Guía de práctica clínica para el diagnóstico y tratamiento de la distrofia muscular de Duchenne. Sociedad Peruana de Neurología. Versión Corta / Clinical Practice Guidelines for diagnosis and treatment of Duchenne muscular dystrophy. Peruvian Neurology Society. Short Version

RESUMEN Objetivo : Elaborar una guía de práctica clínica peruana para el diagnóstico y tratamiento de la Distrofia Muscular de Duchenne y Becker (DMD). Materiales y métodos : Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas en neurología, neuropediatría, genética y metodología. El GEG formuló ocho preguntas para desarrollar las recomendaciones de la Guía de Práctica Clínica (GPC). Se realizó una búsqueda sistemática en Medline, Scopus y CCRT durante el periodo enero-abril 2021 para responder a las preguntas PICO. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados : Las preguntas PICO, se orientaron para explorar el tamizaje, diagnóstico y tratamiento de la DMD. Se formularon 15 recomendaciones (10 fuertes, 5 condicionales) y 11 puntos de buena práctica clínica Conclusión : Se presenta la guía para el diagnóstico y tratamiento de la DMD, elaborada bajo una metodología basada en las evidencias actuales.

ABSTRACT Objective : to provide evidence-based clinical recommendations for the diagnosis and treatment of Duchenne Muscular Dystrophy. Methods : a guideline development group (GEG) was formed that included specialized physicians in the fields of neurology, neuropediatrics, genetics, and methodology. The GEG asked eight clinical questions to be answered by recommendations in this clinical practice guidelines (CPG). We conducted a systematic search and - when deemed relevant - primary studies in Medline, Scopus, and the Cochrane Controlled Register of Trials during 2021 were reviewed. Evidence was selected to answer each of the clinical questions posed. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice, and a diagnosis and treatment flowchart. Results : this CPG addressed eight clinical questions, divided into three topics: screening, diagnosis, and treatment. Based on these questions, fifteen recommendations were formulated (10 strong, 5 conditional) and 11 points for good clinical practice. Conclusion : this paper summarizes the methodology and evidence- based conclusions of the CPG for the diagnosis and treatment of Duchenne muscular dystrophy.

Barriers to Effective HIV Testing Services and Strategies for Its Promotion at the Primary Health Care Facilities in Ibadan, Nigeria

Background:HIV testing services (HTS) act as a critical entry point to HIV care, treatment and prevention services, and offer the opportunity for specially-trained health care providers to encourage avoidance of high risk sexual behaviour among both HIV negative andHIV-positive individuals. However,there aresome challenges that can hinder effective delivery ofHIV Counseling and Testingservices by health care providers. This studywastherefore designed to investigate barriers to effective HIV testing services and strategies for its promotion at the primary health care facilities in Ibadan.Methods: This descriptive cross-sectional study was carried out among health care providers in primary health care facilities in five local government areas in Ibadan metropolis, Nigeria. A 4-stage sampling techniques was used to select 19 respondents and interviewed using key informan interview guide. Interviews were transcribed verbatim. Spot check of transcripts wereconducted to ensure completeness of the transcription. Thedata were sorted, categorized, and analyzed using a qualitative data analysis computer software package (NVivo). Results: All the respondents interviewed reported that,there were pre and post-tests counseling including HIV testing services in their facilities. Some respondents added there were laboratory services and linkages to other care and support services for those tested positive to HIV. However, most of the respondents reported insufficient consumables, insufficient staff, no privacy, lack of infrastructures as barriers to effective HIV testing services. Many of the respondents recommended community sensitization, more provision for consumables, drugs and kits as strategies for promoting HIV testing services. Conclusion: This study revealed that the primary health centres have pre-test and post-test HIV counseling services but insufficient consumables and staff were the major barriers to HIV testing services in this study. Itis therefore necessary for government to make provision for consumables and more personnel to boost the activities of the health facilities.

Prevalence of Risk Factors of Noncommunicable Diseases in 12 Barangays of the AMIGA Municipalities of Cavite

Objective@#This study aims to determine the prevalence of risk factors of non-communicable diseases (NCDs) in 16 barangays of the AMIGA municipalities of Cavite. @*Methods@#The research is a cross-sectional study. Randomly chosen participants were interviewed using a translated version of the WHO Steps questionnaire. Interviewees were then invited to participate in another session where their anthropometric measurements were taken and their fasting blood sugar and cholesterol levels were determined.@*Results@#The research was done in 12 out of the 16 targeted barangays. A total of 1,527 participants were interviewed and 1,123 of them completed the study. The most significant findings in all 12 barangays were a very high rate of passive smoking (range of 60-80%); a relatively high proportion of respondents with obesity by all 3 parameters (BMI 29-52%; waist circumference 42-78%; and waist-to-hip ratio 41-78%) despite sufficient intake of fruits and vegetables and more than adequate physical activity; and a high proportion of participants with hypertension (more than 30% in 8 out of 12 barangays) and diabetes mellitus (more than 8% in 7 out of 12 barangays). @* Conclusion@#A high prevalence of risk factors of NCDs, particularly obesity, hypertension, and diabetes was found in the 12 barangays of AMIGA that participated in the study. Results of this study should provide the baseline data against which the success of an ongoing program in the area can be measured.

Assessment of the Cardiovascular Risk of Persons with Hypertension and Diabetes Attending Clinics and Hypertension/Health Club Meetings in the AMIGA Municipalities of Cavite, Philippines using WHO/ISH Risk Prediction Charts

Objectives@#This study aims to (1) determine the cardiovascular risk of persons with hypertension and diabetes attending hypertension/diabetic clinics or hypertension/health club meetings in the AMIGA (Alfonso, Mendez, Indang, General Emilio Aguinaldo and Amadeo) municipalities of Cavite; (2) suggest measures to improve the cardiovascular disease (CVD) program in these municipalities using the results of the study. @*Methods@#A cross-sectional study was performed on patients diagnosed with hypertension and/or diabetes who are attending clinics or club meetings in the barangays of the five AMIGA municipalities of Cavite. Participants were interviewed using an abbreviated version of the World Health Organization (WHO) STEPS questionnaire on risk factors. The participants’ anthropometric measurements were obtained and their total blood cholesterol levels determined. CVD risk was then estimated using the WHO / International Society of Hypertension (ISH) risk prediction chart for the Western Pacific Region B. @*Results@#1,032 participants from 27 barangays qualified for the study. Participants were predominantly female (74%); over-all mean age was 58.43 years. The majority of the participants (79.17%) were found to be in the low-risk group; 11.34% were in the moderate risk group; 4.46% were in the high-risk group; while 5.05% were in the very high-risk group. Majority of the participants were also found to be obese. Mean total cholesterol was 207.02 mg/dl. @*Conclusion@#Majority of participants were stratified in the low-risk category (<10% chance to have cardiovascularevents in the next 10 years), while 9.5% were in the high-risk category (≥20% risk). Obesity is a major risk factor that could be addressed in this population.

Nine-year follow up after hematopoietic stem cell transplantation in five multiple sclerosis patients / Nove anos de seguimento após transplante autólogo de células tronco hematopoiéticas em cinco pacientes com esclerose múltipla

ABSTRACT Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. Its treatment has focused on inflammation control as early as possible to avoid disability. Autologous hematopoietic stem cell transplantation (AHSCT) has been used for treating MS since 1996, with recent decisive results regarding benefits in long-term efficacy. Five patients followed up at an MS center in Belo Horizonte, Brazil, who had relapsing-remitting MS with high disease activity, underwent AHSCT between 2009 and 2011. They were evaluated clinically, with magnetic resonance imaging, and by the EDSS every six months after transplantation, up to July 2018. The patients were four women and one man, with ages ranging from 25-50 years, and time since disease onset ranging from 4-17 years at the time of the procedure. Four patients improved, one patient was stabilized, and all patients were free of disease activity after 5-9 years. Through improving patient selection and decreasing the time from disease onset, AHSCT could stop epitope spreading and disease progression. Despite multiple other therapeutic choices being approved for relapsing-remitting MS, AHSCT continues to be a treatment to consider for aggressive MS disease.

RESUMO A esclerose múltipla é uma doença imunomediada do sistema nervoso central. Seu tratamento tem sido focado no controle da inflamação o mais cedo possível para evitar incapacidade. O transplante autólogo de células tronco hematopoiéticas (TACTH) vem sendo usado para tratar esclerose múltipla desde 1996, e recentes resultados foram decisivos a respeito do benefício na eficácia a longo prazo. Cinco pacientes seguidos num centro de esclerose múltipla de Belo Horizonte, Brasil, que apresentavam forma clínica remitente recorrente com alta atividade de doença foram submetidos a esse tratamento de 2009 a 2011. Após o transplante foram avaliados clinicamente e com ressonância magnética, e escala de EDSS, a cada seis meses até julho de 2018. Os pacientes eram quatro mulheres e um homem, com idade entre 25 e 50 anos e tempo de doença variando de 4 a 17 anos na época do procedimento. Quatro pacientes melhoraram após a primeira avaliação e um manteve-se estável. Todos os pacientes permaneceram sem evidência de doença clínica ou radiológica de 5 a 9 anos após. Com uma seleção cada vez mais criteriosa de pacientes o TACTH pode interromper a disseminação do epítopo e controlar a progressão da doença. Apesar de várias outras opções terapêuticas aprovadas para esclerose múltipla o TACTH continua a ser uma forma de tratamento a ser considerada em casos de doença muito agressiva.

Disability as a determinant of fatigue in MS patients / Incapacidade como determinante da fadiga em pacientes com EM

ABSTRACT Fatigue is one of the most frequent and disabling symptoms in multiple sclerosis (MS). Central, psychological, and peripheral factors may contribute to the occurrence of fatigue. Objectives: The current study aimed to evaluate potential fatigue determinants in patients with relapsing-remitting MS with a low functional impairment. Methods: We compared inflammatory markers, respiratory pressures, disability, and quality of life in 39 relapsing-remitting MS patients with and without fatigue. Results: Patients with relapsing-remitting MS with fatigue had higher Expanded Disability Status Scale scores (p = 0.002). We observed a significant association between the results of the Guy Neurological Disability Scale, the Functional Assessment of MS Quality of Life Rating Scale and the presence of fatigue (p < 0.05). Conclusions: The degree of functional impairment is a determinant for the presence of fatigue in MS patients, but respiratory function and inflammatory markers are not.

RESUMO A fadiga é um dos sintomas mais frequentes e incapacitantes na esclerose múltipla (EM). Fatores centrais, psicológicos e periféricos podem contribuir para a ocorrência de fadiga. Objetivos: O presente estudo teve como objetivo avaliar potenciais determinantes de fadiga em pacientes com EM remitente-recorrente (EMRR) com baixo nível de incapacidade funcional. Métodos: Foram comparados marcadores inflamatórios, pressões respiratórias, incapacidade e qualidade de vida em 39 pacientes com EMRR com e sem fadiga. Resultados: Pacientes com EMRR com fadiga apresentaram maior Escala de Incapacidade Funcional Expandida (p = 0,002). Observamos uma associação significativa entre os resultados da Escala de Incapacidade Neurológica de Guy e Escala de Avaliação da Qualidade de Vida Funcional com a presença de fadiga (valores de p < 0,05). Conclusão: O grau de comprometimento funcional, mas não a função respiratória e os marcadores inflamatórios, são determinantes para a presença de fadiga em pacientes com EM.

Association of glycerol kinase gene with class 3 integrons: A novel cassette array within Escherichia coli

Background: Integrons are genetic elements which are known for their role in capturing and spreading of antibiotic resistance determinants among Gram-negative bacilli. So far, there is no study regarding Class 3 integron and their genetic organisation in India. Objective: This study investigates the occurrence of Class 3 integron and their gene cassette array among Escherichia coli. Materials and Methods: In this study, a total of 200 E. coli isolates were collected from indoor and outdoor patients from Silchar Medical College and Hospital during September 2015 to February 2016. Detection of the integrase genes and gene cassettes within the Class 3 integron was performed by polymerase chain reaction which was further analysed by sequencing. Results: Twenty-seven isolates were found to harbour Class 3 integron. Sequencing of the gene cassettes and whole Class 3 integron revealed the presence of nine different types of cassettes array, out of which the arrangement with glycerol kinase gene cassette was found to be the most prevalent. Arrangement with blaCTX-Mgene cassette was also detected in few isolates. Conclusion: This study provides epidemiological profiling of Class 3 integrons in this geographical area. The data generated in this study are helpful in infection control programme, anti-infective research and search for epidemiological markers.

A preliminary study on the safety, efficacy and acceptability of the community preparation of Siling Labuyo (Capsicum frutescens) Liniment in the management of Knee Osteoarthritis in a six-week, active-controlled community-based clinical trial

Objective@#The study determined the safety, efficacy and acceptability of a Philippine community preparation of Siling Labuyo liniment in the management of knee osteoarthritis.@*Methods@#A 6-week randomized, double-blind, active-controlled clinical trial was conducted in three municipalities of Cavite from 2017-2018. The municipalities were randomly assigned to either the control or experimental group, using a commercially available Diclofenac 1% gel as the control agent. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Pain Visual Analogue Scale (VAS) were used to measure the outcomes.@*Results@#Forty-seven participants completed the study. Statistically significant improvement (p<0.05) in pain relief, reduction of symptoms and increase in knee functionality was reported by participants in both the experimental and control groups. Across the dimensions measured, at least 30% improvement in scores was reported by the experimental group, and at least 40% by the control group. The difference was statistically not significant (p>0.05). Itching (13%), burning sensation (11%) and reddening of the skin (15%) were experienced in both the experimental and the active control groups.@*Conclusion@#Use of the liniment led to a modest therapeutic effect and was well-tolerated by the participants.

Application of the theory of Unpleasant Symptoms in Practice: A Challenge for Nursing

Symptoms are at the heart of nursing care. Much of what nurses do for and with patients is focused on symptoms: measuring them, assessing factors that may inuence changes, developing prevention and management strategies, and helping patients with ongoing monitoring and self-management. e eory of Unpleasant Symptoms (TOUS) was developed to highlight important aspects of the symptom experience in order to improve understanding and help guide nursing research and practice. It is exciting that interest in the theory and its application has been increasing internationally.

Miastenia gravis de tipo bulbar en niños: un caso de difícil diagnóstico / Bulbar Myasthenia Gravis in children: a case of difficult diagnosis

La miastenia gravis (MG) es un trastorno autoinmune caracterizado por debilidad y fatigabilidad de los músculos esqueléticos debida a la disfunción de la unión neuromuscular. Se presenta el caso de una adolescente de 11 años de edad, con diagnóstico de miastenia gravis de tipo bulbar. La paciente presentó dos crisis de MG previamente diagnosticadas de manera equivocada como crisis asmáticas. Recibió tratamiento con inmunoglobulina humana, corticoides, piridostigmina y timectomía. Se discute la evolución clínica y riesgos atribuibles a situaciones sociales que pueden retrasar el diagnóstico y su manejo efectivo.

Myasthenia gravis (MG) is an autoimmune disorder characterized by weakness and fatigability of the skeletal muscles due to dysfunction of the neuromuscular junction. We report the case of an 11-year-old girl diagnosed with bulbar myasthenia gravis. The patient had two previous crises of myasthenia gravis erroneously diagnosed as asthma attacks. She received treatment with human immunoglobulin, corticosteroids, pyridostigmine and thymectomy. We discuss the clinical course and the risks attributable to social situations that can delay the diagnosis and its effective management.

Síndrome de Kinsbourne por neuroblastoma de localización mediastinal: a propósito de un caso infantil / Kinsbourne syndrome due to neuroblastoma of mediastinal location: a child case report

Se presenta el caso de un niño de un año de edad con neuroblastoma de localización en el mediastino posterior, que debutó con manifestaciones de Síndrome de Kinsbourne (opsoclonus, mioclonus), y que mejoró ostensiblemente después de la extracción quirúrgica del tumor. Se discute la frecuencia, localización, forma de presentación y tratamiento del síndrome.

The case of a 1-year old child with a neuroblastoma of posterior mediastinal location is presented. The initial manifestations were those of the Kinsbourne Syndrome (opsoclonus, myoclonus), which improved significantly after the surgical removal of the tumor. The frequency, location, form of presentation and treatment of the Kinsbourne Syndrome are discussed.

Perceived Control and Communication about Sex: A Study of South African Families

Caregiver-youth communication about sex protects youth against HIV/AIDS; and caregivers who believe that sex knowledge is important are more likely to talk to their youth about sex. However; caregivers who experience barriers to communication about sex may not talk to their youth about sex even if the caregiver believes that sex education is important. The Theory of Planned Behaviour predicts that an actor has perceived control is necessary for behavioural change. This study therefore hypothesised that caregivers' perceived control moderates the relationship between caregiver attitudes about youth sex knowledge and caregiver-youth communication about sex. Results from a sample of 99 female South African caregivers of adolescent (10-14 year old) youth supported our hypothesis; indicating that caregiver attitudes about providing youth with sex knowledge positively predict communication about sex only when caregivers have perceived control. This finding illustrates the importance of perceived control in predicting caregiver-youth communication; and therefore has implications for family-based interventions aimed at improving caregiver-youth communication about sex

Genital human papillomaviruses among women of reproductive age in Jamaica / Virus de los papilomas humanos genitales en mujeres en edad reproductiva de Jamaica

OBJECTIVE: To characterize the prevalence and distribution of genital human papillomavirus (HPV) types among women in Jamaica, and to explore risk factors associated with HPV infection. METHODS: This was a cross-sectional study that took place in April-July 2010 with 852 sexually-active women, 16-49 years of age, who had attended a selected public or private primary health clinic in one of Jamaica's four health authority regions. Sociodemographic data was collected from each participant by trained study staff. Each participant had a gynecological examination that included a clinical Pap test and a cervical sample for HPV detection and typing-performed using the Research Use Only Linear Array (LA) genotyping assay (Roche Diagnostics Corp., Indianapolis, Indiana, United States). Overall and type-specific prevalence of HPV infection was calculated for 37 HPV types included in the LA genotyping assay. RESULTS: HPV DNA was detected in 460 of the 852 women (54.0%). Oncogenic HPV was detected in 297 women (34.9%) and HPV types 16/18 were found in 86 women (10.1%). The most frequently occurring HPV types were: 16 (6.2%); 35 (6.0%); 62 and 83 (5.5%); 61 and 58 (5.4%); 84 (4.7%); 18 (4.3%); and, 66 and 81 (4.2%). HPV prevalence was highest among women who were single, young (16-19 years), and had had more than three sexual partners in their lifetime. CONCLUSIONS: These results, coupled with high rates of cervical cancer, support introducing HPV vaccines while maintaining and strengthening cervical cancer screening services. Policy decisionmaking that reflects these results is instrumental to establishing a comprehensive cervical cancer program in Jamaica.

OBJETIVO: Determinar la prevalencia y la distribución de los tipos de virus de los papilomas humanos (VPH) genitales en las mujeres de Jamaica y explorar los factores de riesgo asociados con la infección por VPH. MÉTODOS: Este estudio transversal se llevó a cabo de abril a julio del 2010. Participaron 852 mujeres sexualmente activas, de 16 a 49 años de edad, que acudieron a uno de los consultorios públicos o privados de atención primaria seleccionados en cada una de las cuatro autoridades sanitarias regionales de Jamaica. Personal capacitado del estudio recopiló datos sociodemográficos de cada participante. Todas las participantes fueron sometidas a un examen ginecológico que comprendía una prueba clínica de Papanicolaou y la obtención de una muestra del cuello uterino a efectos de detectar y tipificarlos VPH mediante la prueba de genotipado Linear Array (LA) (Roche Diagnostics Corp., Indianápolis, Indiana, Estados Unidos), de uso exclusivo en investigación. Se calcularon las prevalencias global y específica de tipo de la infección por VPH para los 37 tipos de VPH incluidos en la prueba de genotipado LA. RESULTADOS: Se detectó ADN de VPH en 460 de las 852 mujeres (54,0%). Se detectaron VPH oncógenos en 297 mujeres (34,9%), y VPH de los tipos 16 y 18 en 86 mujeres (10,1%). Los tipos de VPH detectados con mayor frecuencia fueron 16 (6,2%), 35 (6,0%), 62 y 83 (5,5%), 61 y 58 (5,4%), 84 (4,7%), 18 (4,3%), y 66 y 81 (4,2%). La prevalencia de VPH fue más elevada en mujeres solteras, jóvenes (de 16 a 19 años) y que habían tenido más de tres compañeros sexuales en sus vidas. CONCLUSIONES: Estos resultados, junto a las elevadas tasas de cáncer cervicouterino, fundamentan la introducción de las vacunas contra el VPH al tiempo que se mantienen y refuerzan los servicios de tamizaje del cáncer cervicouterino. Las decisiones políticas que se adopten como consecuencia de estos resultados serán determinantes para establecer un programa integral contra el cáncer cervicouterino en Jamaica.

Immersion in water in labour and birth

BACKGROUND: Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Critics cite the risk of neonatal water inhalation and maternal/neonatal infection. OBJECTIVES: To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes. METHODS: Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2011) and reference lists of retrieved studies. Selection criteria: Randomised controlled trials comparing immersion in any bath tub/pool with no immersion, or other non-pharmacological forms of pain management during labour and/or birth, in women during labour who were considered to be at low risk of complications, as defined by the researchers. Data collection and analysis: We assessed trial eligibility and quality and extracted data independently. One review author entered data and the other checked for accuracy. MAIN RESULTS: This review includes 12 trials (3,243 women): 8 related to just the first stage of labour: one to early versus late immersion in the first stage of labour; two to the first and second stages; and another to the second stage only. We identified no trials evaluating different baths/pools, or the management of third stage of labour. Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1,254 versus 529/1,245; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.82 to 0.99, six trials). There was also a reduction in duration of the first stage of labour (mean difference -32.4 minutes; 95% CI -58.7 to -6.13). There was no difference in assisted vaginal deliveries (RR 0.86; 95% CI 0.71 to 1.05, seven trials), ...

Dendritic surface functionalization of nanomaterials: controlling properties and functions for biomedical applications

A wide variety of nanomaterials have demonstrated promise in medical applications such as drug delivery and imaging. In these applications, the surface chemistry of the materials is critical as it plays an important role in determining the toxicity and biodistribution behavior of the material. We review here the functionalization of nanomaterials with dendrons as an efficient method to alter the surface chemistry of the materials, introducing new properties and functions. Described here is the functionalization of superparamagnetic iron oxide nanoparticles (SPIO) with dendritic guanidines to enhance their transport into cells for magnetic resonance imaging applications. The introduction of dendrons bearing peripheral hydroxyls, amines, guanidines, carbohydrates and Gd(III) chelates to polymer vesicles (polymersomes) is also described. These dendritic moieties allow for modulation of toxicity, cell uptake, protein binding, and contrast agent efficiency, while at the same time allowing the stabilities of the polymersomes to be maintained. Thus, this approach holds promise for the development of a wide range of multifunctional materials for pharmaceutical applications.

Uma grande variedade de nanomateriais tem demonstrado aplicações médicas promissoras, tais como liberação de fármacos e em imagens. Nestas aplicações, a superfície química dos materiais é crítica, uma vez que exerce papel importante na determinação da toxicidade e comportamento de biodistribuição do material. Aqui, nós revisamos a funcionalização de nanomateriais, como dendrons, como método eficiente de alterar a superfície química destes compostos, introduzindo novas propriedades e funções. Descritos aqui estão nanopartículas superparamagnéticas de óxido de ferro (do inglês, SPIO), com guanidinas dendríticas para aumentar seu transporte para o interior das células, úteis em imagens de ressonância magnética. A introdução de dendrons contendo hidroxilas, aminas, guanidinas, carboidratos e quelatos de Gd(III) periféricos em vesículas poliméricas (polymersomes) também está descrita. Esses grupos dendríticos permitem a modulação de toxicidade, captura celular, ligação à proteína e eficiência como agente de contraste, enquanto que, ao mesmo tempo, permitem a manutenção da estabilidade das vesículas poliméricas. Assim, essa abordagem é promissora para o desenvolvimento de grande variedade de materiais multifuncionais para aplicações farmacêuticas.

Burnout, apoyo social y satisfacción laboral en docentes / Burnout, social support and job satisfaction of teachers working / Burnout, apoio social e satisfação no trabalho professores

Se analiza la relación entre las variables Burnout, Apoyo Social y Satisfacción Laboral en una muestra de 89 docentes pertenecientes a establecimientos educacionales municipalizados de la ciudad de Rengo, Chile. Se administraron las escalas de Burnout, Apoyo Social y de Satisfacción Laboral correspondientes a las variables estudiadas. Se observa que los docentes se encontraban altamente afectados por sintomatologías y presencia de Burnout. Sin embargo, presentaron altos niveles de Apoyo Social y Satisfacción Laboral, factores que amortiguarían las consecuencias nocivas del Síndrome de quemarse por el trabajo. Además, se encontraron relaciones significativas entre estas variables, demostrando que el Burnout se relaciona de forma inversa tanto con la variable Apoyo Social (r=-0,526; p<0,01) como con Satisfacción Laboral (r=-0,477; p<0,01). Finalmente, se reporta que el Apoyo Social y la Satisfacción Laboral relacionan de manera directa (r=0,684; p<0,01).

In this work we analyze the relationship existing among the variables of burnout, social support and job satisfaction in a sample of 89 teachers in municipal schools in Rengo city Chile. We administered Burnout scales, Social Support and Job Satisfaction corresponding to the studied variables. We observed that teachers were significantly affected by symptoms and the presence of burnout. However, they also presented high levels of social support and satisfaction at work, factors that decrease the harmful effects of burnout syndrome due to work. In addition, we found significant relationships between these variables, demonstrating that Burnout is related inversely with both the with variable and social support (r = - 0.526, p <0.01) as well as with work satisfaction (r = - 0.477, p <0, 01). Finally we conclude that social support and job satisfaction are directly related (r = 0.684, p <0.01).

Foi analisada a relação entre as variáveis de Burnout, Apoio social e Satisfação no trabalho em uma amostra de 89 professores de estabelecimentos municipais de ensino da cidade de Rengo, Chile. Foram administradas escalas de Burnout, Apoio Social e Satisfação no Trabalho correspondentes às variáveis estudadas. Foi observado que os professores estavam afetados significativamente por sintomatologia e presença de Burnout. No entanto, apresentaram altos níveis de Apoio social e Satisfação no trabalho, fatores que diminuiriam os efeitos nocivos da Síndrome Burnout devido ao trabalho. Além disso, foram encontradas relações significativas entre essas variáveis , demonstrando que o Burnout relaciona-se de forma inversa tanto com a variável Apoio social (r =- 0,526, p <0,01) quanto com Satisfação no trabalho (r =- 0,477, p <0 , 01). Finalmente, relata-se que o Apoio social e a Satisfação no trabalho estão diretamente relacionados (r = 0,684, p <0,01).

The prevalence of multiple sclerosis in Belo Horizonte, Brazil / Prevalência da esclerose múltipla em Belo Horizonte, Brasil

Investigations on the prevalence rates of multiple sclerosis (MS) around the world have yielded important clues on the interplay between genetic susceptibility and environmental factors. As Brazil is a huge country laid on many latitudes and inhabited by population with distinct ethnic backgrounds, it might be assumed that the frequency of MS varies in its different regions. Objective: To determine the prevalence rate of MS in Belo Horizonte, the capital of the State of Minas Gerais, Southeastern Brazil. Methods: We used six sources to draw up a provisional list of identified cases of MS. Only patients with diagnosis of clinically definite MS according to Poser Committee criteria were included. Results: The calculated crude MS prevalence was 18.1/100,000 inhabitants. Conclusions: The MS prevalence in Belo Horizonte is similar to that found in São Paulo and Botucatu, two other cities in southeastern Brazil with similar ethnic background.

Estudos sobre as taxas de prevalência da esclerose múltipla (EM) no mundo têm fornecido importantes evidências do papel da inter-relação dos fatores genéticos e ambientais determinando estas frequências. Como o Brasil é um país muito extenso e com populações de diversas origens étnicas, supõe-se que a frequência da EM seja variável em suas diferentes regiões. Objetivo: Determinar a taxa de prevalência da esclerose múltipla (EM) em Belo Horizonte, capital do estado de Minas Gerais, no sudeste do Brasil. Métodos: Nós usamos seis fontes para a identificação dos pacientes que preenchiam os critérios diagnósticos de EM clinicamente definida de acordo com o Comitê de Poser. Resultados: A taxa de prevalência encontrada foi de 18,1/100.000 habitantes. Conclusões: A prevalência em Belo Horizonte de EM é semelhante à encontrada nos estudos em São Paulo e Botucatu, duas outras cidades na região sudeste do Brasil habitadas por populações com similar origem étnica.

Desempenho de seis modelos de predição prognóstica em pacientes críticos que receberam suporte renal extracorpóreo / Performance of six prognostic scores in critically ILL patients receiving renal replacement therapy

JUSTIFICATIVA E OBJETIVOS: Não existe consenso sobre qual modelo prognóstico deva ser utilizado em pacientes com disfunção renal aguda (DRA). O objetivo deste estudo foi avaliar o desempenho de seis escores de prognóstico em pacientes que necessitaram de suporte renal. MÉTODO: Coorte prospectiva de pacientes internados nas unidades de terapia intensiva (UTI) de três hospitais terciários que necessitaram de suporte renal por DRA durante 32 meses. Foram excluídos os pacientes crônicos em programa de diálise ou com < 24h de internação na UTI. Os dados das primeiras 24h de UTI foram utilizados no cálculo do SAPS II e do APACHE II, e os dados das primeiras 24h de suporte renal foram utilizados no cálculo dos escores LOD, ODIN, Liaño e Mehta. A discriminação foi avaliada através da área sobre a curva ROC (AUROC) e a calibração através do teste do goodness-of-fit de Hosmer-Lemeshow. A letalidade hospitalar foi o desfecho de interesse. RESULTADOS: Quatrocentos e sesseta e sete pacientes foram incluídos e a letalidade hospitalar foi 75 por cento. Os valores dos escores SAPS II, APACHE II e LOD foram 48,5 ± 11,2, 27,4 ± 6,3, 7 (5-8) pontos, respectivamente. A calibração foi adequada para todos os escores, com exceção do Mehta (p = 0,001). Entretanto, a discriminação foi ruim para todos os modelos, com AUROC variando entre 0,60 para o ODIN e 0,72 para o SAPS II e Mehta. Com exceção do Mehta, todos os modelos subestimaram a letalidade. CONCLUSÕES: Todos os seis modelos estudados foram inadequados na predição prognóstica de pacientes graves com DRA e necessidade de suporte renal.

BACKGROUND AND OBJECTIVES: There is no consensus about prognostic scores for use in patients with acute kidney injury (AKI). The aim of this study was to evaluate the performance of six prognostic scores in predicting hospital mortality in patients with AKI and need for renal replacement therapy (RRT). METHODS: Prospective cohort of patients admitted to the intensive care units (ICU) of three tertiary care hospitals that required RRT for AKI over a 32-month period. Patients with end-stage renal disease and those with ICU stay < 24h were excluded. Data from the first 24h of ICU admission were used to calculate SAPS II and APACHE II scores, and data from the first 24h of RRT were used in the calculation of LOD, ODIN, Liaño and Mehta scores. Discrimination was evaluated using the area under ROC curve (AUROC) and calibration using the Hosmer-Lemeshow goodness-of-fit test. The hospital mortality was the end-point of interest. RESULTS: 467 patients were evaluated. Hospital mortality rate was 75 percent. Mean SAPS II and APACHE II scores were 48.5 ±11.2 and 27.4 ± 6.3 points, and median LOD score was 7 (5-8) points. Except for Mehta score (p = 0.001), calibration was appropriate in all models. However, discrimination was uniformly unsatisfactory; AUROC ranged from 0.60 for ODIN to 0.72 for SAPS II and Mehta scores. In addition, except for Mehta, all models tended to underestimate hospital mortality. CONCLUSIONS: Organ dysfunction, general and renal-specific severity-of-illness scores were inaccurate in predicting outcome in ICU patients in need for RRT.

Assessing the sensitivity of surveillance for pneumonia in rural Thailand.

We conducted a household survey among Sa Kaeo residents to characterize self-reported health-seeking behavior for pneumonia and the proportion of individuals who seek care at a hospital to determine the coverage of a surveillance system. A 2-stage cluster sample was used to select households. A case of pneumonia was defined as a self-reported history of cough and difficulty breathing for at least 2 days or being given a diagnosis of pneumonia by a healthcare provider in the 12-month period beginning February 1, 2002, and ending January 31, 2003. Interviewers administered a structured questionnaire that asked about clinical illness and utilization of healthcare services. Among 1,600 households, 5,658 persons were surveyed, of whom 62 persons met the case definition. Of the 59 persons with complete data, 53 (90%, 95% CI: 79-96) sought medical care and 47 (80%, 95% CI: 67-89) sought care at a hospital facility in the province. Neither distance nor cost was reported as a barrier to seeking care. Most individuals with self-reported pneumonia sought care at the hospital level. Population-based surveillance can provide reliable estimates of hospitalized, chest radiograph-confirmed pneumonia in Sa Kaeo if adjustments are made to account for the proportion of individuals who access a hospital where radiologic assessment is available.

COL18A1 is highly expressed during human adipocyte differentiation and the SNP c.1136C > T in its "frizzled" motif is associated with obesity in diabetes type 2 patients

Collagen XVIII can generate two fragments, NC11-728 containing a frizzled motif which possibly acts in Wnt signaling and Endostatin, which is cleaved from the NC1 and is a potent inhibitor of angiogenesis. Collagen XVIII and Wnt signaling have recently been associated with adipogenic differentiation and obesity in some animal models, but not in humans. In the present report, we have shown that COL18A1 expression increases during human adipogenic differentiation. We also tested if polymorphisms in the Frizzled (c.1136C>T; Thr379Met) and Endostatin (c.4349G>A; Asp1437Asn) regions contribute towards susceptibility to obesity in patients with type 2 diabetes (113 obese, BMI =30; 232 non-obese, BMI < 30) of European ancestry. No evidence of association was observed between the allele c.4349G>A and obesity, but we observed a significantly higher frequency of homozygotes c.1136TT in obese (19.5 percent) than in non-obese individuals (10.9 percent) [P = 0.02; OR = 2.0 (95 percentCI: 1.07-3.73)], suggesting that the allele c.1136T is associated to obesity in a recessive model. This genotype, after controlling for cholesterol, LDL cholesterol, and triglycerides, was independently associated with obesity (P = 0.048), and increases the chance of obesity in 2.8 times. Therefore, our data suggest the involvement of collagen XVIII in human adipogenesis and susceptibility to obesity.

Colágeno XVIII pode gerar dois fragmentos, um correspondendo à região NC11-728 contendo o motivo ''frizzled'', o qual possivelmente atua na sinalização Wnt, e outro correspondendo a Endostatina, que é clivada a partir da região NC1 e é uma potente inibidora de angiogênese. Colágeno XVIII e a via de sinalização Wnt foram recentemente associados à diferenciação adipogênica e obesidade em alguns modelosanimais, porém ainda não em humanos. No presente trabalho, mostramos que os níveis de expressão gênica do COL18A1 aumentam durante o processo de diferenciação adipogênica em humanos. Também testamos se polimorfismos localizados no motivo ''Frizzled'' (c.1136C > T; Thr379Met) e na região da Endostatina (c.4349G > A; Asp1437Asn) contribuem na predisposição a obesidade em pacientes com diabetes tipo 2. (113 obesos, BMI > 30; 232 não-obesos, BMI < 30) de ancestralidade Européia. Nenhuma evidência de associação entre o alelo c.4349G > A e obesidade foi observada, contudo, observamos uma freqüência significativamente maior de homozigotos c.1136TT em obesos (19.5 por cento) do que em não-obesos (10.9 por cento)[P = 0.02; OR = 2.0 (95 por centoCI: 1.07-3.73)], sugerindo que o alelo c.1136T está associado com obesidade conforme ummodelo recessivo. Este genótipo manteve-se associado à obesidade (P = 0.048) mesmo após o controle das variáveis colesterol, LDL e triglicérides, e confere um risco 2.8 vezes maior de obesidade. Portanto, nossos dados sugerem o envolvimento do colágeno XVIII em adipogênese humana e predisposição a obesidade.