119, and thus overall activity. This increased understanding of inter- and intramolecular interactions and demonstration of the highly coordinated nature of the M. tuberculosis IGPS active site provide new mechanistic information and guidance for future work with this potential new drug target.

The differential prognostic implications of PD-L1 expression in the outcomes of Filipinos with EGFR-mutant NSCLC treated with tyrosine kinase inhibitors.

Background: The tumor immune microenvironment influences tumor evolution in non-small cell lung cancer (NSCLC). Yet, the prognostic value of programmed death-ligand 1 (PD-L1) in epidermal growth factor receptor (EGFR)-mutant NSCLC remains controversial. Additionally, prognostic studies in Filipinos with EGFR-mutant NSCLC remain unexplored to this day. Methods: We prospectively studied the outcomes of EGFR-mutant NSCLC in Filipino cohort, and retrospectively verified the survival trend using The Cancer Genome Atlas (TCGA) cohort. Kaplan-Meier method and generalized linear regression were used to assess survival. Expression and DNA methylation of cluster of differentiation 274 (CD274, gene that codes for PD-L1) were examined from TCGA tumor profiles. Pearson's correlation was used to correlate PD-L1 expression with outcomes associated with occurrence of EGFR mutations, tyrosine kinase inhibitor (TKI) types, and programmed cell death protein 1 (PD-1) expression. Proteome network analysis was used to examine the correlation between drug resistance and PD-L1. Results: PD-L1 positivity was associated with significantly longer progression-free survival (PFS; P=0.0096) but had a significantly contrasting influence in the overall survival (OS; P=0.0011). PD-L1 positivity (in both protein and RNA) was associated with longer median OS (mOS) in exon21 L858R, whereas, negativity was associated with longer mOS in exon19 deletion (exon19del). Stratification (high, low, negative) of PD-L1 expression lacked significant prognostic value (all P>0.05). PD-L1/CD274 expression (P<0.05) and DNA methylation (P<0.001) vary significantly among NSCLC subtypes and in different disease stages. Erlotinib treatment produced the longest median progression-free survival (mPFS; 874 days) relative to other EGFR-TKIs (137-311 days). PD-L1 lacked a significant correlation with EGFR-TKIs. Consistent with the immune-regulation activities of PD-1, higher expression leads to relatively shorter mOS. PD-1 correlated positively with PD-L1 expression and occurrence of exon21 L858R. Conclusions: PD-L1 differentially influenced the outcomes of Filipinos with EGFR-mutant NSCLC. NSCLC subtypes, disease stage, and PD-1 expression may impact the collective outcomes associated with PD-L1 and EGFR-sensitizing mutations.

Voluntary exercise attenuates nociceptive abnormalities with no significant alterations of social interaction deficits in the BTBR mouse model of autism.

Due to the financial burden and undesired side effects of treatment options, researchers have begun exploring alternative methods of treating autism spectrum disorder (ASD). Based on research suggesting impressive health benefits of engaging in physical activity, exercise treatment to alleviate symptoms could be a more cost effective alternative to pharmaceutical interventions. This study examined the effects of physical exercise on nociceptive responses and social interactions in an autism mouse model (BTBR T+ Itpr3tf/J). Subjects (n = 32) were separated into groups (BTBR vs B6 controls) based on the genetic strain and activity condition they were assigned. When compared to B6 controls, the BTBR mice demonstrated thermal hypoalgesia that normalized following 5 weeks of voluntary wheel running. However, exercise did not significantly attenuate social interaction deficits in BTBR mice, despite scores trending toward a positive direction. These results suggest that exercise could serve as a potential additive to other therapies for abnormal nociception in individuals with Autism Spectrum Disorder.

[Diagnostic capacity of neck circumference to evaluate obesity in a young adult population. Data analysis from the second national health survey in Chile, 2009-2010]. / Capacidad diagnóstica de la circunferencia de cuello para evaluar la obesidad en la población adulta joven. Análisis de datos de la segunda Encuesta Nacional de Salud 2009-2010. Chile.

Introduction: Introduction: Chile is among the countries with the highest rate of excess malnutrition, for that reason it is important to have effective tools to evaluate the nutritional status; interest in neck circumference (NC) measurement as a potential prognostic tool that is easy to access and low-cost has increased. Objective: to evaluate the diagnostic capacity of neck circumference to predict obesity in the population aged 15-16 years, using data from the third National Health Survey 2009-2010. Materials and methods: Concurrent Criteria of Diagnostic Validation were used for the study. The sample consisted of 536 people of ages from 15 to 26 years, where BMI data where taken in order to classify obesity versus normality (gold standard), as was NC (measured in centimeters). People with hyperthyroidism were excluded. Indicators of diagnostic accuracy were obtained; the SPSS, version 25 was used for calculations. Results: according to age and gender ranks, the NC cut-off points to classify general obesity showed sensitivities and specificities above 0.85, with an area under the curve over 0.90, all with p < 0.001. Conclusion: there is evidence that supports that NC cutoff points are a suitable tool for diagnosing obesity in this age group.

Introducción: Introducción: Chile está dentro de los países con mayor tasa de malnutrición por exceso, lo que obliga a disponer de herramientas eficaces para evaluar el estado nutricional; así surge nuestro interés por explorar la posibilidad de utilizar la medición de la circunferencia del cuello (CCUE) como herramienta potencial de diagnóstico de fácil obtención y acceso, y bajo costo. Objetivo: evaluar la capacidad diagnóstica de la circunferencia del cuello como predictor de obesidad en la población de 15-26 años de edad. Materiales y métodos: dado que se encuentran disponibles, y son adecuados para nuestra investigación, se utilizarán datos extraídos de la Tercera Encuesta Nacional de Salud 2009-2010. Nuestro estudio se realizó aplicando el Método de Validación Diagnóstica por Criterio Concurrente. La muestra estuvo compuesta por 536 personas cuyas edades fluctuaban entre los 15 y 26 años, de quienes se tomaron los datos de IMC, para clasificarlas en las categorías de obesidad o normalidad (patrón oro), y la CCUE (en centímetros). Se excluyeron las personas con hipertiroidismo. Se obtuvieron indicadores de exactitud diagnóstica y valores predictivos. Se aplicó el SPSS, versión 25. Resultados: según los rangos de edad y el sexo, los puntos de corte de la CCUE para clasificar la obesidad general presentaron sensibilidades y especificidades superiores a 0,85 con una área bajo la curva superior a 0,90, todos con p < 0,001. Conclusión: existe evidencia a favor de que los puntos de corte de la CCUE presentan una adecuada capacidad de diagnosticar la obesidad en este grupo etario.

Predominance of antibody-resistant SARS-CoV-2 variants in vaccine breakthrough cases from the San Francisco Bay Area, California.

Associations between vaccine breakthrough cases and infection by different SARS coronavirus 2 (SARS-CoV-2) variants have remained largely unexplored. Here we analysed SARS-CoV-2 whole-genome sequences and viral loads from 1,373 persons with COVID-19 from the San Francisco Bay Area from 1 February to 30 June 2021, of which 125 (9.1%) were vaccine breakthrough infections. Vaccine breakthrough infections were more commonly associated with circulating antibody-resistant variants carrying ≥1 mutation associated with decreased antibody neutralization (L452R/Q, E484K/Q and/or F490S) than infections in unvaccinated individuals (78% versus 48%, P = 1.96 × 10-8). Differences in viral loads were non-significant between unvaccinated and fully vaccinated cases overall (P = 0.99) and according to lineage (P = 0.09-0.78). Symptomatic vaccine breakthrough infections had comparable viral loads (P = 0.64), whereas asymptomatic breakthrough infections had decreased viral loads (P = 0.023) compared with infections in unvaccinated individuals. In 5 cases with serial samples available for serologic analyses, vaccine breakthrough infections were found to be associated with low or undetectable neutralizing antibody levels attributable to an immunocompromised state or infection by an antibody-resistant lineage. Taken together, our results show that vaccine breakthrough infections are overrepresented by antibody-resistant SARS-CoV-2 variants, and that symptomatic breakthrough infections may be as efficient in spreading COVID-19 as unvaccinated infections, regardless of the infecting lineage.

Capacidad diagnóstica de la circunferencia de cuello para evaluar la obesidad en la población adulta joven. Análisis de datos de la segunda Encuesta Nacional de Salud 2009-2010. Chile / Diagnostic capacity of neck circumference to evaluate obesity in a young adult population. Data analysis from the second national health survey in Chile, 2009-2010

Introducción: Chile está dentro de los países con mayor tasa de malnutrición por exceso, lo que obliga a disponer de herramientas eficaces para evaluar el estado nutricional; así surge nuestro interés por explorar la posibilidad de utilizar la medición de la circunferencia del cuello (CCUE) como herramienta potencial de diagnóstico de fácil obtención y acceso, y bajo costo. Objetivo: evaluar la capacidad diagnóstica de la circunferencia del cuello como predictor de obesidad en la población de 15-26 años de edad. Materiales y métodos: dado que se encuentran disponibles, y son adecuados para nuestra investigación, se utilizarán datos extraídos de la Tercera Encuesta Nacional de Salud 2009-2010. Nuestro estudio se realizó aplicando el Método de Validación Diagnóstica por Criterio Concurrente. La muestra estuvo compuesta por 536 personas cuyas edades fluctuaban entre los 15 y 26 años, de quienes se tomaron los datos de IMC, para clasificarlas en las categorías de obesidad o normalidad (patrón oro), y la CCUE (en centímetros). Se excluyeron las personas con hipertiroidismo. Se obtuvieron indicadores de exactitud diagnóstica y valores predictivos. Se aplicó el SPSS, versión 25. Resultados: según los rangos de edad y el sexo, los puntos de corte de la CCUE para clasificar la obesidad general presentaron sensibilidades y especificidades superiores a 0,85 con una área bajo la curva superior a 0,90, todos con p < 0,001. Conclusión: existe evidencia a favor de que los puntos de corte de la CCUE presentan una adecuada capacidad de diagnosticar la obesidad en este grupo etario. (AU)

Introduction: Chile is among the countries with the highest rate of excess malnutrition, for that reason it is important to have effective tools to evaluate the nutritional status; interest in neck circumference (NC) measurement as a potential prognostic tool that is easy to access and low-cost has increased. Objective: to evaluate the diagnostic capacity of neck circumference to predict obesity in the population aged 15-16 years, using data from the third National Health Survey 2009-2010. Materials and methods: Concurrent Criteria of Diagnostic Validation were used for the study. The sample consisted of 536 people of ages from 15 to 26 years, where BMI data where taken in order to classify obesity versus normality (gold standard), as was NC (measured in centimeters). People with hyperthyroidism were excluded. Indicators of diagnostic accuracy were obtained; the SPSS, version 25 was used for calculations. Results: according to age and gender ranks, the NC cut-off points to classify general obesity showed sensitivities and specificities above 0.85, with an area under the curve over 0.90, all with p < 0.001. Conclusion: there is evidence that supports that NC cutoff points are a suitable tool for diagnosing obesity in this age group. (AU)

Cuidados de enfermería en pacientes con abdomen abierto y fístulas enterocutáneas / Nursing Care of Patients with Open Abdomen and Enterocutaneous Fistulas / Cuidados de enfermagem em pacientes com abdome aberto e fístulas enterocutâneas

Introducción. Una de las principales intervenciones que realiza el profesional de enfermería es el cuidado de las heridas, su finalidad es evitar posibles complicaciones y estimular la cicatrización del tejido lesionado. El objetivo de esta investigación fue determinar las intervenciones de enfermería realizadas en pacientes con abdomen abierto y fístulas enterocutáneas mediante la revisión de literatura. Metodología. Se realizó una revisión narrativa en un lapso de 10 meses. Las bases de datos utilizadas fueron: PubMed, ScienceDirect, ClinicalKey, MEDLINE, SciELO y Ovid. Se realizó revisión de 50 artículos que cumplían con el objetivo de la revisión. Resultados. Se encontraron cuidados de enfermería relacionados con los cuidados básicos y específicos en pacientes con abdomen abierto y en fístulas enterocutáneas. Discusión. Diversos autores coinciden en que el uso de la Bolsa de Bogotá, es una de las intervenciones de enfermería más utilizadas para las heridas de abdomen abierto, la medición intraabdominal, que permite la identificación precoz del Síndrome Compartimental Abdominal, y el mantenimiento del objetivo nutricional en pacientes con fístulas enterocutáneas, permiten una recuperación exitosa. Conclusiones. Se pudo determinar que existen diversos cuidados de enfermería que deben considerarse en el manejo del abdomen abierto y de las fístulas enterocutáneas, todos estos cuidados permiten que el personal de enfermería tenga un soporte científico útil en el momento de brindar un cuidado a los pacientes con estas condiciones de salud. Esto, con el fin de evitar o disminuir los riesgos de deshidratación, desequilibrio hidroelectrolítico, desnutrición, sepsis e incluso la muerte.

Introduction. One of the main interventions carried out by nursing professionals is the care of wounds. Its purpose is to avoid possible complications and stimulate the scarring of the wounded tissue. The objective of this investigation was to determine the nursing interventions carried out in patients with open abdomens and enterocutaneous fistulas via a literature review. Methodology. A narrative review was carried out over 10 months. The databases used were: PubMed, ScienceDirect, ClinicalKey, MEDLINE, SciELO, and Ovid. Fifty articles that met the objective of the review were used. Results. Nursing care related to basic and specific care in patients with open abdomens and enterocutaneous fistulas was found. Discussion. Different authors agree on the use of the Bogotá Bag, is one of the most used nursing interventions for open abdominal wounds, intraabdominal measurement, which allows for early identification of Abdominal Compartment Syndrome, and maintenance of nutritional objectives in patients with enterocutaneous fistulas allow for successful recovery. Conclusions. We could determine that there are different types of nursing care that must be considered in the handling of open abdomen and enterocutaneous fistulas. All these types of care allow for nursing staff to have a useful scientific support when providing care to patients with these health conditions. This is in order to avoid or reduce the risks of dehydration, hydroelectrolytic imbalance, malnutrition, sepsis, and even death.

Introdução. Uma das principais intervenções realizadas pelo profissional de enfermagem é o cuidado de feridas, sua finalidade é evitar possíveis complicações e estimular a cicatrização do tecido lesado. O objetivo desta pesquisa foi determinar as intervenções de enfermagem realizadas em pacientes com abdome aberto e fístulas enterocutâneas por meio de uma revisão de literatura. Metodologia. Foi realizada uma revisão narrativa durante um período de 10 meses. As bases de dados utilizadas foram: PubMed, ScienceDirect, ClinicalKey, MEDLINE, SciELO e Ovid. Foi realizada uma revisão de 50 artigos que atenderam ao objetivo da revisão. Resultados. Foram encontrados cuidados de enfermagem relacionados aos cuidados básicos e específicos em pacientes com abdome aberto e fístulas enterocutâneas. Discussão. Vários autores concordam que o uso da Bolsa de Bogotá, é uma das intervenções de enfermagem mais utilizadas para feridas abertas abdominais; a medida intra-abdominal, que permite a identificação precoce da Síndrome do Compartimento Abdominal; e a manutenção do objetivo nutricional nos pacientes com fístulas enterocutâneas, permitem uma recuperação bem sucedida. Conclusões. Foi possível determinar que existem diversos cuidados de enfermagem que devem ser considerados no manejo de abdome aberto e fístulas enterocutâneas, todos esses cuidados permitem que a equipe de enfermagem tenha um apoio científico útil no momento de prestar cuidados aos pacientes com estas condições de saúde. Isso, a fim de evitar ou reduzir os riscos de desidratação, desequilíbrio hidroeletrolítico, desnutrição, sepse e até mesmo a morte.

Incidence of and risk factors for surgical-site infections in a Peruvian hospital.

OBJECTIVE: To determine the incidence of and risk factors for surgical-site infections (SSIs) after abdominal surgery. DESIGN: A cohort study was conducted from January to June 1998. CDC criteria for SSI and the NNIS System risk index were used. SETTING: A tertiary-care hospital in Peru. PATIENTS: Adult patients undergoing abdominal surgery who consented were enrolled and observed until 30 days after surgery. Patients who had undergone surgery at another hospital or who died or were transferred to another hospital within 24 hours after surgery were excluded. RESULTS: Four hundred sixty-eight patients were enrolled. Their mean age was 37.2 years. One hundred twenty-five patients developed SSIs, 18% of which were identified after discharge. The overall incidence rate (IR) was 26.7%. The IR was 13.9% for clean, 15.9% for clean-contaminated, 13.5% for contaminated, and 47.2% for dirty interventions. The IR was 3.6% for NNIS System risk index 0 and 60% for index 3. Risk factors for SSI on logistic regression analysis were dirty or infected wound (RR, 3.8; CI95, 1.7-8.4), drain use longer than 9 days (RR, 6.0; CI95, 2.5-12.5), and length of surgery greater than the 75th percentile (RR, 2.1; CI95, 1.0-4.4). Patients with SSI had a longer hospital stay than did non-infected patients (14.0 vs 6.1 days; p < .001). CONCLUSIONS: SSI is a major problem in this hospital, which has a higher IR (especially for clean interventions) than those of developed countries. In developing countries, prevention of SSI should include active surveillance and interventions targeting modifiable risk factors.

Autonomía en ancianos institucionalizados: relación con el género, la escolaridad y el tiempo de institucionalización / Autonomy in elderly people living in residences: relationship with gender, education level and time of institutionalization

Objetivo: El envejecimiento patológico se asocia con la pérdida de autonomía, por lo que se investigaron las relaciones entre variables sociodemográficas y de la institucionalización con autonomía funcional, dependencia y deterioro cognitivo en ancianos institucionalizados. Metodología: Los participantes fueron 78 ancianos de tres centros en dos ciudades de Colombia (Bucaramanga y Santa Marta). Los instrumentos utilizados fueron el Mini-Examen de Estado Mental, el índice de Barthel y la escala de valoración de la autonomía funcional (EVA). Resultados: Aunque se encontraron más ancianos con baja dependencia y buena autonomía general, se halló que el 56% presentaba deterioro cognitivo, con afectación de las actividades instrumentales y las funciones mentales. Se encontró significativamente más deterioro cognitivo (χ2 = 6,69 [gl = 1], p = 0,010) y dependencia (χ2 = 0,9,22 [gl = 2], p =0,010) en las mujeres. Las personas con mayor nivel de estudios tuvieron más autonomía general (prueba de KruskalWallis: χ2 = 6,79 [gl = 1], p = 0,009). Se halló que, a mayor tiempo de institucionalización, menor autonomía (Rho de Spearman = -0,346, p = 0,003). Conclusiones: El género se relacionó significativamente con la dependencia y el deterioro cognitivo, mientras que la autonomía, especialmente en las actividades instrumentales de la vida diaria, se relacionó con el nivel de estudios, así como con el tiempo de institucionalización, lo que debe tenerse en cuenta en la planificación y organización de las intervenciones

Purpose: Pathological aging is associated with the loss of autonomy, so the relationships between sociodemographic variables and institutionalization with functional autonomy, dependence and cognitive deterioration in institutionalized elderly were investigated. Method: Participants were 75 old persons from three centers in two cities of Colombia (Bucaragamanga and Santa Marta). The instruments used were Mini-Mental State Examination (MMSE), the Barthel Index, and the Functional Autonomy Rating Scale (EVA). Results: Although more elderly people were found with low dependency and good autonomy, 56% had cognitive impairment. The major problems were in the instrumentals activities and mental functions. Women had significative more cognitive impairment (χ2=6.69 [gl=1], p=.010) and dependence (χ2=,9.22 [gl=2], p=.010) than men. People with high educational level had better general autonomy (Prueba de Kruskal-Wallis: χ2=6.79 [gl=1], p=.009) Time of institutionalization was correlationated with low autonomy in daily instrumental activities. Conclusions: The autonomy were related with institutionalization and education, while dependence and cognitive impairment were related with gender, so is important design appropiate organization of the activities for elderly who is living in a geriatric home for a long time

Funcionamiento cognitivo, autonomía e independencia del adulto mayor institucionalizado / Cognitive function, and independence of autonomy elderly institutionalized

RESUMEN Introducción: En el envejecimiento se puede producir un deterioro de las capacidades físicas y mentales que conduzcan a dependencia y minusvalía; y esto suele ser más frecuente en el anciano institucionalizado. Objetivo: Determinar funcionamiento cognitivo, autonomía e independencia del adulto mayor institucionalizado. Métodos: Estudio descriptivo cuantitativo de corte trasversal, realizado en el Asilo Sagrado Corazón de Jesús entre los meses de septiembre a noviembre del 2015. El universo está constituido por 62 adultos mayores institucionalizados, la muestra de 37 que cumplieron con los criterios de inclusión. Instrumentos utilizados Minimental State Examination, Escala de Valoración de la Autonomía para el Autocuidado y Escala de Autonomía para las actividades básicas de la vida diaria -Barthel. Se procesó la información mediante estadística descriptiva. Resultados: El 51,20 por ciento fueron mujeres, 48,80 por ciento hombres. 88,23 por ciento entre 71 a 90 años. 32,40 por ciento presentaron deterioro cognitivo grave, 24,20 por ciento deterioro moderado y 27,00 por ciento sin deterioro. En la realización de actividades de la vida diaria 76,70 por ciento tenían autonomía total, 5,10 por ciento eran dependientes. 40,50 por ciento fueron independientes, 2,70 por ciento presentó dependencia leve y 13,50 por ciento entre dependencia severa y total. Conclusiones: Los adultos mayores en su mayoría son autónomos e independientes en las actividades básicas de la vida diaria, no siendo así la funcionalidad cognitiva que presento mayor deterioro(AU)

ABSTRACT Introduction: In the aging there is a deterioration of the capabilities physical and mental that lead to dependency and disability This problems tends to be more frequent in the elderly institutionalized. Objective: To determine the cognitive functions, autonomy and independence of the institutionalized elderly. Methods: A descriptive study of quantitative crosscut, held at the Asilo Sagrado Corazon de Jesus between the months of September and November of 2015. The sample group consist of 62 institutionalized elderly, of which 37 meet the self-reliance requirement. Among the tools used to evaluate and the Minimental State Examination, Rating Scale for Self-Care Autonomy, and Autonomy Scale for basic activities of daily living -Barthel. This information was processed using descriptive statistics. Results: 51.20 percent were women, 48.80 percent men. 88.23 percent between 71-90 years. 32.40 percent had severe cognitive impairment, 24.20 percent had moderate impairment and 27.00 percent had no deterioration. In carrying out daily activities, 76.70 percent had full autonomy, 5.10 percent were dependent, 40.50 percent had been independent, 2.70 percent had mild dependence and 13.50 percent between severe and total dependence. Conclusions: Older adults are mostly self-reliant and independent in basic activities of daily life since cognitive functioning is not mostly affected(AU)

Instrumento de valoración familiar por el modelo de dominios de la taxonomía II de NANDA / Family assessment instrument based on the Nanda taxonomy II domains model

Introducción: Una familia es saludable cuando se logra un equilibrio entre el control, crecimiento, la estabilidad y la espiritualidad de cada uno de sus integrantes con el entorno que los rodea (2). Objetivo: Diseñar un instrumento validado que permita la valoración familiar por el Modelo de Dominios de la Taxonomía II de NANDA. Metodología: Diseño cuantitativo, de tipo tecnológica psicométrica con análisis de datos descriptivos. La muestra para la validación del instrumento fue de 8 profesionales en enfermería; además, se realizó una prueba piloto en donde participaron 40 familias pertenecientes a las ciudades de Bucaramanga y Santa Marta, Colombia, 20 para cada ciudad. Para la validación de contenido, se tuvo en cuenta el Modelo de Lawshe Modificado. Resultados: Existió un consenso general entre los jueces evaluadores en la validación de contenido del Instrumento, el Coeficiente Alpha de Cronbach fue de 0.847, la correlación no paramétrica Rho de Spearman, arrojó una buena correlación entre los ítems contemplados en el instrumento, con un valor de r mayor de 0.5 y un nivel de significancia < de 0.05, con un valor de p de cero. Conclusiones: Se encontró consenso entre los jueces evaluadores, una fiabilidad por medio del Alpha de Cronbach superior a 0.7 y correlaciones no paramétrica Rho de Spearman significativas entre algunos ítems del instrumento (AU)

Introduction: A family is healthy when a balance among the control, growth, stability and spirituality of each of its members is achieved with the surrounding environment (2). Objective: To design a validated instrument that permits family assessment based on the North American Nursing Diagnosis Association (NANDA) Taxonomy II domains model. Methodology: A quantitative design, of the psychometric technological type with descriptive data analysis. The sample for the validation of the instrument comprised eight nursing professionals. In addition, a pilot test was conducted; 40 families from the cities of Bucaramanga and Santa Marta, Colombia, including 20 from each city, participated. For the content validation, the Modified Lawshe’s Model was considered. Results: There was a general consensus among the evaluating judges regarding the validation of the content of the instrument. Cronbach’s alpha was 0.847. Regarding Spearman’s rho nonparametric correlation, there was a good correlation among the items considered by the instrument, with a value of r greater than 0.5, a significance level of <0.05 and a p-value of zero. Conclusions: A bibliographical review was performed, according to the context of family. The Family Assessment Instrument, based on the NANDA Taxonomy II Domains Model and consisting of 45 items, was designed. Consensus among the evaluating judges, a reliability by means of Cronbach's alpha value greater than 0.7 and significant Spearman’s rho nonparametric correlations among some items of the instrument were found (AU)

Grado de deterioro cognitivo de los adultos mayores institucionalizados en dos hogares para ancianos del área metropolitana de Bucaramanga - Santander, Colombia / Degree of cognitive impairment of older adults institutionalized in two homes for the elderly in the metropolitan area of Bucaramanga - Santander, Colombia

Resumen Introducción: El deterioro cognitivo es uno de los problemas que se presentan con mayor frecuencia en la población adulta mayor como consecuencia del envejecimiento. Objetivo: Determinar el grado de deterioro cognitivo de los adultos mayores institucionalizados en dos hogares para ancianos del área metropolitana de Bucaramanga, Santander, Colombia. Materiales y métodos: Estudio cuantitativo con diseño descriptivo, de corte transversal, con una población de 165 y una muestra de 60 adultos mayores de dos hogares para ancianos, cuyos criterios de inclusión fueron: edad entre 65 y 95 y más años, presencia o ausencia de patología crónica. Se utilizó el muestreo no probabilístico por conveniencia, y se aplicó el instrumento: MMSE (Examen Cognoscitivo Mini-Mental). Resultados: La población adulta mayor que participó en el estudio oscila entre las edades de 75 a 94 años, existió predominio del género masculino; la mayoría se encontraban en nivel básico primario, tenían contacto familiar, el tiempo de institucionalización fue de 1 a 5 años. Conclusiones: El 41,7% de los adultos mayores estudiados presentaron deterioro cognitivo grave y requieren intervenciones de enfermería enfocadas en la terapia cognitiva.

Abstract Introduction: Cognitive impairment is one of the most frequent occurring problems in the older adult population as a result of ageing. Objective: Determine the degree of cognitive impairment of older adults institutionalized in two homes for the elderly in the metropolitan area of Bucaramanga, Santander in Colombia. Materials and methods: A quantitative study was made by using a cross-sectional descriptive design with a population of 165 and a sample of 60 older adults from two homes for the elderly, whose inclusion criteria were: age between 65 to 95 or more and presence or absence of chronic pathology. A non-probabilistic sampling was used for convenience, and the instrument MMSE (Mini-Mental state examination) was applied. Results: The older adult population who participated in the study is between the ages of 75 to 94. Most of them were male, had a primary school level, had family contact and the time for institutionalization was 1 to 5 years. Conclusions: 41.7% of older adults studied showed severe cognitive impairment and require nursing interventions focused on cognitive therapy.