Quality improvement collaborative for improving patient care delivery in Argentine public health sector intensive care units.

BACKGROUND: The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. OBJECTIVE: The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). METHODS: We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. RESULTS: We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. CONCLUSION: A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.

Tuberculosis disease in immunocompromised children and adolescents: a pTBnet multi-centre case-control study.

BACKGROUND: In high-resource settings the survival of immunocompromised (IC) children has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools and outcome of IC children with TB in Europe. METHODS: Multicentre, matched case-control study within the Paediatric Tuberculosis Network European Trials Group (ptbnet), capturing TB cases <18 years diagnosed 2000-2020. RESULTS: 417 TB cases were included, comprising 139 children with IC (HIV, inborn errors of immunity, drug-induced immunosuppression and other immunocompromising conditions) and 278 non-IC children as controls. Non-respiratory TB was more frequent among cases than controls (32.4% vs. 21.2%; p = 0.013). IC patients had an increased likelihood of presenting with severe disease (57.6% vs. 38.5%; p < 0.001; OR [95% CI]: 2.073 [1.37-3.13]). Children with IC had higher rates of false-negative tuberculin skin test (31.9% vs. 6.0%; p < 0.001) and QuantiFERON-TB Gold assay (30.0% vs. 7.3%; p < 0.001) results at diagnosis. Overall, the microbiological confirmation rate was similar in IC and non-IC cases (58.3% vs. 49.3%; p = 0.083). Although the mortality in IC children was <1%, the rate of long-term sequelae was significantly higher than in non-IC cases (14.8% vs. 6.1%; p = 0.004). CONCLUSIONS: IC children with TB disease in Europe have increased rates of non-respiratory TB, severe disease, and long-term sequelae. Immune-based TB tests have poor sensitivity in those children. Future research should focus on developing improved immunological TB tests that perform better in IC patients, and determining the reasons for the increased risk of long-term sequelae, with the aim to design preventive management strategies.

Interleukin-6-elicited chronic neuroinflammation may decrease survival but is not sufficient to drive disease progression in a mouse model of Leigh syndrome.

BACKGROUND: Mitochondrial diseases (MDs) are genetic disorders characterized by dysfunctions in mitochondria. Clinical data suggest that additional factors, beyond genetics, contribute to the onset and progression of this group of diseases, but these influencing factors remain largely unknown. Mounting evidence indicates that immune dysregulation or distress could play a role. Clinical observations have described the co-incidence of infection and the onset of the disease as well as the worsening of symptoms following infection. These findings highlight the complex interactions between MDs and immunity and underscore the need to better understand their underlying relationships. RESULTS: We used Ndufs4 KO mice, a well-established mouse model of Leigh syndrome (one of the most relevant MDs), to test whether chronic induction of a neuroinflammatory state in the central nervous system before the development of neurological symptoms would affect both the onset and progression of the disease in Ndufs4 KO mice. To this aim, we took advantage of the GFAP-IL6 mouse, which overexpresses interleukin-6 (IL-6) in astrocytes and produces chronic glial reactivity, by generating a mouse line with IL-6 overexpression and NDUFS4 deficiency. IL-6 overexpression aggravated the mortality of female Ndufs4 KO mice but did not alter the main motor and respiratory phenotypes measured in any sex. Interestingly, an abnormal region-dependent microglial response to IL-6 overexpression was observed in Ndufs4 KO mice compared to controls. CONCLUSION: Overall, our data indicate that chronic neuroinflammation may worsen the disease in Ndufs4 KO female mice, but not in males, and uncovers an abnormal microglial response due to OXPHOS dysfunction, which may have implications for our understanding of the effect of OXPHOS dysfunction in microglia.

Plantar Thermography in High-Risk Patients With Diabetes Mellitus Compared to Nondiabetic Individuals.

Diabetic foot (DF) is one of the most devastating complications of diabetes mellitus (DM). Infrared thermography has been studied for its potential in early diagnosis and preventive measures against DF ulcers, although its role in the management and prevention of DF complications remains uncertain. The objective of this study was to determine the average temperatures of different points of the plantar foot using infrared thermography in patients with DM and history of DF (DFa group, at the highest risk of developing foot ulcers) and compare them to people without DM (NoDM group). One hundred and twenty-three feet were included, 63 of them belonged to DFa Group and the other 60 to NoDM Group. The average temperature in the NoDM Group was 27.4 (26.3-28.5) versus 28.6 (26.8-30.3) in the DFa Group (p = .002). There were differences between both groups in temperatures at the metatarsal heads and heels, but not in the arch. Average foot temperatures did not relate to sex, ankle-brachial index, and age, and had a mild correlation with daily temperature (Spearman 0.51, p < .001). Data provided in our study could be useful in establishing a parameter of normal temperatures for high-risk patients. This could serve as a foundational framework for future research and provide reference values, not only for preventative purposes, as commonly addressed in most studies, but also to assess the applicability of thermography in clinical scenarios particularly when one foot cannot serve as a reference, suspected osteomyelitis of the remaining bone, or instances of increased temperature in specific areas which may necessitate adjustments to the insoles in secondary prevention.

Contribution of Outpatient Ultrasound Transvaginal Biopsy and Puncture in the Diagnosis and Treatment of Pelvic Lesions: A Bicenter Study.

BACKGROUND: The use of transvaginal ultrasound guided biopsy and puncture of pelvic lesions is a minimally invasive technique that allows for accurate diagnosis. It has many advantages compared to other more invasive (lower complication rate) or non-invasive techniques (accurate diagnosis). Furthermore, it offers greater availability, it does not radiate, enables the study of pelvic masses accessible vaginally with ultrasound control in real time, and it is possible to use the colour Doppler avoiding puncturing large vessels among others. The main aim of the work is to describe a standardized ambulatory technique and to determine its usefulness. METHODS: This is a retrospective study of ultrasound transvaginal punctures (core needle biopsies and cytologies) and drainages of pelvic lesions performed on an outpatient basis during the last two years. The punctures were made with local anesthesia, under transvaginal ultrasound guidance with an automatic or semi-automatic 18G biopsy needle with a length of 20-25 cm and a penetration depth of 12 or 22 mm. The material obtained was sent for anatomopathological, cytological and/or microbiological study if necessary. RESULTS: A total of 42 women were recruited in two centers. Fifty procedures (nine punctures, seven drains, and 34 biopsies) were performed. In five cases the punction and drain provided clinical relief in benign pelvic masses. Regarding material of the biopsies performed, 15 were vaginal in women previously histerectomized, finding 10 carcinomas, eight were ovarian tumours in advanced stages or peritoneal carcinomatosis obtaining the appropriate histology in each case, seven were suspicious cervical biopsies finding carcinomas in five of them, three were myometrial biopsies including one breast carcinoma metastasis in the miometrium and a benign placental nodule, and a periurethral biopsy was performed on a woman with a history of endometrial cancer confirming recurrence. The pathological diagnosis was satisfactory in all cases, confirming the nature of the lesion (25 malignant-ten vaginal recurrences of previous gynaecological cancers, eight cases of primary ovarian/peritoneal carcinoma, four new diagnosis of cervical malignant masses, one cervical metastasis of lymphoma, one periurethral recurrence of endometrial carcinoma and one recurrence of breast cancer in the myometrium-and 23 benign). The tolerance was excellent and no complications were detected. CONCLUSION: The ambulatory ultrasound transvaginal puncture and drainage technique is useful for obtaining a sample for pathological and microbiological diagnosis with excellent tolerance that can be used to rule out the recurrence of malignant lesions or progression of the disease, diagnose masses not accessible to gynecological exploration (vaginal vault, myometrium or cervix) and for early histologic diagnosis in cases of advanced peritoneal carcinomatosis or ovarian carcinoma as well as drainage and cytological study of cystic pelvic masses.

A Comparison Between Diabetic Foot Classifications WIfI, Saint Elian, and Texas: Description of Wounds and Clinical Outcomes.

Several wound classification systems are used to assess diabetic foot wounds. The recommendations for their use depend on the authors and foot associations. In this study, we compared Saint Elian score system, WIfI classification and Texas in 101 patients with foot wounds, and we followed them for a median of 149 days, finding differences both in the assigned risk and in the association with major amputation and wound healing. Saint Elian and WIfI scores match when Saint Elian is low or high risk but not when it is moderate. WIfI stages correlate with major amputation and wound healing. Saint Elian III correlates with major amputation. Prevalence of major amputations was 41% for WIfI 4 and 83% for Saint Elian III. WIfI 1 and 2 and Saint Elian I had a rate of wound healing of 80% to 85%. Stages 1 and 2 of WIfI score behave similar with regard to wound healing, 82% and 80% (P = .71), and major amputation, 0% and 10% (P = .68). Stages I and II of Saint Elian have the same rates of major amputation, 0% and 8% (P = .66), but not of wound healing, 85% and 51% (P < .05). The optimal cut point for detecting major amputation in Saint Elian is 18, with a sensitivity of 90.9 and specificity of 84.9, but there is no recommended cut point for wound healing. These classifications are validated for their use in diabetic foot wounds and to assess amputation risk, helping physicians make decisions and talk to the patients about prognosis.

Performance of QuantiFERON-TB Gold Plus assays in children and adolescents at risk of tuberculosis: a cross-sectional multicentre study.

INTRODUCTION: The QuantiFERON-TB Gold Plus (QFT-Plus) assay, which features two antigen-stimulated tubes (TB1 and TB2) instead of a single tube used in previous-generation interferon-gamma release assays (IGRAs), was launched in 2016. Despite this, data regarding the assay's performance in the paediatric setting remain scarce. This study aimed to determine the performance of QFT-Plus in a large cohort of children and adolescents at risk of tuberculosis (TB) in a low-burden setting. METHODS: Cross-sectional, multicentre study at healthcare institutions participating in the Spanish Paediatric TB Research Network, including patients <18 years who had a QFT-Plus performed between September 2016 and June 2020. RESULTS: Of 1726 patients (52.8% male, median age: 8.4 years), 260 (15.1%) underwent testing during contact tracing, 288 (16.7%) on clinical/radiological suspicion of tuberculosis disease (TBD), 649 (37.6%) during new-entrant migrant screening and 529 (30.6%) prior to initiation of immunosuppressive treatment. Overall, the sensitivity of QFT-Plus for TBD (n=189) and for latent tuberculosis infection (LTBI, n=195) was 83.6% and 68.2%, respectively. The agreement between QFT-Plus TB1 and TB2 antigen tubes was excellent (98.9%, κ=0.961). Only five (2.5%) patients with TBD had discordance between TB1 and TB2 results (TB1+/TB2-, n=2; TB1-/TB2+, n=3). Indeterminate assay results (n=54, 3.1%) were associated with young age, lymphopenia and elevated C reactive protein concentrations. CONCLUSIONS: Our non-comparative study indicates that QFT-Plus does not have greater sensitivity than previous-generation IGRAs in children in both TBD and LTBI. In TBD, the addition of the second antigen tube, TB2, does not enhance the assay's performance substantially.

[Atypical presentation of diabetic foot in post-COVID-19 patients]. / Presentación atípica de pie diabético en pacientes pos-COVID-19.

Medical attention of patients with a diabetic foot has been disrupted since de COVID-19 pandemic began, because health systems had to provide care to those patients affected by this disease to the detriment of the control of chronic diseases. Several reports show an increase in amputations during the pandemic, primarily due to the lack of health controls in patients suffering from diabetes or diabetic foot. This could have resulted in later consultation and more severe presentations. We describe three medical cases that had recently been affected by COVID-19 and developed a rare and rapidly evolving diabetic foot that required a major amputation. One possible explanation for this atypical presentation could be that COVID-19 predisposes patients to vein and arterial thrombosis due to systemic inflammation, platelet activation, endothelial dysfunction and stasis from prolonged immobility. This could have exacerbated chronic ischemia secondary to diabetes in which metabolic disturbances often seen in these patients predispose to atherosclerosis.

La atención de pacientes con pie diabético se vio afectada luego de la aparición de COVID-19, ya que los sistemas de salud debieron dar prioridad a la atención de dicha enfermedad y se restringió el control de las enfermedades crónicas. Existen algunas comunicaciones sobre el aumento de las amputaciones durante la pandemia, el cual fue atribuido principalmente a la falta de controles de los pacientes con diabetes y pie diabético. Esto pudo haber influido en la consulta tardía y en la aparición de presentaciones más graves. Presentamos los casos de tres pacientes con reciente enfermedad por COVID-19 que desarrollaron una forma atípica de pie diabético grave y rápidamente evolutiva cuyo desenlace fue la amputación mayor. Una posible explicación estaría relacionada a que los pacientes con COVID-19 tienen mayor riesgo de enfermedad trombótica, tanto venosa como arterial, debido a la intensa respuesta inflamatoria, la activación plaquetaria, la disfunción endotelial y la estasis sanguínea por inmovilización, que se asocia a esta enfermedad. Esto podría agravar la isquemia crónica que desarrollan las personas con diabetes, causada por el estado metabólico anormal que favorece la ateroesclerosis de todo el árbol vascular.

Presentación atípica de pie diabético en pacientes pos-COVID-19 / Atypical presentation of diabetic foot in post-COVID-19 patients

Resumen La atención de pacientes con pie diabético se vio afectada luego de la aparición de COVID-19, ya que los sistemas de salud debieron dar prioridad a la atención de dicha enfermedad y se restringió el control de las enfermedades crónicas. Existen algunas comunicaciones sobre el aumento de las amputaciones durante la pandemia, el cual fue atribuido principalmente a la falta de controles de los pacientes con diabetes y pie diabético. Esto pudo haber influido en la consulta tardía y en la aparición de presentaciones más graves. Presentamos los casos de tres pacientes con reciente enfermedad por COVID-19 que desarrollaron una forma atípica de pie diabético grave y rápidamente evolutiva cuyo desenlace fue la amputación mayor. Una posible explicación estaría relacionada a que los pacientes con COVID-19 tienen mayor riesgo de enfermedad trombótica, tanto venosa como arterial, debido a la intensa respuesta inflamatoria, la activación plaquetaria, la disfunción endotelial y la estasis sanguínea por inmovilización, que se asocia a esta enfermedad. Esto podría agravar la isquemia crónica que desarrollan las personas con diabetes, causada por el estado metabólico anormal que favorece la ateroesclerosis de todo el árbol vascular.

Abstract Medical attention of patients with a diabetic foot has been disrupted since de COVID-19 pandemic began, because health systems had to provide care to those patients affected by this disease to the detriment of the control of chronic diseases. Several reports show an increase in amputations during the pandemic, primarily due to the lack of health controls in patients suffering from diabetes or diabetic foot. This could have resulted in later consultation and more severe presentations. We describe three medical cases that had recently been affected by COVID-19 and developed a rare and rapidly evolving diabetic foot that required a major amputation. One possible explanation for this atypi cal presentation could be that COVID-19 predisposes patients to vein and arterial thrombosis due to systemic inflammation, platelet activation, endothelial dysfunction and stasis from prolonged immobility. This could have exacerbated chronic ischemia secondary to diabetes in which metabolic disturbances often seen in these patients predispose to atherosclerosis.

Developmental Differences in Platelet Inhibition Response to Prostaglandin E1.

BACKGROUND: The mechanisms underlying neonatal platelets hyporesponsiveness are not fully understood. While previous studies have demonstrated developmental impairment of agonist-induced platelet activation, differences in inhibitory signaling pathways have been scarcely investigated. OBJECTIVE: To compare neonatal and adult platelets with regard to inhibition of platelet reactivity by prostaglandin E1 (PGE1). METHODS: Platelet-rich plasma from umbilical cord (CB) or adult blood was incubated with PGE1 (0-1 µM). We assessed aggregation in response to adenosine diphosphate (ADP), collagen, and thrombin receptor activating peptide as well as cyclic adenosine 3'5'-monophosphate (cAMP) levels (ELISA). Gαs, Gαi2, and total- and phospho-protein kinase A (PKA) were evaluated in adult and CB ultrapure and washed platelets, respectively, by immunoblotting. RESULTS: Neonatal (vs. adult) platelets display hypersensitivity to inhibition by PGE1 of platelet aggregation induced by ADP and collagen (PGE1 IC50: 14 and 117 nM for ADP and collagen, respectively, vs. 149 and 491 nM in adults). They also show increased basal and PGE1-induced cAMP levels. Mechanistically, PGE1 acts by binding to the prostanoid receptor IP (prostacyclin receptor), which couples to the Gαs protein-adenylate cyclase axis and increases intracellular levels of cAMP. cAMP activates PKA, which phosphorylates different target inhibitor proteins. Neonatal platelets showed higher basal and PGE1-induced cAMP levels, higher Gαs protein expression, and a trend to increased PKA-dependent protein phosphorylation compared to adult platelets. CONCLUSION: Neonatal platelets have a functionally increased PGE1-cAMP-PKA axis. This finding supports a downregulation of inhibitory when going from neonate to adult contributing to neonatal platelet hyporesponsiveness.

[Infections in diabetic foot. Choice of empirical antibiotic regimen]. / Infecciones en pie diabético. Elección del tratamiento antibiótico empírico.

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

Infecciones en pie diabético: Elección del tratamiento antibiótico empírico / Infections in diabetic foot. Choice of empirical antibiotic regimen

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Significado de la anemia en las diferentes etapas de la vida / Significance of anaemia in the different stages of life

Resumen: La anemia presenta una elevada prevalencia en las consultas de atención primaria y pediatría, y la ADH representa el 50% de todos los casos de anemia. Metodología: Revisión bibliográfica y análisis descriptivo documental sobre etiopatogenia de la anemia ferropénica, las pruebas diagnósticas básicas para el estudio de la ADH y su significado, utilizando una temporalidad determinada en la búsqueda documental y criterios de inclusión atendiendo a las dimensiones que se analizan en el estudio: Nociones acerca del metabolismo del hierro. Nociones acerca de la hematopoyesis. Diagnóstico por el laboratorio y clasificación de las anemias. Clínica de la anemia ferropénica. Causas de la deficiencia de hierro. Resultados y conclusión: EL estudio documental efectuado nos presenta la existencia de publicaciones con contenidos sobre etiopatogenia de la anemia ferropénica, las pruebas diagnósticas básicas para el estudio de la ADH y su significado, evidenciando la importancia de este contenido para el profesional de enfermería en el área de la atención primaria y pediatría (AU)

Overview: Anemia is very common in primary care consultations and pediatrics, and IDA is the cause of 50% of all cases of anemia. Methodology: Literature review and documentary descriptive analysis of the pathogenesis of iron-deficiency anemia, the basic diagnostic tests to study IDA and the significance of such using a specific time period in the documentary search and inclusion criteria that takes into account factors that are analyzed in the study: Ideas about the metabolism of iron. Ideas about hematopoiesis. Laboratory diagnosis and classification of anemia. Clinical features of iron deficiency anemia. Causes of iron deficiency. Results and conclusion: The staged documentary study covers the publications on the pathogenesis of iron deficiency anemia, the basic diagnostic tests to study the IDA and the significance of such, and it shows how important this data is for professional nursing in the area of primary care and pediatrics, to identify it and act accordingly

Simple descriptors and simple rules of the International Ovarian Tumor Analysis (IOTA) Group: a prospective study of combined use for the description of adnexal masses.

OBJECTIVE: External validation of the IOTA group's three-step diagnostic model (Strategy 1) and comparison with assessment by an expert sonographer (Strategy 2). STUDY DESIGN: Prospective study in patients with persistent adnexal masses, in which an inexperienced sonographer performed transvaginal ultrasound applying simple descriptors (SD) and rules (SR) for classifying as benign or malignant. Any non-classifiable mass was then submitted to an expert examiner for subjective assessment (SA). RESULTS: Eighty-one patients (mean age, 43; 27.2% postmenopausal) were included in this prospective study. Surgery was performed for 30 (8 malignant and 22 benign) masses; 51 masses were considered as benign and managed expectantly (they were assumed to be benign for statistical purposes). Diagnostic performance for Strategy 1 (SD+SR+SA) was sensitivity (SN): 87.5% (7/8, 95% CI, 47.3-99.7%) and specificity (SP): 100% (73/73, 95% CI, 95.1-100%). For Strategy 2 (SA only) it was SN 87.5% (7/8, 95% CI, 47.3-99.7%), SP 98.6% (72/73, 95% CI, 92.6-100%). CONCLUSIONS: The three-step diagnostic strategy designed by the IOTA group for adnexal masses has a diagnostic performance comparable to that of subjective expert assessment and could be used as a triage method by nonexpert sonographers.

Instrumentos de marketing para controle de qualidade de alimentos e bebidas no mercado de alimentação fora do lar / Marketing instruments for food and beverages quality control in food service

OBJETIVO O mercado de alimentação fora do lar vem se consolidando como o setor que mais cresce na industria de alimentação no Brasil. Os departamentos de marketing dos diversos segmentos desse setor estão alinhados aos seus fornecedores quanto à crescente demanda dos consumidores por alimentos de qualidade e que proporcionem o bem-estar. Nesse sentido realizou-se um trabalho com o objetivo de desenvolver instrumentos avaliadores da qualidade sensorial de alimentos e bebidas a serem utilizados pelos departamentos de marketing em cafeterias. MÉTODOS Para desenvolvimento e aplicação dos instrumentos foram selecionados dois produtos de grande consumo em cafeteiras na cidade de São Paulo: café expresso e brownie. Os instrumentos foram desenvolvidos na forma de questionários para caracterização da população e realização dos testes sensoriais afetivos. Para detectar a aceitação do consumidor pelo café foram utilizadas escalas hedônicas de nove pontos e para verificar a preferência por uma das receitas de brownie foi utilizada a comparação pareada. RESULTADOS A aplicação dos instrumentos foi simples, rápida e contou com a colaboração de todos os consumidores que foram abordados no momento da compra dos produtos. O café obteve em média 98 por cento de aceitação em todos os atributos, refletindo a satisfação dos consumidores e a eficiência nos procedimentos de preparo. O teste do brownie mostrou que não houve preferência sendo possível a substituição da receita antiga pela nova formulação (mais nutritiva e mais econômica). CONCLUSÕES Os instrumentos propostos e aplicados para avaliação da qualidade sensorial do café e brownie pelos consumidores se mostraram viáveis para execução em cafeterias, além da possibilidade da adaptação para outros produtos e migração para outros segmentos do mercado de alimentação fora do lar

Antioxidant systems and their relationship with the response of pepper fruits to storage at 20 degrees C.

Fresh peppers (Capsicum annuum L., variety California) in their green and red ripe stages were stored at 20 degrees C for 7 and 19 days to determine the effects of storage on whole fruit antioxidant capacity (TAA) and ascorbate (ASC) content, as well as on some antioxidant enzyme activities, such as catalase (CAT), superoxide dismutase (SOD), and those of the ASC-glutathione cycle. At least one Mn-SOD, two Fe-SODs, and three CuZn-SODs were detected in the fruit extract after native polyacrylamide gel electrophoresis. All of the SOD isozymes and glutathione reductase had higher activity levels in the red control fruits than in the green fruits, whereas the activities of monodehydroascorbate and dehydroascorbate reductase were higher in green fruits. Ascorbate peroxidase (APX) was found to be similar in both fruits. SODs, CAT, and APX seem to be involved in pepper fruit ripening and senescence during storage at 20 degrees C, perhaps influencing the active oxygen species levels in the fruit. TAA, as well as the ASC content, was higher in red peppers than in green, and storage increased the ASC in both green and red fruits.

Hemodynamic state and the role of angiotensin II in ovarian hyperstimulation syndrome in the rabbit.

OBJECTIVE: To investigate the hemodynamic state in the ovarian hyperstimulation syndrome (OHSS) in the rabbit model and to determine the role of angiotensin II in the pathophysiology of this syndrome. DESIGN: Experimental study. SETTING: Physiology laboratory. ANIMAL(S): Female New Zealand rabbits were studied; 16 rabbits were stimulated with gonadotropins, and 6 were controls. Six of the stimulated rabbits received additional treatment with captopril. MAIN OUTCOME MEASURE(S): Cardiac index, blood pressure, and heart rate were recorded. RESULT(S): Gonadotropin-stimulated rabbits had significant enlargement of ovaries that was not modified by captopril. Ascites was present in 80% of animals in the OHSS group; captopril significantly decreased the incidence and volume of ascites. The three groups did not differ in blood pressure, heart rate, cardiac index, and total peripheral resistance. CONCLUSION(S): In rabbits with OHSS, ascites are a primary event. Such animals are normotensive and have normal vascular resistance and cardiac index. Angiotensin-converting enzyme inhibition decreases the incidence of OHSS in the rabbit model by 30%, suggesting that angiotensin II may play a role in the formation of ascites.