Objectives
In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex‐combatants into the healthcare system. However, FARC ...ex‐combatants have faced significant challenges in receiving healthcare, and little is known about physicians’ abilities to address this population's healthcare needs.
Methods
An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians’ knowledge, attitudes, and experiences with the FARC ex‐combatant reincorporation process.
Results
Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two‐thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex‐combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty‐two participants (41.5%) had identified a patient as an ex‐combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex‐combatants (r = 0.356, n = 47, P = 0.014).
Conclusion
Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex‐combatants, and cared for these patients when they self‐identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex‐combatant healthcare reintegration.
Pulmonary arterial hypertension, a rare entity Morales-Blanhir, Jaime Eduardo; Carmona-Rubio, Andrés Eduardo; Rosas-Romero, María de Jesús ...
Revista de investigacion clinica,
2014 Jan-Feb, 20140101, Letnik:
66, Številka:
1
Journal Article
Recenzirano
Pulmonary arterial hypertension (PAH) is a rare disease. It is characterized by the progressive remodeling of the small pulmonary arteries that lead to an elevation of the pulmonary vascular ...resistance and right ventricular dysfunction. Early diagnosis and prompt treatment avoid the deterioration of the patient's quality of life. Statistics show that there are 15 cases per million people worldwide, the majority comprised of young women, with an age at diagnosis of 30 to 40 years. At present, the exact processes that initiate the pathophysiologic changes observed in PAH are unknown; it is thought to be multifactorial. Diagnosis in PAH must be done in a step by step manner. Under the suspicion of pulmonary hypertension (PH), the first thing to do is confirm the diagnosis. The second step is to identify the specific etiology and lastly evaluate the severity by echocardiography, hemodynamic parameters, biomarkers and exercise capacity. PH treatment, particularly PAH, has evolved over the last 2 decades due to the advance in disease knowledge and the availability of agents that act on different pathways. Concerning surgical treatment, it is indicated in PAH when there is not an adequate response to medical treatment. In conclusion, PAH is recognized worldwide as a rare or infrequent disease. The countries that have a registry for the diagnostics, treatment, follow-up and prevalence of PH are mainly in Europe. With the exception of the United States and Canada, there are no registries in America. Recent years have shown an important advance in Latin America.
The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the ...framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physiciansreviewed and analyzed the 2021 SSC guidelines from our specialty's point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians' experience- and evidence-based proposals. Secondarily, the review's recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis.
Although infection rates and the impact of infection on hospital emergency departments (EDs) are known or can be reliably estimated, the incidence and prevalence of sepsis vary in relation to which ...definitions or registers used. Sepsis is also well known to be under-diagnosed by physicians in general and by ED physicians in particular. Over half of sepsis cases are community-acquired, and 50% to 60% of patients in intensive care units (ICUs) with sepsis or septic shock are admitted directly from the ED. Pneumonia and urinary tract infections are the most common points of focus in sepsis, septic shock, bacteremia, and ED admissions to the ICU for infectious processes. For this article a multinational group of experts representing Latin American emergency medicine associations reviewed and analyzed similarities and differences in the epidemiology of sepsis in different geographic locations. We consider key aspects and geographic similarities and differences in the early identification of patients with severe sepsis; criteria that define the diagnosis; appropriate early antibiotic and fluid therapy; the roles of triage systems and multidisciplinary sepsis code units; and the use of biological markers in this time-dependent disease. We also discuss key points and strategies for improving the diagnosis, prognosis, and care of sepsis patients in the ED.
En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el ...mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara – México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como “la Declaración de Guadalajara”.
The inflorescences of
are used as folk medicine to treat various respiratory diseases. In this work, we report the isolation of seven known flavones: 5-hydroxy-3,7-dimethoxyflavone
, ...5,8-dihydroxy-3,7-dimethoxyflavone
, 5,7-dihydroxy-3,8-dimethoxyflavone
(gnaphaliin A), 3,5-dihydroxy-7,8-dimethoxyflavone
(gnaphaliin B), 3,5-dihydroxy-6,7,8-trimethoxyflavone
, 3,5,7-trimethoxyflavone
and 3-
-methylquercetin
. All these flavones except
and
showed a relaxant effect on guinea pig tracheal preparation with EC
between 69.91 ± 15.32 and 118.72 ± 7.06 µM. Aminophylline (EC50 = 122.03 ± 7.05 µM) was used as a relaxant reference drug. The active flavones shifted the concentration-response curves of forskolin and nitroprusside leftward, and significantly reduced the EC
values of these drugs. Furthermore, these flavones dose-dependently inhibited phosphodiesterase (PDE) in an
assay. This reveals that the inflorescences of
contain several flavones with relaxant effect on airway smooth muscle and with PDEs inhibition that contribute to supporting the anti-asthmatic traditional use.
La pesca ribereña o artesanal requiere la generación de conocimiento como soporte a la toma de decisiones en la administración de los recursos pesqueros para lograr su uso sustentable. En este ...sentido, la delimitación de áreas de aprovechamiento pesquero ha sido objeto de diversos estudios ya que se considera el primer paso para realizar esfuerzos de planificación y ordenamiento espacial marino, donde el uso de sistemas de información geográfica (SIG) y su aplicación influye en la comprensión del manejo de las pesquerías. Implementando el análisis espacial, el presente trabajo presenta una primera aproximación del comportamiento de la pesca ribereña del recurso escama marina que se realiza en el litoral Veracruzano, México, considerando el establecimiento de zonas de pesca y asentamiento de los sitios pesqueros, las localidades con mayor acopio del recurso en la región, la distribución del esfuerzo humano así como la profundidad y operación de las artes de pesca. Se revisaron los permisos de pesca comercial oficiales para embarcaciones menores, en campo se identificaron los principales centros de acopio; y mediante el uso de herramientas de análisis espacial se estableció un esquema de zonificación que dividió en 3 zonas de aprovechamiento pesquero al litoral Veracruzano. Integrando el conocimiento experto de pescadores locales, se contabilizaron un total de 164 sitios de captura distribuidos en diferentes estratos de profundidad, donde se implementan diversos sistemas de captura para la actividad pesquera. Se encontró que existen áreas de mayor aprovechamiento pesquero en el litoral y posibles zonas de conflicto social por las áreas de captura. Los resultados de este estudio pueden convertirse en una herramienta útil como soporte al proceso de toma de decisiones, para el diseño de esquemas de zonificación y para definir otras estrategias de manejo para los recursos pesqueros en el litoral Veracruzano.
Type 2 diabetes (T2D) has been linked to the expression of Human Leukocyte Antigens, principally to the Major Histocompatibility Complex Class II, with only scarce reports of Major Histocompatibility ...Complex Class I in specific populations. The objective of the present work was to explore the presence of polymorphisms in the MHC Class I related to T2D in the Mexican population using the Genome-Wide Association Studies Slim Initiative in Genomic Medicine of the Americas (GWAS SIGMA) database. This database contains information on 3848 Mexican individuals with T2D and 4366 control individuals from the same population without a clinical or hereditary history of the disease. The searching criteria considered a p-value of <0.005 and an odds ratio (OR) of >1.0. Ten novel, statistically significant nucleotide variants were identified: four polymorphisms associated with HLA-A (A*03:01:01:01) and six with HLA-C (C*01:02:01:01). These alleles have a high prevalence in Latin American populations and could potentially be associated with autoimmunity mechanisms related to the development of T2D complications.
Neuromyelitis Optica (NMO) is an autoimmune disease with a higher prevalence in non-European populations. Because the Mexican population resulted from the admixture between mainly Native American and ...European populations, we used genome-wide microarray, HLA high-resolution typing and AQP4 gene sequencing data to analyze genetic ancestry and to seek genetic variants conferring NMO susceptibility in admixed Mexican patients. A total of 164 Mexican NMO patients and 1,208 controls were included. On average, NMO patients had a higher proportion of Native American ancestry than controls (68.1% vs 58.6%; p = 5 × 10
). GWAS identified a HLA region associated with NMO, led by rs9272219 (OR = 2.48, P = 8 × 10
). Class II HLA alleles HLA-DQB1*03:01, -DRB1*08:02, -DRB1*16:02, -DRB1*14:06 and -DQB1*04:02 showed the most significant associations with NMO risk. Local ancestry estimates suggest that all the NMO-associated alleles within the HLA region are of Native American origin. No novel or missense variants in the AQP4 gene were found in Mexican patients with NMO or multiple sclerosis. To our knowledge, this is the first study supporting the notion that Native American ancestry significantly contributes to NMO susceptibility in an admixed population, and is consistent with differences in NMO epidemiology in Mexico and Latin America.
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