Benznidazole (BZL) and Nifurtimox (NFX) are the pharmacological treatment for acute phase Chagas Disease (CD); however, therapy resistance and residual mortality development remain important ...unresolved issues. Posaconazole (POS) has shown a trypanocidal effect in vivo and in vitro. Thus, this study aimed at comparing the T. Cruzi parasitic load-reducing effect of the combination of BZL+POS against that of monotherapy with either, during acute phase CD, in an experimental murine model.
Nineteen Wistar rats were randomly allocated to four groups and inoculated with the trypomastigotes of T. cruzi strain´s JChVcl1. The rats were administered anti-parasites from day 20-29 post-infection. The Pizzi and Brener method was used for parasitemia measurement. Longitudinal data analysis for the continuous outcome of repeated measures was performed using parasitemia as the outcome measured at days 20, 22, 24, 27, and 29 post-infection.
All four groups had similar parasitic loads (p=0.143) prior to therapy initiation. Among the three treatment groups, the BZL+POS (n=5) group showed the highest mean parasitic load reduction (p=0.000) compared with the control group. Likewise, the BZL+POS group rats showed an earlier therapeutic effect and were the only ones without parasites in their myocardial samples.
Treatment of acute phase CD with BZL+POS was more efficacious at parasitemia and myocardial injury reduction, compared with monotherapy with either.
Abstract Background/objectives Up 30 to 40% of Chagas patients exhibit cardiomyopathy with different degrees of cardiac involvement. Biomarkers may help in differentiation of the severity of CCM. ...This study sought to examine the diagnostic value of a panel of biomarkers to distinguish the severity of Chagas cardiomyopathy (CCM). Methods 100 patients with CCM were included in this cross-sectional study. Based on electrocardiogram and echocardiogram, CCM patients were classified in three stages according to disease's severity. Levels of high-sensitivity cardiac troponin T (Hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), soluble ST2 (sST2) and cystatin-c (Cys-c) were measured. Logistic regression models were used to assess the association between levels of natural log-transformed values of biomarkers and stages C/D versus B. We also calculated the area under curve (AUC) for each of the models. Results In models adjusted for age, sex, body mass index, kidney function and medication use, increased levels of NT-proBNP (per 1 unit natural log-transformed values, odds ratio (OR) = 5.55; 95CI%:1.65–18.72) and Hs-cTnT (per 1 unit natural log-transformed values, OR = 7.11; 95CI%:1.41–35.90) showed significant association with the severity of CCM per 1 unit increase of biomarkers. The accuracy of NT-proBNP and Hs-cTnT for diagnosis of the severity of CCM was high: AUC of 0.968 and 0.956 respectively. No significant difference was found in the AUC between NT-proBNP and Hs-cTnT. No association was found between Gal-3, NGAL, sST2 and Cys-C and severity of CCM. Conclusions NT-proBNP and Hs-cTnT have both same diagnostic value in distinguishing severity of CCM.
Introducción: La posición prono (PP) es una alternativa terapéutica ampliamente recomendada e implementada en los pacientes con COVID-19. Sin embargo, aunque es un procedimiento no invasivo, es ...complejo y se asocia con eventos adversos como las úlceras por presión (UPP). Nuestro objetivo es proponer un plan de cuidados de enfermería basado en el lenguaje estandarizado NANDA-I, NIC, NOC para la prevención de las UPP secundarias a la PP en la enfermedad de COVID-19. Síntesis del contenido: En los pacientes con COVID-19, además de factores de riesgo propios del paciente como la edad avanzada y la presencia de comorbilidades, la PP contribuye a la presencia de los diagnósticos de enfermería de riesgo de úlcera por presión 00249, de deterioro de la integridad cutánea 00047 y tisular 00248. Por su parte, la intervención de enfermería prevención de úlceras por presión 3540, es clave para minimizar el desarrollo de esta complicación, mejorar la calidad de la atención y el pronóstico en este tipo de pacientes. Finalmente, para determinar la efectividad del cuidado de enfermería se proponen los resultados NOC consecuencias de la inmovilidad: fisiológicas 0204 e integridad tisular: piel y membranas mucosas 1101. Conclusión: La PP es una terapia coadyuvante recomendada para el manejo de los pacientes con COVID-19 críticamente enfermos, debido a que optimiza la función pulmonar, sin embargo está asociada a eventos adversos como las UPP. Este artículo presenta recomendaciones basadas en una revisión narrativa para facilitar la implementación de cuidados de enfermería preventivos que reduzcan su frecuencia en esta población.
The present study aimed to estimate the prevalence of 25-OH-D status (insufficiency and deficiency) in children and adolescents residing in Bucaramanga, Colombia and to determine its association with ...excess weight. A case–control study was nested in the SIMBA II cohort in children and adolescents between the ages of 11 and 20 years old. Cases were defined as those children and adolescents with overweight or obesity. The control group was composed of children and adolescents from the same population sample with similar sociodemographic and economic characteristics but without overweight or obesity diagnosis. 25-hydroxyvitamin D (25-OH-D) was quantified in serum using a chemiluminescent microparticle immunoassay. Logistic regression models were used to assess the association between vitamin D status and overweight or obesity adjusted for the main confounding variables. A total of 494 children and adolescents cases were 138 (52⋅17% boys and 47⋅83% girls; median age 16⋅0 Q1 15; Q3 18). The median BMI S-Score minors age in the cases was 1⋅36 Q1 1⋅06; Q3 2⋅00 and BMI (kg/m2) 28⋅0 Q1 26⋅2; Q3 30⋅8. The prevalence of vitamin D in the cases was deficiency 16⋅67%, insufficiency 57⋅25%, sufficiency 26⋅09. 25-OH-D insufficiency was associated with overweight or obesity after adjusting for the main confounding variables (OR 1⋅73; 95% CI 1⋅05–2⋅84). Our study concludes that the 25-OH-D insufficiency is common in children and adolescents in Bucaramanga, Colombia, and it was associated with overweight or obesity.
Background
Chronic Chagas cardiomyopathy (CCM) is characterized by a unique type of cardiac involvement. Few studies have characterized echocardiographic (Echo) transitions from the indeterminate ...Chagas disease (ChD) form to CCM. The objective of this study was to identify the best cutoffs in multiple Echo parameters, speckle tracking, and N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) to distinguish patients without CCM (stage A) vs patients with myocardial involvement (stages B, C, or D).
Methods
Cross‐sectional study conducted in 273 consecutive patients with different CCM stages. Echo parameters, NT‐proBNP, and other clinical variables were measured. Logistic regression models (dichotomized in stage A versus B, C, and D) adjusted for age, sex, body mass index, and NT‐proBNP were performed.
Results
Left ventricular global longitudinal strain (LV‐GLS), mitral flow E velocity, LV mass index, and NT‐proBNP identified early changes that differentiated stages A vs B, C, and D. The LV‐GLS with a cutoff −20.5% showed the highest performance (AUC 92.99%; accuracy 84.56% and negative predictive value (NPV) 88.82%), which improved when it was additionally adjusted by NT‐proBNP with a cutoff −20.0% (AUC 94.30%; accuracy 88.42% and NPV 93.55%).
Conclusions
Our findings suggest that Echo parameters and NT‐proBNP may be used as diagnostic variables in detecting the onset of myocardial alterations in patients with the indeterminate stage of ChD. LV‐GLS was the more accurate measurement regarding stage A differentiation from the stages B, C, and D. Prospective longitudinal studies are needed to validate these findings.
Introducción: La hipertensión y la diabetes mellitus son enfermedades crónicas que representan una importante carga tanto económica como social. El manejo de estas patologías requiere de estrategias ...que involucran cambios en el estilo de vida, cumplimiento del tratamiento farmacológico y monitoreo eficaz de la enfermedad. Usualmente, la medición del cumplimiento se enfoca en el tratamiento farmacológico, dejando de lado el enfoque integral que involucra diferentes recomendaciones que son clave para el adecuado control de estas enfermedades. Objetivo: Determinar la validez de constructo y reproducibilidad de la etiqueta de resultado de enfermería “Conducta terapéutica: enfermedad o lesión (1609)” para medir la adherencia al régimen terapéutico en personas con hipertensión arterial y diabetes mellitus tipo 2. Materiales y Métodos: Estudio de corte transversal realizado en 500 usuarios de programas de riesgo cardiovascular en Bucaramanga-Colombia. Se diseñó un instrumento para medir la adherencia al tratamiento con base en la taxonomía Clasificación de Resultados de Enfermería, recomendaciones vigentes de la literatura científica y la experiencia de los investigadores. La validez de constructo fue evaluada a través de un análisis factorial de componentes principales y bajo la metodología Rasch. La reproducibilidad por medio del coeficiente de correlación intraclase en 100 usuarios. Resultados: Se obtuvo un instrumento de 13 ítems que representan 5 indicadores de la etiqueta de resultado de enfermería 1609, los cuales explicaron el 67.62% de la variación total y se ajustaron al modelo Rasch (unidimensionalidad del constructo adherencia). La reproducibilidad fue del 0.63 (IC 95% 0.46 - 0.75). Discusión y Conclusiones: Se encontró evidencia de la validez de constructo del instrumento que operacionaliza la etiqueta de resultado de enfermería (1609) para la medición de la adherencia al régimen terapéutico en pacientes con hipertensión y diabetes.
Aunque múltiples estudios indican una mayor mortalidad en la miocardiopatía de Chagas crónica (MCC) en comparación con otras miocardiopatías, la ausencia de metanálisis que respalden esta perspectiva ...limita la posibilidad de generar conclusiones robustas respecto a este fenómeno. El objetivo de este estudio es evaluar de manera sistemática la evidencia actual respecto al riesgo de mortalidad en la MCC respecto a otras miocardiopatías.
Se realizaron búsquedas en PubMed/Medline y EMBASE de estudios que compararan el riesgo de mortalidad entre pacientes con MCC y con otras miocardiopatías, como la miocardiopatía no isquémica (MNI), la miocardiopatía isquémica y la miocardiopatía no chagásica (MNC). Se realizó un metanálisis de efectos aleatorios para combinar los efectos de los estudios evaluados.
Se incluyeron 37 estudios que evaluaron a 17.949 pacientes. Los pacientes con MCC presentaron un riesgo de mortalidad significativamente mayor en comparación con los pacientes con MNI (HR=2,04; IC95%, 1,60-2,60; I2, 47%; 8 estudios) y MNC (HR=2,26; IC95%, 1,65-3,10; I2, 71%; 11 estudios). Sin embargo, no se observó ningún efecto significativo entre los grupos con MCC y con miocardiopatía isquémica (HR=1,72; IC95%, 0,80-3,66; I2, 69%; 4 estudios) en el metanálisis de efectos ajustados.
Los pacientes con MCC se enfrentan a un riesgo de mortalidad casi 2 veces mayor en comparación con los individuos con otras etiologías de miocardiopatía isquémica. Este resultado pone de relieve la necesidad de políticas públicas eficaces e iniciativas de investigación centradas en abordar de manera óptima los retos de la MCC.
Although multiple studies suggest that chronic Chagas cardiomyopathy (CCC) has higher mortality than other cardiomyopathies, the absence of meta-analyses supporting this perspective limits the possibility of generating robust conclusions. The aim of this study was to systematically evaluate the current evidence on mortality risk in CCC compared with that of other cardiomyopathies.
PubMed/Medline and EMBASE were searched for studies comparing mortality risk between patients with CCC and those with other cardiomyopathies, including in the latter nonischemic cardiomyopathy (NICM), ischemic cardiomyopathy, and non-Chagas cardiomyopathy (nonCC). A random-effects meta-analysis was performed to combine the effects of the evaluated studies.
A total of 37 studies evaluating 17 949 patients were included. Patients with CCC had a significantly higher mortality risk compared with patients with NICM (HR, 2.04; 95%CI, 1.60-2.60; I2, 47%; 8 studies) and non-CC (HR, 2.26; 95%CI, 1.65-3.10; I2, 71%; 11 studies), while no significant association was observed compared with patients with ischemic cardiomyopathy (HR, 1.72; 95%CI, 0.80-3.66; I2, 69%; 4 studies) in the adjusted-measures meta-analysis.
Patients with CCC have an almost 2-fold increased mortality risk compared with individuals with heart failure secondary to other etiologies. This finding highlights the need for effective public policies and targeted research initiatives to optimally address the challenges of CCC.
Full English text available from:www.revespcardiol.org/en
Highlights Los campeones son roles del liderazgo en enfermería, encargados de la implementación de cambios dentro de una organización. Los campeones tienen diferentes características y funciones, ...estas varían según las necesidades y los objetivos de la organización. La implementación de la práctica basada en la evidencia en una organización se beneficia por la acción de los campeones. Es necesario identificar los enfermeros campeones dentro de la organización para apoyar y fomentar su liderazgo. La práctica de enfermería en una organización, es el resultado de los procesos de liderazgo que se desarrollan en pro de la profesión y que se reflejan en cómo se desenvuelven los enfermeros en los equipos interprofesionales y en la calidad de cuidado que brindan a los pacientes1, mientras que, la práctica basada en la evidencia (PBE) hace referencia a la toma de decisiones en el desarrollo y la prestación de servicios de salud de acuerdo con la mejor evidencia de investigación disponible, la experiencia de los proveedores de la atención en salud, los valores y las preferencias de los pacientes; la adopción o implementación de está por parte de las organizaciones puede crear prácticas más seguras, mejores resultados para las personas y disminuir los costos de la atención médica2. En la literatura, se han identificado a los “champions” o “campeones” como determinantes y agentes de cambio para garantizar esta adopción dentro de las instituciones1,3. Como citar este artículo: Quiroga-Pico Lizeth N, Aceros-Lora Andrea M, Díaz-Castañeda Tatiana M, Rojas Lyda Z. Champions en enfermería: cómo transformar la práctica basada en la evidencia. Revista Cuidarte. 2024;15(2):e3745. https://doi.org/10.15649/cuidarte.3745
Cardiovascular diseases are the leading cause of mortality worldwide, for this reason, they are a public health problem. In Colombia, cardiovascular diseases are the main cause of mortality, having a ...death rate of 152 deaths per 100,000 population. There are 80% of these cardiovascular events that are considered avoidable.
The objective of the study is to determine the prevalence of the cardiovascular risk and its associated factors among the institution's workers in order to design and implement interventions in the work environment which may achieve a decrease in such risk.
An analytical cross-sectional study was designed to determine the cardiovascular risk and its associated factors among workers of a high complexity health care institution. A self-applied survey will be conducted considering sociodemographic aspects, physical activity, diet, alcohol consumption, smoking, level of perceived stress, and personal and family history. In a second appointment, a physical examination will be made, as well as anthropometric measurements and blood pressure determination. Also, blood samples for evaluating total and high density lipoprotein cholesterol, triglycerides, and fasting blood sugar will be taken. A ten-year global risk for cardiovascular disease will be determined using the Framingham score. A descriptive analysis of the population's characteristics and a stratified analysis by sex, age, and occupation will be made. Bivariate and multivariate analysis will be made using logistic regression models to evaluate the association between cardiovascular risk and the independent variables. The research protocol was approved by the Scientific and Technical Committee and the Ethics Committee on Research of the Fundación Cardiovascular de Colombia.
The protocol has already received funding and the enrollment phase will begin in the coming months.
The results of this study will give the foundation for the design, implementation, and evaluation of a program based on promoting healthy lifestyles, such as performing regular physical activity and healthy food intake in order to avoid and/or control the cardiovascular risk in the workers of a high complexity health care institution.
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