The 21st century has seen an ever-growing ageing population. Therefore, strategies are necessaryin order to improve their quality of life. Health is one of the most important variables in determining ...quality of life in the elderly. Currently, there are numerous theories attempting to improve the health of the elderly through the use of activity as healthy habits. Aims. The objective of this research study is to determine whether or not the degree of activity in individuals over the age of 60 influences their perceived health. Metodology. A descriptive correlational study was conducted. The sample consisted of 500 elderly individuals in Almeria (and its province) over the age of 60, having a mean age of 70.80 years. The Questionnaire on Occupational Behavior in the Elderly (C-COM) and the SF-36 on Quality of life, related to health were used. Result. A moderate correlation was found between being active, be it with daily tasks or leisure-related activities, and a higher degree of perceived health. Conclusions and recommendations. Further study is necessary inthis area in order to help guide future occupational programs and policies for the elderly. If activityhelps to improve the level of health in the elderly, then surely healthcare costs will be reduced, and further investments may be made in these activities.
Scorpion stings are a public health problem in many countries. However, in Colombia, very few epidemiological, clinical or toxicological studies have been undertaken.
Ecological and epidemiological ...aspects were related to the prevalence of scorpion stings by Tityus asthenes. The clinical features of envenomization were described in patients and in an experimental animal model.
The study was conducted in four localities of Mutatá and Urabá Counties in the province of Antioquia, Colombia. The sample consisted of 1,593 (929 urban, 664 rural) of the 5,305 exposed people, inhabitating 324 households (188 urban (58%); 136 rural (42%) of 1,448 houses total in the study area. An interview survey was performed in every selected family for a more realistic estimate of sting prevalence. Additionally, a prospective study was directed toward patients presenting scorpion stings at care at the local hospital over an 18-month period.
The probability was 12.9 times greater of finding T. asthenes inside or around houses in places near to forest and high agrarian plantations (odds ratio = 13). Eighty scorpion stings were reported in the retrospective study (4.1% prevalence 95% CI 3.3-4.8% ), but only 14 of the patients (17.5%) sought care in the local hospital (an 82.5% underreportage). Seventy percent of the stings occurred in rural places; 50% occurred in the locality of Caucheras, with an attack rate of 10.6%. The overall household infestation rate was 269% (95% CI 22.9-30.8%) and an area dispersion ratio of 100%. Signs of systemic envenomization occurred mainly in children (67%). The 50% lethal dose of T. asthenes venom was 121.6 µg for 18-20 g Swiss Webster rats (95% CI 103.7-139.6). Immunodetection of T. asthenes and Centruroides gracilis/C.margantatus venoms in the experimental animals was possible when were tested by Western blot against Alacramyn (Instituto Bioclón, México) and Soro antiaracnídico (Instituto Butantan, Brasil) antivenoms. Scorpion interspecific differences were noted.
The prevalence of stings by T. asthenes were common and their presence was associated with tropical rainforests. Envenomization at low density can be neutralized efficiently by anti-scorpion antivenoms produced in México and Brazil but with differing specificities for the venom of each scorpion species.
Introduction: Even with the use of novel drugs in patients with multiple myeloma (MM), relapse remains a challenge. Anti-myeloma activity of the immunomodulatory drug lenalidomide has been shown to ...rely on cereblon E3 ubiquitin ligase complex-dependent degradation of IRF4 and Ikaros, both required for MM cell survival. As these two factors are involved in the regulation of MYC transcription, we wanted to evaluate the effect of combining a MYC-interfering therapy with a lenalidomide and dexamethasone (Len/Dex) regimen.
Methods: Seven MM cell lines (ARP-1, JJN-3, U266, MM.1S, MM.1R, RMPI-8226 and KMM.1) were exposed to the BET bromodomain inhibitor CPI203 in the presence or absence of a standard dose of Len/Dex, followed by MTT assay, flow cytometry, western blot and gene expression arrays. Significant gene signatures were identified using gene set enrichment analysis (GSEA) v2.0 (Broad Institute at MIT).
These results were validated in primary cells derived from bone marrow of 9 patients with MM co-cultured with mesenchymal stromal cells plus IL-6, as well as in a SCID mouse xenotransplant model of MM. Mice were randomly assigned into cohorts of 5 mice each and received during 2 weeks (5 days on/2 days off) by intraperitoneal injection a twice daily dose of CPI203, daily dose lenalidomide plus twice weekly dexamethasone, the combination of both, or an equal volume of vehicle.
Results: We found CPI203 to exert a dose-dependent cell growth inhibition in all the cell lines tested (median response: 62.5%) (Figure 1) characterized by G1 cell cycle arrest and a concomitant inhibition of MYC and Ikaros signaling. Most interestingly, these effects were potentiated by the addition of Len/Dex treatment, with CI values ranging from 0.08 to 0.51. In the GSEA with an increasing profile analysis, the gene sets signatures related with MYC appeared downregulated in cells treated with the drug, and this downregulation was higher in cells treated with the combination of the three drugs. Moreover, genes associated with Ikaros and IRF4 also became downregulated after three drug treatment; these findings were confirmed by western blot analysis. Similarly, in 9 MM primary-stroma co-cultures, the drug combination evoked a 53% reduction in cell proliferation (Figure 1), and was associated with basal Ikaros mRNA levels (p=0.04).
Finally, in immunodeficient mice engrafted with MM cells, addition of CPI203 to Len/Dex therapy further decreased tumor burden, evidenced by a lower glucose uptake (Figure 2) and a simultaneous downregulation of MYC- and Ikaros-related genes by immunohistochemical analysis of the tumoral tissue after mice death.
Conclusion: The combination of a BET bromodomain inhibitor CPI203 with a lenalidomide-based regimen may represent a promising, rationally based therapeutic approach for patients with MM.
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No relevant conflicts of interest to declare.
Many patients experiencing a rare disease remain undiagnosed even after genomic testing. Reanalysis of existing genomic data has shown to increase diagnostic yield, although there are few systematic ...and comprehensive reanalysis efforts that enable collaborative interpretation and future reinterpretation. The Undiagnosed Rare Disease Program of Catalonia project collated previously inconclusive good quality genomic data (panels, exomes, and genomes) and standardized phenotypic profiles from 323 families (543 individuals) with a neurologic rare disease. The data were reanalyzed systematically to identify relatedness, runs of homozygosity, consanguinity, single-nucleotide variants, insertions and deletions, and copy number variants. Data were shared and collaboratively interpreted within the consortium through a customized Genome-Phenome Analysis Platform, which also enables future data reinterpretation. Reanalysis of existing genomic data provided a diagnosis for 20.7% of the patients, including 1.8% diagnosed after the generation of additional genomic data to identify a second pathogenic heterozygous variant. Diagnostic rate was significantly higher for family-based exome/genome reanalysis compared with singleton panels. Most new diagnoses were attributable to recent gene-disease associations (50.8%), additional or improved bioinformatic analysis (19.7%), and standardized phenotyping data integrated within the Undiagnosed Rare Disease Program of Catalonia Genome-Phenome Analysis Platform functionalities (18%).
The universities have the responsibility to train nurses able to recognize the needs of the health system, which must respond to ethical conduct and humane care. Objective: To determine the knowledge ...on ethical principles and their application to the care process by nursing students at the University of Cauca. Methodology: Quantitative approach study, descriptive cross-sectional type. The sample 155 students enrolled in the nursing program between III and X semester I period 2015. This adapts and validates a questionnaire evaluation questions to determine knowledge and a problematic question to measure the application of the principles. Results: the principles of loyalty, charity and loyalty were the best known and the principles of non-maleficence, justice and truth were the least knowledge. Those who had less knowledge were students of lower semesters, which in turn were those who had received fewer courses and more knowledge were students of higher semesters, with greater participation in ethics courses. The principles were applied acceptably despite not having solid knowledge about them. Conclusion: The research allows us to conclude that the teaching of ethics in nursing requires more attention and should be transversal in career development because it creates a solid foundation in ethical principles that will allow the nurse (a) address the ethical dilemmas present throughout his professional life and provide a humanized care
Guía de unidades de hemodiálisis 2020 Alcalde-Bezhold, Guillermo; Alcázar-Arroyo, Roberto; Angoso-de-Guzmán, Manuel ...
Nefrología,
December 2021, 2021-12-00, 2021-12-01, Letnik:
41
Journal Article
Recenzirano
Odprti dostop
Presentamos una nueva edición de la Guía de Centros de Hemodiálisis. Se enmarca en el programa de actualización de las Guías Clínicas de la Sociedad Española de Nefrología. Es un documento de ...consenso en el que han colaborado nefrólogos con amplia experiencia en diálisis y expertos de la enfermería nefrológica. La Guía ha sido corregida por un grupo de evaluadores externos. Se ha informado y se ha tomado en consideración la opinión de los pacientes a través de la Asociación de Enfermos Renales (ALCER). Esta Guía incluye en sus diez capítulos aspectos arquitectónicos, logísticos y organizativos. Hace especial énfasis en las necesidades de recursos humanos y su cualificación. Revisa las modalidades actuales de hemodiálisis, su dosificación y adecuación y la monitorización y seguimiento intra e interdiálisis. La hemodiálisis es una de las formas de tratamiento renal sustitutivo, por lo que menciona la necesidad de la inclusión en lista de espera para trasplante y la relación con las unidades de diálisis peritoneal. La calidad de vida del paciente en hemodiálisis comprende la necesidad de relacionarse y viajar por lo que se revisa y estandariza la atención de los pacientes transeúntes. La gestión de calidad es una herramienta necesaria actualmente para lograr la mejora continua de cualquier procedimiento como la hemodiálisis. Esta Guía pretende ser una ayuda para el buen funcionamiento de las Unidades de Diálisis, para los responsables de las mismas, así como para los gestores sanitarios.
We present a new edition of the Hemodialysis Center Guide. It is part of the program of updating the Clinical Guides of the Spanish Society of Nephrology. It is a consensus document in which nephrologists with extensive experience in dialysis and experts in nephrological nursing have collaborated. The Guide has been corrected by a group of external evaluators. The opinion of the patients through the kidney diseases patient association (ALCER) has been reported and taken into consideration. This Guide includes in its ten chapters architectural, logistical and organizational aspects. It places special emphasis on human resources needs and their qualification. Review current hemodialysis modalities, dosage and adequacy, and intra and interdialysis monitoring. Hemodialysis is one of the forms of renal replacement therapy, so it mentions the need for transplant waiting list inclusion and the relationship with peritoneal dialysis units. The patient's quality of life on hemodialysis understands the need to relate and travel so care of transitory patients is reviewed and standardized. Quality management is a tool currently needed to achieve continuous improvement of any procedure such as hemodialysis. This Guide is intended to be an aid for the proper functioning of the Dialysis Units, for those responsible for them, as well as for health managers.
To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD).
Clinical research questions relevant to the objective of the document ...were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made.
Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus.
There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.
Elaborar recomendaciones para prevención de infección en pacientes adultos con enfermedades reumáticas autoinmunes sistémicas (ERAS).
Un panel de expertos, seleccionados en base a su experiencia, identificó preguntas clínicas de investigación relevantes para el objetivo del documento. Se realizaron revisiones sistemáticas de la evidencia, que se graduó de acuerdo con los criterios del Scottish Intercollegiate Guidelines Network. Tras ello se formularon las recomendaciones.
Se seleccionaron cinco preguntas, referentes a la prevención de infección por Pneumocystis jirovecii con trimetoprim/sulfametoxazol, medidas profilácticas frente al virus de la hepatitis B, vacunación frente al virus del papiloma humano, vacunación frente al Streptococcus pneumoniae y vacunación frente al virus de la gripe. Se formularon un total de 18 recomendaciones, estructuradas por pregunta, con base en la evidencia encontrada para las diferentes ERAS y/o consenso de expertos.
Existe suficiente evidencia sobre la seguridad y eficacia de las vacunaciones y otras medidas profilácticas frente a los microrganismos revisados en este documento para ser recomendadas específicamente en pacientes con ERAS.
To analyze the impact of the COVID-19 pandemic on Spanish emergency department (ED) care for patients aged 65 years or older during the first wave vs. a pre-pandemic period.
Retrospective ...cross-sectional study of a COVID-19 portion of the EDEN project (Emergency Department and Elder Needs). The EDEN-COVID cohort included all patients aged 65 years or more who were treated in 52 EDs on 7 consecutive days early in the pandemic. We analyzed care variables, discharge diagnoses, use of diagnostic and therapeutic resources, use of observation units, need for hospitalization, rehospitalization, and mortality. These data were compared with data for an EDEN cohort in the same age group recruited during a similar period the year before the pandemic.
The 52 participating hospital EDs attended 33 711 emergencies during the pandemic vs. 96 173 emergencies in the pre-COVID period, representing a 61.7% reduction during the pandemic. Patients aged 65 years or older accounted for 28.8% of the caseload during the COVID-19 period and 26.4% of the earlier cohort (P .001). The COVID-19 caseload included more men (51.0%). Comorbidity and polypharmacy were more prevalent in the pandemic cohort than in the earlier one (comorbidity, 92.6% vs. 91.6%; polypharmacy, 65.2% vs. 63.6%). More esturesources (analgesics, antibiotics, heparins, bronchodilators, and corticosteroids) were applied in the pandemic period, and common diagnoses were made less often. Observation wards were used more often (for 37.8% vs. 26.2% in the earlier period), and hospital admissions were more frequent (in 56.0% vs. 25.3% before the pandemic). Mortality was higher during the pandemic than in the earlier cohort either in ED (1.8% vs 0.5%) and during hospitalization (11.5 vs 2.9%).
The proportion of patients aged 65 years or older decreased in the participating Spanish EDs. However, more resources were required and the pattern of diagnoses changed. Observation ward stays were longer, and admissions and mortality increased over the numbers seen in the reference period.
To describe the sociodemographic characteristics of and the health care resources used to treat patients aged 65 years or older who come to hospital emergency departments (EDs) in Spain, according to ...age groups.
We studied the phase-1 data for the EDEN cohort (Emergency Department and Elder Needs). Forty Spanish EDs collected data on all patients aged 65 years or older who were treated on the first 7 days in April 2019. We registered information on 6 sociodemographic and 5 function variables for all patients. For health resource use we used 6 diagnostic, 13 therapeutic, and 5 physical structural variables, for a total of 24 variables. Differences were analyzed according to age in blocks of 5 years.
A total of 18 374 patients with a median age of 78 years were included; 55% were women. Twenty-seven percent arrived by ambulance, 71% had not previously been seen by a physician, and 13% lived alone without assistance. Ten percent had a high level of functional dependence, and 14% had serious comorbidity. Resources used most often were blood analysis (in 60%) and radiology (59%), analgesics (25%), intravenous fluids (21%), antibiotics (14%), oxygen (13%), and bronchodilators (11%). Twenty-six percent were kept under observation in the ED, 26% were admitted to wards, and 2% were admitted to intensive care units (ICUs). The median stay in the ED was 3.5 hours, and the median hospital stay was 7 days. Sociodemographic characteristics changed according to age. Functional dependence worsened with age, and resource requirements increased in general. However, benzodiazepine use was unaffected, while the use of nonsteroidal anti-inflammatory drugs and ICU admission decreased.
The functional dependence of older patients coming to EDs increases with age and is associated with a high level of health care resource use, which also increases with age. Planners should take into consideration the characteristics of the older patients and the proportion of the caseload they represent when arranging physical spaces and designing processes for a specific ED.
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