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Resumen ChatGPT es un asistente virtual con inteligencia artificial que utiliza lenguaje natural para comunicarse, es decir, mantiene conversaciones como las que se tendrían con otro humano. Puede aplicarse en educación a todos los niveles, que incluye la educación médica, tanto para la formación, la investigación, la escritura de artículos científicos, la atención clínica y la medicina personalizada. Puede modificar la interacción entre médicos y pacientes para mejorar los estándares de calidad de la atención médica y la seguridad, por ejemplo, al sugerir medidas preventivas en un paciente que en ocasiones no son consideradas por el médico por múltiples causas. Los usos potenciales del ChatGPT en la educación médica, como una herramienta de ayuda en la redacción de artículos científicos, un asistente en la atención para pacientes y médicos para una práctica más personalizada, son algunas de las aplicaciones que se analizan en este artículo. Los aspectos éticos, originalidad, contenido inapropiado o incorrecto, citas incorrectas, ciberseguridad, alucinaciones y plagio son ejemplos de las situaciones a tomar en cuenta al usar las herramientas basadas en inteligencia artificial en medicina.
Abstract ChatGPT is a virtual assistant with artificial intelligence (AI) that uses natural language to communicate, i.e., it holds conversations as those that would take place with another human being. It can be applied at all educational levels, including medical education, where it can impact medical training, research, the writing of scientific articles, clinical care, and personalized medicine. It can modify interactions between physicians and patients and thus improve the standards of healthcare quality and safety, for example, by suggesting preventive measures in a patient that sometimes are not considered by the physician for multiple reasons. ChatGPT potential uses in medical education, as a tool to support the writing of scientific articles, as a medical care assistant for patients and doctors for a more personalized medical approach, are some of the applications discussed in this article. Ethical aspects, originality, inappropriate or incorrect content, incorrect citations, cybersecurity, hallucinations, and plagiarism are some examples of situations to be considered when using AI-based tools in medicine.
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Resumen Las innovadoras tecnologías del metaverso y el chat GPT4 (basado en inteligencia artificial) están presentes en el discurso cotidiano de la sociedad; recientemente se han introducido en la práctica médica y están provocando importantes cambios. En cuanto al metaverso ("después del universo"), diversas escuelas y facultades de medicina del mundo comienzan a utilizarlo como una estrategia innovadora dirigida a la enseñanza de materias como anatomía, histología, oftalmología y simulación en mundos paralelos (virtuales) para el aprendizaje y supervisión de cirugías, así como para otras aplicaciones en educación médica y en la relación médico-paciente. Si bien debe tomarse en cuenta como un área de oportunidad para la transformación de la medicina, es importante considerar las diversas limitaciones y riesgos del metaverso en la práctica médica, la formación de estudiantes y la relación del médico con los problemas de salud a los que se enfrenta en su práctica.
Abstract Innovative technologies such as the metaverse and chat GPT-4 (based on artificial intelligence) are present in the daily discourse of society; recently, they have been introduced into medical practice and are bringing about important changes. In the case of the metaverse ("beyond the universe"), various medical schools and departments around the world are beginning to use it as an innovative strategy for teaching subjects such as anatomy, histology, ophthalmology, and simulation in parallel (virtual) worlds for learning and supervision of surgeries, as well as for other applications in medical education and in the doctor-patient relationship. Although it should be regarded as an area of opportunity for the transformation of medicine, it is important to consider the various limitations and risks of the metaverse in medical practice, student training, and physicians' relationship with the health problems they have to deal with in their practice.
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Los páramos almacenan grandes reservas de carbono orgánico en el suelo (COS), influenciados por las condiciones climáticas y biogeoquímicas, propias del ecosistema; sin embargo, su progresiva conversión hacia cultivos, ganadería o minería incide directamente en las reservas de COS. Con el fin de determinar el efecto que ejerce el cambio de uso de suelo sobre la variabilidad de las reservas de COS, se realizó un monitoreo de COS entre 2013, 2018 y 2020, en el Parque Natural Regional Cortadera. Se estudiaron parcelas permanentes de muestreo (PPM), ubicadas bajo tres diferentes usos del suelo: conservado, en recuperación e intervenido. Se analizaron muestras de carbono orgánico y densidad aparente, a dos profundidades (0-15 cm y 15-30 cm). Se encontró que la PPM en escenario conservado presentó los contenidos más altos de COS, con valores de 290,37; 199,22 y 257,5 tC ha-1, para cada uno de los años en estudio; seguido por la PPM en recuperación, que evidenció valores de COS 215,3 tC ha-1, en el 2020, en contraste con la PPM intervenida, que presentó contenidos mínimos de 15,50; 34,01 y 88,06 tC ha-1. Se observó que los mayores contenidos de COS se encuentran a la profundidad de 15 a 30 cm. Dichos aspectos, resaltan la importancia de avanzar en acciones enfocadas a la protección de ecosistemas estratégicos, considerando las constantes amenazas relacionadas con la transformación del paisaje y, con ello, la posibilidad de proveer funciones y servicios asociados a la captura de carbono y la regulación climática.
The paramos accumulate high stocks of soil organic carbon (SOC), influenced by the climatic and biogeochemical conditions of the ecosystem. However, their progressive conversion to crops, livestock, or mining has a direct impact on the SOC stocks. To determine the effect of land use change on the variability of SOC stocks, monitoring of SOC content was conducted between the years 2013, 2018, and 2020 in the Parque Natural Regional Cortadera. Permanent sampling plots (PPS) located under three different land uses were studied: conserved, recovering, and intervened. To do so, samples of soil organic carbon and bulk density at two depths were analyzed (0-15 cm and 15-30 cm). The conserved PPS showed the highest SOC contents, with maximum values of 290.37; 199.22, and 257.5 tC ha-1 for each of the years under study; follow by the recovery PPM that presented COS values of 215.3 tC ha-1 in 2020, in contrast to the intervened PSP that showed minimum contents of 15.50; 34.01 and 88.06 tC ha-1. Furthermore, the highest SOC contents were found at 15-30 cm depth. These factors emphasize the importance of carrying out actions focused on protecting strategic ecosystems such as paramos, taking into account the continuous threats related to the transformation of the landscape and, consequently, the possibility of providing ecosystem functions and services related to carbon capture and climate regulation.
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Introducción: El recién nacido prematuro presenta una inmadurez del sistema cardiorespiratorio, lo que dificulta su adaptación al medio extrauterino y conlleva a múltiples complicaciones las cuales se requieren intervenciones que mejoren la ventilación y el intercambio gaseoso tales como la oxigenación a través de dispositivos de apoyo terapéutico como la presión positiva continua de la vía aérea o CPAP. Objetivo: determinar el efecto del tacto terapéutico en la adaptación del recién nacido pretérmino con CPAP. Materiales y métodos: Estudio cuasi-experimental, con una muestra de 13 RNPT a quienes se les aplicó el tacto terapéutico durante 15 minutos, con 2 sesiones diarias (6 am y 8pm), con evaluación antes y después del CRE: "Adaptación del prematuro". A lo cual se le realizó el análisis descriptivo correspondiente. Resultados: El total de los participantes, fue asignado al grupo control y grupo intervenido de forma similar, evidenciando cambios antes y después de la intervención, pero en especial en el indicador postura de las manos, con una diferencia entre ambos grupos de p 0,74 con valor de 0.006. Conclusiones: La aplicación del tacto terapéutico al RNPT con CPAP nasal permite mejorar el confort del RNPT a través de indicadores fisiológicos y neurocomportamentales.
Introduction: Premature newborns have an immature cardiorespiratory system that hinders adaptation to the extrauterine environment. This leads to multiple complications which require interventions to improve ventilation and gas exchange, like oxygenating using therapeutic support devices such as continuous positive airway pressure or CPAP. Objective: To determine the effect of therapeutic touch on preterm newborns' adaptation to CPAP. Materials and methods: This is a quasi-experimental study, with a sample of 13 PTNB who underwent therapeutic touch for 15 minutes in 2 daily sessions (6 am and 8 pm), with pre- and post-assessment of NOC "Preterm Infant Organization." Descriptive analysis was performed. Results: The participants were allocated to the control group and the intervention group in a similar way. Pre- and post-intervention changes were observed, but especially in the hand posture indicator, with a difference between both groups of 0.74 with a p-value of 0.006. Conclusions: The practice of therapeutic touch with RNPT receiving nasal CPAP allows for improving the comfort of the RNPT through physiological and neurobehavioral indicators.
Introdução: O recém-nascido prematuro apresenta uma imaturidade do sistema cardiorrespiratório, o que dificulta a adaptação ao ambiente extrauterino e leva a múltiplas complicações que requerem intervenções que melhorem a ventilação e as trocas gasosas como a oxigenação por meio de dispositivos de suporte terapêutico, como via aérea positiva contínua pressão ou CPAP. Objetivo: determinar o efeito do toque terapêutico na adaptação do recém-nascido pré-termo com CPAP. Materiais e métodos: Estudo quase experimental, com uma amostra de 13 PTNIs a quem foi aplicado o toque terapêutico durante 15 minutos, com 2 sessões diárias (6h e 20h), com avaliação antes e após CRE: "Adaptação do prematuro". Ao qual foi realizada a análise descritiva correspondente. Resultados: Todos os participantes foram alocados no grupo controle e no grupo intervenção de forma semelhante, apresentando alterações antes e após a intervenção, mas principalmente no indicador de postura das mãos, com diferença entre os dois grupos foi de 0,74 com um valor de p 0,006. Conclusões: A aplicação do toque terapêutico ao RNPT com CPAP nasal permite melhorar o conforto do RNPT através de indicadores fisiológicos e neurocomportamentais.
Subject(s)
Infant, Premature , Child Development , Neonatal Nursing , Therapeutic Touch , Continuous Positive Airway PressureABSTRACT
Justificación: En Colombia, el comercio de especies de fauna silvestre sin la documentación necesaria es prohibido por ley, por lo que, en el contexto de una investigación penal sobre venta de reptiles a través de internet, como parte de una diligencia de allanamiento y registro, se realizó el procesamiento del lugar de los hechos. Objetivo: realizar la asignación taxonómica más probable utilizando análisis genético en muestras biológicas recolectadas del lugar de los hechos para establecer la presencia de reptiles, dada la ausencia de animales en el momento del allanamiento. Métodos: se recolectaron seis muestras biológicas que incluyeron un trozo de muda de piel, hisopados de superficies y materia fecal, para su posterior procesamiento siguiendo los protocolos de análisis establecidos. Se realizó extracción de ADN empleando sílice y se amplificó un marcador mitocondrial 12S-120pb; los fragmentos resultantes fueron secuenciados y las secuencias fueron comparadas con la información disponible en la base de datos Genbank mediante el algoritmo BLASTn. Resultados y discusión: a partir de los datos obtenidos de la comparación realizada, 100% de cobertura y 100% de identidad y tras analizar las características de cada grupo taxonómico y la información genética disponible se realizó la asignación taxonómica. En la muestra de muda de piel se encontró dificultad para la amplificación y secuenciación de todo el fragmento, lo que limitó el empleo de marcadores de mayor tamaño, sin embargo, a partir de la información obtenida se logró la identificación de la especie Boa constrictor (boa común); en el caso de la materia fecal y los hisopados se determinó la presencia de muestras provenientes de grupos taxonómicos comúnmente empleados para alimentación de algunas especies de reptiles, como Mus musculus (ratón común) y el género Rattus (especies de ratas). Conclusión: El marcador mitocondrial 12S-120pb empleado en este caso resultó exitoso para la obtención de secuencias a partir de muestras forenses, sin embargo, la utilización de cualquier marcador para la asignación taxonómica depende en gran medida de la información disponible y las características propias de cada grupo taxonómico...(AU)
Subject(s)
Animals , Reptiles , Forensic Genetics , DNA , Wildlife TradeABSTRACT
Resumen La inteligencia artificial (IA) promete una transformación significativa del cuidado de la salud en todas las áreas médicas, lo que podría representar el «momento Gutenberg¼ para la medicina. El futuro de las especialidades médicas dependerá en gran medida de la interacción humana y la creatividad, obligando a los médicos a evolucionar y emplear la IA como una herramienta en la atención del enfermo. La IA ofrecerá a los pacientes seguridad, autonomía y posibilidad de atención médica oportuna en zonas de difícil acceso, y a los médicos les ayudará a disminuir la carga administrativa, el tiempo en pantallas y el agotamiento profesional. La IA permitirá también reducir la frecuencia de errores médicos y mejorar la precisión diagnóstica a través de la integración, el análisis y la interpretación de información por algoritmos y software. La automatización de actividades repetitivas liberará tiempo al personal de salud y potencialmente mejorará la relación médico-paciente, regresando a la atención personalizada y la interacción con el enfermo, a través del acompañamiento, la comunicación, la empatía y la confianza durante la enfermedad, actividades que nunca serán reemplazadas por la IA. Aún es necesario estandarizar la investigación en el área, que permita mejorar la calidad de la evidencia científica conociendo sus ventajas y riesgos, y acelerar su implementación en la práctica médica actual.
Abstract Artificial intelligence (AI) promises a significant transformation of health care in all medical areas, which could represent "Gutenberg moment" for medicine. The future of medical specialties came largely from human interaction and creativity, forcing physicians to evolve and use AI as a tool in patient care. AI will offer patients safety, autonomy, and access to timely medical care in hard-to-reach areas while reducing administrative burden, screen time, and professional burnout for physicians. AI will also make it possible to reduce the frequency of medical errors and improve diagnostic accuracy through the integration, analysis, and interpretation of information by algorithms and software. The safety of repetitive activities will free up time for health personnel and will enhance the doctor-patient relationship, return to personalized attention and interaction with the patient, through accompaniment, communication, empathy, and trust during illness, activities that will never be replaced by AI. It is still necessary to standardize research in the area, which allows improving the quality of scientific evidence knowing its advantages and risks, accelerating its implementation in current medical practice.
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ABSTRACT Objective Investigation onthe systemic inflammatory profile ofpatients affected by prostate cancer (PCa) or prostatic hyperplasia (BPH) may contribute to characterize the pathological profile as well as enable identification of markers and promote alternatives for appropriate, less invasive treatments. Methods This research compared serum levels of 10 classic inflammatory mediators among patients aged 50 years or older affected by PCa or BPH. For this, clinical, biochemical, metabolic, anthropometric and inflammatory aspects of each patient was considered. Results From the statistical analysis, a weakpositive correlation (r = 0.16) between IL-2 with serum total PSA values was found. In addition, median serum IL-2 values were three times higher in patients with PCa compared to BPH patients. Conclusion By interpretation of current literature, we hypothesize that the activity of infiltratedtype M1 macrophages and activated cytotoxic cells in the neoplasm milieu might explain this increase of IL-2 as part of anendogenous anti-neoplastic response.
RESUMO Objetivo A investigação do perfil inflamatório sistêmico de pacientes acometidos por câncer de próstata (CaP) ou hiperplasia prostática (HPB) pode contribuir para caracterizar o perfil patológico, bem como possibilitar a identificação de marcadores e promover alternativas de tratamentos adequados e menos invasivos. Métodos Esta pesquisa comparou os níveis séricos de 10 mediadores inflamatórios clássicos em pacientes com 50 anos ou mais afetados por CaP ou HPB. Para tanto, foram considerados os aspectos clínicos, bioquímicos, metabólicos, antropométricos e inflamatórios de cada paciente. Resultados A partir da análise estatística, foi encontrada umacorrelação positiva fraca (r = 0,16) entre IL-2 com os valores de PSA total sé o. Além disso, os valores medianos de IL-2 no soro foram três vezes maiores em pacientes com CaP em comparação com pacientes com HPB. Conclusão Pela interpretação da literatura atual, hipotetizamos que a atividade de macrófagos do tipo M1 infiltrados e células citotóxicas ativadas no meio da neoplasia pode explicar esse aumento de IL-2 como parte de uma resposta antineoplásica endógena.
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INTRODUCCIÓN: La restricción programada (RP) de antimicrobianos puede disminuir selectivamente la tasa de infecciones por determinados microorganismos. En este sentido, los bacilos gramnegativos productores de beta-lactamasas AmpC (BGN-blaAmpC) son seleccionados por el sobreuso de cefalosporinas de tercera generación (C3G). Estas bacterias, también adquieren genes y co-producen otras beta-lactamasas, como las de Nueva Delhi (BGN-blaNDM). OBJETIVOS: Disminuir la tasa de aislamiento de BGN-blaAmpC y BGN-blaNDM en cultivos de pacientes de la UCI luego de una RP de C3G en el marco de un brote nosocomial por estos microrganismos. MATERIALES Y MÉTODOS: Estudio cuasi-experimental, previo (P1= 12 meses) y posterior (P2= 12 meses) a una RP de C3G en un hospital de adultos, donde, en el contexto de brote mencionado, se aplicaron medidas de control de infecciones generales. El uso de antimicrobianos se expresó como "porcentaje de los días de tratamiento (%DDT)"/100 camas ocupadas al día (100-COD). Se compararon las tasas de aislamiento de BGN-blaAmpC y BGN-blaNDM en hemocultivos (HC), mini-lavados bronquio-alveolares (mB) y urocultivos (UC) en la UCI. RESULTADOS: En P2 el consumo de C3G fue 2,5% DDT/100-COD. Hubo un descenso en los aislamientos de BGN-blaAmpC en HC (RR 0,48 [0,2-0,9] p < 0,02) y mB (RR 0,52 [0,3-0,9] p < 0,02), así como también de BGN-blaNDM en HC (RR 8,1 [1,6-39,4] p < 0,00). Conclusiones: La RP de C3G se asoció con la reducción de los BGN-blaAmpC y BGN-blaNDM en HC, así como de los BGN-blaAmpC mB.
BACKGROUND: Programmed restriction (PR) of antimicrobials can selectively decrease the rate of infections by certain microorganisms. In this sense, AmpC beta-lactamase-producing gram-negative bacilli (GNB-blaAmpC) are selected for the overuse of third generation cephalosporins (3GC). These bacteria also acquire genes and co-produce other β-lactamases, such as New Delhi ones (GNB-blaNDM). AIM: To decrease the isolation rate of GNB- blaAmpC and GNB- blaNDM in cultures from ICU patients after a PR of 3GC. METHODS: Quasi-experimental study, before (P1= 12 months) and after (P2= 12 months) a PR of 3GC in an adults' hospital. The use of antibiotics was expressed as "percentage days of treatment (%DOT)" /100 beds occupied per day (100-BOD). The rates of GNB-blaAmpC and GNB-blaNDM were compared in blood cultures (BC), mini-bronchio alveolar lavages (mB) and urine cultures (UC) in the ICU. RESULTS: In P2, 3GC consumption was 2.5% DOT/100-COD. There was a decrease in GNB-blaAmpC from BC (RR 0.48 [0.2-0.9] p < 0.02) and mB (RR 0.52 [0.3-0.9] p < 0.02), as well as of GNB-blaNDM from BC (RR 8.1 [1.6-39.4] p < 0.00). Conclusions: PR of 3GC was linked to the reduction of GNB-blaAmpC and GNB-blaNDM in BC, as well as GNB-blaAmpC in mB from ICU patients.
Subject(s)
Humans , Adult , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/epidemiology , Bacterial Proteins , beta-Lactamases/genetics , Cephalosporins/pharmacology , Disease Outbreaks , Gram-Negative Bacteria/genetics , Anti-Bacterial Agents/pharmacologyABSTRACT
Abstract Introduction: Acute aortic dissection (AAD) is a devastating surgical emergency, with high operative mortality. Several scoring algorithms have been used to establish the expected mortality in these patients. Our objective was to define the predictive factors for mortality in our center and to validate the EuroSCORE and Penn classification system. Methods: Patients who underwent surgery for AAD from 2006 to 2016 were retrieved from the institution's database. Preoperative, operative and postoperative variables were collected. Observed and expected mortality was calculated by EuroSCORE. Logistic regression analysis and Cox regression analysis were performed to find predictors of operative mortality and survival, respectively. The receiver operating characteristic (ROC) curves were plotted for logistic EuroSCORE, and the area under the ROC curve (AUC) was calculated. Results: 87 patients (27.6% female) underwent surgery for AAD. The mean age was 58.6±9.7 years. Expected and observed operative mortality was 25.8±15.1% and 20.7%, respectively. Penn Aa, Ab and Abc shared similar observed/expected (O/E) mortality ratio. The only independent predictor of operative mortality (OR: 3.63; 95% CI: 1.19-11.09) and survival (HR: 2.6; 95% CI: 1.5-4.8) was female gender. EuroSCORE showed a very poor prediction capacity, with an AUC=0.566. Conclusion: Female gender was the only independent predictor of operative mortality and survival in our institution. EuroSCORE is a poor scoring algorithm to predict mortality in AAD, but with consistent results for Penn Aa, Ab and Abc.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Algorithms , Cardiac Surgical Procedures/statistics & numerical data , Aortic Dissection/surgery , Logistic Models , Risk Factors , ROC Curve , Hospital Mortality/trends , Risk AssessmentABSTRACT
Resumen Introducción: Actualmente, los efectos del enjuague bucal con carbohidratos sobre el rendimiento son controvertidos, algunos estudios plantean efectos ergogénicos, mientras que otros no han reportado efecto luego de suministrar enjuague bucal con carbohidratos. Objetivo: Determinar si existe evidencia científica que avale los distintos protocolos de enjuagues bucales con carbohidratos y su efecto sobre el rendimiento deportivo en carreras de ciclismo contrarreloj. Materiales y métodos: se realizó una búsqueda bibliográfica entre el 2015 y 2019 en las bases de datos Medline, Biblioteca Cochrane y Scopus utilizando los términos Carbohydrates, Mouth rinse y Athletic performance. Resultados: Se revisaron 96 estudios y se seleccionaron 7 en diversos grupos poblacionales, con diferentes métodos de evaluación y diversas dosis de enjuague con carbohidratos. Los resultados obtenidos fueron controversiales, en algunos casos se demostró efecto ergogénico y en otros no. Conclusiones: Los efectos de los enjuagues bucales con carbohidratos son controvertidos, por lo que no se puede asegurar que provoquen mejoras de rendimiento en carreras de ciclismo contrarreloj. Se requiere de más estudios aleatorizados controlados que logren homogeneizar e identificar los mecanismos de acción específicos mediante el cual los enjuagues bucales con carbohidratos actúan sobre distintas poblaciones de estudio.
Abstract Introduction: Currently, the effects of carbohydrate mouthwash use on sports performance are controversial. While some studies have shown ergogenic effects, others have not demonstrated any advantage. Objective: To determine whether there is scientific evidence to support the different protocols for carbohydrate mouthwashes use and their effect on sports performance in cycling races time trial. Materials and methods: A search of literature published between 2015 and 2019 was conducted in the Medline, Cochrane Library, and Scopus databases using the terms Carbohydrates, Mouth rinses and Athletic performance. Results: 7 out of 96 reviewed studies were selected, which included different population groups, evaluation methods, and doses of rinsing carbohydrates. The results obtained on the impact of carbohydrate mouthwashes on sport performance were controversial as only some studies demonstrated an ergogenic effect. Conclusions: As the effects of carbohydrate mouthwashes are debatable, it cannot be assured that they improve performance in different cycling races time-trial. More randomized controlled studies are required to homogenize and identify the specific action mechanisms through which carbohydrate mouthwashes act on different study populations.
Subject(s)
Sports Medicine , Mouthwashes , Carbohydrates , Dietary Supplements , Athletic PerformanceABSTRACT
Resumen Actualmente se han propuesto múltiples estrategias que logren garantizar mejores procesos de supercompensación al entrenamiento deportivo, no obstante, aún no existe un consenso debido al surgimiento de nuevos conocimientos relacionados a los procesos de interferencia relacionados a programas de entrenamiento concurrente y su impacto sobre la definición de estrategias para la planificación deportiva. Este trabajo se planteó como objetivo evaluar las variables de fuerza explosiva y su relación con la capacidad aeróbica como una herramienta para definir estrategias de planificación de deportiva. Se realizó un estudio descriptivo correlacional que constó con la participación seis corredores aficionados, valorados en su capacidad aeróbica y fuerza explosiva mediante la prueba de carrera de 2 km y los saltos squat jump (SJ), counter movement jump (CMJ) y horizontal a pies juntos (SH) respectivamente. La mayor correlación encontrada fue entre la capacidad aeróbica y el salto SJ (p<0,001), lo que demuestra que la capacidad aeróbica y la fuerza muscular son pilares fundamentales en el entrenamiento y planificación atlética, del mismo modo, la no existencia de una relación entre el SH y el salto vertical CMJ (p=0,121) permiten establecer la importancia practica de dar un énfasis al desarrollo de la capacidad aeróbica y fuerza especifica en plano de carrera horizontal como una estrategia optimizadora que responde al rendimiento deportivo en corredores aficionados.
Resumo Atualmente, foram propostas múltiplas estratégias para garantir melhores processos de sobre compensação na parte do treinamento esportivo, mas ainda não há consenso devido ao surgimento de novos conhecimentos relacionados com os processos de interferência relacionados com programas de treinamento simultâneos e seu impacto na definição de estratégias para o planejamento esportivo. O objectivo deste estudo foi avaliar as variáveis da força explosiva e a sua relação com a capacidade aeróbica como ferramenta para definir estratégias de planeamento desportivo. Foi realizado um estudo descritivo correlacional com a participação de seis corredores amadores, que foram avaliados quanto à sua capacidade aeróbica e resistência explosiva por meio do teste de corrida de 2 km e do Salto de Agachamento (SJ), Salto de Contramarcha (CMJ) e Salto Horizontal a Pés (SH), respetivamente. A maior correlação encontrada foi entre a capacidade aeróbica e o salto SJ (p<0,001), o que demonstra que a capacidade aeróbica e a força muscular são pilares fundamentais no treino e no planejamento atlético. Da mesma forma, a ausência de relação entre SH e CMJ salto vertical (p=0,121) permite estabelecer a importância prática de dar ênfase ao desenvolvimento da capacidade aeróbica e da força específica no plano de corrida horizontal como estratégia de otimização que responde ao desempenho desportivo dos corredores amadores.
Abstract Currently, multiple strategies have been proposed to guarantee better processes of super compensation for sports training, however, there is still no consensus due to the emergence of new knowledge related to interference processes related to concurrent training programs and their impact on the definition of strategies for sports planning. The objective of this work was to evaluate the explosive strength variables and their relationship with aerobic capacity as a tool to define sports planning strategies. A descriptive correlational study was carried out that included the participation of 6 amateur runners, valued in their aerobic capacity and explosive strength through the 2-kilometer running test and the Squat Jump (SJ), Counter Movement Jump (CMJ) and horizontal feet jump together (SH) respectively. The highest correlation found was between aerobic capacity and SJ jump (p <0.001), which shows that aerobic capacity and muscular strength are fundamental pillars in training and athletic planning, in the same way, the non-existence of a relationship between the SH and the CMJ vertical jump (p = 0.121) allow establishing the practical importance of giving an emphasis to the development of aerobic capacity and specific strength in the horizontal running plane as an optimizing strategy that responds to sports performance in amateur runners.
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Abstract Objective: To evaluate the clinical and echocardiographic outcomes in aortic valve replacement (AVR) patients with aortic bioprosthesis under oral anticoagulation (OA). Methods: Patients who underwent AVR with bioprosthesiswere prospectively enrolled. They were classified based on postoperative use of OA. Clinical and operative variables were collected. Echocardiographic and clinical follow-ups were performed two years after surgery. The primary outcome evaluated was change in transprosthetic gradient. Secondary outcomes analyzed were change in New York Heart Association (NYHA) class, major bleeding episodes, hospitalization, stroke, and transient ischemic attack. Results: We included 103 patients (61 without OA and 42 with OA). Clinical characteristics were similar among groups, except for younger age (76±6.3 vs. 72.4±8.1 years, P=0.016) and higher prevalence of atrial fibrillation (0% vs. 23.8%, P<0.001) in the OA group. Mean (21.4±10 mmHg vs. 16.8±7.7 mmHg, P=0.037) and maximum (33.4±13.7 mmHg vs. 28.4±10.2 mmHg, P=0.05) transprosthetic gradients were higher in patients without OA. Improvement in NYHA class was more frequent in patients with OA (73% vs. 45.3%, P=0.032). Major bleeding, stroke, and hospitalization were similar among groups. OA was the only independent predictor for improvement of NYHA class after multivariate logistic regression analysis (odds ratio [OR]: 5.9, 95% confidence interval [CI]: 1.2-29.4; P=0.028). Stratification by prosthesis size showed that patients with ≤ 21 mm prosthesis benefited from OA. Conclusion: Early anticoagulation after AVR with bioprosthesis was associated with significant decrease of transprosthesis gradient and improvement in NYHA class. These associations were seen mainly in patients with ≤ 21 mm prosthesis.
Subject(s)
Humans , Aged , Aged, 80 and over , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/drug therapy , Aortic Valve Stenosis/diagnostic imaging , Bioprosthesis/adverse effects , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Prosthesis Design , Treatment Outcome , Hemodynamics , Anticoagulants/therapeutic useABSTRACT
Abstract This article analyzes the Physical Fitness Test (PFT) which is performed by the Brazilian Navy to check the physical parameters of its military members in order to present the performance of probabilities with increasing age. We analyzed 702 PFT data in this study, separated into three groups based on the age of those assessed by the PFT, as follows: young adults (YA, n=91, age range between 20-30 years), adults (A, n=243, age range between 30-40 years) and mature adults (MA, n=368, age range between 40-50 years old). PFT measurements were: Body Mass Index (BMI), 100 m freestyle swimming, 3,200 m running, 1 min sit-ups, Pull-up on the bar and Push-up test. The main results indicated significant differences between groups when compared Body mass (YA: 79.1±11.4kg and A: 82.1±14kg < MA: 84.1±12.3kg), BMI (YA: 25.4±2.9 < A: 26.4±4.3 < MA: 27.5±4),Pull-ups (YA: 10.8±4.6 freq./min < A: 10±3.6 freq./min < MA: 8.5±4.7 freq./min), 3,200 m running time (YA: 1282,1±172,4s < A: 1421±199.8s < MA: 1566.7±192.4s) and 100 m swimming time (YA: 140.1±45.6s < A: 149.7±37.9s < MA: 180.8±50s) and the regression analysis demonstrated that 3,200 m running and pull-ups were the most affected variable of aging process (p<0.05). In summary, it is possible to carry out a practical application, considering aging process and the decline of the aerobic capacity and the upper limbs strength-power in Military Physical Training.
Resumo Este artigo analisou o Teste de Aptidão Física (PFT), realizado pela Marinha do Brasil para medir os parâmetros físicos de seus militares, a fim de apresentar as probabilidades de desempenho com o aumento da idade. Analisamos 702 dados de PFT, separados em três grupos com base na idade, como segue: adultos jovens (YA, n=91, faixa etária entre 20-30 anos), adultos (A, n=243, faixa etária entre 30-40 anos) e adultos de meia idade (MA, n=368, faixa etária entre 40-50 anos). As medidas da PFT foram: Índice de Massa Corporal (BMI), natação de 100m livre, 3.200m de corrida, 1min de abdominais, flexão na barra e flexão de braço. Os principais resultados indicaram diferenças significativas entre os grupos quando comparados a massa corporal (YA: 79,1±11,4kg e A: 82,1±14kg <MA: 84,1±12,3kg), IMC (IA: 25,4±2,9 <A: 26,4±4,3 <MA: 27,5±4,0), Pull-ups (YA: 10,8±4,6 freq./min <A: 10,0±3,6 freq./min <MA: 8,5±4,7 freq./min), 3.200 m de tempo de execução (YA: 1282,1±172,4s <A: 1421±199,8s <MA: 1566,7±192,4s) e 100m de natação (YA: 140,1±45,6s <A: 149,7±37,9s <MA: 180,8±50s) e a análise de regressão demonstrou que 3.200m de corrida e flexões de braço foram a variável mais afetada do processo de envelhecimento (p<0,05). Em resumo, é possível realizar uma aplicação prática, considerando o processo de envelhecimento e o declínio da capacidade aeróbica e da força-força dos membros superiores no treinamento físico militar.
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INTRODUCCIÓN: los Virus del Papiloma Humano (VPH) constituyen un diverso grupo de virus, siendo los genotipos 16 y 18 los más prevalentes y, por lo tanto, principales objetivos de varios estudios en infecciones del tracto anogenital. El presente estudio pretende determinar la infección por VPH de Alto Riesgo en muestras genitales, mediante la aplicación de tecnología molecular para la genotipificación de VPH16 y VPH18 por PCR en Tiempo Real. MATERIALES Y MÉTODOS: se trabajó con 151 muestras de hisopados genitales, las extracciones de ADN se realizaron mediante columnas de sílice y la identificación de los VPH de Alto Riesgo fue mediante la optimización de una PCR en Tiempo Real duplex para la genotipificación de VPH16 y 18, para lo cual se realizó el diseño de cebadores y sondas TaqMan por software especializado, y se determinó las concentraciones de reactivos y temperaturas de reacción ideales. RESULTADOS: en la identificación de los VPH de Alto Riesgo se obtuvo un total de 41 casos positivos, muestras que fueron seleccionadas para realizar la genotipificación de VPH16 y VPH18 mediante la técnica de PCR en Tiempo Real. La mayor presencia de estos virus oncogénicos se determinó en mujeres de 15 a 29 años (40% y 26,7% respectivamente). CONCLUSIÓN: mediante la optimización e implementación de nuevas técnicas moleculares se pretende mejorar el seguimiento epidemiológico sobre la presencia de los VPH de Alto Riesgo y así proporcionar una mejor guía sobre la diseminación y presencia de los distintos genotipos oncogénicos de VPH en nuestra población.
INTRODUCTION: Human Papillomavirus (HPV) constitute a diverse group of viruses, being genotypes 16 and 18 the most prevalent and main objectives of several studies on anogenital tract infections. The present study intends to determine the High Risk HPV infection in genital samples, through the application of molecular technology for the genotyping of HPV16 and HPV18 by Real Time PCR. MATERIALS AND METHODS: we worked with 151 samples of genital swabs whereDNA extractions were performed using silica columns and the identification of High Risk HPV was through the optimization of a duplex real-time PCR for genotyping of HPV16 and 18, for which primers and TaqMan probes were designed by specialized software, and ideal reagent concentrations and reaction temperatures were determined. RESULTS: in the identification of HPV High Risk, a total of 41 positive cases were obtained. These samples were selected to perform genotyping of HPV16 and HPV18 using the Real Time PCR technique. The greater presence of these oncogenic viruses was determined in women aged 15 to 29 years (40% and 26.7% respectively). CONCLUSION: through the optimization and implementation of new molecular techniques, it is intended to improve the epidemiological follow-up on the presence of High Risk HPV and thus provide a better guide on the dissemination and presence of the different oncogenic HPV genotypes in our population.
Subject(s)
Uterine Cervical Neoplasms , Polymerase Chain Reaction , Alphapapillomavirus , Papillomavirus Infections , Human papillomavirus 16 , Human papillomavirus 18ABSTRACT
Abstract Background There is no specific antiviral treatment for parvovirus B19 (PVB19) infection. Objective The objective of this study was to study the treatment and outcome of PVB19 infection in kidney transplant recipients (KTR) at our institution, and cases published in the medical literature. Methods We conducted a retrospective review of PVB19 infection in KTR at an academic medical center over a 16-year period and summarized the data on its treatment and outcome in 120 KTR in the medical literature. Results In our cohort of eight patients, the median time to the onset of PVB19 disease was 7.2 weeks after transplantation. All patients had severe aregenerative anemia (mean hemoglobin (Hb) of 6.2 ± 1.0 g/dl); all were treated with a reduction in their immunosuppressive regimen and the administration of single-dose intravenous immunoglobulin (IVIG) (mean total dosage of 0.87 ± 0.38 g/kg). The median time to anemia improvement (Hb >10 g/dl) was 3-week post-treatment. No recurrences were documented during follow-up (median 25 months). Among 128 patients (including our cohort of 8 and 120 reported in literature), therapeutic strategies included: 43% IVIG alone, 39% IVIG and reduced immunosuppression, 9% reduction of immunosuppression, and 9% conservative therapy. Clinical relapses were observed in 35% of 71 reported cases. Conclusions In KTR, decreasing immunosuppression and the administration of low-dose immunoglobulin seem to be not worse than the standard dose in PVB19 infection.
Subject(s)
Humans , Male , Female , Young Adult , Kidney Transplantation/methods , Immunoglobulins, Intravenous/administration & dosage , Erythema Infectiosum/therapy , Immunosuppressive Agents/administration & dosage , Recurrence , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Erythema Infectiosum/etiology , Academic Medical CentersABSTRACT
Abstract Objective: In contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes. Methods: Retrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry. Results: We included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age. Conclusion: Coronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.
Subject(s)
Humans , Male , Female , Aged , Preoperative Care/methods , Coronary Artery Bypass/methods , Adrenergic beta-Agonists/administration & dosage , Angina, Stable/surgery , Survival Analysis , Coronary Artery Bypass/mortality , Retrospective Studies , Risk Factors , Treatment Outcome , Diabetes Mellitus , Angina, Stable/complications , Angina, Stable/mortality , HypertensionABSTRACT
Introducción: La detección de alteraciones en la circulación fetal y materna advierte sobre las alteraciones hemodinámicas que comienza a sufrir el feto. Si la edad gestacional garantiza la viabilidad fetal no se requiere prolongar la gestación, evitando complicaciones por hipoxia crónica. Sin embargo, en fetos con inmadurez pulmonar se esperan trastornos más severos por alteraciones en el sistema venoso fetal. En embarazos de alto riesgo, la ecografía fetal con Doppler es el método de elección debido a su alta sensibilidad que, además de ser no invasivo y accesible, permite la identificación de alteraciones que ponen en riesgo la vida del feto, ayudando al diagnóstico y monitoreo de las mismas. Su buen uso reduce el riesgo de muerte fetal en casos de alto riesgo. La evaluación de las arterias uterinas en el tamizaje de patologías del embarazo es de utilidad en preeclampsia, restricción de crecimiento intrauterino, desprendimiento de placenta y muerte fetal. El estudio de la morfología de onda de la arteria umbilical se utiliza ante sospecha de hipoxia, siendo el mejor indicador para interrupción de la gestación ante la presencia de anomalías, mientras que los cambios en la velocimetría de la arteria cerebral media son de utilidad en la evaluación de fetos con insuficiencia placentaria y anemia. El índice cerebro-placentario es el marcador más sensible para diagnosticar la redistribución cerebral como primer fenómeno adaptativo del feto ante la injuria. El estudio del sistema venoso fetal detecta estados más avanzados de hipoxia fetal, acompañados de acidemia e insuficiencia cardíaca. Objetivo: Describir aspectos a evaluar con EcoDoppler fetal para identificar alteraciones sugerentes de patología materno-fetal. Destacar su utilidad en embarazos de alto riesgo. Revisión de bibliografía actualizada. Materiales y Método: Para la localización de la bibliografía se utilizaron varias fuentes documentales, abarcando una búsqueda crítica en internet desde Google Académico, incluyendo artículos publicados a partir del año 2002, utilizando los descriptores: ecografía, ecoDoppler, embarazo, control prenatal, preeclampsia, restricción del crecimiento intrauterino. Se seleccionaron aquellos documentos que informasen sobre los aspectos físicos del ecoDoppler, aplicación del ecoDoppler en embarazos de alto riesgo y metodología del estudio
Introduction: The detection of alterations in the fetal and maternal circulation warns about the hemodynamic alterations that the fetus begins to suffer. If gestational age guarantees fetal viability, it is not necessary to prolong gestation, avoiding complications due to chronic hypoxia. However, in fetuses with pulmonary immaturity more severe disorders are expected due to alterations in the fetal venous system. In high-risk pregnancies, fetal ultrasound with Doppler is the method of choice due to its high sensitivity that, in addition to being non-invasive and accessible, allows the identification of alterations that put the life of the fetus at risk, aiding diagnosis and monitoring from the same. Its good use reduces the risk of fetal death in high-risk cases. The evaluation of the uterine arteries in the screening of pathologies of pregnancy is useful in preeclampsia, intrauterine growth restriction, placental abruption and fetal death. The study of the wave morphology of the umbilical artery is used when hypoxia is suspected, being the best indicator for interruption of gestation in the presence of anomalies, while changes in the velocimetry of the middle cerebral artery are useful in the evaluation of fetuses with placental insufficiency and anemia. The brain-placental index is the most sensitive marker to diagnose cerebral redistribution as the first adaptive phenomenon of the fetus before injury. The study of the fetal venous system detects more advanced stages of fetal hypoxia, accompanied by acidemia and heart failure. Objective: Describe aspects to be evaluated with Fetal EcoDoppler to identify alterations suggestive of maternal-fetal pathology. Highlight its usefulness in high risk pregnancies. Review of updated bibliography. Materials and Method:Several documentary sources were used to locate the bibliography, covering a critical search on the Internet from Google Scholar, including articles published since 2002, using the descriptors: ultrasound, ecoDoppler, pregnancy, prenatal control, preeclampsia, intrauterine growth restriction . We selected those documents that reported on the physical aspects of ecoDoppler, application of ecoDoppler in high-risk pregnancies and study methodology.
Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia/prevention & control , Prenatal Care/trends , Ultrasonography/trends , Doppler Effect , Fetal Growth Retardation/prevention & control , Pregnancy/metabolism , Diagnostic Techniques, Obstetrical and GynecologicalABSTRACT
Introducción: la video cápsula endoscópica (VCE) y la enteroscopía de doble balón (EDB) han cambiado radicalmente el diagnóstico y tratamiento de las patologías del intestino delgado (ID). Objetivo: valorar la utilidad diagnóstica y terapéutica de la EDB en enfermedades del ID. Pacientes, material y método: se realizó un estudio retrospectivo, descriptivo, de las primeras 20 EDB realizadas en nuestro servicio de endoscopía. Los pacientes fueron referidos por sospecha de patología del ID y contaban con estudios endoscópicos o imagenológicos previos. Se utilizó un videoenteroscopio EN-450, Fujinon, de 2.000 mm de longitud y sobretubo TS-12140 Fujinon. Resultados: se realizaron 20 EDB en 19 pacientes (14 hombres con edad promedio de 52,2 años y 5 mujeres con edad promedio de 58,6 años). El abordaje oral fue de elección en 15 procedimientos y el anal en cuatro, un paciente requirió doble abordaje. La indicación más frecuente fue la búsqueda de sangrado intestinal de origen desconocido y el hallazgo más común fueron las angiodisplasias, que fueron tratadas con coagulación con gas argón. Conclusiones: la EDB es una herramienta útil y necesaria para el diagnóstico y tratamiento de las patologías del ID, pudiendo brindar a nuestros pacientes una solución terapéutica que hasta hace pocos años no era posible en nuestro país.
Abstract Introduction: the capsule endoscopy video and the double balloon enteroscopy have dramatically changed diagnosis and treatment of small intestine pathologies. Objective: to assess the diagnostic and therapeutic usefulness of double balloon enteroscopy in small intestine diseases. Patients, material and method: we conducted a retrospective, descriptive study on the first 20 double balloon enteroscopies performed in our endoscopy service. Patients were referred for suspicion of small intestine pathology, and they had previous endoscopic exams or imagenology. An EN-450, 2,000 mm long Fujinon and TS-12140 overtube videoenteroscopy was used. Results: 20 double balloon enteroscopies were performed in 19 patients (14 men, average age was 58.6 years old). Oral approach was chosen in 15 procedures and the anal in four, a patient required double approach. The most frequent indication was search for intestine bleeding of unknown origin, and the most common finding was angiodysplasias, which were treated with argon gas coagulation. Conclusions: double balloon enteroscopies is a useful and necessary tool for the diagnosis and treatment of small intestine pathologies, and we were able to provide our patients with a therapy solution that was not available until recently.
Resumo Introdução: a cápsula endoscópica (VCE) e a enteroscopia de balão duplo (EDB) mudaram radicalmente o diagnóstico e o tratamento das patologias do intestino delgado (ID). Objetivo: avaliar a utilidade diagnóstica e terapêutica da EDB nas patologias do ID. Pacientes, material e método: um estudo retrospectivo, descritivo, das primeiras 20 EDB realizadas no nosso serviço de endoscopia foi realizado. Os pacientes foram referidos por suspeita de patologia do ID e já haviam realizado estudos endoscópicos ou imagenológicos. Utilizou-se um enteroscópio EN-450, Fujinon de 2.000 mm de comprimento e overtube TS-12140 Fujinon. Resultados: foram realizadas 20 EDB em 19 pacientes (14 homens com idade média 52,2 anos e 5 mulheres com idade média 58,6 anos). A abordagem de eleição foi por via oral em 15 procedimentos e por via anal em quatro sendo que foi necessário realizar uma dupla abordagem em um paciente. A indicação mais frequente foi a pesquisa de sangrado intestinal de origem desconhecida e o achado mais comum foi angiodisplasia; estas foram tratadas com coagulação com gás argônio. Conclusões: a EDB é uma ferramenta útil e necessária para o diagnóstico e tratamento das patologias do ID, podendo oferecer a nossos pacientes uma solução terapêutica que não estava disponível no nosso país até pouco tempo atrás.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Capsule Endoscopes , Double-Balloon Enteroscopy , Intestine, Small/diagnostic imagingABSTRACT
La pancreatitis aguda por hipercalcemia secundaria a hiperparatiroidismo primario es una etiología infrecuente. Presentamos una paciente mujer de 77 años que presentó dolor abdominal en hemiabdomen superior y vómitos; colecistectomizada, no bebe alcohol ni presenta dislipidemia. Los estudios de laboratorio mostraron, amilasa de 394 U/L y lipasa de 906 U/L, calcio sérico 17,93 mg/dL y el PTHi 441 pg/ml. En la TEM de cuello, se observó bocio multinodular (nódulos de 9 y 7 mm) en el lóbulo izquierdo de tiroides y un nódulo en paratiroides. La paciente fue sometida a una paratiroidectomía superior derecha y una hemitiroidectomía del mismo lado. Después de la cirugía, los niveles de Ca sérico y PTHi disminuyeron. Asimismo, como hallazgo en la biopsia, se encontró carcinoma papilar variante folicular de tiroides. Este reporte explica las posibles teorías de asociación entre adenoma paratiroideo y pancreatitis por hipercalcemia y describe además la asociación con carcinoma papilar variante folicular de tiroides, no antes descrito...
Acute pancreatitis due to hypercalcemia secondary to primary hyperparathyroidism is a rare aetiology. We present a female patient with pancreatitis; with prior cholecystectomy, no alcohol usage or dyslipidemia. Laboratory studies showed, serum calcium 17.93 mg/dL and iPTH 441 pg/ml. Neck CT showed multinodular goiter and a parathyroid nodule. The patient underwent surgery after which serum Ca and PTH decreased. Biopsy showed follicular variant papillary thyroid carcinoma. This report discusses possible theories of association between parathyroid adenoma and hypercalcemic pancreatitis and describes the association with follicular variant papillary thyroid carcinoma, not previously described...