Complicaciones hospitalarias en una unidad geriátrica de agudos

Introduction:

In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care.

Objective:

To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia

Materials and methods:

We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson’s linear regression model to identify associated variables.

Results:

The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications.

Conclusion:

In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.     

Absence of mutations in GJB2 (Connexin-26) gene in an ethnic group of southwest Iran

BACKGROUND:

The common GJB2 gene mutation (35delG) has been previously reported from Iranian patients that were affected with nonsyndromic autosomal recessive deafness. We, therefore, for the first time, investigated the prevalence and frequency of the GJB2 gene mutation in the Iranian deaf population with Arabian origins.

MATERIALS AND METHODs:

We amplified and sequenced the entire coding sequence of the GJB2 gene from 61 deaf patients and 26 control subjects.

RESULT:

None of the analyzed samples revealed deafness-associated mutation.

CONCLUSION:

This finding differs from several reports from Iran as we have focused on the GJB2 gene that possesses various mutations as the cause of congenital recessive deafness.     

Conflicto armado,contaminación y riesgos en salud: una evaluación de riesgo de tres fuentes de exposición ambiental asociadas con el conflicto en Colombia

Introduction:

Armed conflicts affect territories rich in resources and biodiversity. As a result of the environmental damage caused by violent actions, the health of populations can be affected.

Objectives:

To assess the risks to human health due to environmental degradation associated with three violent actions in the context of the Colombian armed conflict: Pipeline bombing, informal mining with mercury, and spraying of illicit crops with glyphosate.

Materials and methods:

We conducted a quantitative evaluation of the risks to individual health associated with armed conflict activities using methodologies focused on the routes of pollutants dispersion, their concentrations in the environment, the exposure of the individuals, and the risks of carcinogenic and non-carcinogenic effects.

Results:

The risk assessment of the armed conflict-related actions under study evidenced intolerable carcinogenic risk and unacceptable non-carcinogenic risk due to the consumption of water and fish contaminated by polycyclic aromatic hydrocarbons (PAH), mercury, and glyphosate.

Conclusions:

The study reiterates the inextricable connections existing among the environment, society, and health, as well as the implications of environmental violence for the public health of vulnerable population groups and, in general, for the well-being of all living beings affected by the armed conflict.     

Subtipos del carcinoma luminal de mama según el consenso de Saint Gallen en un grupo de pacientes venezolanas

Introduction:

Breast cancer is the most frequent malignancy in women worldwide. Different intrinsic subtypes have different prognoses and their prevalence varies significantly according to the criteria established in the Saint Gallen Consensus.

Objective:

To classify the luminal subtypes of breast carcinoma according to Saint Gallen 2009, 2011, 2013, and 2015 consensuses in a group of Venezuelan patients.

Materials and methods:

We conducted a retrospective study in 209 patients with infiltrating ductal carcinoma of the breast followed up at the Institute of Oncology "Dr. Miguel Pérez Carreno" in Valencia, Venezuela.

Results:

The distribution of the luminal A and B subtypes changed after the reclassification of the cases according to 2011, 2013, and 2015 Saint Gallen Consensuses. The luminal B subtype was the most common in the study series.

Conclusions:

With the use of a classification based on the latest Saint Gallen criteria we identified more luminal B tumors. This could contribute to selecting those patients who can avoid adjuvant chemotherapy and/or benefit from the adjuvant hormonal therapy in clinical practice.     

Efficacy and safety of 2-hour urokinase regime in acute pulmonary embolism: a randomized controlled trial

Backgrounds

Urokinase (UK) 2 200 U/kg·h for 12 hours infusion(UK-12 h)is an ACCP recommended regimen in treating acute pulmonary embolism (PE). It is unclear whether this dose and time can be reduced further. We compared the efficacy and safety of 20, 000 U/kg for 2 hours (UK-2 h) with the UK-12 h regime in selected PE patients.

Methods

A randomized trial involving 129 patients was conducted. Patients with acute PE were randomly assigned to receive either UK-12 h (n = 70), or UK-2 h (n = 59). The efficacy was determined by the improvement of right heart dysfunction and perfusion defect at 24 h and 14 d post UK treatment. The bleeding incidence, death rate and PE recurrence were also evaluated.

Results

Similarly significant improvements in right heart dysfunction and lung perfusion defects were observed in both groups. Overall bleeding incidents were low in both groups. Major bleeding directly associated with UK infusion occurred in one patient in the UK-2 h group and one in the UK-12 h group. Mortality rates were low, with one reported fatal recurrent in the UK-12 h group and none in the UK-2 h group. When the rate of bleeding, death and PE recurrence were compared separately in the hemodynamic instability and the massive anatomic obstruction subgroups, no significant difference was found.

Conclusions

The UK-2 h regimen exhibits similar efficacy and safety as the UK-12 h regimen for acute PE.

Trial Registration

Clinical trial registered with http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00799968","term_id":"NCT00799968"}}NCT00799968 (Identifier: {"type":"clinical-trial","attrs":{"text":"NCT 00799968","term_id":"NCT00799968"}}NCT 00799968)     

Grupos de riesgo citogenético de leucemia mieloide aguda pediátrica a partir del análisis de supervivencia en un hospital de referencia para cáncer en Perú

Introduction:

Acute myeloid leukemia is a heterogeneous disorder characterized by immature myeloid cell proliferation. Cytogenetic analysis has revealed the presence of chromosomal aberrations important to patient prognosis.

Objective:

To determine cytogenetic risk groups of pediatric patients with acute myeloid leukemia according to overall survival.

Materials and methods:

In this cross-sectional observational study, the clinical records of pediatric patients diagnosed with de novo acute myeloid leukemia admitted to the Instituto Nacional de Enfermedades Neoplásicas between 2001 and 2011 with cytogenetic analysis of bone marrow were included. Cytogenetic risk groups were established according to the criteria of the Medical Research Council. Overall survival curves were generated with the Kaplan-Meier method and compared using the Mantel-Cox test and Cox regression with the software R, version 3.3.2.

Results:

A total of 130 patients were included, 68 males (52.3%) and 62 females (47.7%), most of them with subtype M2 (33%). The average age was 7.7 years (range: 0-15 years).Chromosomal aberrations were observed in 60.8% of the patients, the most frequent of which was the translocation t(8;21). According to the overall survival analysis, two cytogenetic risk groups were established: favorable and unfavorable.

Conclusion:

Two groups of cytogenetic risk were determined: high (or unfavorable) and standard (favorable).     

Importancia de la determinación de variantes en el número de copias en neonatos con aneuploidías autosómicas

Introduction:

Aneuploidies are frequent genetic disorders in clinical practice. However, little is known about other genetic variants that may influence the final phenotype.

Objective:

To determine the variations in the number of copies and regions with homozygosity greater than 0.5% or larger than 10 Mb in newborns with autosomal aneuploidies.

Materials and methods:

We performed a chromosomal microarray analysis on newborns with autosomal aneuploidies (n=7), trisomy 21 (n=5), and trisomy 18 (n=2) evaluated at the Hospital Antonio Lorena and Hospital Regional of Cusco, Perú, during 2018.

Results:

We found pathogenic and probably pathogenic variants in the number of copies in other genomic regions different to chromosomes 21 or 18 in two neonates. Additionally, we found two variants bigger than 500 kpb of unknown pathogenicity.

Conclusions:

Although the number of analyzed individuals was small, it is important to highlight that we found other variants in the number of copies that have been described in association with neurodevelopmental disorders, congenital anomalies, deafness, and short/ tall stature, among others, in almost half of them, which will probably impact the phenotype negatively in patients with aneuploidies.     

Digit Ratio (2D:4D) and Handgrip Strength in Hani Ethnicity

Introduction

The ratio of the length of the second finger to the fourth finger (2D:4D) in humans is considered as a putative marker of prenatal exposure to testosterone, and has been progressively adopted as one useful tool to evaluate the effect of prenatal hormones in some traits such as physical ability. Handgrip strength is one authentic measure of physical ability and is generally used on the anthropological research within an evolutionary viewpoint.

Methods

Here we present the first evidence on 2D:4D and handgrip strength on adult participants of Hani ethnicity and explore the relationship between digit ratio (2D:4D) and handgrip strength. We examined 2D:4D and handgrip strength of 80 males and 60 females at Bubeng village, in the Yunnan province of China.

Results

The mean 2D:4D in females was higher than that in males for each hand. Females showed significantly higher 2D:4D than males in the right hand rather than in the left hand. Males displayed significantly higher handgrip strength than females for both hands. Handgrip strength decreased with age for both sexes. A significant negative correlation between 2D:4D and handgrip strength was found in the right hand of males.

Conclusion

The relationship between 2D:4D and handgrip strength may be attributed to evolutionary drive of sexual selection operating on fetal programming.     

Molecular epidemiology of ��-thalassemia in Pakistan: Far reaching implications

BACKGROUND:

β -Thalassaemia, an autosomal recessive hemoglobinopathy, is one of the commonest genetically transmitted disorders throughout the world. Collective measures including carrier identification, genetic counseling and prenatal diagnosis are required for preventing β-thalassemia.

Aim:

To achieve this objective, Identification of the spectrum of genetic mutations, especially for various ethnic backgrounds in Pakistan. Therefore, we designed a cross sectional prospective study to identify the frequency of various gene mutations in different ethnic groups of Pakistan.

MATERIALS AND METHODS:

Over a 5-year period, DNA from 648 blood samples {including specimens of chorionic villus sampling (CVS)} were analyzed for the twelve most common β-thalassemia mutations found in the Pakistani population by a Multiplex amplification refractory mutation system (ARMS). Each sample was analyzed for the mutation as well as the normal gene, appropriate with negative and positive controls, and reagent blanks.

RESULTS:

Out of 648 samples mutations were identified in 640 (98.75%) samples by multiplex ARMS. 8 common β-thalassemia mutations were identified in 8 different ethnic groups accounting for 93.9% of the β-thalasemia alleles.

CONCLUSIONS:

Based on the outcome of this study a cost effective proposal is formulated for detection of β-thalassemia mutations.     

Decreased levels of soluble Toll-like Receptor 2 in patients with asthma

Background:

Recently, reports have indicated a role for the membrane form of Toll-like Receptor 2 (TLR2) in asthma pathogenesis. In this study we examined soluble TLR2 levels in serum and sputum of asthmatic and healthy subjects.

Methods:

Serum and sputum samples were obtained from 33 asthmatic and 19 healthy subjects. The asthmatics were classified into four groups according to the Global Initiative for Asthma. A sandwich ELISA was developed to measure soluble TLR2 (sTLR2) in serum and sputum. TLR2 mRNA expression was determined by semi-quantitative RT-PCR of all sputum samples.

Results:

The mean sTLR2 levels from serum and sputum of asthmatics were significantly lower than those from healthy subjects. Moreover, sTLR2 concentration decreased concomitantly with asthma severity. The differences observed, however, were not statistically significant. TLR2/GAPDH mRNA of sputum leukocytes was also significantly lower in asthmatics than in healthy subjects.

Conclusion:

This study demonstrated for the first time thatsTLR2 levels are lower in serum and sputum samples from asthmatic than from healthy subjects, and this could be an indicator of TLR2 expression. We also found that sTLR2 concentration in serum decreased concomitantly with an increase of asthma severity clinical score. Key Words: Asthma, Expression, TLR2 mRNA, Soluble Toll-like receptor     

Clima de aprendizaje y enganche al trabajo del residente clínico: relación con la autodeterminación humana

Introduction:

The learning climate is a factor associated with the clinical resident’s engagement in work activities and the improvement of students’ well-being in the workplace through their self-determination during clinical rotation.

Objective:

To determine the relationship between the learning climate measured with the D-RECT 35 scale and residents’ self-determination and commitment to work using the UWES 17 scale.

Materials and methods:

We conducted a cross-sectional correlational study with residents of surgical medical specialties in clinical rotation at the practice site and who completed the measurement questionnaires.

Results:

We evaluated 188 residents of clinical specialties. The median of the results in the learning climate scale was 3.9/5.0; in the self-determination scale, 4.86/7.0, and in the job engagement scale, 5.0/6.0. The learning climate was considered adequate and a positive relationship was found with self-determination and the residents’ attachment to their activities; these correlations were statistically significant.

Conclusions:

Adequate learning climates are positively related to the ability to engage in work activities and the self-determination of clinical residents as they favor collaborative work and access to supervision generating greater autonomy and more enthusiasm and dedication to assigned activities. This can drive improvements in educational programs in clinical departments and translate into safer patient care.     

Small ubiquitin-like modifier 4 M55V polymorphism is not associated with diabetic nephropathy in Iranian type 2 diabetes patients

INTRODUCTION:

We studied the impact of small ubiquitin-like modifier 4 (SUMO4) M55V polymorphism on susceptibility to diabetic nephropathy in Iranian type 2 diabetes patients.

MATERIALS AND METHODS:

The patient group consisted of 50 Iranian type 2 diabetes patients with nephropathy, and the control group consisted of 50 Iranian type 2 diabetes patients without nephropathy. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism method for the M55V.

RESULTS:

The frequency of SUMO4 AA, AG, and GG genotypes were 23%, 18%, and 9% in the patient group and 10%, 22%, and 18% in the control group. There was no significant difference in frequency of SUMO4 genotypes in patients compared to controls.

CONCLUSION:

These findings indicate that SUMO4 M55V polymorphism is not associated with diabetic nephropathy in Iranian type 2 diabetes patients.     

How best to use partial meal replacement in managing overweight or obese patients with poorly controlled type 2 diabetes

Objective:

To compare patient compliance and benefits, over 12 months, of 1 versus 2 partial meal replacement (PMR) for the management of overweight/obese subjects with inadequately controlled type 2 diabetes.

Design and Methods:

Thirty‐six overweight patients with inadequately controlled type 2 diabetes (BMI > 27 kg/m² and HbA1c > 7.5% [58 mmol/mol]) were randomized to receive 1 or 2 PMR/day, while maintaining usual lifestyle. Subjects were seen monthly and adjustment of medications was made to prevent hypoglycemia. Compliance was assessed by counting unused sachets.

Results:

Patients on 2 PMR/day lost almost 4 kg compared with only 0.5 kg in the 1 PMR/day group. This difference was statistically significant (P < 0.05). Overall PMR was about 30% as effective as in our previous study on total meal replacement. Reductions in weight, waist, and HbA1c were better in the 2 PMR/day group while patient dropout and compliance were not worse over a 12‐month period.

Conclusion:

PMR provides a further management option for overweight/obese individuals with type 2 diabetes. The initial recommendation should be 2 PMR/day.     

Statins research unfinished saga: desirability versus feasibility

Aims

Resistin is an adipocyte-derived factor implicated in obesity-associated type 2 diabetes (T2DM). This study examines the association between human serum resistin, T2DM and coronary heart disease.

Methods

One hundred and fourteen Saudi Arabian patients (male: female ratio 46:68; age 51.4 (mean ± SD)11.7 years; median and range: 45.59 (11.7) years and BMI: 27.1 (mean ± SD) 8.1 Kgm² median and range: 30.3 (6.3) were studied. Serum resistin and C-reactive protein (CRP), a marker of inflammation CRP levels, were measured in all subjects. (35 patients had type 2 diabetes mellitus (T2DM); 22 patients had coronary heart disease (CHD).

Results

Serum resistin levels were 1.2-fold higher in type 2 diabetes and 1.3-fold higher in CHD than in controls (p = 0.01). In addition, CRP was significantly increased in both T2DM and CHD patients (p = 0.007 and p = 0.002 respectively). The use of regression analysis also determined that serum resistin correlated with CRP levels (p = 0.04, R² 0.045).

Conclusion

The findings from this study further implicate resistin as a circulating protein associated with T2DM and CHD. In addition this study also demonstrates an association between resistin and CRP, a marker of inflammation in type 2 diabetic patients.     

Subject: Distribution: Influence of biotic and abiotic factors

Research Notes on Avian Biology 1994: Selected Contributions from the 21st International Ornithological CongressEcology: Distribution

Subject: Distribution: Influence of biotic and abiotic factors     

Subject: foraging

Research Notes on Avian Biology 1994: Selected Contributions from the 21st International Ornithological CongressBehavior: Foraging

Subject: foraging     

Subject: Sensory physiology and neurobiology

Research Notes on Avian Biology 1994: Selected Contributions from the 21st International Ornithological CongressMorphology and Physiology: Neurobiology

Subject: Sensory physiology and neurobiology     

Subject: Endocrinology and chronobiology

Research Notes on Avian Biology 1994: Selected Contributions from the 21st International Ornithological CongressMorphology and Physiology: Endocrinology

Subject: Endocrinology and chronobiology     

Subject: Methods

Research Notes on Avian Biology 1994: Selected Contributions from the 21st International Ornithological CongressApplied Ornithology and Conservation: Methodologies

Subject: Methods