RESUMO
PURPOSE: The aim of this study is to compare optical quality results obtained in laboratory analysis (in vitro) versus clinical data (in vivo). METHODS: The optical quality of ISOPure intraocular lens was assessed both in vitro and in vivo using the modulation transfer function (MTF) for 3.0 and 4.5 mm pupil diameters. In vitro measurements were obtained using deflectometer NIMO TRF1504, while in vivo measurements were taken with OPD-Scan III in a set of patients implanted with this lens. Ray tracing techniques were used to determine the MTF and area under MTF curve (MTFa) from the measured wavefront for the isolated lens and for the whole eye. RESULTS: The MTF of the isolated lens obtained under both in vitro and in vivo conditions showed comparable results for both pupil sizes. However, differences were found when comparing the MTF of the whole eye with the lens implanted versus the MTF measured in vitro for 4.5 mm pupil size. Also, the MTFa defocus curve was compared with the defocus curve measured in vivo. CONCLUSION: The defocus curve from the in vivo study aligns closely with the MTFa of the in vitro model, with a useful defocus range of 0.40D. Thus, it is possible to anticipate the visual results of the implanted isofocal lens by using measurements on an optical bench and conducting optical simulations.
RESUMO
PURPOSE: This study is to evaluate the optical characteristics of a non-diffractive wavefront-shaping intraocular lens which incorporates surface refractive modifications for shaping the wavefront in order to achieve extended depth of focus (EDoF) and to assess whether the nominal power of this IOL influences the attainable add power. METHODS: A commercially available optical bench NIMO TR1504 device (LAMBDA-X, Nivelles, Belgium) was employed to obtain full optical characterization of three non-diffractive EDoF intraocular lenses with + 10 D, + 20 D, and + 30 D powers. After NIMO measurements, data were computed using a custom-made MATLAB program (Mathworks, Inc., Natick, MA, USA) to evaluate the optical quality functions, such as the point spread function (PSF), wavefront profiles, and modulation transfer function (MTF) for two pupil sizes: 3 mm and 4.0 mm. RESULTS: The non-diffractive EDoF intraocular lens showed a central serrated power profile behavior with additions of + 2.00 to + 2.50 D over the nominal power. Higher order aberrations were found to be driven mainly by the spherical aberration, with almost null comatic influence. Optical quality metrics showed good values, better for a 3 mm pupil compared to a 4.5 mm one, as expected. The three IOL powers tested showed a very similar behavior in terms of power and aberrometric profiles, with minimal to null differences related to the nominal power. CONCLUSION: The non-diffractive wavefront-shaping EDoF intraocular lens achieves a near addition up to + 2.50 D aiming for an extended range of vision, almost independently of the base power.
Assuntos
Percepção de Profundidade , Lentes Intraoculares , Óptica e Fotônica , Desenho de Prótese , Refração Ocular , Acuidade Visual , Humanos , Refração Ocular/fisiologia , Percepção de Profundidade/fisiologia , Acuidade Visual/fisiologia , Aberrações de Frente de Onda da Córnea/fisiopatologia , Aberrações de Frente de Onda da Córnea/diagnósticoRESUMO
Long intergenic noncoding RNAs (lincRNAs) play important roles in disease, but the vast majority of these transcripts remain uncharacterized. We defined a set of 54 944 human lincRNAs by drawing on four publicly available lincRNA datasets, and annotated â¼2.5 million single nucleotide polymorphisms (SNPs) from each of 15 cardiometabolic genome-wide association study datasets into these lincRNAs. We identified hundreds of lincRNAs with at least one trait-associated SNP: 898 SNPs in 343 unique lincRNAs at 5% false discovery rate, and 469 SNPs in 146 unique lincRNAs meeting Bonferroni-corrected P < 0.05. An additional 64 trait-associated lincRNAs were identified using a class-level testing strategy at Bonferroni-corrected P < 0.05. To better understand the genomic context and prioritize trait-associated lincRNAs, we examined the pattern of linkage disequilibrium between SNPs in the lincRNAs and SNPs that met genome-wide-significance in the region (±500 kb of lincRNAs). A subset of the lincRNA-trait association findings was replicated in independent Genome-wide association studies data from the Pakistan Risk of Myocardial Infarction Study study. For trait-associated lincRNAs, we also investigated synteny and conservation relative to mouse, expression patterns in five cardiometabolic-relevant tissues, and allele-specific expression in RNA sequencing data for adipose tissue and leukocytes. Finally, we revealed a functional role in human adipocytes for linc-NFE2L3-1, which is expressed in adipose and is associated with waist-hip ratio adjusted for BMI. This comprehensive profile of trait-associated lincRNAs provides novel insights into disease mechanism and serves as a launching point for interrogation of the biology of specific lincRNAs in cardiometabolic disease.
Assuntos
Genoma Humano , Estudo de Associação Genômica Ampla , Infarto do Miocárdio/genética , RNA Longo não Codificante/genética , Adipócitos/metabolismo , Alelos , Humanos , Desequilíbrio de Ligação , Infarto do Miocárdio/fisiopatologia , Paquistão , Polimorfismo de Nucleotídeo Único , Análise de Sequência de RNA , Relação Cintura-QuadrilRESUMO
Understanding the complex interplay among protein coding genes and regulatory elements requires rigorous interrogation with analytic tools designed for discerning the relative contributions of overlapping genomic regions. To this aim, we offer a novel application of Bayesian variable selection (BVS) for classifying genomic class level associations using existing large meta-analysis summary level resources. This approach is applied using the expectation maximization variable selection (EMVS) algorithm to typed and imputed SNPs across 502 protein coding genes (PCGs) and 220 long intergenic non-coding RNAs (lncRNAs) that overlap 45 known loci for coronary artery disease (CAD) using publicly available Global Lipids Gentics Consortium (GLGC) (Teslovich et al., 2010; Willer et al., 2013) meta-analysis summary statistics for low-density lipoprotein cholesterol (LDL-C). The analysis reveals 33 PCGs and three lncRNAs across 11 loci with >50% posterior probabilities for inclusion in an additive model of association. The findings are consistent with previous reports, while providing some new insight into the architecture of LDL-cholesterol to be investigated further. As genomic taxonomies continue to evolve, additional classes such as enhancer elements and splicing regions, can easily be layered into the proposed analysis framework. Moreover, application of this approach to alternative publicly available meta-analysis resources, or more generally as a post-analytic strategy to further interrogate regions that are identified through single point analysis, is straightforward. All coding examples are implemented in R version 3.2.1 and provided as supplemental material.
Assuntos
Teorema de Bayes , Suscetibilidade a Doenças , Loci Gênicos , Estudo de Associação Genômica Ampla , Genômica , Humanos , Polimorfismo de Nucleotídeo ÚnicoRESUMO
Emerging data suggest that the genetic regulation of the biological response to inflammatory stress may be fundamentally different to the genetic underpinning of the homeostatic control (resting state) of the same biological measures. In this paper, we interrogate this hypothesis using a single-SNP score test and a novel class-level testing strategy to characterize protein-coding gene and regulatory element-level associations with longitudinal biomarker trajectories in response to stimulus. Using the proposed class-level association score statistic for longitudinal data, which accounts for correlations induced by linkage disequilibrium, the genetic underpinnings of evoked dynamic changes in repeatedly measured biomarkers are investigated. The proposed method is applied to data on two biomarkers arising from the Genetics of Evoked Responses to Niacin and Endotoxemia study, a National Institutes of Health-sponsored investigation of the genomics of inflammatory and metabolic responses during low-grade endotoxemia. Our results suggest that the genetic basis of evoked inflammatory response is different than the genetic contributors to resting state, and several potentially novel loci are identified. A simulation study demonstrates appropriate control of type-1 error rates, relative computational efficiency, and power. Copyright © 2017 John Wiley & Sons, Ltd.
Assuntos
Biomarcadores , Estudos Longitudinais , Modelos Estatísticos , Polimorfismo de Nucleotídeo Único , Biometria/métodos , Simulação por Computador , Endotoxemia , Humanos , Modelos Lineares , Desequilíbrio de Ligação , Niacina , Fases de Leitura Aberta/genéticaRESUMO
OBJECTIVE: Human macrophages can shift phenotype across the inflammatory M1 and reparative M2 spectrum in response to environmental challenges, but the mechanisms promoting inflammatory and cardiometabolic disease-associated M1 phenotypes remain incompletely understood. Alternative splicing (AS) is emerging as an important regulator of cellular function, yet its role in macrophage activation is largely unknown. We investigated the extent to which AS occurs in M1 activation within the cardiometabolic disease context and validated a functional genomic cell model for studying human macrophage-related AS events. APPROACH AND RESULTS: From deep RNA-sequencing of resting, M1, and M2 primary human monocyte-derived macrophages, we found 3860 differentially expressed genes in M1 activation and detected 233 M1-induced AS events; the majority of AS events were cell- and M1-specific with enrichment for pathways relevant to macrophage inflammation. Using genetic variant data for 10 cardiometabolic traits, we identified 28 trait-associated variants within the genomic loci of 21 alternatively spliced genes and 15 variants within 7 differentially expressed regulatory splicing factors in M1 activation. Knockdown of 1 such splicing factor, CELF1, in primary human macrophages led to increased inflammatory response to M1 stimulation, demonstrating CELF1's potential modulation of the M1 phenotype. Finally, we demonstrated that an induced pluripotent stem cell-derived macrophage system recapitulates M1-associated AS events and provides a high-fidelity macrophage AS model. CONCLUSIONS: AS plays a role in defining macrophage phenotype in a cell- and stimulus-specific fashion. Alternatively spliced genes and splicing factors with trait-associated variants may reveal novel pathways and targets in cardiometabolic diseases.
Assuntos
Processamento Alternativo , Diferenciação Celular , Perfilação da Expressão Gênica , Células-Tronco Pluripotentes Induzidas/metabolismo , Inflamação/genética , Ativação de Macrófagos/genética , Macrófagos/metabolismo , Transcriptoma , Proteínas CELF1/genética , Proteínas CELF1/metabolismo , Células Cultivadas , Perfilação da Expressão Gênica/métodos , Redes Reguladoras de Genes , Estudo de Associação Genômica Ampla , Humanos , Inflamação/metabolismo , Lipopolissacarídeos/farmacologia , Ativação de Macrófagos/efeitos dos fármacos , Macrófagos/efeitos dos fármacos , Análise de Sequência com Séries de Oligonucleotídeos , Fenótipo , Mapeamento de Interação de Proteínas , Interferência de RNA , Transdução de Sinais , TransfecçãoRESUMO
This tutorial is a learning resource that outlines the basic process and provides specific software tools for implementing a complete genome-wide association analysis. Approaches to post-analytic visualization and interrogation of potentially novel findings are also presented. Applications are illustrated using the free and open-source R statistical computing and graphics software environment, Bioconductor software for bioinformatics and the UCSC Genome Browser. Complete genome-wide association data on 1401 individuals across 861,473 typed single nucleotide polymorphisms from the PennCATH study of coronary artery disease are used for illustration. All data and code, as well as additional instructional resources, are publicly available through the Open Resources in Statistical Genomics project: http://www.stat-gen.org.
Assuntos
Biologia Computacional , Estudo de Associação Genômica Ampla , Bases de Dados Genéticas , Estudo de Associação Genômica Ampla/estatística & dados numéricos , Humanos , SoftwareAssuntos
Neoplasias do Colo/complicações , Obstrução Intestinal/etiologia , Intussuscepção/etiologia , Lipoma/complicações , Dor Abdominal/etiologia , Neoplasias do Colo/diagnóstico por imagem , Constipação Intestinal/etiologia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Laparoscopia , Lipoma/diagnóstico por imagem , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Chronic heart failure (HF) has high rates of mortality and hospitalization in patients with advanced chronic kidney disease (aCKD). However, randomized clinical trials have systematically excluded aCKD population. We have investigated current HF therapy in patients receiving clinical care in specialized aCKD units. METHODS: The Heart And Kidney Audit (HAKA) was a cross-sectional and retrospective real-world study including outpatients with aCKD and HF from 29 Spanish centers. The objective was to evaluate how the treatment of HF in patients with aCKD complied with the recommendations of the European Society of Cardiology Guidelines for the diagnosis and treatment of HF, especially regarding the foundational drugs: renin-angiotensin system inhibitors (RASi), angiotensin receptor blocker/neprilysin inhibitors (ARNI), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). RESULTS: Among 5,012 aCKD patients, 532 (13%) had a diagnosis of HF. Of them, 20% had reduced ejection fraction (HFrEF), 13% mildly reduced EF (HFmrEF), and 67% preserved EF (HFpEF). Only 9.3% of patients with HFrEF were receiving quadruple therapy with RASi/ARNI, BB, MRA, and SGLT2i, but the majority were not on the maximum recommended doses. None of the patients with HFrEF and CKD G5 received quadruple therapy. Among HFmrEF patients, approximately half and two-thirds were receiving RASi and/or BB, respectively, while less than 15% received ARNI, MRA, or SGLT2i. Less than 10% of patients with HFpEF were receiving SGLT2i. CONCLUSIONS: Under real-world conditions, HF in aCKD patients is sub-optimally treated. Increased awareness of current guidelines and pragmatic trials specifically enrolling these patients represent unmet medical needs.
Assuntos
Antagonistas Adrenérgicos beta , Antagonistas de Receptores de Angiotensina , Insuficiência Cardíaca , Antagonistas de Receptores de Mineralocorticoides , Insuficiência Renal Crônica , Inibidores do Transportador 2 de Sódio-Glicose , Volume Sistólico , Humanos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Estudos Retrospectivos , Masculino , Feminino , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Idoso , Estudos Transversais , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Volume Sistólico/fisiologia , Pessoa de Meia-Idade , Espanha/epidemiologia , Fidelidade a Diretrizes , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Idoso de 80 Anos ou maisRESUMO
Introduction: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI). Materials and methods: In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded. Results: From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24 h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases. Conclusions: The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.
RESUMO
INTRODUCTION: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI). MATERIALS AND METHODS: In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded. RESULTS: From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases. CONCLUSIONS: The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.
Assuntos
COVID-19 , Abscesso Peritonsilar , Tonsilectomia , Tonsilite , Humanos , Pandemias/prevenção & controle , Estudos Retrospectivos , Tonsilectomia/efeitos adversos , COVID-19/complicações , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Abscesso Peritonsilar/epidemiologia , Tonsilite/epidemiologia , Tonsilite/cirurgia , Atenção à SaúdeRESUMO
A novel scoring algorithm based on unique solvent accessible surface area (SASA) descriptors was comparatively evaluated for its database enrichment potential against the virtual screening (VS) methods GOLD and Glide. Several protein test cases, including adenosine deaminase and estrogen receptor alpha, were used for the evaluation. The structure-based VS method GOLD was used to generate the protein-ligand docking poses. These docking poses were then postprocessed with a protein-ligand interaction fingerprint metric. Next, the SASA descriptors were computed for each ligand and its respective protein in their bound/unbound states; a Bayesian model was learned with SASA descriptors and subsequently used to score the remaining ligands in the screening databases. Early database enrichments using SASA descriptors were found comparable or superior to those of GOLD and Glide. Moreover, SASA descriptors display an outstanding robustness to produce satisfactory early enrichments for a large variety of target classes. Based on these encouraging results, these novel topological descriptors constitute a valuable in silico tool in hit finding practices.
Assuntos
Descoberta de Drogas/métodos , Solventes/química , Adenosina Desaminase/química , Adenosina Desaminase/metabolismo , Algoritmos , Teorema de Bayes , Biologia Computacional , Bases de Dados de Proteínas , Receptor alfa de Estrogênio/química , Receptor alfa de Estrogênio/metabolismo , Modelos Moleculares , Conformação Proteica , Propriedades de Superfície , TermodinâmicaRESUMO
AIM: The aim of the study was to evaluate urgent care practice with regard to anorectal abscesses (AA) in a tertiary-level referral hospital. MATERIALS AND METHODS: this was retrospective and unicentric study. Patients who underwent surgery for AA between 2016 and 2017 were included in the study. Demographic variables were analyzed as well as the treatment performed, the need for hospitalization, use of antibiotics, and referral to the coloproctology outpatient department (COD). The recurrence risk factors were also evaluated. RESULTS: A total of 220 evaluations under anesthesia were performed, corresponding to 190 patients, 129 males (mean age 46 ± 14.9 years). The most frequent treatment in the emergency department (ED) was simple drainage (75.8%). Antibiotic therapy was prescribed in 62.9% of the cases. A total of 41.1% of the patients were referred to a specialized COD. The only risk factor associated with recurrence was the presence of an associated anal fistula. CONCLUSIONS: Anorectal abscesses are very frequent in the ED. There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.
OBJETIVO: Evaluar el manejo de los abscesos perianales por parte del servicio de cirugía de urgencias. MÉTODO: Estudio unicéntrico retrospectivo. Se incluyeron pacientes que requirieron manejo quirúrgico de abscesos perianales de 2016 a 2017. Se analizaron variables demográficas, tratamientos realizados, necesidad de ingreso hospitalario, uso de antibióticos y necesidad de derivación a la consulta externa de coloproctología. Así mismo, se evaluaron los factores relacionados con la recurrencia del absceso. RESULTADOS: Durante el periodo de estudio se realizaron 220 exploraciones, correspondientes a 190 pacientes (129 hombres) con una edad media de 46 ± 14.9 años. El tratamiento quirúrgico más frecuentemente realizado fue el drenaje simple (75.8%). Se prescribieron antibióticos en el 62.9% de los casos. El 41.1% de los pacientes fueron remitidos a consulta externa de coloproctología. El único factor de riesgo asociado a la recurrencia fue la presencia de una fístula perianal asociada. CONCLUSIONES: Los abscesos perianales son frecuentes en los servicios de urgencias. Hay una gran variabilidad clínica en su manejo, sobre todo en lo relativo a la realización de cultivos, la prescripción de antibióticos y la derivación a unidades de coloproctología especializadas, sin que ninguna de estas medidas tenga un claro impacto en la recurrencia.
Assuntos
Doenças do Ânus , Fístula Retal , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Assistência Ambulatorial , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/cirurgia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
A novel scoring algorithm based on molecular interaction fingerprints (IFPs) was comparatively evaluated in its scaffold hopping efficiency against four virtual screening standards (GlideXP, Gold, ROCS, and a Bayesian classifier). Decoy databases for the two targets under examination, adenosine deaminase and retinoid X receptor alpha, were obtained from the Directory of Useful Decoys and were further enriched with approximately 5% of active ligands. Structure and ligand-based methods were used to generate the ligand poses, and a Tanimoto metric was chosen for the calculation of the similarity interaction fingerprint between the reference ligand and the screening database. Database enrichments were found to strongly depend on the pose generator algorithm. In spite of these dependencies, enrichments using molecular IFPs were comparable to those obtained with GlideXP, Gold, ROCS, and the Bayesian classifier. More interestingly, the molecular IFP scoring algorithm outperformed these methods at scaffold hopping enrichment, regardless of the pose generator algorithm.
Assuntos
Adenosina Desaminase/química , Ligantes , Modelos Moleculares , Receptor X Retinoide alfa/química , Algoritmos , Teorema de Bayes , Sítios de Ligação , Fenômenos Químicos , Físico-Química , Bases de Dados Factuais , Ligação ProteicaRESUMO
Heat capacities have been measured for Al(n-1)Cu(-) clusters (n=49-62) and compared with results for pure Al(n) (+) clusters. Al(n-1)Cu(-) and Al(n) (+) have the same number of atoms and the same number of valence electrons (excluding the copper d electrons). Both clusters show peaks in their heat capacities that can be attributed to melting transitions; however, substitution of an aluminum atom by a copper atom causes significant changes in the melting behavior. The sharp drop in the melting temperature that occurs between n=55 and 56 for pure aluminum clusters does not occur for the Al(n-1)Cu(-) analogs. First-principles density-functional theory has been used to locate the global minimum energy structures of the doped clusters. The results show that the copper atom substitutes for an interior aluminum atom, preferably one with a local face-centered-cubic environment. Substitution does not substantially change the electronic or geometric structures of the host cluster unless there are several Al(n) (+) isomers close to the ground state. The main structural effect is a contraction of the bond lengths around the copper impurity, which induces both a contraction of the whole cluster and a stress redistribution between the Al-Al bonds. The size dependence of the substitution energy is correlated with the change in the latent heat of melting on substitution.
RESUMO
Introducción: Las enfermedades crónicas implican un reto sanitario e intersectorial. Por ello, los prestadores requieren adquirir competencias específicas según estándares nacionales e internacionales para implantar una atención primaria de salud que provea acceso y cobertura universal. Objetivo: Reflexionar sobre elementos relevantes vinculados a las competencias de los proveedores de salud para la atención de personas con condiciones crónicas, en el contexto de la atención primaria de salud. Métodos: Se discuten estrategias, la implementación del Modelo de Cuidados Crónicos y la adquisición de competencias, analizando aspectos de la formación profesional, el aseguramiento de la educación continua y la disposición de los proveedores para estar a la vanguardia de los cuidados. Conclusiones: Para proveer una atención integral a personas con enfermedades crónicas es necesario el fortalecimiento del capital humano y la instalación de relaciones coproductivas entre el equipo multidisciplinario. Además, es fundamental que los equipos conozcan e incorporen estrategias con demostración de eficacia a nivel internacional, entre ellos se encuentra el Modelo de Cuidados Crónicos, cuya implementación ha sido lenta y con desarrollo parcial(AU)
Introduction: Chronic diseases represent a health and intersectoral challenge. Therefore, providers need to acquire specific competences according to national and international standards, in order to implement primary healthcare providing universal access and coverage. Objective: To reflect on the relevant elements related to the competences of healthcare providers for the care of people with chronic conditions in the context of primary healthcare. Methods: Strategies are discussed, together with the implementation of the chronic care model and the acquisition of competences, analyzing aspects of professional training, the assurance of continuing education and the willingness of providers to be at the forefront of care. Conclusions: In order to provide comprehensive care to people with chronic diseases, it is necessary to strengthen human capital and create coproductive relationships among the multidisciplinary team. In addition, it is essential that the teams be aware of and incorporate strategies that have been shown to be effective at the international level, including the chronic care model, whose implementation has been slow and only partially developed(AU)
Assuntos
Humanos , Atenção Primária à Saúde , Doença Crônica , Pessoal de Saúde/educação , Educação Baseada em Competências , Educação Continuada , Mão de Obra em Saúde , ChileRESUMO
Objective: determine the prevalence of Effective Universal Coverage of Diabetes Mellitus Type 2 in Chile and its relation with the variables: Health Care Coverage of Diabetes Mellitus Type 2; Average of diabetics with metabolic control in 2011-2013; Mortality Rate for Diabetes Mellitus; and Percentage of nurses participating in the Cardiovascular Health Program. Method: cross-sectional descriptive study with ecological components that uses documentary sources of the Ministry of Health. It was established that there is correlation between the Universal Effective Coverage of Diabetes Mellitus Type 2 and the independent variables; it was applied the Pearson Coefficient, being significant at the 0.05 level. Results: in Chile Universal Health Care Coverage of Diabetes Mellitus Type 2 (HbA1c<7% estimated population) is less than 20%; this is related with Mortality Rate for Diabetes Mellitus and Percentage of nurses participating in the Cardiovascular Health Program, being significant at the 0.01 level. Conclusion: effective prevalence of Universal Health Coverage of Diabetes Mellitus Type 2 is low, even though some regions stand out in this research and in the metabolic control of patients who participate in health control program; its relation with percentage of nurses participating in the Cardiovascular Health Program represents a challenge and an opportunity for the health system.
Assuntos
Diabetes Mellitus Tipo 2 , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Chile , Estudos Transversais , Diabetes Mellitus Tipo 2/terapia , HumanosRESUMO
BACKGROUND: Sustained and dysfunctional macrophage activation promotes inflammatory cardiometabolic disorders, but the role of long intergenic noncoding RNA (lincRNA) in human macrophage activation and cardiometabolic disorders is poorly defined. Through transcriptomics, bioinformatics, and selective functional studies, we sought to elucidate the lincRNA landscape of human macrophages. METHODS AND RESULTS: We used deep RNA sequencing to assemble the lincRNA transcriptome of human monocyte-derived macrophages at rest and following stimulation with lipopolysaccharide and IFN-γ (interferon γ) for M1 activation and IL-4 (interleukin 4) for M2 activation. Through de novo assembly, we identified 2766 macrophage lincRNAs, including 861 that were previously unannotated. The majority (≈85%) was nonsyntenic or was syntenic but not annotated as expressed in mouse. Many macrophage lincRNAs demonstrated tissue-enriched transcription patterns (21.5%) and enhancer-like chromatin signatures (60.9%). Macrophage activation, particularly to the M1 phenotype, markedly altered the lincRNA expression profiles, revealing 96 lincRNAs differentially expressed, suggesting potential roles in regulating macrophage inflammatory functions. A subset of lincRNAs overlapped genomewide association study loci for cardiometabolic disorders. MacORIS (macrophage-enriched obesity-associated lincRNA serving as a repressor of IFN-γ signaling), a macrophage-enriched lincRNA not expressed in mouse macrophages, harbors variants associated with central obesity. Knockdown of MacORIS, which is located in the cytoplasm, enhanced IFN-γ-induced JAK2 (Janus kinase 2) and STAT1 (signal transducer and activator of transcription 1) phosphorylation in THP-1 macrophages, suggesting a potential role as a repressor of IFN-γ signaling. Induced pluripotent stem cell-derived macrophages recapitulated the lincRNA transcriptome of human monocyte-derived macrophages and provided a high-fidelity model with which to study lincRNAs in human macrophage biology, particularly those not conserved in mouse. CONCLUSIONS: High-resolution transcriptomics identified lincRNAs that form part of the coordinated response during macrophage activation, including specific macrophage lincRNAs associated with human cardiometabolic disorders that modulate macrophage inflammatory functions.