Vivir con dolor crónico desde la experiencia de adultos mayores con enfermedades crónico degenerativas / Living with cronic pain from the experience of older adults with chronic degenerative diseases

INTRODUCCIÓN: Ser adulto mayor conlleva a cambios físicos, psicológicos y sociales que se ven aún más afectados por comorbilidades como las enfermedades crónicas y el dolor. El propósito es interpretar las experiencias de vivir con dolor de los adultos mayores con enfermedades crónico-degenerativas. METODOLOGÍA: Diseño cualitativo de tipo fenomenológico, recolectado mediante un muestreo intencional a través de una entrevista semi estructurada, en la cual se seleccionó a la población adulta mayor con una patología crónico-degenerativa que haya experimentado dolor crónico; se analizaron los datos con el proceso cognitivo de Janice Morse, hasta llegar a la saturación de la información. Participaron 8 personas entre los 66 y 72 años, habiendo siete mujeres y un hombre. RESULTADOS: Se encontraron cuatro categorías: 1. El desgaste de vivir con dolor; 2. Cotidianidad del vivir con dolor; 3. Alternativas para aliviar el dolor, y 4. Afectación en el entorno social. CONCLUSIÓN: Ser adulto mayor trae muchos cambios en todas las esferas de la vida, sin embargo, el padecer una enfermedad crónica acelera toda esta transición, viéndose afectados la salud mental, físico y social, adaptando esta situación a su cotidianidad, buscando a su vez medios alternos que mitiguen o disminuya el dolor.

INTRODUCTION: Being an older adult leads to physical, psychological, and social changes that are further affected by comorbidities such as chronic diseases and pain. The purpose is to interpret the experiences of living in pain of older adults with chronic-degenerative diseases. METHOD: Qualitative phenomenological research, recollected by an intentional sampling through a semi-structured interview in which was selected the adult population with a chronic-degenerative pathology that have experienced an state of chronic pain. The data was analyzed with the cognitive process of Janice Morse and reached to a saturation of 8 participants. There were 8 participants between the ages of 66 and 72, with seven women and one man. RESULTS: Four categories were found: 1. Wearing of living with pain; 2. Daily Living with Pain; 3. Alternatives for Pain Relief, and 4. Social Affectation. CONCLUSION: Being an older adult brings many changes in all spheres of life, however, suffering from a chronic disease accelerates this whole transition, being affected mental, physical and social health, adapting this situation to its daily life, seeking in turn alternate means to mitigate or decrease pain.

Grado de funcionalidad de las familias de la comunidad Minerva con paciente con enfermedad crónica degenerativa durante el año 2015 / Degree of functionality of the families of the Minerva community of patients with chronic degenerative disease during 2015

La presente investigación desarrolla un análisis acerca del grado de funcionalidad de las familias con paciente con enfermedad crónico degenerativa. El objetivo fue determinar el grado de funcionalidad familiar de las familias con paciente con enfermedad crónica degenerativa de la Comunidad Minerva durante el año 2015. Se realizó un estudio de tipo observacional descriptivo, se visitaron en su domicilio la población de la comunidad Minerva que tiene 100 familias inscritas en las fichas familiares, de las cuales se estudiaron a las que cumplieron los criterios de inclusión que fueron 40, los resultados obtenidos: según tipología familiar fue de familias extensas en un 45 % , 30% y 25% de las mixtas y nucleares, respectivamente, en relación con la prevalencia de enfermedades se encontró que un 65 % padece de Hipertensión arterial, un 25 % de diabetes mellitus y 5 % para cáncer y enfermedad renal, el grado de funcionalidad presente en las familias de los sujetos estudiados fue funcional en la mayoría con un 60%.En cuanto a cohesión 82.5% de semirelacionada. En cuanto a adaptabilidad un 82.5 % de familias son flexibles. En relación a los resultados del FACES III, se encontró a un 15 % de familias en rango medio, un 82.5% a familias balanceadas y un 2.5 % a familias extremas. Conclusiones: el grado de funcionalidad fue de un 82.5 % con familias balanceadas

Pathological characterization of TgElk mice injected with brain homogenate from elk with chronic wasting disease

Chronic wasting disease (CWD) is classified as a transmissible spongiform encephalopathy or prion disease that affects cervids. CWD has been reported in 15 US states, two Canadian provinces, and in imported elk on several farms in Korea. This study was conducted to examine the molecular biological and pathogenic characteristics of a CWD-associated prion isolated in Korea. The epidemiological origin of this pathogen was also determined. Homozygous TgElk mice were infected with a CWD-affected elk brain pool prepared from the brain of an imported Canadian elk. We measured the incubation time of the pathogen, neuropathological changes by immunohistochemical staining, the pattern(s) of scrapie prion protein (PrPSc) deposition, and PrPSc protein profiles by Western blotting. We found that TgElk mice infected with brain homogenate from the elk suffering from CWD showed incubation times, vacuolar degeneration, and PrPSc accumulation similar to those previously reported in the literature. Our results suggest that homozygous TgElk mice efficiently transmit CWD with short incubation times and that this animal can serve a valuable research model and reliable in vivo diagnostic tool.

Pathological characterization of TgElk mice injected with brain homogenate from elk with chronic wasting disease

Chronic wasting disease (CWD) is classified as a transmissible spongiform encephalopathy or prion disease that affects cervids. CWD has been reported in 15 US states, two Canadian provinces, and in imported elk on several farms in Korea. This study was conducted to examine the molecular biological and pathogenic characteristics of a CWD-associated prion isolated in Korea. The epidemiological origin of this pathogen was also determined. Homozygous TgElk mice were infected with a CWD-affected elk brain pool prepared from the brain of an imported Canadian elk. We measured the incubation time of the pathogen, neuropathological changes by immunohistochemical staining, the pattern(s) of scrapie prion protein (PrPSc) deposition, and PrPSc protein profiles by Western blotting. We found that TgElk mice infected with brain homogenate from the elk suffering from CWD showed incubation times, vacuolar degeneration, and PrPSc accumulation similar to those previously reported in the literature. Our results suggest that homozygous TgElk mice efficiently transmit CWD with short incubation times and that this animal can serve a valuable research model and reliable in vivo diagnostic tool.

Development of monoclonal antibodies against the abnormal prion protein isoform (PrPres) associated with chronic wasting disease (CWD)

Monoclonal antibodies (mAbs) specific for the abnormal prion protein isoform (PrPres) are indispensable for diagnosing chronic wasting disease (CWD). In this study, eight mAbs were developed by immunizing PrP knockout mice with recombinant elk PrP and an immunogenic PrP peptide. The reactivity of the mAbs to recombinant PrP and the PrP peptide was measured, and their isotypes were subsequently determined. Among them, four mAbs (B85-05, B85-08, B85-12, and B77-75) were shown by Western blotting to recognize proteinase K-treated brain homogenate derived from an elk suffering from CWD.

A vulnerabilidade da vida com HIV/AIDS / Vulnerability of life with HIV/Aids

Esta tese pretende contribuir para o desenvolvimento de respostas públicas rumo à diminuição do impacto do HIV/Aids nos campos, econômico, político e social tanto no nível coletivo quanto no individual. Discute aspectos téorico-conceituais das noções de risco e vulnerabilidade, mostrando que a atual aplicação e apropriação dessas noções na resposta à essa epidemia dificulta o reconhecimento dos problemas adicionais enfrentados após o diagnóstico. Apresenta as diversas formas de pobreza, desigualdade e exclusão a partir dos indicadores sociais comumente usados e respectivas lógicas construtivas. Questiona as afirmações recentes sobre a queda da desigualdade, da pobreza e da indigência no país; e considera que a desigualdade e a exclusão que afetam a população em geral é a mesma a afetar pessoas que vivem com HIV/Aids. Porém, aponta a existência de vulnerabilidade potencial, conceito desenvolvido nesta tese, na ausência de rede de suporte social. Para identificar e inferir sobre o que ocorre nas vidas das pessoas que vivem em situação de desigualdade ou exclusão após a infecção pelo HIV utiliza dados coletados em pesquisa de survey, discursos, estórias e memórias de casos reais da prática profissional desta autora. O objetivo desta tese é demonstrar que o conceito de vulnerabilidade aplicado após o diagnóstico é importante ferramenta para reconhecer e intervir sobre as dificuldades e problemas adicionais enfrentados. Ressalta a evolução da resposta brasileira à essa epidemia e demonstra as lacunas existentes como desafios a seu aperfeiçoamento. Conclui que o reconhecimento dos problemas adicionais após o diagnóstico e o uso do conceito de vulnerabilidade potencial abre novas possibilidades de enfrentamento do HIV/Aids e exige respostas públicas interligadas e intersetoriais.

This thesis aims to contribute to the development of public responses geared towards the reduction of the impact of HIV/Aids in economic, political and social terms, as well as at the individual level. It discusses theoretic and conceptual aspects of different notions ofrisk and vulnerability, showing that the current application of such notions to the response to that epidemic makes it difficult to acknowledge the additional problems faced after the diagnosis is made. It presents the different forms of poverty, inequality and exclusion taking the social indicators usually employed and their respective constructive logics as a starting point. It brings into question the recent statements made on the decline of inequality, poverty and indigence in the country; and it considers that the inequality andexclusion faced by the population in general is the same that affects the people who live with HIV/Aids. It points out, though, to the presence of a potentiation of vulnerability in this group, in the absence of a social protection network. In order to identify an infer about what happens in the lives of the people who live in a situation of inequality or exclusion after the HIV infection the thesis uses data collected in a survey, discourses, stories andmemories of real cases of the professional practice of the author. The goal of this thesis is to demonstrate that the concept of vulnerability applied after the diagnosis is an important tool to acknowledge and intervene on the additional difficulties and problems that are faced by people in that situation. The thesis stresses the evolution of the Brazilian response to that epidemic and demonstrates its existing gaps as challenges to its improvement. Itfinally concludes that acknowledging the problems faced after diagnosis and the utilization of the concept of potential vulnerability opens new possibilities to the fight against HIV/Aids and demands interconnected and intersectorial responses.

Serum adiponectin level and cardiovascular disease in patients with end-stage renal disease / 대한내과학회지

BACKGROUND: Adiponectin is a fat-based protein that alters the insulin sensitivity, has anti-inflammatory properties, and reduces the incidence of cardiovascular disease (CVD). However, this connection is unclear in patients with chronic wasting disease, such as heart failure or end-stage renal disease (ESRD). Therefore, this study examined the relationship between adiponectin and the cardiovascular risk/predictive factors in ESRD patients. METHODS: The serum concentrations of adiponectin and leptin were measured in 48 adult patients on maintenance hemodialysis. In addition, the blood levels of B-type natriuretic peptide (BNP) and cardiac troponin T (cTnT) as cardiovascular biomarkers were measured, and the CVD history was reviewed in order to determine if there was any correlation with adiponectin. RESULTS: There was a significant correlation between the adiponectin levels and the serum concentrations of HDL-cholesterol (r=0.456, p=0.001), triglyceride (r=-0.528, p<0.001), and leptin (r=-0.427, p=0.002) and an inverse correlation with the body mass index (BMI) (r=-0.326, p=0.024). The BNP levels were positively correlated with the adiponectin concentrations (r=0.372, p=0.009) and negatively correlated with the BMI (r=-0.310, p=0.032), and there was a slight positive correlation between cTnT and adiponectin (r=0.276, p=0.058). Patients with a history of CVD had higher levels of cTnT (p=0.012) and BNP (p=0.017), and a lower BMI (p=0.026) than patients without such a history. There was no significant difference in the adiponectin levels between the two patient groups. CONCLUSIONS: A higher adiponectin level is related to a favorable lipid profile. However, adiponectin is not directly associated with a history of CVD, and there was a correlation between a higher adiponectin level and a higher BNP and lower BMI, which are cardiovascular predictive factors, in ESRD patients. However, further research with more patients will be needed to properly determine the complicated relationship between adiponectin and the development of CVD.

The Study for the Relationship of Weight Loss with Plasma Leptin and TNF-alpha Level in Patients with Chronic Bronchitis and Emphysema / 결핵

BACKGROUND: Unexplained weight loss, which commonly occurs in patients with chronic obstructive pulmonary disease(COPD), is important because weight loss is an independent risk factor of mortality and morbidity in these patients. Leptin is known to play an important role in regulating body weight. In addition, the tumor necrosis factor(TNF-α) might also play a potential role in the weight loss experienced in chronic wasting disease. The aim of this study was to determine the influence of plasma leptin and the circulating TNF-α system to the difference in the body compositions in patients with COPD. METHODS: Spirometry, body composition analysis and the plasma concentrations of leptin, TNF-α and a soluble TNF receptor 55, 75 were measured in 31 patients with chronic bronchitis and 10 patients with emphysema. The COPD subtype was classified by the transfer coefficient of carbon monoxide, DLco/VA. RESULTS: The circulating levels of leptin were significantly lower in those patients with emphysema(108.5±39.37 pg/ml) than those with chronic bronchitis(180.9±57.7 pg/ml). The circulating levels of sTNF-R55 were significantly higher in the emphysema patients(920.4±116.4 pg/ml) than in those with chronic bronchitis(803.2±80.8 pg/ml). There was no relationship between the circulating leptin levels and the activated TNF system in patients with chronic bronchitis and emphysema. However, the circulating leptin levels correlated well with the BMI and fat mass in both patient groups. CONCLUSION: These results suggest that the weight loss noted in emphysema patients may be associated with the activation of the TNF-α system rather than the plasma leptin level.