Validación de instrumentos para diabetes mellitus tipo 2 en adultos mayores / Instrument validation for older adults with type 2 diabetes mellitus

Una de las principales dificultades en la atención al adulto mayor diabético continúa siendo la falta de educación hacia un estilo de vida y una actitud favorable hacia la enfermedad, lo cual solo puede lograrse mediante estrategias educativas. Objetivo: Validar los instrumentos AM1 ­ MO de la investigación factores modificables y su influencia en la presencia de complicaciones en adultos mayores con Diabetes Mellitus tipo 2 en el club de adultos mayores Lupita Nolivos en la Carrera de Enfermería de la Universidad de Guayaquil, en los periodos de septiembre a diciembre 2019. Materiales y Métodos: El Instrumento AM1 ­MO se realizó un estudio descriptivo, exploratorio y transversal, este instrumento cuantitativo se aplicó al universo de 50 adultos mayores entre 55 y 65 años y más, utilizando el SOFTWARE IBM SPSS Statistics Base 22.0. Resultados: Del total de pacientes con DMT2, el sexo femenino estuvo representado con 60,0 % y el masculino aportó 40,0 %. El grupo de edad de 70-79 fue el de mayor predominio de dicha afección con 62,0 %, de ellos 18 eran mujeres y 13 hombres. En cuanto a los hábitos alimentarios resulto se obtuvo los siguientes resultados que hay un alto consumo de gaseosas y dulces 24%. Conclusiones: En este trabajo se identificó que las personas que tienen mayor riesgo de desarrollar DMT2 son aquellas que tienen una edad superior a 55 años, presentan antecedentes familiares para esta enfermedad, son del sexo femenino, presentan exceso de peso, son físicamente inactivas y padecen HTA. En conclusión, el instrumento construido constituye una aproximación para determinar los factores modificables y su influencia en la presencia de complicaciones en adultos mayores con diabetes mellitus tipo 2. Los resultados obtenidos por las diferentes vías para evaluar los instrumentos utilizados fueron adecuados. Está disponible un instrumento válido y confiable que justifica su uso y aplicación en el ámbito investigativo(AU)

One of the main difficulties in caring for the elderly with diabetes continues to be the lack of education towards a lifestyle and a favorable attitude towards the disease, which can only be achieved through educational strategies. Objective: to validate the AM1 ­ MO instrument of the research, modifiable factors and their influence on the presence of complications in older adults with Type 2 Diabetes Mellitus in the Lupita Nolivos club for older adults in the Nursing Career of the University of Guayaquil, in the periods from September to December 2019. Materials and Methods: The AM1-MO Instrument was carried out a descriptive, exploratory and cross-sectional study, this quantitative instrument was applied to the universe of 50 older adults between 55 and 65 years old and over, using the IBM SPSS SOFTWARE Statistics Base 22.0. Results: Of the total number of patients with T2DM, the female sex was represented with 60.0% and the male contributed 40.0%. The age group 70-79 was the one with the highest prevalence of this condition with 62.0%, of which 18 were women and 13 were men. Regarding eating habits, the following results were obtained that there is a high consumption of soda and sweets 24%. Conclusions: In this work it was identified that the people who have a higher risk of developing T2DM are those who are older than 55 years, have a family history for this disease, are female, are overweight, are physically inactive and suffer from HTA. In conclusion, the instrument constructed constitutes an approximation to determine the modifiable factors and their influence on the presence of complications in older adults with type 2 diabetes mellitus. The results obtained by the different ways to evaluate the instruments used were adequate. A valid and reliable instrument is available that justifies its use and application in the research field(AU)

Effectiveness of a multifaceted strategy to improve the appropriateness of cesarean sections.

The objective was to assess the effectiveness of a multifaceted strategy for improving the appropriateness of indications for cesarean sections in two public Spanish hospitals. A multifaceted strategy was used including the adoption of a consensus protocol with indications for emergency and prescheduled cesarean sections, continuing education and improvement, and the correction of deficiencies in organization. A pre and post-intervention design was applied. The overall appropriateness rates for emergency cesarean sections increased from 68.3 to 84.3% in Son Llatzer Hospital, and from 80.0 to 92.0% in the hospital in Menorca. The overall cesarean section rates at the end of the post-intervention period decreased (not statistically significant) from 17.5 to 15.8% and from 29.0 to 22.0%, respectively. The multifaceted strategy applied seems to be effective in increasing the appropriateness of cesarean sections and possibly in decreasing the cesarean section rate.

[Lesions produced by radiofrequency ablation of the cavotricuspid isthmus in an experimental model]. / Lesiones producidas por la ablación con radiofrecuencia del istmo cavotricuspídeo en un modela experimental.

INTRODUCTION AND OBJECTIVES: Experimental studies have shown that deeper and wider lesions (up to 10 mm long or deep) can be safely created using an 8 mm or irrigated tip catheter for ablation to treat atrial flutter. However, potential damage to the tricuspid valve or inferior cava vein has not been systematically evaluated. PATIENTS AND METHOD: The cavotricuspid isthmus was ablated in 26 pigs (body weight 26-52 kg), with a total of 187 radiofrequency pulses. Standard 4 mm, 8 mm and irrigated tip catheters were used at random. For each ablation, energy, impedance and temperature were recorded continuously. RESULTS: The lesions were larger with irrigated tip and 8-mm catheters than with standard ones. In 7 animals (1 with an irrigated tip, 4 with an 8-mm, and 2 with a standard tip) the tricuspid valve was damaged. The tricuspid valve was severely damaged in 3 pigs and lesions were moderate in 4. In animals with tricuspid valve lesions, maximal energy was higher (59 +/- 27 vs. 51 +/- 24 W; p=0,03) and higher temperatures were reached (63 +/- 4 vs. 55 +/- 11 degrees C; p<0.001). Low energy pulses measured before ablation were also more intense in animals in which damage was produced (0.55 +/- 0.24 vs. 0.35 +/- 0.29; p=0.001), indicating greater contact pressure. CONCLUSIONS: The tricuspid valve may be severely damaged during the ablation of the cavotricuspid isthmus for atrial flutter: damage was seen most often with high energy pulses and with 8-mm catheters, but can also occur with usual energy levels and standard catheters. To minimize damage this technique should not be used from the inside of the right ventricle just above the tricuspid valve.

Lesiones producidas por la ablación con radiofrecuencia del istmo cavotricuspídeo en un modelo experimental / Lesions produced by radiofrequency ablation of the cavotricuspid isthmus in an experimental model

Introducción y objetivos. El empleo de catéteres con punta de 8 mm o irrigados para la ablación del aleteo auricular produce lesiones más anchas y profundas que los estándares, hasta de 10 mm de longitud y profundidad. El daño potencial sobre la válvula tricúspide o la vena cava inferior no se ha evaluado de forma reglada. Pacientes y método. Se hizo ablación del istmo cavotricuspídeo en 26 animales (cerdos, con un peso de 2652 kg) con un total de 187 aplicaciones, empleando aleatoriamente catéteres estándar de 4 y 8 mm, y catéteres irrigados, con control de la potencia, la impedancia y la temperatura. Resultados. Los catéteres irrigados y de 8 mm produjeron lesiones de mayor tamaño. En 7 animales (uno con catéter irrigado, 4 con catéter de 8 mm y 2 con catéter estándar) se dañó la válvula tricúspide, la lesión fue severa en 3 casos y moderada, en 4. Los casos con lesión valvular habían recibido mayor potencia (59 ñ 27 frente a 51 ñ 24 W; p = 0,03) y alcanzado temperaturas más altas (63 ñ 4 frente a 55 ñ 11 °C; p < 0,001). La medición del pulso de baja energía preablación fue también mayor cuando se produjeron lesiones (0,55 ñ 0,24 frente a 0,35 ñ 0,29; p = 0,001), lo que indicó una mayor presión de contacto del catéter. Conclusiones. El daño valvular durante la ablación del istmo cavotricuspídeo puede ser más frecuente con el uso de alta energía y con catéteres de 8 mm e irrigados, pero también se puede producir con catéteres estándares y energías habituales. Para evitarlo, no se deben hacer aplicaciones en el interior del ventrículo derecho, justo encima de la válvula tricúspide (AU)

Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study.

BACKGROUND: Data from studies of angiotensin-converting enzyme inhibitors provide evidence that the renin-angiotensin-aldosterone system plays a role as a mediator of atrial remodeling in atrial fibrillation. The present study has evaluated the effect of treatment with the angiotensin I type 1 receptor blocker irbesartan on maintaining sinus rhythm after conversion from persistent atrial fibrillation. METHODS AND RESULTS: To be included in the present study, patients must have had an episode of persistent atrial fibrillation for >7 days. The patients were then randomized and scheduled for electrical cardioversion. Two groups of patients were compared: Group I was treated with amiodarone, and group II was treated with amiodarone plus irbesartan. The primary end point was the length of time to a first recurrence of atrial fibrillation. From a total of 186 patients assessed in the study, 154 were analyzed with the use of intention-to-treat analysis. Seventy-five patients were randomly allocated to group I and 79 to group II. After 2 months of follow-up in the intention-to-treat analysis, the group treated with irbesartan had fewer patients with recurrent atrial fibrillation (Kaplan-Meier analysis, 84.79% versus 63.16%, P=0.008). The Kaplan-Meier analysis of time to first recurrence during the follow-up period (median time, 254 days [range, 60 to 710]) also showed that patients treated with irbesartan had a greater probability of remaining free of atrial fibrillation (79.52% versus 55.91%, P=0.007). CONCLUSIONS: Patients treated with amiodarone plus irbesartan had a lower rate of recurrence of atrial fibrillation than did patients treated with amiodarone alone.

[External and internal electrical cardioversion: comparative, prospective evaluation of cell damage by means of troponin I]. / Cardioversión eléctrica externa y sistemas de cardioversión interna: evaluación prospectiva y comparativa del daño celular con troponina I.

INTRODUCTION AND OBJECTIVES: In this study we measured the concentrations of cardiac troponin I (cTnI) and several biochemical markers of myocardial damage after elective external cardioversion or internal cardioversion by specific catheters or automatic defibrillators. MATERIAL AND METHODS: Biochemical markers were analyzed prospectively for 30 consecutive patients after electrical cardioversion. Concentrations of cTnI, myoglobin, creatine kinase (CK), CK-MB and the MB/CK ratio were determined in samples before cardioversion and 2, 8 and 24 h later. The shock energy ranged from 50 to 360 joules (235 106 joules) in external cardioversions and from 3 to 37 joules (15 8 joules) in internal cardioversions. RESULTS: We detected abnormal concentrations of CK, myoglobin, CK-MB and MB/CK in 33% of the patients after external cardioversion. The concentrations of cTnI remained within normal limits at all times, with no elevations detected. Whereas no abnormal concentration of any biochemical marker was detected in any patient who required internal cardioversion for atrial fibrillation, two patients who underwent external cardioversion from an automatic defibrillator did have abnormal concentrations of CK-MB, myoglobin, and even of cTnI. CONCLUSIONS: The concentration of cTnI remained below the detection limit after external cardioversion, even though the other more non-specific markers changed. No enzyme alteration was detected in patients who underwent internal cardioversion of atrial fibrillation.

Cardioversión eléctrica externa y sistemas de cardioversión interna: evaluación prospectiva y comparativa del daño celular con troponina I / External and internal electrical cardioversion: comparative, prospective evaluation of cell Damage by means of troponin I

Introducción y objetivos. En este estudio evaluamos las concentraciones de troponina I cardíaca (cTnI) y distintos marcadores de lesión miocárdica tras cardioversión externa electiva o interna a través de catéteres específicos o de desfibrilador automático. Material y métodos. Analizamos prospectiva y consecutivamente los datos de 30 pacientes tras cardioversión eléctrica. Se determinaron concentraciones de cTnI, mioglobina, creatincinasa (CK), CK-MB-masa e índice MB/CK en muestras precardioversión, y a las 2, 8 y 24 h poscardioversión. La energía de choque estuvo comprendida entre 50 y 360 J (235 ñ 106 J) en cardioversiones externas, y entre 3 y 37 J (15 ñ 8 J) en cardioversiones internas. Resultados. Tras las cardioversiones externas se detectaron valores anormales de CK en el 33 por ciento de los pacientes, así como de mioglobina, CK-MB e índex. Las concentraciones de cTnI permanecieron en todo momento dentro de límites normales, sin detectarse elevaciones patológicas en ninguno de los pacientes. A diferencia de las cardioversiones externas, tras las internas, en los pacientes que la precisaron por fibrilación auricular, no se detectaron valores patológicos de ningún marcador bioquímico. Por el contrario, sí encontramos concentraciones patológicas de CK-MB-masa y mioglobina, e incluso de cTnI en dos de los pacientes que recibieron cardioversión interna a través de un desfibrilador automático. Conclusiones. La concentración de cTnI se mantuvo en valores indetectables tras la cardioversión externa, aunque el resto de los marcadores más inespecíficos se modificaran. En el grupo de cardioversión interna por fibrilación auricular no se detectó ningún movimiento enzimático (AU)