The protective role of coenzyme Q10 in renal injury associated with extracorporeal shockwave lithotripsy: a randomised, placebo-controlled clinical trial.

OBJECTIVE: To determine the efficacy of coenzyme Q10 (CoQ10) in preventing renal injury in patients with lithiasis undergoing extracorporeal shockwave lithotripsy (ESWL). PATIENTS AND METHODS: Prospective, randomised, double-blind, placebo-controlled clinical trial of 100 patients with renal lithiasis who were treated with ESWL. The patients were distributed randomly into two groups receiving either placebo or CoQ10 (200 mg/day), a powerful antioxidant with vasoactive properties, orally administered during the week before ESWL and for 1 week after. Renal dysfunction markers, vasoactive hormones, oxidative stress, plasma levels of several interleukins and vascular resistance index (VRI) using Doppler ultrasound were evaluated the week before ESWL, 2 h before ESWL and at 2 h, 24 h and 7 days after ESWL. RESULTS: There was a significant increase in glomerular filtration (P = 0.013), as well as a decrease in the albumin/creatinine ratio and the ß2 -microglobulin level (P = 0.02) after 1 week of treatment in the CoQ10 group. These changes were maintained at the follow-up after ESWL. The administration of CoQ10 was associated with improvement in vasoactive hormone parameters, VRI and interleukin levels. These improvements were maintained until the end of the follow-up period. However, the administration of CoQ10 was not associated with significant changes in the oxidative stress parameters. CONCLUSION: Our results indicate that CoQ10 administration improves renal function and vasoactive and inflammation parameter values, allowing for preconditioning before the tissue insult caused by ESWL.

Knowledge, attitudes, practices and perceptions about Zika in women of childbearing age in Amazonas, Peru. / Conocimientos, actitudes, prácticas y percepción sobre Zika en mujeres en edad fértil de Amazonas, Perú.

OBJECTIVE.: To describe the knowledge, attitudes, practices, and perceptions about Zika in women of childbearing age (WCA) in the department of Amazonas in Peru, following a Zika outbreak. MATERIALS AND METHODS.: Descriptive study with a mixed quantitative-qualitative approach. We carried out stratified sampling, by applying a survey to a sample of 723 WCA aged 15 to 49 years in the district of Bagua, department of Amazonas, then we carried out four focus groups with 35 WCA in each group. Frequencies and the grounded theory were used for quantitative and qualitative analysis respectively. Interpretation of both methods was integrated using a narrative approach. RESULTS.: We found that 86.3% of WCA knew that it is possible to get sick with Zika, 10.1% knew that it is transmitted through sexual intercourse, 2.2% knew that it can be transmitted during pregnancy and 68.5% consider that the information is insufficient. In practice, 60% (n=434) used mosquito nets, 53.4% (n=386) covered water containers and 7.3% (n=4) perceived local government involvement. Qualitative data showed distrust of vector control and expressed the need for psychological support for pregnant women and their families. CONCLUSIONS.: There are gaps in the knowledge and practices of WCA regarding the prevention of sexual and vertical transmission of Zika; WCA distrust vector control, do not perceive local government involvement, suggest psychological support should be provided to pregnant women with Zika, as well as to mothers with disabled children, and wish to access more information about Zika.

OBJETIVOS.: Describir los conocimientos, actitudes, prácticas y percepciones del zika en mujeres en edad fértil (MEF) en el departamento de Amazonas, posterior a un brote de zika. MATERIALES Y MÉTODOS.: Estudio descriptivo de enfoque mixto cuanticualitativo. Se realizó un muestreo estratificado, aplicándose una encuesta a una muestra de 723 MEF de 15 a 49 años del distrito de Bagua, departamento de Amazonas y cuatro grupos focales con 35 MEF. Se aplicó una encuesta y guía de grupo focal. Se usaron frecuencias y teoría fundamentada para el análisis cuantitativo y cualitativo respectivamente. Se integró ambos enfoques en la interpretación mediante abordaje narrativo. RESULTADOS.: El 86,3% de MEF conocen que es posible enfermar con zika, 10,1% que se transmite por relaciones sexuales, 2,2% durante el embarazo y 68,5% consideran que es insuficiente la información. En la práctica; 60%(n=434) usa mosquiteros, 53,4%(n=386) tapa recipientes de agua y el 7,3%(n=4) perciben participación del gobierno local. Los datos cualitativos muestran desconfianza al control vectorial y expresan necesidad de apoyo psicológico a las gestantes y familia. CONCLUSIONES.: Existen brechas en el conocimiento y prácticas para la prevención del zika por trasmisión sexual y vertical, tienen desconfianza del control vectorial, no perciben participación del gobierno local, sugieren acompañamiento psicológico a la gestante con zika, a la madre con niño discapacitado y desean acceder a más información sobre zika.

Clinical Utility of Ghrelin-O-Acyltransferase (GOAT) Enzyme as a Diagnostic Tool and Potential Therapeutic Target in Prostate Cancer.

Recent data suggested that plasma Ghrelin O-Acyl Transferase enzyme (GOAT) levels could represent a new diagnostic biomarker for prostate cancer (PCa). In this study, we aimed to explore the diagnostic and prognostic/aggressiveness capacity of GOAT in urine, as well as to interrogate its putative pathophysiological role in PCa. We analysed urine/plasma levels of GOAT in a cohort of 993 patients. In vitro (i.e., cell-proliferation) and in vivo (tumor-growth in a xenograft-model) approaches were performed in response to the modulation of GOAT expression/activity in PCa cells. Our results demonstrate that plasma and urine GOAT levels were significantly elevated in PCa patients compared to controls. Remarkably, GOAT significantly outperformed PSA in the diagnosis of PCa and significant PCa in patients with PSA levels ranging from 3 to 10 ng/mL (the so-called PSA grey-zone). Additionally, urine GOAT levels were associated to clinical (e.g., Gleason-score, PSA levels) and molecular (e.g., CDK2/CDK6/CDKN2A expression) aggressiveness parameters. Indeed, GOAT overexpression increased, while its silencing/blockade decreased cell-proliferation in PCa cells. Moreover, xenograft tumors derived from GOAT-overexpressing PCa (DU145) cells were significantly higher than those derived from the mock-overexpressing cells. Altogether, our results demonstrate that GOAT could be used as a diagnostic and aggressiveness marker in urine and a therapeutic target in PCa.

[Impact of the use of simulators on the mental workload and confidence in a digital rectal examination and bladder catheterization workshop.] / Impacto del uso de simuladores sobre la carga mental y la confianza en un taller de tacto rectal y cateterización vesical en estudiantes.

OBJECTIVES: Primary: to assess the use of simulators in prostate digital rectal examination and bladder catheterization on mental workload and the level of confidence in medical students. Secondary: to analyze student satisfaction and skills acquired by students with simulators. METHODS: We conducted a prospective, randomized study on medical students. Participants were divided into two groups: Group 1 (G1) (only the explanation) and group 2 (G2) (explanation + simulator workshop). For workload assessment, the validated NASA-TLX questionnaire was completed. The acceptability of the activity, the degree of confidence and the skills acquired were also evaluated. RESULTS: A total of 28 students participated in the practice of prostate examination. All participants reported a higher level of confidence after the theoretical explanation. 34 students participated in the bladder catheterization workshop and all of them increased their confidence after the activity. The G2 showed better scores on the acquired skills exam than the G1. Most students considered positive the incorporation of these models in their learning. According to the NASA-TLX results, less frustration is experienced with the use of simulators in both activities. CONCLUSIONS: The implementation of simulators in the training of students may improve their level of confidence, reducing frustration when performing these explorations in the future and improving care quality.

Determinantes socioculturales asociados a la neumonía en Puno, Perú: estudio cualitativo / Sociocultural determinants associated to pneumonia in Puno, Peru: a qualitative study

Objetivo: Identificar los determinantes socioculturales de la neumonía a través de la percepción de los trabajadores de salud y de la comunidad en Puno, Perú. Material y métodos: Del 8 al 11 de junio de 2009, se aplicaron técnicas cualitativas que incluyeron grupos focales en trabajadores administrativos de la Dirección Regional de Salud de Puno, trabajadoras asistenciales de un hospital del Ministerio de Salud de la provincia de Juliaca, Puno, y escolares entre 8 y 9 años de una escuela pública de la provincia de Juliaca. Las técnicas proyectivas se aplicaron a los escolares, quienes a través de dibujos libres expresaron sus sentimientos, opiniones, razones para comportamientos y actitudes, tanto de ellos como de sus padres, sobre la neumonía. Los grupos focales fueron grabados y posteriormente transcritos, también se entrevistaron a dos familiares de una niña fallecida por neumonía en la comunidad de los UROS en Puno, mediante una guía de preguntas. Resultados: Los determinantes asociados a la neumonía que se identificaron son la falta de liderazgo y coordinación de los trabajadores de salud en la atención de los pacientes con neumonía, las demoras en la atención y en los pagos por los servicios de salud, la influencia de la suegra quien decide qué hacer con los niños con neumonía, los padres que automedican a los niños, el que los niños permanecen solos en casa hasta altas horas de la noche y una demora en acudir al hospital; los trabajadores de salud reconocen que la atención en los servicios de salud es limitada y no es de calidad. Conclusiones: Los determinantes socioculturales son la falta de liderazgo y coordinación de los equipos de salud, las demoras en la atención y en los pagos por los servicios, la influencia de la suegra en la toma de decisiones, la automedicación y el acudir tarde al hospital cuando el niño enfermo está grave.

Objective: To identify the sociocultural determinants of pneumonia through the perception of health workers and community in Puno, Peru. Methods: From June 8 to 11, 2009, we applied qualitative techniques including focus groups in administrative workers of the Regional Health Directorate of Puno, healthcare workers from a public hospital of the province of Juliaca, Puno, and schoolchildren between 8 and 9 years from a public school in the province of Juliaca. Projective techniques were also applied to the schoolchildren, who through free drawing expressed their feelings, opinions, reasons for behaviors and attitudes of both children and their parents, related to pneumonia. Focus groups were recorded and later transcribed; we also interviewed two relatives of a girl who died from pneumonia in the community of Uros, Puno, using a questionaire guide. Results: The determinants associated with pneumonia that were identified are lack of leadership and coordination of health workers in the care of patients with pneumonia, delayed in care and payments for health services, the influence of the mother-in-law who decides what to do with children with pneumonia, parents who medicate their children, children that stay alone at home uintil late at night and a delay in the attendance to the hospital; health workers recognized that attention in health services is limited and not of quality. Conclusions: The sociocultural determinants are lack of leadership and coordination of health teams, delays in care and payments for services, the mother-in law influence in decision making, self-medication and going to the hospital when the child is seriously ill.

Estudio epidemiológico sobre la violencia y comportamientos asociados en Lima Metropolitana y Callao / Epidemiology study about violence and associated behaviour in Lima and Callao

El presente estudio epidemiológico fue ejecutado en Lima Metropolitana evaluando 3590 hogares debidamente muestreados y utilizando un instrumento especialmente construído para el caso. Los resultados fueron obtenidos por áreas: Area familiar, se halló que el 35,4 por ciento recibieron violencia psicológica por parte de su pareja, el 17,4 por ciento señaló haber sido víctima de violencia física por parte de su pareja. En el Area de violencia y maltrato infantil, con respecto al maltrato pre-natal el 9,6 por ciento de las madres no tuvieron ningún control mensual pre-natal durante la gestación, el 18,6 por ciento experimentó depresión, respecto al consumo de medicamentos, el 1,9 por ciento consumió analgésicos, el 0,6 por ciento antibióticos, el 0,5 por ciento neurolépticos y el 0,3 por ciento ansiolíticos; en relación al consumo de sustancias el 19,3 por ciento consumió café, el 1,5 por ciento tabaco, el 1,1 por ciento alcohol y el 0,2 por ciento cocaína. En cuanto al maltrato infantil el 36,2 por ciento de los padres señalaron maltratar psicológicamente a sus hijos. En el Area de violencia callejera, los encuestados (n=3590) reportan haber sido víctimas de grupos de pandillas callejeras; sufriendo el 15,4 por ciento lesiones leves, el 2,8 por ciento lesiones graves y el 0,3 por ciento la muerte de algún miembro de la familia. Asimismo u 42,7 por ciento reportan haber sido víctimas de algún tipo de violencia delincuencial. En el Area de comportamientos asociados, se encontró que las principales sustancias psicoactivas que alguna vez fueron consumidas regularmente por los encuestados son: el alcohol 27,5 por ciento, el tabaco 18,7 por ciento, medicamentos no recetados el 3,7 por ciento. En el Perú el problema de la violencia en sus diferentes modalidades, según los resultados hallados, involucra a la población en general; no solo comprende a mujeres o niños, o un determinado nivel socioeconómico o un cierto nivel cultural