Complicaciones tromboembólicas y hemorrágicas en pacientes portadores de prótesis valvulares del corazón en un centro de tercer nivel. ¿Qué hemos aprendido? / Thromboembolic and hemorrhagic complications in patients with prosthetic heart valves at third level care center. What have we learned?

Resumen Antecedentes: El reemplazo valvular por prótesis mecánicas o biológicas implica riesgo de tromboembolismo y complicaciones hemorrágicas. Objetivo: Determinar las complicaciones relacionadas con la terapia de anticoagulación complementaria y la probabilidad de riesgo en pacientes portadores de prótesis valvulares del corazón. Métodos: Se estudiaron 163 pacientes entre 2002 y 2016, portadores de prótesis mecánicas y biológicas, quienes recibieron antagonistas de la vitamina K posterior al egreso hospitalario. La terapia de anticoagulación se categorizó en óptima y no óptima conforme a los valores de INR previos a las complicaciones. Fueron excluidos los pacientes con comorbilidades y otros factores de riesgo de trombosis y/o sangrado. Resultados: a 68.7 % de los pacientes se les colocó prótesis mecánica y a 31.3 %, biológica (p ≤ 0.001); 25.2 % presentó las complicaciones motivo de estudio (p ≤ 0.001), hemorrágicas en 48.8 %, tromboembólicas en 26.8 % y de ambos tipos en 24.4 % (riesgo relativo = 4.229); a 95.1 % de los pacientes con complicaciones se les colocó prótesis mecánica y a 4.9 %, biológica (p = 0.005); 49.7 % presentó INR no óptimo (p ≤ 0.001). Conclusiones: Ante riesgo alto de complicaciones tromboembólicas y hemorrágicas, la elección de las prótesis valvulares, la prevención y el seguimiento son prioridades, principalmente en quienes requieren terapia de anticoagulación.

Abstract Background: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. Objective: To determine the complications related to complementary anticoagulation therapy and the probability of risk. Methods: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. Results: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). Conclusions: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.

2021 clinical practice guidelines in the evaluation and management of pediatric community-acquired pneumonia

Preface@#The Clinical Practice Guidelines (CPG) for the Diagnosis and Management of Pediatric Community-Acquired Pneumonia (PCAP) was initiated by the Philippine Academy of Pediatric Pulmonologists, Inc. (PAPP) and the Pediatric Infectious Disease Society of the Philippines (PIDSP), in cooperation with Philippine Pediatric Society, Inc. (PPS) way back in 2004. Several CPG updates were then undertaken by the PAPP PCAP CPG Task Force from 2008 to 2016. Clinically-relevant research questions were answered with recent and current recommendations based on evidence from local and international data. The 2021 PCAP CPG initiative was envisioned in March 2018 upon the recommendations of the 2018 PAPP Board for the purpose of updating the evidence in the PCAP CPG 2016 clinical questions. This led to the collaboration of PAPP and PIDSP to develop this CPG. Individual members were identified from each society as content experts to form the Steering Committee along with a clinical epidemiologist and technical writer as review experts. The committee identified the scope and target end user of the CPG as well as additional clinical questions to be included in the 2021 update aside from the questions on the previous CPGs. Selected members from the two societies formed the Technical Working Group (TWG) who did the literature search, appraisal of evidences, and formulation of recommendations. These recommendations were then presented to the stakeholders who became part of the consensus panel. There was no identified conflict of interest among the CPG developers, TWG members and stakeholders. A survey to determine potential competing interests were conducted during the development of this CPG. This initiative was fully funded by the PAPP and PIDSP societies. The 2021 PCAP CPG significantly differs from the previous CPGs in several aspects. First, the current guideline is a consensus between two pediatric societies. Second, much of the literature review has been centered on meta-analyses or systematic reviews instead of individual studies. Finally, appraisal of published literature was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Such methodological differences may provide difficulties in defining evolution of care through the years. As identified in the previous CPG updates, there is lack of local data hence most of the evidences gathered came from international studies. The applicability of such data to the local setting needs to be critically assessed for its value and relevance. Corollary to this, several gaps in knowledge are identified and these may serve as a guide for future research.

Effect of propolis on Th2 and Th17 cells: interplay with EtxB- and LPS-treated dendritic cells

Dendritic cells (DCs) are antigen-presenting cells that drive the differentiation of T CD4+ cells into different profiles according to the nature of the antigen or immunomodulator. Propolis is a resinous product made by bees that has numerous pharmacological properties, including an immunomodulatory action. To assess whether propolis can modulate the activation of CD4+ T cells by stimulating DCs with heat-labile enterotoxin B subunit (EtxB) or lipopolysaccharide (LPS), we aimed to elucidate the mechanisms affected by propolis in the differential activation of T lymphocytes. Cell viability, lymphocyte proliferation, gene expression (GATA-3 and RORc), and cytokine production (interleukin (IL)-4 and IL-17A) were analyzed. Propolis, EtxB, and LPS induced a higher lymphoproliferation compared with the control. Propolis induced GATA-3 expression and, in combination with EtxB, maintained the baseline levels. Propolis alone or in combination with LPS inhibited RORc expression. EtxB alone and in combination with propolis increased IL-4 production. Propolis in combination with LPS prevented LPS-induced IL-17A production. These results opened perspectives for the study of biological events that may be favored by propolis by promoting Th2 activation or helping in the treatment of inflammatory conditions mediated by Th17 cells.

Analysis of the Hive Yield of Three Species of Bees for Honey Production in Eastern Honduras

Objectives: The analysis of the performance of honey production hives of three species of honeybees was carried out. Study Design: Three harvests per year of honey per hive of each species the first was on March-April, the second was on June-July, and the third was on November -December, with a sampling of ten hives per species, data were evaluated by ANOVA analysis, and Duncan mean separation test developed by SAS/STAT program. Place and Duration of the Study: This research was developed in the department of Para韘o, municipality of Danl�, Honduras, Central America, in Cerro El 羐uila, latitude 13�'59" N, and longitude 86�'59" W, the sampling was carried out in 2020. Methodology: The qualitative variables were evaluated for each species by In Situ observation that characterized the honeycombs of the three species, and the data were subjected to an analysis of variance and Duncan's mean separation, where the dependent variable is the average yield of Kg of honey/hive. Results: According to the ANOVA, there are significant differences in: the harvest of the three species of bees (p<0.0001), for the three annual harvests (p=0.0024), and by hives (p<0.0001) and in the analysis of separation of means the three averages of honey yield observed are not homogeneous (P>0.05), the Apis mellifera produces 63.1 kg/hive-year, the Tetragonisca angustula obtained an average of 0.679 kg / hive-year, and Melipona beecheii obtained 13.19 kg/hive-year. Conclusion: In the three species is observed that they have differences in the structures of the construction of their hives, their entrance, the construction of their cells, production and storage of honey and pollen, birth of queens, and method of defense; and when evaluating the average annual yield by species, by harvest, and by hives, is found that the three variables evaluated of bees are different averages of honey production.

Tumor fibroso solitario de la pleura / Solitary fibrous tumor of the pleura

El tumor fibroso solitario de la pleura (TFSP) representa una neoplasia benigna de evolución habitualmente silente, hallazgo incidental y heterogeneidad en su presentación. Raramente se malignizan y la sintomatología se relaciona fundamentalmente con el compromiso por compresión de las estructuras vecinas. Su tratamiento es la cirugía. Se describe el caso de un paciente masculino de 49 años con antecedentes de hipertensión arterial, diabetes mellitus y obesidad que consultó al Servicio de urgencias por disnea. Se solicitó tomografía de tórax que evidenció voluminosa masa de densidad de partes blandas en hemitórax izquierdo con desplazamiento del mediastino y descenso del diafragma del mismo lado. La fibrobroncoscopia no evidenció lesión endoluminal. Fue evaluado por Cirugía del Tórax. Se realizó abordaje de la masa mediante toracotomía postero lateral izquierda. El estudio anatomopatológico informó formación tumoral de 25 × 16 × 13 cm, peso de 1905 gr y en la microscopía se describió proliferación celular fibroblástica, células fusiformes de núcleos pequeños ovoides y escaso citoplasma dispuestas en haces desordenados con colágeno interpuesto. La inmunohistoquímica informó vimentina y CD34 positivos. Se realizó el diagnóstico de tumor fibroso solitario de la pleura. La evolución posterior fue buena.

The solitary fibrous tumor of the pleura (SFTP) represents a benign neoplasm of commonly silent evolution, incidental finding and heterogeneous presentation. It rarely becomes malignant and symptoms mainly result from the involvement of neighboring structures due to compression. It is treated with surgery. We describe the case of a 49-year-old male patient with history of arterial hypertension, diabetes mellitus and obesity who consulted the Emergency Services because he was experiencing dyspnea. We requested chest tomography that showed a voluminous soft tissue density mass in the left hemithorax with mediastinal shift and decreased diaphragm on the same side. The fibrobronchoscopy didn't show endoluminal lesion. The patient was evaluated by the Thorax Surgery staff. The mass was treated by means of left posterolateral thorachotomy. The anatomopathological study reported the formation of a tumor of 25 × 16 ×13 cm and 1905 gr, and the microscopy described fibroblast cell proliferation, spindle cells of small ovoid nuclei and very little cytoplasm placed in disorganized bundles with collagen interposition. The immunohistochemistry disclosed positive vimentin and CD34. The patient was diagnosed with solitary fibrous tumor of the pleura, with good subsequent evolution.

Bases para um programa de controle da artrite encefalite caprina em rebanho leiteiro / [Bases for a program of control of caprine arthritis encephalite in dairy flock]

Objetivou-se avaliar um programa de controle da artrite encefalite caprina (AEC), por meio de testes diagnósticos sensíveis, separação de mãe e cria após o parto e medidas de manejo, com o intuito de formar rebanho livre do vírus. Utilizou-se um total de 47 cabritos da raça Saanen, mantidos isoladamente até o resultado dos primeiros testes de reação em cadeia de polimerase nested (PCR nested) e Western Blotting (WB), com base na coleta de sangue no momento do nascimento (M0). No PCR nested, quatro animais foram positivos, no M0, e foram eutanasiados. Posteriormente, os demais 43 cabritos foram submetidos à coleta de sangue aos 60 (M60) e 270 (M270) dias de vida para realização de novos testes de WB e PCR nested, que não detectaram animais positivos. Pode-se afirmar que a metodologia adotada neste estudo foi efetiva no controle da doença, nas fases de aleitamento e pós-aleitamento, e que a combinação do sistema de manejo, a fim de propiciar diminuição de risco de transmissão horizontal, com técnicas de diagnóstico mais apuradas, como o WB e a PCR nested, é relevante para elaboração de plano estratégico de controle da enfermidade.(AU)

We aimed to evaluate a program to control Caprine Arthritis Encephalitis (CAE), using diagnostic tests, separation of the mother and postpartum and other management measures, in order to form a free flock of the virus. We used a total of 47 Saanengoats in isolation until the results of the first nested Polymerase Chain Reaction (nested PCR) and Western Blotting (WB) tests, based on blood collection at the time of birth (M0). In the nested PCR, 4 animals were positive, at M0, and were eliminated. Later, the other 43goats were submitted to blood collection at 60 (M60) and 270 (M270) days of life to perform new tests of WB and nested PCR, which did not detect positive animals. We can affirm that the methodology adopted in this study was effective in the control of the disease, in the phase of breastfeeding and post-breastfeeding, and that the combination of the management system, which allows a reduction of risk of horizontal transmission, with more accurate diagnostic techniques, such as WB and nested PCR, is relevant for the elaboration of a strategic plan for the disease control.(AU)

Red Blood Cell Alloimmunization in Pediatric Sickle Cell Disease Population of Puerto Rico: An Observational Study

No abstract available.

Methods of aril removal and lightness conditions on seeds physiological quality of sour passion fruits / Métodos de remoção do arilo e condições de luminosidade sobre a qualidade fisiológica das sementes de maracujá azedo

Abstract Passion fruits species presents a larger economic importance for in natura consumption and industry. The main way to propagate these species is by seeds; however, the aril presence and environmental conditions may inhibit the seeds germination. In this sense, the objective of this study was to evaluate the effect of aril removal methods and light conditions on P. edulis var. flavicarpa seeds quality and germination. There were used five methods to remove the seeds aril: (1) friction on steel mesh sieve for 5 minutes; (2) friction with coarse sand on steel mesh sieve for 5 minutes; (3) immersion in lime solution at 10% (w/v), for 30 minutes; (4) fermentation in sugar solution at 10% (w/v), during 48 hours; and (5) natural pulp fermentation, during five days. The seeds were submitted to germination test at darkness and lightness, as well as, to length seedlings and emergence test. Regardless the aril removal method, the germination percentage was lower at lightness than darkness highlighting the natural pulp fermentation treatment, which presented 86% of seeds germinated. On the other hand, the aril removal methods did not affect the seedlings emergence, with emergence percentages ranged from 88 to 94%.

Resumo As espécies de maracujá apresentam grande importância econômica, tanto para o consumo in natura, quanto para a indústria. A principal maneira de propagar essas espécies é por sementes; contudo, a presença de arilo e condições ambientais pode inibir a germinação. Nesse sentido, objetivou-se estudar o efeito de métodos de remoção do arilo e luminosidade na qualidade e germinação das sementes de Passiflora edulis var. flavicarpa. Cinco métodos foram empregados para a remoção do arilo: (1) fricção em peneira de malha de aço por cinco minutos; (2) fricção com areia grossa em peneira de malha de aço por cinco minutos; (3) imersão em solução de cal a 10% (m/v), por 30 minutos; (4) fermentação da polpa em solução de açúcar a 10% (m/v), por 48 horas; e (5) fermentação natural da polpa, por cinco dias. As sementes foram submetidas ao teste de germinação no escuro e no claro, teste de comprimento de plântulas e teste de emergência. Independente do método de remoção do arilo, a porcentagem de germinação no claro apresentou-se menor em comparação ao escuro, com destaque para o tratamento de fermentação natural da polpa, o qual apresentou 86% de sementes germinadas. Por outro lado, os métodos de remoção do arilo não afetaram a emergência das plântulas, com porcentagem de emergência variando entre 88 a 94%.

Validación del Índice Funcional para Osteoartritis de Manos (FIHOA) en pacientes con artritis reumatoidea / Validation of the Functional Index for Hand Osteoarthritis (FIHOA) in patients with rheumatoid arthritis

El FIHOA fue desarrollado para evaluar la capacidad funcional de pacientes con OA de manos. Objetivo: Validar FIHOA en pacientes con AR. Métodos: Estudio analítico, observacional prospectivo de corte transversal. Se incluyeron pacientes consecutivos con diagnóstico de AR (ACR/EULAR 2010). Se consignaron datos demográficos y características de la enfermedad. Todos los pacientes completaron los siguientes cuestionarios autoadministrados: FIHOA, HAQ-A, HAQ-UP-A y Quick DASH. En un subgrupo de pacientes, una terapista ocupacional valoró la capacidad funcional de la mano por medio del test de SODA-A. Se evaluó la reproducibilidad de FIHOA. Análisis estadístico: Estadística descriptiva. Confiabilidad con test de Cronbach. Validez de constructo con correlación de Spearman. Reproducibilidad test re-test. Modelo de regresión lineal. Resultados: Se incluyeron 100 pacientes. La prueba alfa de Cronbach fue de 0,94. No se evidenciaron preguntas redundantes. El FIHOA mostró excelente correlación con HAQ-A (r=0,89); HAQ-UP-A (r=0,89); Quick DASH (r=0,90) y SODA-A (r=-0,80); y buena correlación con DAS28-ERS (r=0,65), y con otros parámetros de la enfermedad. La reproducibilidad fue 0,73. La regresión lineal múltiple mostró como principal determinante del FIHOA a la presencia de rigidez matinal seguida por el uso de corticoides y el EVA general de pacientes. Conclusión: El FIHOA resultó ser confiable, válido y reproducible en pacientes con AR

FIHOA was developed to evaluate the functional capacity of patients with OA hands. Objetive: To validate FIHOA in patients with RA. Methods: Analytical, observational, prospective cross-sectional study. Consecutive patients with diagnosis of RA (ACR/EULAR 2010) were included. Demographic and RA characteristics were recorded. Patients completed the following self-administered questionnaires: FIHOA, HAQ-A, HAQ-UP-A and Quick DASH. For a patient subgroup, an occupational therapist performed an objective evaluation of the functional capacity of the hands using the SODA-A. Reproducibility was assessed. Statistical analysis: Descriptive statistics. Reliability with the Cronbach test. Construct validity with Spearman correlation. Reproducibility with test-retest reliability. Linear regression model. Results: One hundred patients were included. Cronbach's alpha test was 0.94. There were no redundant questions. FIHOA showed an excellent correlation with HAQ-A (r=0.89); HAQUP-A (r=0.89); Quick DASH (r=0.90) and SODA-A (r=-0.80); and a good correlation with DAS28- ERS (r=0.65) and with other disease parameters. Questionnaire reproducibility was 0.73. A multiple linear regression showed morning stiffness as the main determinant of FIHOA, followed by glucocorticoid use and patient global assessment. Conclusion: FIHOA was found to be reliable, valid and reproducible in patients with RA

Patrones de tratamiento, sobrevida y efectividad a largo plazo de agentes biológicos en pacientes con Artritis Psoriásica / Patterns of treatment, survival and long-term effectiveness of biological agents in patients with Psoriatic Arthritis

Objetivos: Evaluar los patrones de tratamiento de las DME-b (Drogas Modificadoras de la Enfermedad-biológicas), su sobrevida acumulada y su eficacia a largo plazo en pacientes con Artritis Psoriásica (APs) utilizando el índice LUNDEX. Materiales y métodos: Estudio multicéntrico retrospectivo. Se incluyeron pacientes con diagnóstico de APs que hayan iniciado tratamiento con DME-b. Se recolectaron datos sociodemográficos y clínicos. Se consignaron fechas de inicio de DME-b, tratamiento concomitante, suspensión o cambio de tratamiento, y razones de suspensión. La respuesta terapéutica se definió acorde a MDA (Minimal Disease Activity), a los 6, 12 meses y anualmente a partir del inicio de DME-b. Análisis estadístico: Test de Student y Chi². Curvas de Kaplan Meier y Log Rank. Análisis de regresión de Cox. Resultados: Se incluyeron 72 pacientes con APs, 39 (54,2%) de sexo masculino. La edad mediana fue de 54,5 años (RIC 45-61) y el tiempo mediano de evolución de la enfermedad de 11 años (RIC 6-15). 71,2% (n=42) presentaron comorbilidades. El primer DME-b fue en orden decreciente de frecuencia: Adalimumab (45,8%), Etanercept (36,1%), Certolizumab (5,6%), Infliximab (4,2%), Ustekinumab (4,2%), Abatacept (2,7%) y Golimumab (1,4%). 15 pacientes (25,4%) recibieron DME-b en monoterapia. La sobrevida media fue de 82 meses (DE±7,4). El LUNDEX del primer biológico fue 24,7% a los 6 meses y 44,3% al año. La sobrevida media de Adalimumab fue de 90 meses (DE±10,4) y de Etanercept 79 meses (DE±12). Los pacientes añosos presentaron menor sobrevida de la droga [≥55 años: X59,8 (DE±10,5) vs <55 años: X101,2 (DE±9,7), p=0,006]. Luego de ajustar por diferentes confundidores, la edad ≥55 años se mantuvo significativamente a menor sobrevida [HR=1,064 (IC=1,01-1,11) p=0,005]. El LUNDEX fue menor en obesos vs no obesos (16% vs 66% al año, p=0,89; 10,5 vs 74,9% a los 2 años, p=0,011 y 5,9 vs 81,8% a los 3 años, p=0,005). Conclusiones: La sobrevida promedio del primer DME-b fue de 6,8 años. La única variable asociada a menor sobrevida fue la mayor edad.

Objectives: To evaluate the treatment patterns of DME-b (Disease-Modifying Drugs-biological), their accumulated survival and their long-term efficacy in patients with psoriatic arthritis (PsA) using the LUNDEX index. Materials and methods: Retrospective multicentre study. We included patients diagnosed with PsA who started treatment with DME-b. Sociodemographic and clinical data were collected. BMI-D start dates, concomitant treatment, suspension or change of treatment, and reasons for suspension were recorded. The therapeutic response was defined according to MDA (Minimal Disease Activity), at 6, 12 months and annually from the beginning of DME-b. Statistical analysis: Student test and Chi². Curves of Kaplan Meier and Log Rank. Cox regression analysis. Results: We included 72 patients with PsA, 39 (54.2%) male. The median age was 54.5 years (IQR 45-61) and the median time of evolution of the disease was 11 years (IQR 6-15). 71.2% (n=42) presented comorbidities. The first DME-b was in decreasing order of frequency: Adalimumab (45.8%), Etanercept (36.1%), Certolizumab (5.6%), Infliximab (4.2%), Ustekinumab (4.2%), Abatacept (2.7%) and Golimumab (1.4%). 15 patients (25.4%) received DME-b monotherapy. The mean survival was 82 months (SD±7.4). The LUNDEX of the first biological was 24.7% at 6 months and 44.3% per year. The mean survival of Adalimumab was 90 months (SD±10.4) and Etanercept 79 months (SD±12). Older patients had a lower survival of the drug [≥55 years: X59.8 (SD±10.5) vs <55 years: X101.2 (SD±9.7), p=0.006]. After adjusting for different confounders, age ≥55 years was significantly maintained at lower survival [HR=1.064 (CI=1.01-1.11) p=0.005]. The LUNDEX was lower in obese vs. non-obese (16% vs. 66% per year, p=0.89, 10.5 vs 74.9% at 2 years, p=0.011 and 5.9 vs 81.8% at 3 years, p=0.005). Conclusions: The average survival of the first DME-b was 6.8 years. The only variable associated with lower survival was the older age.

Effect of odontoplasty on apparent digestibility and consumption time of diet for equines / Efeito da odontoplastia sobre a digestibilidade aparente e o tempo de consumo de dieta para equinos

The aim of this study was to investigate the effect of odontoplasty on apparent digestibility of diet for horses, consumption time, and particle size of feces. Nine horses were used, aged 14.5±3.3 years and weightng 531±38.7kg. The diet consisted of 1.5% of live weight (LW) in Tifton 85 hay and 0.75% of LW in concentrate for both assays. The experiment consisted of two tests of apparent digestibility using the method of total collection, before and after the odontoplasty, where the consumption time of hay and concentrate was also evaluated and the particle size of the feces was analyzed. An effect (P<0.05) of odontoplasty on the apparent digestibility coefficients of dry matter, organic matter, crude protein, neutral detergent fiber and acid detergent fiber was observed. Effect of the consumption time for the concentrate (P<0.05) was observed, but not for the forage (P<0.05). There was more retention (P<0.05) of the fecal particles in the sieves of bigger granulometry. The odontoplasty increases the digestibility of dietary nutrients and feces particle size, without changing feces quality. Animals after the procedure have shorter concentrate consumption time.(AU)

O objetivo deste estudo foi investigar o efeito da odontoplastia sobre a digestibilidade aparente de dieta para equinos, o tempo de consumo e o tamanho de partícula das fezes. Foram utilizados nove equinos, com idade de 14,5±3,3 anos e peso de 531±38,7kg. A dieta consistiu do oferecimento de 1,5% do peso vivo (PV) em feno de Tifton 85 e 0,75% do PV em concentrado para ambos os ensaios. O experimento compôs-se de dois ensaios de digestibilidade aparente pelo método de coleta total, antes e após a odontoplastia, em que também foi avaliado o tempo de consumo do feno e do concentrado e analisado o tamanho de partícula das fezes. Foi observado efeito (P<0,05) da odontoplastia sobre os coeficientes de digestibilidade aparente da matéria seca, matéria orgânica, proteína bruta, fibra em detergente neutro e fibra em detergente ácido. Verificou-se efeito do tempo de consumo para o concentrado (P<0,05), porém não se observou para o volumoso (P<0,05). Houve maior retenção (P<0,05) das partículas das fezes nas peneiras de maior granulometria. A odontoplastia aumenta a digestibilidade dos nutrientes da dieta e o tamanho de partículas nas fezes, sem alterar a qualidade destas. Animais após o procedimento apresentam menor tempo de consumo de concentrado.(AU)

A influência da morfina ou tramadol pela via epidural no trânsito gastrintestinal de equinos / Influence of epidural morphine or tramadol in gastrointestinal transit of horses

Os opioides são utilizados na medicina veterinária na analgesia dos animais, porém há restrição quanto ao uso desses fármacos em equinos, pois podem desencadear alterações gastrintestinais, mas a administração pela via epidural minimiza os efeitos adversos. Assim, oito equinos hígidos foram utilizados em três grupos experimentais, objetivando-se avaliar a influência no trânsito gastrintestinal da injeção epidural de morfina (0,2mg/kg), tramadol (1,0mg/kg) ou NaCl 0,9%. Para a avaliação do trânsito gastrintestinal, foi administrada a lignina purificada e enriquecida (Lipe®), pela via oral, a qual posteriormente foi analisada nas fezes. As fezes foram coletadas para investigação desse marcador, antes da epidural e em intervalos até totalizar 48 horas do início do experimento. Os dados foram submetidos à análise de variância (ANOVA) de uma via, com repetições múltiplas. As médias entre cada momento dos grupos e dos momentos dentro de cada grupo foram comparadas pelo teste de Student-Newman-Keuls (P≤0,05). A morfina ou o tramadol administrados pela via epidural não alteraram o tempo médio de retenção da fase líquida, a taxa de passagem e o tempo de trânsito do marcador utilizado. Diante de tais achados, conclui-se que a morfina ou o tramadol pela via epidural não alteram o trânsito gastrintestinal.(AU)

Opioids provide analgesia and are used in veterinary, however there is a restriction regarding the use of these drugs in horses, because may lead to ileus, but epidural opioids minimize those side effects. Eight healthy horses were used in three experimental groups, to evaluate the gastrointestinal influence after epidural morphine (0.2mg / kg), tramadol (1.0mg / kg) or NaCl 0.9%. Intestinal transit was evaluated with the administration of Lipe® (purified enriched isolated lignin) and later analyzed in the feces. Feces were collected before the epidural and at intervals up to 48 hours after the beginning of the experiment. The data were analyzed by a one-way analysis of variance or Friedman or Kruskal-Wallis and Student-Newman Keuls test as a post hoc. A value of P≤ 0.05 was considered significant. Epidural morphine or tramadol did not change the mean time for retention of the liquid phase, passage rate, and the transit time of the marker used. In conclusion, epidural morphine or tramadol does not change gastrointestinal transit.(AU)

Methods of aril removal and lightness conditions on seeds physiological quality of sour passion fruits

Abstract Passion fruits species presents a larger economic importance for in natura consumption and industry. The main way to propagate these species is by seeds; however, the aril presence and environmental conditions may inhibit the seeds germination. In this sense, the objective of this study was to evaluate the effect of aril removal methods and light conditions on P. edulis var. flavicarpa seeds quality and germination. There were used five methods to remove the seeds aril: (1) friction on steel mesh sieve for 5 minutes; (2) friction with coarse sand on steel mesh sieve for 5 minutes; (3) immersion in lime solution at 10% (w/v), for 30 minutes; (4) fermentation in sugar solution at 10% (w/v), during 48 hours; and (5) natural pulp fermentation, during five days. The seeds were submitted to germination test at darkness and lightness, as well as, to length seedlings and emergence test. Regardless the aril removal method, the germination percentage was lower at lightness than darkness highlighting the natural pulp fermentation treatment, which presented 86% of seeds germinated. On the other hand, the aril removal methods did not affect the seedlings emergence, with emergence percentages ranged from 88 to 94%.

Resumo As espécies de maracujá apresentam grande importância econômica, tanto para o consumo in natura, quanto para a indústria. A principal maneira de propagar essas espécies é por sementes; contudo, a presença de arilo e condições ambientais pode inibir a germinação. Nesse sentido, objetivou-se estudar o efeito de métodos de remoção do arilo e luminosidade na qualidade e germinação das sementes de Passiflora edulis var. flavicarpa. Cinco métodos foram empregados para a remoção do arilo: (1) fricção em peneira de malha de aço por cinco minutos; (2) fricção com areia grossa em peneira de malha de aço por cinco minutos; (3) imersão em solução de cal a 10% (m/v), por 30 minutos; (4) fermentação da polpa em solução de açúcar a 10% (m/v), por 48 horas; e (5) fermentação natural da polpa, por cinco dias. As sementes foram submetidas ao teste de germinação no escuro e no claro, teste de comprimento de plântulas e teste de emergência. Independente do método de remoção do arilo, a porcentagem de germinação no claro apresentou-se menor em comparação ao escuro, com destaque para o tratamento de fermentação natural da polpa, o qual apresentou 86% de sementes germinadas. Por outro lado, os métodos de remoção do arilo não afetaram a emergência das plântulas, com porcentagem de emergência variando entre 88 a 94%.

Validación y estandarización del instrumento: Evaluación de los comportamientos de cuidado otorgado en enfermeras mexicanas / Validation and standardization of the instrument: Assessment of the provided caring behaviors in Mexican nurses / Validação e estandardização do instrumento: avaliação dos comportamentos de cuidado outorgado em enfermeiras mexicanas

Introducción: La evaluación del cuidado se ha convertido en un indicador de calidad para la práctica de enfermería, sin embargo, debido a la escasez de instrumentos que consideren la perspectiva de la enfermera y no solo del usuario, es necesario contar con una herramienta que evalúe la percepción de los comportamientos de cuidado que las enfermeras ofrecen en la práctica hospitalaria para mejorar los procesos de calidad y calidez. Objetivo: Validar y adecuar la versión en español del Caring Behaviors Assessment, para obtener una primera versión que pueda evaluar los comportamientos del cuidado otorgado en una población de enfermeras mexicanas de un hospital de segundo nivel de atención. Metodología: Diseño descriptivo, transversal y de proceso. Muestreo por conveniencia, la muestra estuvo integrada por 83 enfermeras mexicanas de un ambiente hospitalario. Resultados: El índice de validez de contenido fue igual a 0.96. El coeficiente en la escala general fue de a=0.96, por subescalas osciló entre 0.75 y 0.86 respectivamente. El análisis factorial mostró una varianza explicada del 72% para el primer factor. Conclusión: La primera versión del instrumento que se adecuó para valorar la percepción del cuidado otorgado por enfermería mostró una validación y consistencia interna aceptables, por tanto, se considera una herramienta útil en la evaluación de cuidados de enfermería que puede llegar a contribuir a mejorar estándares de calidad de los servicios desde el punto de vista humanístico.

Introduction: The assessment of care has become a quality indicator in the nursing practice, however, due to the few instruments which consider the perspective of nurses, not only that of the user, and in order to improve the quality of care, it is important to rely on a tool which assesses the perceived caring behaviors that nurses provide within the clinical practice. Objective: To validate and adequate the version in Spanish of the Caring Behaviors Assessment in order to establish a first draft which can be used to assess the provided caring behaviors of a population of Mexican nurses at a hospital of second level of attention. Methodology: This is a study with descriptive, transversal, and process design, which uses sampling by convenience. The sample included 83 Mexican nurses. Results: The content validity index turned out to be 0.96. The coefficient in the general scale was a = 0.96, and those of the sub-scales ranged from .75 to .86 respectively. The analysis of factors indicated a 72% of the total variance explained by the first factor. Conclusion: The first version of the adapted instrument showed acceptable validity and consistency, and therefore was considered a useful tool for the assessment of perceived provided nursing care, which can contribute to the improvement of the standards of health services from the humanistic point of view.

Introdução: A avaliação do cuidado virou um indicador de qualidade para a prática de enfermagem, porém, devido à escassez de instrumentos que considerem a perspectiva da enfermeira e não só do usuário, é necessário contar com uma ferramenta que avalie a percepção dos comportamentos de cuidado que as enfermeiras oferecem na prática hospitalar para melhorar os processos de qualidade e cordialidade. Objetivo: validar e adequar a versão em espanhol do Caring Behaviors Assessment, para obter uma primeira versão que possa avaliar os comportamentos do cuidado outorgado na população de enfermeiras mexicanas de um hospital de segundo nível de atenção. Metodologia: Desenho descritivo, transversal e de processo. Amostragem por conveniência, a amostra esteve integrada por 83 enfermeiras mexicanas de um ambiente hospitalar. Resultados: O índice de validade de conteúdo igual a 0.96. O coeficiente na escala geral foi de a = 0.96, por sub-escalas variou entre .75 e .86 respetivamente. A análise fatorial mostrou uma variância explicada do 72% para o primeiro fator. Conclusão: A primeira versão do instrumento que se adequou para valorizar a percepção do cuidado conferido por enfermagem, mostrou uma validade e consistência interna aceitáveis, portanto, considera-se uma ferramenta útil na avaliação de cuidados de enfermagem que pode chegar a contribuir a melhorar padrões de qualidade dos serviços desde o ponto de vista humanístico.

Estandarización de la técnica de PCR para la detección de ADN de Leishmanía sp. en muestras de sangre de caninos / Standardization of the PCR technique for detection of Leishmania sp. DNA in canine blood samples

La leishmaniasis es una enfermedad con diversidad clínica y epidemiológica, producida por varias especies de protozoarios parásitos del género Leishmania. Estos parásitos infectan una amplia variedad de hospedadores mamíferos y son transmitidos por insectos del género Lutzomyia, en nuestro país. Los caninos han sido implicados como posibles reservorios del parásito. Para el diagnóstico de leishmaniasis se utilizan técnicas parasitológicas que generalmente tienen baja sensibilidad e inmunológicas, con pobre especificidad. Debido a las limitaciones en el diagnóstico, y lo difícil de la obtención, transporte y almacenamiento de las muestras, en este trabajo se planteó estandarizar de una técnica de PCR anidada (Leishmania nested PCR, Ln-PCR) para la detección de ADN de Leishmania sp. en muestras de sangre de caninos colectadas en papel de filtro. Para ello se titularon las concentraciones de reactivos de la PCR para la amplificación del ADN del parásito y se determinó la sensibilidad analítica y la especificidad de la técnica. Se evaluaron 36 muestras de sangre de caninos (6 infectados y 30 no infectados). Las condiciones óptimas de reacción fueron 0,2 mM de dNTPs, 0,4 µM de cada cebador y 1 U de Taq polimerasa. La sensibilidad analítica de Ln-PCR fue de 10 fg y la especificidad fue de 100% en la detección de ADN de Leishmania sp., ya que no se observó amplificación con ADN de otros parásitos, ni con ADN humano, ni de perro. De las muestras de caninos evaluadas los seis controles infectados todos amplificaron por la PCR, mientras que los 30 no infectados, en ninguno se observó amplificación. La extracción de ADN de muestras de sangre colectadas en papel de filtro fue eficiente para la amplificación por la PCR, técnica que puede ser muy útil para el diagnóstico de leishmaniasis en animales y su implicación como posibles reservorios.

Leishmaniasis is a disease with clinical and epidemiological diversity, caused by several species of protozoan parasites of the genus Leishmania. These parasites infect a wide variety of mammalian hosts, and are transmitted by insects of the genus Lutzomyia in our country. Canines have been implicated as potential reservoirs of the parasite. For the diagnosis of leishmaniasis, parasitological techniques generally with low sensitivity and immunological techniques, with poor specificity, are used. Because of limitations in the diagnosis, and the difficulty to obtain, transport, and store samples, the aim of this research was to standardize a Leishmania nested PCR test (Ln-PCR), for the detection of Leishmania sp. DNA in blood samples from dogs collected in filter paper. For that purpose, concentrations of the PCR reagent for DNA parasite amplification were titrated and the analytical sensitivity and specificity of the technique were determined. A total of 36 canine blood samples (6 infected and 30 uninfected) were evaluated.  The optimal reaction conditions were: 0.2 mM dNTPs; 0.4 µM of each primer; and 1 U of Taq polymerase. The analytical sensitivity of the Ln-PCR was 10 fg and the specificity was 100% in detecting Leishmania sp. DNA, since no amplification was observed with DNA from other parasites, human DNA or canine DNA. The six samples from infected canines evaluated amplified Leishmania sp. DNA by PCR, whereas in none of the 30 samples from uninfected canines the amplification was observed. The DNA extraction from blood samples collected in filter paper was efficient for the PCR amplification, a technique that can be very useful for the diagnosis of leishmaniasis in animals and their involvement as potential reservoirs.

Leishmaniasis.

dogs.

diagnosis.

PCR.

Physiology of acid-base balance in bovines with diarrhea backgrounds from Monteria, Colombia / Fisiología del estado ácido-básico en bovinos con antecedentes diarreicos de Montería, Colombia

Objective. Evaluate the acid-base balance (ABB) in bovines with diarrheic backgrounds in four areas of Montería, Colombia. Materials and methods. From a total of 300 pregnant cows, 60 were selected with their newborns. A direct inspection was performed of vital signs on the calves and the ABB indicators were determined using a gasometric method. Data were processed by means of descriptive statistics and the Duncan test was used to differentiate between the averages. The degree of association was established between the ABB indicators in cows and calves by using the Pearson correlation and a comparison of proportions was performed on the indexes of the newborns. Results. Regarding the cows, the ABB indicators were found within the reference values; however, in the calves the pH, pCO2, HCO3-, the anion gap (AG) and the bases excess (BE) varied. A correlation was found between AG, BE and metabolic hydrogen ions (M*H). The AG in cows and calves showed notable differences (p<0.05) among the farms in the study. According to the numeric classification system, the suction reflect indicated a greater percentage of calves in group one. Conclusions. The ABB analyte measurement in cows was similar to the consulted reference; however, in calves some analytes did not coincide. This suggests metabolic acidosis in newborn calves due to the increase of AG and the decrease of BE. Additionally, its correlation with M*H opens the possibility of new proposals to determine ABB in bovines.

Objetivo. Evaluar el equilibrio ácido-básico (EAB) en bovinos con antecedentes diarreicos de cuatro zonas de Montería, Colombia. Materiales y métodos. De un total de 300 vacas preñadas se seleccionaron 60 vacas y sus recién nacidos. Se realizó una inspección directa de los signos vitales en terneros y los indicadores del EAB se determinaron mediante técnica gasométrica. Los datos se procesaron mediante estadística descriptiva y para la diferencia entre medias se empleó la prueba de Duncan. El grado de asociación se estableció entre los indicadores del EAB en vacas y terneros mediante la correlación de Pearson y una comparación de proporciones se realizó en los índices del recién nacido. Resultados. En las vacas, los indicadores del EAB se encontraron dentro de los valores de referencia; sin embargo, en los terneros varió el pH, pCO2, HCO3-, la brecha aniónica (AG) y el exceso de bases (EB). Se encontró correlación entre AG, EB e hidrogeniones metabólicos (H+M). El AG en vacas y terneros indicó diferencias notables (p<0.05) entre las fincas de estudio. De acuerdo con el sistema de calificación numérica, el signo reflejo de succión indicó el mayor porcentaje de terneros en el grupo uno. Conclusiones. La medición de los analitos del EAB en vacas fue similar a la referencia consultada; sin embargo, en terneros no coincidió con algunos analitos. Se sugiere acidosis metabólica en los terneros recién nacidos por el aumento del AG y descenso del EB, además, su correlación con los H+M abre la posibilidad de nuevas propuestas para la determinación del EAB en bovinos.

Estandarización de la técnica de aglutinación directa para el inmunodiagnóstico de la enfermedad de Chagas / Standardization of a direct agglutination test for the immunodiagnosis of Chagas disease

Introducción. La enfermedad de Chagas es causada por el parásito Trypanosoma cruzi y su diagnóstico inmunológico se basa principalmente en la detección de anticuerpos contra T. cruzi mediante pruebas tales como ELISA, inmunofluorescencia indirecta (IFI) y hemaglutinación indirecta (HAI). Esta última tiene el inconveniente de requerir la preparación de eritrocitos de carnero, difíciles de obtener y de poca duración. Sin embargo, existen pruebas alternativas, como la técnica de aglutinación directa. Objetivo. Estandarizar la técnica de aglutinación directa para el diagnóstico de la enfermedad de Chagas. Materiales y métodos. Se prepararon parásitos epimastigotes de T. cruzi mediante dos protocolos, con tratamiento con tripsina y sin él. Los parásitos se colorearon, y se determinaron las condiciones óptimas de concentración parasitaria y diluciones de suero. Se utilizaron sueros de pacientes con enfermedad de Chagas, de individuos sanos y con otras parasitosis. Resultados. La concentración parasitaria óptima fue de 500 x10 6 parásitos/ml, utilizando parásitos coloreados y sin tratamiento con tripsina. Las diluciones de suero óptimas fueron de 1/25, 1/50 y1/100, y el punto de corte, la dilución de 1/50. La técnica estandarizada mostró índices diagnósticos de sensibilidad de 94,3 % (IC 95% 79,5-99,0) y de especificidad de 96,3 % (IC 95% 88,8-99,0); se encontró reacción cruzada en tres sueros de individuos con leishmaniasis visceral, con valores pronósticos positivo y negativo de 91,7 % (IC 95% 76,4-97,8) y de 97,5 % (IC 95% 90,4-99,6), respectivamente. Se compararon los resultados con los obtenidos por HAI, ELISA e IFI y la concordancia fue de 96 % con un índice kappa de 0,90 (IC 95% 0,81-0,99). Conclusión. La técnica de aglutinación directa estandarizada podría ser útil para el inmunodiagnóstico de la enfermedad de Chagas.

Introduction: Chagas´ disease is caused by the parasite Trypanosoma cruzi and its immunological diagnosis is mainly based on the detection of antibodies against T. cruzi using tests such as the ELISA, the indirect fluorescence antibody test (IFAT) and the indirect hemagglutination test (IHAT). The main disadvantage of the IHAT is the need to prepare sheep erythrocytes, whose availability is limited and they have a short duration once prepared. However, there are alternative tests, such as the direct agglutination test (DAT). Objective: To standardize the direct agglutination test for the diagnosis of Chagas disease. Materials and methods: Trypanosoma cruzi epimastigotes were prepared using two protocols, with and without trypsin treatment. The parasites were stained and optimal conditions for parasitic concentration and serum dilutions were determined. We evaluated the technique using sera from patients with Chagas disease, from healthy individuals and from individuals with other parasitic diseases. Results: The optimal parasitic concentration was 500 x 10 6 parasites/ml using stained parasites without trypsin treatment. The optimal serum dilutions were 1/25, 1/50 y 1/100 and the cut-off point was the 1/50 dilution. The diagnostic indices for the standardized technique were as follows: Sensitivity, 94.3% (95% CI: 79.5-99.0) and specificity, 96.3% (95% CI: 88.8-99.0), with positive and negative predictive values ?? of 91.7% (95% CI: 76.4-97.8) and 97.5% (95% CI: 90.4-99.6), respectively. Cross-reaction was observed only in three sera from individuals with visceral leishmaniasis. The results were compared with those obtained by IHA, ELISA, and IFA, and the concordance rate was 96% and the kappa index, 0.90 (95% CI: 0.81-0.99). Conclusion: The standardized direct agglutination test could be useful for immunodiagnosis of Chagas disease.

Desenvolvimento de bezerros leiteiros alimentados com silagem de leite de transição: I - Trato digestivo / Development of dairy calves fed silage transition milk: I - Digestive tract

Avaliou-se o desenvolvimento do trato digestivo de bezerros Holandeses aleitados com silagem de leite de transição. Foram utilizados 18 animais, com peso corporal inicial médio de 36,50kg (±4,03), alimentados individualmente em baias com concentrado, feno de Cynodon sp., água e suplemento mineral oferecidos ad libitum. O delineamento experimental foi inteiramente ao acaso, com três tratamentos e seis repetições. Os tratamentos consistiram em leite integral e silagem de leite de transição diluída em água ou misturada em leite, correspondendo a quatro litros diários divididos em duas refeições, durante 59 dias. Aos 60 dias, os bezerros foram abatidos e realizaram-se pesagens do trato digestivo e medidas histológicas das papilas ruminais. O sistema de aleitamento não interferiu nos consumos de concentrado e matéria seca total e no desenvolvimento de papilas ruminais (P>0,05). A silagem de leite de transição diluída em água resultou em menor peso corporal, menor peso corporal vazio e absoluto do abomaso e maior desenvolvimento intestinal. O aleitamento com silagem misturada em leite não comprometeu o desenvolvimento corporal e do trato digestivo até 60 dias de idade, representando alternativa ao aleitamento com leite...

This study aimed to evaluate the development of the digestive tract of Holstein calves which suckled milk from silage transition. We used 18 animals, with an average initial body weight of 36.50kg (±4.03), individually housed in pens with concentrate, hay Cynodon sp., water and mineral supplement offered ad libitum. The experimental design was completely randomized with three treatments and six replications. Treatments consisted of whole milk and silage transitional milk, diluted with water or mixed with milk, corresponding to four liters per day divided over two meals during 59 days. The food intake was monitored daily and weighed every week after the supply of liquid diet in the morning. At 60 days, the calves were slaughtered and the digestive tract was weighed and histological measures of rumen papillae were taken. The nursing system did not affect the consumption of concentrate and total dry matter and the development of rumen papillae (P>0.05). The silage transition milk diluted in water resulted in lower final body weight, lower body weight and absolute emptiness abomasum and intestinal further development. Milk transition silage mixed in milk did not affect the development of the digestive tract and body until 60 days of age, representing an alternative to milk...

Reporting detection of Chlamydia trachomatis DNA in tissues of neonatal death cases / Relato de detecção de DNA de Chlamydia trachomatis em tecidos de casos de óbito neonatal

OBJECTIVE: to determine whether C. trachomatis was present in neonates with infection, but without an isolated pathogen, who died during the first week of life. METHODS: early neonatal death cases whose causes of death had been previously adjudicated by the institutional mortality committee were randomly selected. End-point and real-time polymerase chain reaction of the C. trachomatis omp1 gene was used to blindly identify the presence of chlamydial DNA in the paraffinized samples of five organs (from authorized autopsies) of each of the dead neonates. Additionally, differential diagnoses were conducted by amplifying a fragment of the 16S rRNA of Mycoplasma spp. RESULTS: in five cases (35.7%), C. trachomatis DNA was found in one or more organs. Severe neonatal infection was present in three cases; one of them corresponded to genotype D of C. trachomatis. Interestingly, another case fulfilled the same criteria but had a positive polymerase chain reaction for Mycoplasma hominis, a pathogen known to produce sepsis in newborns. CONCLUSION: the use of molecular biology techniques in these cases of early infant mortality demonstrated that C. trachomatis could play a role in the development of severe infection and in early neonatal death, similarly to that observed with Mycoplasma hominis. Further study is required to determine the pathogenesis of this perinatal infection. .

OBJETIVO: determinar se a C. trachomatis está presente em neonatos com infecção, porém sem patógeno isolado, que morreram durante a primeira semana de vida. MÉTODOS: casos de óbito neonatal precoce cujas causas de óbito haviam sido anteriormente determinadas pelo Comitê de Mortalidade da instituição foram aleatoriamente selecionados. Foram utilizadas as reações em cadeia da polimerase convencional e em tempo real do gene omp1 da C. trachomatis, para identificar, às cegas, a presença de DNA de clamídia nas amostras desparafinizadas de cinco órgãos (de autópsias autorizadas) de cada um dos neonatos mortos. Além disso, foram realizados diagnósticos diferenciais por amplificação de um fragmento do rRNA 16S de Mycoplasma ssp. RESULTADOS: em cinco casos (35,7%) a presença de DNA de C. trachomatis foi detectada em um ou mais órgãos. Havia infecção neonatal grave em três casos; um deles correspondente ao genótipo D de C. trachomatis. Curiosamente, outro caso preencheu os mesmos critérios, porém possuía uma reação em cadeia da polimerase positiva para Mycoplasma hominis, um patógeno conhecido por causar sepse em recém-nascidos. CONCLUSÃO: a utilização de técnicas de biologia molecular nos casos de mortalidade infantil precoce mostrou que a C. trachomatis poderia desempenhar um papel no desenvolvimento de infecção grave e no óbito neonatal precoce semelhante ao observado com a Mycoplasma hominis. São necessários estudos adicionais para determinar a patogênese dessa infecção perinatal. .

Consumo de antiinflamatorios no esteroideos en pacientes que concurren por primera vez a un servicio de reumatología / Consumption of nonsteroidal anti-inflammaroty drug in patients attending for the first time a rehumatologic Unit

Introducción: El uso de antiinflamatorios no esteroideos (AINES) conlleva una mayor probabilidad de enfermedad gastrointestinal y cardiovascular en pacientes con factores de riesgo. Por tal motivo, se desarrollaron diversas recomendaciones con el fin de prevenir dichas complicaciones. Objetivo: Evaluar la frecuencia del consumo de AINES al momento de consultar por primera vez a un Servicio de Reumatología de demanda espontánea; y analizar tanto la conducta del médico así como el correcto cumplimiento de las recomendaciones para la toma de estos fármacos al finalizar la consulta. Material y métodos: Estudio observacional de corte transversal. Resultados: Se incluyeron 304 pacientes, 59,5% consumían AINES. La mayoría de estos pacientes presentaban riesgo gastrointestinal moderado/alto, sólo 28,3% recibían adecuada protección. De aquellos pacientes que recibían AINES, se consideró que requerían dicho tratamiento el 50%. Al finalizar la consulta, se tomó una conducta correcta en el 89% de los casos en relación al riesgo gastrointestinal. Conclusión: Más de la mitad de los pacientes consumían AINES. Se observó un buen cumplimiento de las recomendaciones por los médicos tratantes al finalizar la primera consulta. Sin embargo, es importante mencionar que el uso indiscriminado de AINES tanto por parte de los pacientes como por parte de los médicos sigue siendo alto.

Introduction: The use of Non-Steroidal Anti-Inflammatory DrugsNSAID (NSAIDS) leads to a higher probability of gastrointestinaland cardiovascular disease in patients with risk factors. Therefore,a number of recommendations were developed to prevent thesecomplications. The aim of this study was to evaluate the intake frequencyof NSAID by patients who attend to a rheumatology departmentfor the first time; and to analyze the attending physicians´ prescriptionas well as the correct implementation of the recommendationsfor the use of these drugs once this first visit was ended.Methods: We perform a cross-sectional observational study.Results: Three hundred and four patients were included, 59.5%were taking NSAIDs. Most of these patients had moderate/high gastrointestinalrisk and only 28.3% received adequate protection. Ofpatients receiving NSAIDs, it was considered that only 50% requiredsuch treatment. At the end of the first visit, the attending physiciansmade the correct implementation of the recommendations in 89%of cases in regard to gastrointestinal risk.Conclusion: More than half of the patients were taking NSAIDS.A good compliance with the recommendations by the attendingphysicians at the end of the first visit was observed. However, it isnoteworthy that the indiscriminate use of NSAIDs, both by patientsand by physicians, remains high.