Prescription of non-steroidal anti-inflammatory and antirheumatic drugs in outpatient hypertensive patients.

BACKGROUND: It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. OBJECTIVE: Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. MATERIAL AND METHODS: Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. RESULTS: Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. CONCLUSIONS: The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.

ANTECEDENTES: Los antiinflamatorios y los antirreumáticos no esteroideos (AINE) disminuyen la eficacia de algunos antihipertensivos. OBJETIVO: Analizar el patrón de prescripción de AINE y las variables asociadas en pacientes ambulatorios con diagnóstico de hipertensión arterial, así como explorar algunas características de los médicos prescriptores. MATERIAL Y MÉTODOS: Estudio transversal de pacientes con hipertensión de la Unidad de Medicina Familiar 24 en Ciudad Mante, Tamaulipas. De los pacientes se registraron datos sociodemográficos, antecedentes patológicos y tratamientos farmacológicos; y de los médicos, información sociodemográfica y académica. RESULTADOS: La edad promedio de los pacientes fue de 63 ± 11 años, 31.7 % recibía AINE y al contrastarlos con quienes no los recibían, se identificó mayor proporción de obesidad, presión arterial más elevada, más casos en descontrol de la hipertensión arterial, multimorbilidad y polimedicación. Las variables asociadas a la prescripción de AINE fueron estar en descontrol de la hipertensión arterial, multimorbilidad y polimedicación; 56.7 % de los médicos prescriptores fue del sexo femenino, 83.3 % con antigüedad superior a 10 años y 33.3 % con certificación vigente. CONCLUSIONES: La prescripción inapropiada de AINE reveló la necesidad de implementar acciones para mitigar el riesgo potencial de los pacientes hipertensos de presentar una complicación.

Analysis of the immune response using FTIR spectroscopy in mothers and their newborns with different vaccination schemes for COVID-19.

The SARS-CoV-2 outbreak has provoked more than 6 million deaths worldwide. The scarcity of effective treatments and its virulence converted the vaccines into an essential tool to face it. The most used vaccines were the mRNA, adenovirus vector, and inactivated whole-virus. However, nowadays, infants aged < 6 months are not eligible for any vaccines against COVID-19, and their immunization relies on passive immunity. In this research, we investigated the humoral and cellular immune response generated on newborns of SARS-CoV-2 vaccinated mothers with mRNA or viral vector (VV) vaccine employing Fourier transformed infrared (FTIR) spectroscopy in saliva samples. For this purpose, saliva samples of newborns and their mothers were collected; the population was divided into two groups, VV and mRNA, which were subdivided into three subgroups: before pregnancy (BP), at the first (FTP) and second (STP) trimesters of pregnancy. The samples were analyzed using FTIR spectroscopy, and the bands associated with the humoral and cellular immune responses, such as IgG, IgA, and IFN-γ were analyzed. The integrated areas were calculated and compared to elucidate the quantity of those immunoglobins and the cytokine. Likewise, the correlation of the humoral and cellular immune response between the newborns and their mothers and the correlation between cellular and humoral immune response was also evaluated. The VV vaccine produced a significant humoral and cellular immune response in newborns and their mothers when they received it at the STP compared with the mRNA vaccine, evidencing statistical significance. However, no correlation was observed between newborns and their mothers when the vaccine was applied in this trimester of pregnancy. When administered BP, the mRNA vaccine generated more humoral immunity in newborns and their mothers. Nevertheless, compared with the VV vaccine, it only showed statistical significance in the mothers, highlighting that IgG showed a moderate positive correlation between the newborns and their mothers.

Two-trace two-dimensional correlation spectra (2T2D-COS) analysis using FTIR spectra to monitor the immune response by COVID-19.

There is a growing trend in using saliva for SARS-CoV-2 detection with reasonable accuracy. We have studied the responses of IgA, IgG, and IgM in human saliva by directly comparing disease with control analyzing two-trace two-dimensional correlation spectra (2T2D-COS) employing Fourier transform infrared (FTIR) spectra. It explores the molecular-level variation between control and COVID-19 saliva samples. The advantage of 2T2D spectra is that it helps in discriminating remarkably subtle features between two simple pairs of spectra. It gives spectral information from highly overlapped bands associated with different systems. The clinical findings from 2T2D show the decrease of IgG and IgM salivary antibodies in the 50, 60, 65, and 75-years COVID-19 samples. Among the various COVID-19 populations studied the female 30-years group reveals defense mechanisms exhibited by IgM and IgA. Lipids and fatty acids decrease, resulting in lipid oxidation due to the SARS-CoV-2 in the samples studied. Study shows salivary thiocyanate plays defense against SARS-CoV-2 in the male population in 25 and 35 age groups. The receiver operation characteristics statistical method shows a sensitivity of 98% and a specificity of 94% for the samples studied. The measure of accuracy computed as F score and G score has a high value, supporting our study's validation. Thus, 2T2D-COS analysis can potentially monitor the progression of immunoglobulin's response function to COVID-19 with reasonable accuracy, which could help diagnose clinical trials. KEY MESSAGES: The molecular profile of salivary antibodies is well resolved and identified from 2T2D-COS FTIR spectra. The IgG antibody plays a significant role in the defense mechanism against SARS-CoV-2 in 25-40 years. 2T2D-COS reveals the absence of salivary thiocyanate in the 40-75 years COVID-19 population. The receiver operation characteristic (ROC) analysis validates our study with high sensitivity and specificity.

Skin wound healing improvement in diabetic mice through FTIR microspectroscopy after implanting pluripotent stem cells.

Diabetes is a chronic degenerative disease that carries multiple complications. One of the most important complications is the diabetic cutaneous complications, such as skin lesions, ulcerations, and diabetic foot, which are present in 30%-70% of the patients. Currently, the treatments for wound healing include growth factors and cytokines, skin substitutes, hyperbaric oxygen therapy, and skin grafts. However, these treatments are ineffective due to the complex mechanisms involved in developing unhealed wounds. Considering the aforementioned complications, regenerative medicine has focused on this pathology using stem cells to improve these complications. However, it is essential to mention that there is a poor biomolecular understanding of diabetic skin and the effects of treating it with stem cells. For this reason, herein, we investigated the employment of pluripotent stem cells (PSC) in the wound healing process by carrying out morphometric, histological, and Fourier-transform infrared microspectroscopy (FTIRM) analysis. The morphometric analysis was done through a photographic follow-up, measuring the lesion areas. For the histological analysis, hematoxylin & eosin and picrosirius red stains were used to examine the thickness of the epidermis and the cellularity index in the dermis as well as the content and arrangement of collagen type I and III fibers. Finally, for the FTIRM analysis, skin cryosections were obtained and analyzed by employing a Cassegrain objective of 16× of an FTIR microscope coupled to an FTIR spectrometer. For this purpose, 20 mice were divided into two groups according to the treatment they received: the Isotonic Salt Solution (ISS) group and the PSCs group (n = 10). Both groups were induced to diabetes, and six days after diabetes induction, an excisional lesion was made in the dorsal area. Furthermore, using microscopy and FTIRM analysis, the skin healing process on days 7 and 15 post-skin lesion excision was examined. The results showed that the wound healing process over time, considering the lesion size, was similar in both groups; however, the PSCs group evidenced hair follicles in the wound. Moreover, the histological analysis evidenced that the PSCs group exhibited granulation tissue, new vessels, and better polarity of the keratinocytes. In addition, the amount of collagen increased with a good deposition and orientation, highlighting that type III collagen fibers were more abundant in the PSCs. Finally, the FTIR analysis evidenced that the PSCs group exhibited a faster wound healing process. In conclusion, the wounds treated with PSCs showed a more rapid wound healing process, less inflammatory cellular infiltration, and more ordered structures than the ISS group.

Detection of People Positive to COVID-19 through ATR-FTIR Spectra Analysis of Saliva using Machine Learning / Detección de Personas Positivas a COVID-19 mediante el Análisis de Espectros ATR-FTIR de Muestras de Saliva empleando Machine Learning

ABSTRACT COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. This virus's spread is mainly through droplets released from the nose or mouth of an infected person. Although vaccines have been developed that effectively reduce the effects that this viral infection causes, the most effective method to contain the virus's spread is numerous tests to detect and isolate possible carriers. However, the response time, combined with the cost of actual tests, makes this option impractical. Herein, we compare some machine learning methodologies to propose a reliable strategy to detect people positive to COVID-19, analyzing saliva spectra obtained by Fourier transform infrared (FTIR) spectroscopy. After analyzing 1275 spectra, with 7 strategies commonly used in machine learning, we concluded that a multivariate linear regression model (MLMR) turns out to be the best option to identify possible infected persons. According to our results, the displacement observed in the region of the amide I of the spectrum, is fundamental and reliable to establish a border from the change in slope that causes this displacement that allows us to characterize the carriers of the virus. Being more agile and cheaper than reverse transcriptase polymerase chain reaction (RT-PCR), it could be reliably applied as a preliminary strategy to RT-PCR.

RESUMEN La COVID-19 es una enfermedad infecciosa ocasionada por el virus SARS-CoV-2. La propagación de este virus se produce principalmente a través de gotitas liberadas por la nariz o la boca de una persona infectada. Aunque se han desarrollado vacunas que permiten reducir efectivamente los efectos que esta infección viral provoca, el método más eficaz para contener la propagación del virus son las numerosas pruebas para detectar y aislar los posibles portadores. Sin embargo, el tiempo de respuesta, combinado con el costo de las pruebas reales, hace que esta opción sea poco práctica. Aquí, comparamos algunas metodologías de machine learning para proponer una estrategia confiable para detectar personas positivas a COVID-19 analizando espectros de saliva obtenidos por espectroscopia infrarroja transformada de Fourier (FTIR). Tras analizar 1275 espectros, con 7 estrategias comúnmente empleadas en el área de machine learning, concluimos que un modelo de regresión lineal multivariante (MLMR) resulta ser la mejor opción para identificar posibles infectados. De acuerdo con nuestros resultados, el desplazamiento observado en la región de la amida I del espectro, resulta fundamental y confiable para establecer una frontera a partir del cambio de pendiente que este provoca. Al ser más ágil y económica que la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR), podría aplicarse confiablemente como estrategia preliminar a RT-PCR.

ATR-FTIR spectrum analysis of saliva samples from COVID-19 positive patients.

The coronavirus disease 2019 (COVID-19) is the latest biological hazard for the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even though numerous diagnostic tests for SARS-CoV-2 have been proposed, new diagnosis strategies are being developed, looking for less expensive methods to be used as screening. This study aimed to establish salivary vibrational modes analyzed by attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy to detect COVID-19 biological fingerprints that allow the discrimination between COVID-19 and healthy patients. Clinical dates, laboratories, and saliva samples of COVID-19 patients (N = 255) and healthy persons (N = 1209) were obtained and analyzed through ATR-FTIR spectroscopy. Then, a multivariate linear regression model (MLRM) was developed. The COVID-19 patients showed low SaO2, cough, dyspnea, headache, and fever principally. C-reactive protein, lactate dehydrogenase, fibrinogen, D-dimer, and ferritin were the most important altered laboratory blood tests, which were increased. In addition, changes in amide I and immunoglobulin regions were evidenced in the FTIR spectra analysis, and the MLRM showed clear discrimination between both groups. Specific salivary vibrational modes employing ATR-FTIR spectroscopy were established; moreover, the COVID-19 biological fingerprint in saliva was characterized, allowing the COVID-19 detection using an MLRM, which could be helpful for the development of new diagnostic devices.

Culturally and Linguistically Appropriate Hospital Services Reduce Medicare Length of Stay.

Introduction: Almost 40% of the 63 million Americans who speak a language other than English have limited English proficiency (LEP). This communication barrier can result in poor quality care and potentially adverse health outcomes. Of particular interest is that the greatest proportion of LEP adults are aged >65 years and will face barriers and delays in accessing high-quality care. Age cohort variation of LEP burden has not been widely addressed. Culturally and linguistically appropriate hospital care delivery can mitigate these barriers. Methods: In order to test whether culturally competent services reduced length-of-stay (LOS), we linked organizational cultural competence surveys across two-states (CA+FL) for comparison across Medicare acute care LOS. Using the 2013 American Hospital Association Database, and Hospital Compare Data from CMS (N=184), we compared hospital structure with culturally and linguistically appropriate services related to improved care delivery for LEP populations and aging LEP populations. We utilized Kruskal-Wallis to test group differences and a negative binomial regression to model median LOS. All analyses were conducted using SAS 9.4 (Cary, NC). Results: Median LOS across all hospitals was 4.7 days (mean 5.7, standard deviation 6.3). Most hospitals were not-for-profit (46.7%), small (<150 beds, 54.4%), Joint Commission accredited (67.9%), and in urban areas. We found shorter median LOS when hospital units identified cultural or language needs at admission (Wald χ23.82, P=.0506). Hospitals' identification of these needs at discharge had no impact on LOS. Hospitals that accommodated patient cultural or ethnic dietary needs also reported lower median LOS (Wald χ2 12.93, P=.0003). Structurally, public hospitals, accredited hospitals, and hospitals that reported system membership were predictive of a lower median LOS. Discussion: Our findings demonstrate that patient outcomes are responsive to culturally and linguistically appropriate services. Further, our findings suggest understanding of culturally competent care in hospitals is lacking. A larger and multi-level sample across the United States could yield a greater understanding of the role of culturally and linguistically appropriate care for a rapidly growing population of diverse older adults.

Psicosis depresiva como forma de presentación de un tumor cerebral / Depressive Psychosis as an Onset Symptom of a Brain Tumor

Introducción: Los tumores cerebrales a veces tienen una presentación clínica compleja y atípica en sus inicios, en dependencia de su localización, lo que puede confundirse con trastornos de la esfera psiquiátrica. Objetivo: Describir un caso clínico interpretado como una psicosis por su sintomatología cuyo diagnóstico resultó un glioblastoma multiforme de alta malignidad. Caso clínico: Mujer de 35 años que comienza desde hace varios meses con trastornos de la conducta, síntomas depresivos, irritabilidad y conflictos en el hogar. Se instala un cuadro de depresión profunda que no mejora con tratamiento farmacológico impuesto por psiquiatría y se decide tratamiento electroconvulsivo, después del cual cae en estado de coma con elementos de hipertensión intracraneal y focalización neurológica. La tomografía de urgencia evidencia un tumor intracraneal, con áreas de necrosis, infiltración y desplazamiento de estructuras adyacentes y signos de hipertensión intracraneal. Al realizar intervención microquirúrgica fallece. La necropsia reveló glioblastoma multiforme de alta malignidad con focos de necrosis y de hemorragias. Conclusiones: La depresión y manifestaciones de trastornos mentales pueden tener causa orgánica, un hecho que debe considerarse en el contexto clínico. La historia clínica bien obtenida, la evaluación psicopatológica y las técnicas de imágenes en la actualidad son herramientas fundamentales en la precisión diagnóstica(AU)

Introduction: Brain tumors sometimes have a complex and atypical clinical presentation at the beginning, depending on their location, which can be mistaken for psychiatric disorders. Objective: To describe a clinical case interpreted as a psychosis for its symptoms and whose diagnosis was a highly malignant glioblastoma multiforme. Clinical case: This is the case of a 35-year-old woman who, several months ago, started to present behavioral disorders, depressive symptoms, irritability, and conflicts at home. Clinical signs of deep depression onset, which does not improve with pharmacological treatment prescribed by the psychiatry specialist; electroconvulsive treatment is decided, after which she falls into a coma with elements of intracranial hypertension and a neurological focus. The emergency tomography shows an intracranial tumor, with necrotic areas, infiltration, and displacement of adjacent structures, as well as signs of intracranial hypertension. When microsurgical intervention is performed, she died. The necropsy revealed highly malignant glioblastoma multiforme with necrosis focuses and hemorrhage. Conclusions: Depression and manifestations of mental disorders may have an organic cause, a fact that must be considered in the clinical setting. A well-obtained clinical history, psychopathological evaluation, and imaging techniques are currently essential tools for an accurate diagnosis(AU)

Characterization of the Biological Fingerprint and Identification of Associated Parameters in Stress Fractures by FTIR Spectroscopy.

INTRODUCTION: The stress fractures (SFs) are a common condition in athletes and military recruits, characterized by partial fracture caused by repetitive applications of stresses that are lower than the stress required to fracture the bone in a single loading. Fourier transform infrared (FTIR) spectroscopy gives information about the bone composition and also can determine the amount of a molecule. For this reason, the FTIR spectroscopy may be used as a tool for diagnosis of certain bone diseases related to the bone strength. In this research, we established the contributions of mineral and collagen properties to SF risk through FTIR spectroscopy, analyzing the biochemical profile differences between the healthy bone and the bone with an SF. MATERIALS AND METHODS: Previous written informed consent was obtained, and samples of the hip with an SF (n = 11) and healthy bone from the femur with traumatic fracture (n = 5) were obtained and analyzed employing FTIR spectroscopy and its biochemical mapping function. Then, using FTIR spectra and the map, the collagen content and ratios corresponding to matrix maturity, mineralization, carbonate substitution, acid phosphate substitution, and crystallinity were calculated. Moreover, a histopathological analysis through Masson's staining was conducted. RESULTS: The biochemical analysis showed that the bone with an SF presented a bone immaturity characterized by a higher content of collagen, lower matrix maturity, mineralization, carbonate and acid phosphate substitutions, and greater crystallinity compared to the healthy bone, being checked by the ratio analysis and biochemical mapping. Besides, Masson's stain showed a higher collagen content in the bone with an SF. CONCLUSIONS: The bone with an SF presented alterations in its biochemical composition, showing bone immaturity, which broadens the panorama of the condition to investigate future treatments or prophylactic techniques.

Sobrevida en pacientes con Esclerosis Lateral Amiotrófica / Survival in patients with Amyotrophic Lateral Sclerosis

RESUMEN Introducción: La esclerosis lateral amiotrófica (ELA) es la más frecuente del grupo heterogéneo de las enfermedades de la motoneurona. Objetivo: Caracterizar la sobrevida de los pacientes con diagnóstico de esclerosis lateral amiotrófica partiendo de factores relacionados con su comportamiento clínico en el Instituto Nacional de Neurología y Neurocirugía "Dr. José Rafael Estrada González" de a Habana, Cuba. Material y Métodos: Se realizó una investigación descriptiva y retrospectiva de una serie de 147 casos de pacientes diagnosticados con ELA, por la confirmación clínica, neurofisiológica e imágenes, atendidos en la consulta multidisciplinaria en el periodo de octubre de 2005 a octubre de 2015, de los cuales ya han fallecido 110. Resultados: La mayor frecuencia de la enfermedad por grupos de edades estuvo entre 51 y 60 años. En los primeros 40 meses murió la mayor parte de los pacientes (80). La forma clínica espinal predominó en varones quienes, además, tuvieron mayor sobrevida, la bulbar prevaleció en mujeres. El mayor número de pacientes no tenía factores de riesgo. Entre las comorbilidades destacan la diabetes, hipertensión arterial, enfermedad cerebrovascular isquémica, neoplasias, hepatitis C, traumatismo craneal, asma bronquial y la cardiopatía isquémica, y hubo casos de la enfermedad en una misma familia. Conclusiones: La mayor sobrevida desde el diagnóstico de la enfermedad estuvo en el grupo de 51 a 60 años alcanzando algunos hasta 10 años. El promedio general de sobrevida estuvo entre 2 y 5 años. En los pacientes con comorbilidades, antecedentes familiares y forma bulbar, la sobrevida fue menor. La supervivencia al evaluar la efectividad del tratamiento con Riluzol no fue significativa.

ABSTRACT Introduction: Amyotrophic lateral sclerosis (ALS) is the most frequent disease in the heterogeneous group of disorders with motor neuron diseases. Objective: To characterize the survival of patients diagnosed with amyotrophic lateral sclerosis considering factors related to their clinical behavior at "Dr. Jose Rafael Estrada Gonzalez" National Institute of Neurology and Neurosurgery, Havana, Cuba. Material and Methods: A descriptive and retrospective research was conducted. The study included a case series of 147 patients diagnosed with ALS by clinical and neurophysiological confirmation and images. The patients were treated in the multidisciplinary consultation in the period from October 2005 to October 2015. A total of 110 of them already died. Results: The disease most often occurs between the ages of 51 and 60. In the first 40 months, most of the patients in the series died, for a total of 80 people. The spinal clinical form predominated in males who had higher survival; the bulbar form prevailed in women. Most of the patients had no risk factors. Diabetes, arterial hypertension, ischemic cerebrovascular disease, neoplasms, hepatitis C, head trauma, bronchial asthma and ischemic heart disease stand out as comorbidities. There were cases of the disease within a single family. Conclusions: The greatest survival from the diagnosis of the disease was observed in the group between 51 and 60 years of diagnosis of the disease, some of them reaching up to 10 years. The general average of survival was between 2 and 5 years. It was lower in patients with comorbidities, family history and bulbar form. After evaluating the effectiveness of the treatment with Riluzole, the survival was not significant.

Screening for Toxic Stress Risk Factors at Well-Child Visits: The Addressing Social Key Questions for Health Study.

OBJECTIVES: To determine the prevalence of and demographic characteristics associated with toxic stress risk factors by universal screening, the impact of screening on referral rates to community resources, and the feasibility and acceptability of screening in a medical home setting. STUDY DESIGN: We developed the Addressing Social Key Questions for Health Questionnaire, a 13-question screen of adverse childhood experiences (ACEs) and unmet social needs. Parents/guardians of children 0-17 years of age received this questionnaire at well-child visits at 4 academic clinics from August 1, 2016 to February 28, 2017. Providers reviewed the tool and referred to community resources as needed. A subset of families completed demographic and satisfaction surveys. Prevalence of ACEs and unmet social needs, community referral rates at 1 site with available data, and family acceptability data were collected. Analyses included frequency distributions, χ2 tests, and Poisson regression. RESULTS: Of 2569 families completing an Addressing Social Key Questions for Health Questionnaire, 49% reported ≥1 stressor; 6% had ≥1 ACE; 47% had ≥1 unmet social need. At 1 site, community referral rates increased from 2.0% to 13.3% (P < .0001) after screening implementation. Risk factors for having a stressor include male sex and African American or Hispanic race. 86% of 446 families want clinics to continue screening. CONCLUSIONS: Universal screening for toxic stress risk factors in pediatric primary care improved identification and management of family needs. Screening was feasible and acceptable to families. Prevalence of unmet social needs but not ACEs was comparable with prior studies. Further evaluation and modification of the screening protocol is needed to increase screening and identification.

Infarto isquémico mesencefálico: síndrome de Weber / Ischemic mesencephalic infarction: Weber's syndrome

La enfermedad cerebrovascular constituye la tercera causa de muerte en la población adulta, la primera causa de discapacidad a escala mundial y la segunda causa de demencia, problema de salud actual relacionado con otras enfermedades crónicas no transmisibles. Se presenta un caso de un infarto isquémico mesencefálico aterotrombótico en una anciana de 77 años con la expresión clínica de un síndrome de Weber. El síndrome de Weber es uno de los síndromes cruzados o alternos de la clínica y la neurología por lesión peduncular. Es poco frecuente y a la vez, el más frecuente de los alternos de tronco encefálico(AU)

Cerebrovascular disease is the third leading cause of death in the adult population, the leading cause of disability worldwide and the second cause of dementia. It is a current health problem related to other chronic noncommunicable diseases. We present a case of atherothrombotic mesencephalic ischemic infarction in a 77-year-old woman with the clinical expression of Weber syndrome, which is a crossed or alternating clinical syndrome and neurology by pedicle injury. It is rare and, at the same time, the most frequent alternating brainstem(AU)

Consumer Health Informatics Adoption among Underserved Populations: Thinking beyond the Digital Divide.

OBJECTIVES: Underserved populations can benefit from consumer health informatics (CHI) that promotes self-management at a lower cost. However, prior literature suggested that the digital divide and low motivation constituted barriers to CHI adoption. Despite increased Internet use, underserved populations continue to show slow CHI uptake. The aim of the paper is to revisit barriers and facilitators that may impact CHI adoption among underserved populations. METHODS: We surveyed the past five years of literature. We searched PubMed for articles published between 2012 and 2017 that describe empirical evaluations involving CHI use by underserved populations. We abstracted and summarized data about facilitators and barriers impacting CHI adoption. RESULTS: From 645 search results, after abstract and full-text screening, 13 publications met the inclusion criteria of identifying barriers to and facilitators of underserved populations' CHI adoption. Contrary to earlier literature, the studies suggested that the motivation to improve health literacy and adopt technology was high among studied populations. Beyond the digital divide, barriers included: low health and computer literacy, challenges in accepting the presented information, poor usability, and unclear content. Factors associated with increased use were: user needs for information, user-access mediated by a proxy person, and early user engagement in system design. CONCLUSIONS: While the digital divide remains a barrier, newer studies show that high motivation for CHI use exists. However, simply gaining access to technology is not sufficient to improve adoption unless CHI technology is tailored to address user needs. Future interventions should consider building larger empirical evidence on identifying CHI barriers and facilitators.

Las enfermedades crónicas no transmisibles: magnitud actual y tendencias futuras / Non Transmissible Chronic Diseases: Current Magnitude and Future Trends

El tratamiento de las enfermedades crónicas no transmisibles constituye en la actualidad uno de los mayores retos que enfrentan los sistemas de salud a nivel mundial. Esto se debe a que dichas enfermedades afectan a todos los grupos de edad y a todas las regiones y países, con independencia de su grado de desarrollo. Cuba no está exenta de ello. Sin embargo, la Organización Mundial de la Salud señala que se realiza un manejo inadecuado de estos padecimientos, por diferentes razones, en la mayoría de los sistemas de salud. El objetivo del presente artículo, es lograr la concientización de la problemática actual y futura de las enfermedades crónicas, donde la prevención y promoción de salud sigue siendo el arma fundamental para combatir el reto. Se debe tener en cuenta la importancia de estos conocimientos para el personal profesional en formación, la necesidad de establecer estrategias presentes y futuras para garantizar la salud de nuestra población, fundamentalmente desde la atención primaria y las organizaciones vinculados a ellas. La población, que resulta la más afectada, debe tomar mayor conciencia de lo que representa, en general, padecer una enfermedad crónica.

The treatment to non-transmissible chronic diseases is currently on of the greatest challenges faced by the health systems worldwide. This is due to the fact that these diseases affect all age groups, all regions and countries regardless their level of development. Cuba is not the exception. The World Health Organization, however, points out that there is an inadequate management of these ailments, for different reasons, in most of the health systems. The objective of this article is the awareness of the current and future problem of chronic diseases where health promotion and prevention still is the main weapon to fight the challenge. The importance of these elements should be taken into consideration from the personnel in training, the need to set present and future strategies to guarantee the health of our population, mainly from the primary health care attention and organizations linked to them. The most affected population should be aware of what suffering from a chronic disease represents in general.

NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.

BACKGROUND: Although decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs). PURPOSE: The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of NEC. METHODS: Using the Translating Research into Practice (TRIP) framework, we conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations using GRADE criteria across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship. Sub-groups answered 5 key questions, reviewed 11 position statements and 71 research reports. Meta-analyses with random effects were conducted on effects of standardized feeding protocols and donor human milk derived fortifiers on NEC. RESULTS: Quality of evidence ranged from very low (timely recognition) to moderate (feeding protocols, prioritize human milk, limiting antibiotics and antacids). Prioritizing human milk, feeding protocols and avoiding antacids were strongly recommended. Weak recommendations (i.e. "probably do it") for limiting antibiotics and use of a standard timely recognition approach are presented. Meta-analysis of data from infants weighing <1250 g fed donor human milk based fortifier had reduced odds of NEC compared to those fed cow's milk based fortifier (OR = 0.36, 95% CI 0.13, 1.00; p = 0.05; 4 studies, N = 1164). Use of standardized feeding protocols for infants <1500 g reduced odds of NEC by 67% (OR = 0.33, 95% CI 0.17, 0.65, p = 0.001; 9 studies; N = 4755 infants). Parents recommended that NEC information be shared early in the NICU stay, when feedings were adjusted, or feeding intolerance occurred via print and video materials to supplement verbal instruction. DISCUSSION: Evidence for NEC prevention is of sufficient quality to implement. Implementation that addresses system-level interventions that engage the whole team, including parents, will yield the best impact to prevent NEC and foster its timely recognition.

Distrofia miotónica de Steinert. Presentación de un caso / Steinert’s Myotonic Dystrophy. Case Presentation

Frecuentemente la insuficiencia cardiaca es la consecuencia final de diversas enfermedades cardiovasculares; pero en raros casos no sucede así, ya que se reconocen otras causas menos frecuentes por daño miocárdico. Puede ser el resultado de algunos trastornos genéticos, representados por algunas miocardiopatías, hemoglobinopatías, desórdenes mendelianos de la matriz extracelular y enfermedades neuromusculares. Estas últimas incluyen una enfermedad muy poco frecuente, con herencia autosómica dominante, conocida como distrofia miotónica tipo 1 o enfermedad de Steinert. Esta enfermedad se caracteriza por la variabilidad de su expresión, que incluye afectación cardiaca. Se presenta el caso de un paciente atendido en Servicio de Urgencias y Emergencias, con disnea marcada, insuficiencia cardiaca y sin factores de riesgo cardiovascular identificados. En el examen clínico se constató arritmia, distrofia muscular, calvicie y signos miotónicos. Después de realizar algunos exámenes se concluyó con el diagnóstico de miotonía de Steinert. El interés de esta comunicación radica en que se trata de una enfermedad rara; incluso, puede ser de utilidad en el contexto docente.

Heart failure is frequently the final consequence of diverse cardiovascular diseases, but in rare cases it does not happen because some other infrequent causes are identified for myocardial damage. It may be the result of some genetic disorders, represented by some myocardiopathies, hemoglobinopathies, mendelian disorders of the extracellular matrix and neuromuscular diseases. The last ones include an infrequent disease, autosomal dominant inheritance, known as myotonic dystrophy type 1 or Steinert’s disease. This disease is characterized by the variability in its presentation, which include cardiac involvement. A case treated at the Emergency and Urgency Service is presented with marked dyspnea, cardiac failure and without identified cardiovascular risk factors. On clinical examination it was observed arrhythmia, muscular dystrophy, baldness and myotonic signs. After analyzing some tests it was concluded with a diagnosis of Steinert’s Myotonia. The interest of this communication is that it is in relation with a rare disease; it may even be useful in the teaching context.

Adulto mayor: propuesta de abordaje de la neumonía adquirida en la comunidad / Older Adults: A Proposal for the Management of Community-acquired Pneumonia

Fundamento: la neumonía adquirida en la comunidad constituye la causa principal de hospitalización entre los ancianos. Su letalidad es elevada. En la actualidad existen diversos scores de riesgo y pronóstico, así como diferentes Guías Prácticas Clínicas.Objetivo: elaborar una propuesta para el abordaje de la neumonía adquirida en la comunidad en el anciano, aplicable tanto en la Atención Primaria de Salud, como en la hospitalización.Métodos: se realizó la búsqueda de información mediante términos de indexación sobre neumonía adquirida en la comunidad, en especial en el adulto mayor o anciano, así como guías existentes nacionales y de diferentes países, sociedades y consensos regionales a través de Clinical Evidence, The Cochrane Library, PUBMED, Google Académico, MEDLINE, LIS, Scielo, Medscape, LILACS, Latindex, HINARI, MEDIGRAPHIC-NEWS y otros. Se asumieron aquellas publicaciones que reunían las evidencias de mayor calidad de acuerdo con los criterios de Grading of Recommendations of Assessment Development and Evaluations. Resultados: se elaboró una propuesta de abordaje práctico en cualquier nivel de atención de nuestro sistema de salud y teniendo en cuenta el cuadro básico de medicamentos actual. Se consideró la epidemiología, factores de riesgo, estratificación del riesgo, tratamiento y letalidad. Conclusiones: la neumonía adquirida en la comunidad constituye un problema actual y un reto futuro. Esta propuesta puede ser utilizada por los profesionales que participan en la asistencia de esta afección en cualquier nivel de atención. Su aplicación pudiera mejorar la atención médica, disminuir la letalidad, los costos y mejorar la calidad de vida.

Background: community-acquired pneumonia is the leading cause of hospitalization among older adults. It has a high fatality rate. At present, there are several risk and prognosis scores and different clinical practice guidelines available. Objective: to develop a proposal for the management of community-acquired pneumonia in older adults, applicable in both primary care, and the hospital setting. Methods: a search on community-acquired pneumonia, especially in older adults or the elderly, was conducted using index terms and existing guidelines from different countries, companies and regional consensus included in Clinical Evidence, The Cochrane Library, PubMed, Google Scholar, MEDLINE, LIS, Scielo, Medscape, LILACS, Latindex, HINARI, MEDIGRAPHIC-NEWS and others. The publications providing high-quality evidence in accordance with the criteria of the Grading of Recommendations, Assessment, Development and Evaluations approach were selected. Results: a proposal for practical management of community-acquired pneumonia at any level of care in our health system was developed considering the list of medications currently available in the country. Epidemiology, risk factors, risk stratification, treatment, and fatality rate were considered. Conclusions: community-acquired pneumonia is a current problem and future challenge. This proposal can be used by professionals treating this condition at any level of care. Its application could improve care and quality of life and reduce the fatality rate and costs.

Management options for obesity after bariatric surgery.

INTRODUCTION: Many patients do not maintain weight loss after gastric bypass. We compared outcomes for patients undergoing diet/exercise intervention with patients undergoing surgical intervention through restorative obesity surgery-endolumenal, band over bypass, and endoscopic gastro gastric fistula closure. METHODS: We hypothesized surgery would result in greater weight loss. A retrospective analysis was performed on a bariatric database. Patients who underwent gastric bypass and failed to lose weight were selected and evaluated after intervention. Records were reevaluated at 3, 6, and 12 months after intervention for primary outcomes, that is, weight loss and comorbidity resolution. RESULTS: A total of 60 patients met the criteria. Forty-three underwent nonsurgical management; 17 underwent operative intervention. Mean body mass index decreased significantly in surgical patients compared with patients with supervised weight loss (P=0.001). Interventional patients trended toward better comorbidity resolution. CONCLUSIONS: Restorative obesity surgery-endolumenal, band over bypass, and endoscopic fistula closure results in greater weight loss and trend toward greater comorbidity resolution compared with diet and exercise.

Laparoscopic modified Sugarbaker technique results in superior recurrence rate.

BACKGROUND: Parastomal hernia (PH) is a frequent complication of stoma formation, occurring in 35-50% of patients. Recurrence after repair is common, ranging from 24 to 54% of cases. We hypothesized that repair using a laparoscopic modified Sugarbaker technique (SB) would result in a superior recurrence rate when compared with other repairs. METHODS: An Institutional Review Board-approved retrospective review of patients who underwent PH repair between 2004 and 2011 was performed. We collected demographics, factors related to ostomy formation, risk factors for hernia, intraoperative and postoperative information, as well as the absence or presence of PH on their last physical examination or imaging study. RESULTS: Forty-nine PH repairs were performed: 33 (67%) para-ileostomy and 16 (33%) para-colostomy. Repairs included 14 laparoscopic modified SB, 19 laparoscopic keyhole, 11 ostomy re-sitings, and 5 open primary repairs. There was no statistically significant difference between groups when comparing age, BMI, smoking status, steroid use, ostomy type, location, primary diagnoses, or complication rate. Recurrence rates were 0% for SB, 58% for keyhole, 64% for re-siting, and 20% for open repair. When SB was compared with all groups, the incidence of recurrence was significantly lower (p < 0.001) but follow-up was as well (7.2 vs 32.7 months). When analysis was restricted to the 28 repairs performed between 2009 and 2011, there was no significant difference between the groups in terms of demographics or follow-up period (7.2 months for SB group versus 11.8 months for all others), but again there was a significant difference in recurrence (0 of 14 for the SB group vs 8 of 14, p < 0.01). In addition, there were no differences in postoperative complication rates among all techniques. CONCLUSION: The modified SB technique may offer patients a significant decrease in the risk of recurrence compared with other PH repair techniques with no significant increase in postoperative complications.