Calidad microbiológica de las aguas termales del balneario "El Tingo". Pichincha. Ecuador / Microbial Quality of the Thermal Waters of the Spa "El Tingo". Pichincha. Ecuador

OBJETIVO: El propósito del trabajo fue determinar la calidad microbiológica del agua termal del Balneario "El Tingo", situado a 2500 msnm, Provincia de Pichincha, Ecuador. Materiales y MÉTODOS: Se realizaron cuatro muestreos en diferentes épocas del año y en dos zonas del Balneario. Se determinaron "in situ" los parámetros fisicoquímicos (conductividad, dureza, oxígeno disuelto, pH y temperatura). La cuantificación de bacterias heterótrofas, coliformes y hongos se hizo en medios de cultivos específicos para cada grupo microbiano. La identificación de las cepas bacterianas aisladas se realizó de acuerdo con lo indicado por MacFaddin (2004). RESULTADOS: Los resultados indican que el agua termal del Tingo se clasifica como de conductividad muy fuerte, mineralización excesiva, aguas muy duras, con muy poco oxígeno disuelto, pH neutro e hipertermales. El contaje promedio de bacterias heterótrofas en el agua contenida en la cisterna del balneario fue de 2,10 X 102 UFC/mL, coliformes totales de 0,30 X 10 UFC/mL y hongos 1,00 X 10 UFC/mL. Para las duchas de agua termal los valores promedios fueron de 2,42 X 102 UFC/mL de bacterias heterótrofas, 0,85 X 10 UFC/mL coliformes totales y 0,68 X 10 UFC/mL de hongos. No se detectó la presencia de Escherichia coli en ninguna de las muestras analizadas. Se identificaron 14 cepas Gram negativas de los géneros Aeromonas, Burkholderia, Citrobacter y Pseudomonas, 5 Gram positivas de los géneros Bacillus y Staphylococcus y 2 cepas fúngicas del género Aspergillus. CONCLUSIONES: Los resultados obtenidos demuestran una población microbiana escasa y poco diversa, lo que implica una buena calidad del agua y de los acuíferos

OBJECTIVE: The purpose of research was determining the microbiological quality of the thermal water of the "El Tingo" Spa, located at 2500 mamsl, Pichincha Province, Ecuador. METHODS: Four samplings were carried out at different times of the year and in two areas of the Spa. The physicochemical parameters (conductivity, hardness, dissolved oxygen, pH, dissolved solids and temperature) were determined "in situ". The heterotrophic bacteria, coliforms and molds was determined, as well as the identification of the isolated strains according to the indicated by MacFaddin (2004). RESULTS: The Tingo thermal water is classified as very strong conductivity, excessive mineralization, very hard water, with very little dissolved oxygen, neutral pH and hyperthermal. The average count of heterotrophic bacteria in the water contained in the cistern of the spa were 2.10 X 102 CFU / mL, coliforms 0.30 X 10 CFU / mL and fungi1,00 X 10 CFU / mL. For the thermal water showers, the average values were 2.42 X 102 CFU/ mL of heterotrophic bacteria, 0.85 X 10 CFU / mL coliforms and 0.68 X 10 CFU/ mLfungi. Escherichia coli were not detectedin any of the samples. It was possible to identify 14 Gram negative strains of the genus Aeromonas, Burkholderia, Citrobacter and Pseudomonas, 5 Gram positive of the genera Bacillus and Staphylococcus and 2 fungal strains of the genus Aspergillus

Two-Year Safety and Effectiveness of Peficitinib in Moderate-To-Severe Rheumatoid Arthritis: A Phase IIb, Open-Label Extension Study.

INTRODUCTION: Peficitinib is a novel orally bioavailable, once-daily Janus kinase (JAK) inhibitor approved in Japan for the treatment of rheumatoid arthritis (RA). This 2-year extension study of two global phase IIb trials investigated the long-term safety and effectiveness of peficitinib. METHODS: All eligible patients with moderate-to-severe RA including patients in the placebo group who participated in one of two global phase IIb trials ('with methotrexate' or 'without methotrexate') were included in this 2-year open-label extension study and were converted to peficitinib 100 mg once daily. The primary objective was to evaluate an additional 2 years of safety by assessing treatment-emergent adverse events (AEs) and clinical laboratory evaluations for 105 weeks. Evaluation of an additional 2 years of effectiveness using American College of Rheumatology (ACR) 20/50/70 responses was the exploratory objective. RESULTS: Overall, 611 patients were enrolled in the extension study: 319 (52.2%) patients completed the study and 292 (48%) discontinued treatment, including for withdrawal of patient consent (n = 96), failure to achieve low disease activity (n = 62), and AE not including death (n = 41). AEs were reported in 463 (76%) patients. The most common AEs (per 100 patient-years) were upper respiratory tract infections (9.9) and urinary tract infections (7.2). Serious AEs were reported in 80 (13%) patients, with incidences per 100 patient-years of serious infections 2.7, herpes zoster 1.5 (including one herpes zoster ophthalmic), and malignancies 0.6 (most frequently basal cell carcinoma). At week 105, 269 (44%) patients demonstrated an ACR20 response relative to their respective phase IIb trial baselines. CONCLUSION: Among 319 patients who completed this 2-year extension of two global phase IIb studies, peficitinib 100 mg once daily demonstrated a stable safety profile and sustained effectiveness in patients with moderate-to-severe RA. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT01711814. Registered 19 October 2012. FUNDING: Astellas Pharma Global Development, Inc.

Common carotid artery intima-media thickness: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study results.

BACKGROUND: Measurement of far wall common carotid artery intima-media thickness (CCAIMT) has emerged as a predictor of incident cardiovascular events. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was the first large-scale population-based assessment of both CCAIMT and cardiovascular risk factor prevalence in 7 Latin American cities; the relationship between CCAIMT and cardiovascular risk markers was assessed in these urban Latin American centers. METHODS: CARMELA was a cross-sectional, population-based, observational study using stratified, multistage sampling. The participants completed a questionnaire, were evaluated in a clinical visit and underwent carotid ultrasonography. Clinical measurements were obtained by health personnel trained, certified and supervised by CARMELA investigators. Mannheim intima-media thickness consensus guidelines were followed for measurement of CCAIMT. RESULTS: In all cities and for both sexes, CCAIMT increased with higher age. CCAIMT was greater in the presence of cardiovascular risk factors than in their absence. In all cities, there was a statistically significant linear trend between increasing CCAIMT and a growing number of cardiovascular risk factors (p < 0.001). After adjustment for age and sex, metabolic syndrome was strongly associated with increased CCAIMT (p < 0.001 in all cities), as were hypercholesterolemia, obesity and diabetes (p < 0.001 in most cities). By multivariate analysis, hypertension was independently associated with an increase in CCAIMT in all cities (p < 0.01). CONCLUSIONS: CARMELA was the first large-scale population study to provide normal CCAIMT values according to age and sex in urban Latin American populations and to show CCAIMT increases in the presence of cardiovascular risk factors and metabolic syndrome.

Hypertension in seven Latin American cities: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study.

BACKGROUND: Little information is available regarding hypertension, treatment, and control in urban population of Latin America. OBJECTIVE: We aimed to compare blood pressure (BP) distribution, hypertension prevalence, treatment, and control in seven Latin American cities following standard methodology. METHODS: The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was a cross-sectional, epidemiologic study assessing cardiovascular risk factors using stratified multistage sampling of adult populations (aged 25-64 years) in seven cities: Barquisimeto (Venezuela; n = 1848); Bogotá (n = 1553); Buenos Aires (n = 1482); Lima (n = 1652); Mexico City (n = 1720); Quito (n = 1638); and Santiago (n = 1655). The prevalence of hypertension and high normal BP were determined based on 2007 European Society of Hypertension and European Society of Cardiology definitions. RESULTS: BP increased with age in men and women; pulse pressure increased mainly in the upper age group. The hypertension prevalence ranged from 9% in Quito to 29% in Buenos Aires. One-quarter to one-half of the hypertension cases were previously undiagnosed (24% in Mexico City to 47% in Lima); uncontrolled hypertension ranged from 12% (Lima) to 41% (Mexico City). High normal BP was also evident in a substantial number of each city participants (approximately 5-15%). Majority of population has other cardiovascular risk factors despite hypertension; only 9.19% of participants have no risk factors apart from hypertension. CONCLUSION: From 13.4 to 44.2% of the populations of seven major Latin American cities were hypertensive or had high normal BP values. Most hypertensive patients have additional risk factors. Public health programs need to target prevention, detection, treatment, and control of total cardiovascular risk in Latin America.

Cardiovascular risk awareness, treatment, and control in urban Latin America.

Effective prevention and treatment of cardiovascular diseases require regular screening for risk factors, high awareness of the condition, effective treatment of the identified risk factors, and adherence to the prescribed treatment. The Cardiovascular Risk Factor Multiple Evaluation in Latin America study was a cross-sectional, population-based, observational study of major cardiovascular risk factors-including hypertension, diabetes, and hypercholesterolemia-in 7 Latin American cities. This report presents data on assessment, diagnosis, extent, and effectiveness of treatment, adherence to treatment, and reasons for nonadherence. Data were collected through household questionnaire-based interviews administered to 5383 men and 6167 women, 25-64 years of age, living in the following cities: Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. Participants also completed a clinic visit for anthromorphometric and laboratory assessments. Rates of prior diagnosis of hypertension and diabetes were high (64% and 78% of affected individuals, respectively) but relatively low for hypercholesterolemia (41%). The majority of affected individuals (hypercholesterolemia 88%, diabetes 67%, and hypertension 53%) were untreated. Among individuals who were receiving pharmacologic treatment, targets for control of hypertension, diabetes, and hypercholesterolemia were achieved by 51%, 16%, and 52%, respectively. Adherence to treatment was observed in 69% of individuals with hypertension, 63% with diabetes, and 66% with hypercholesterolemia. Forgetfulness was the major cause of nonadherence for all 3 conditions. There is a substantial need for increasing patient education, diagnosis, treatment, adherence, and control of cardiovascular risk factors in the 7 Latin American cities.

Dyslipidemia in seven Latin American cities: CARMELA study.

OBJECTIVE: The objective of this study was to describe the prevalence of dyslipidemia in the CARMELA study population. METHODS: CARMELA was a cross-sectional study of cardiovascular risk conducted between September 2003 and August 2005 in adults (aged 25 to 64 years) living in Barquisimeto (n=1,824), Bogotá (n=1,511), Buenos Aires (n=1,412), Lima (n=1,628), Mexico City (n=1,677), Quito (n=1,620), and Santiago (n=1,605). Dyslipidemia was defined as the presence of one or more of the following conditions: triglycerides>/=200 mg/dL, or total cholesterol (TC)>/=240 mg/dL, or HDL cholesterol<40 mg/dL, or LDL cholesterol=not optimal, or currently taking antilipemic agents. RESULTS: Prevalence rates of dyslipidemia in men and women were: 75.5% (CI: 71.9-79.1) and 48.7% (CI: 45.4-51.9) in Barquisimeto; 70% (CI: 66.2-73.8) and 47.7% (CI: 43.9-51.5) in Bogotá; 50.4% (CI: 46.8-54.0) and 24.1% (CI: 21.0-27.2) in Buenos Aires; 73.1% (CI: 69.3-76.8) and 62.8% (CI: 59.2-66.5) in Lima; 62.5% (CI: 58.5-66.5) and 37.5% (CI: 33.5-41.6) in Mexico City; 52.2% (CI: 47.9-56.5) and 38.1% (CI: 34.5-41.7) in Quito; and, 50.8% (CI: 47.1-54.4) and 32.8% (CI: 29.3-36.3) in Santiago. CONCLUSIONS: Dyslipidemia was disturbingly prevalent and varied across cities. The most frequent dyslipidemia was low HDL-C followed by high triglycerides. The high TC/HDL-C ratios and non-HDL-C levels suggest a high risk of cardiovascular disease.

Prevalence of the metabolic syndrome in Latin America and its association with sub-clinical carotid atherosclerosis: the CARMELA cross sectional study.

BACKGROUND: Metabolic syndrome increases cardiovascular risk. Limited information on its prevalence in Latin America is available. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study included assessment of metabolic syndrome in 7 urban Latin American populations. METHODS: CARMELA was a cross-sectional, population-based, observational study conducted in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. The prevalence of metabolic syndrome, defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and associated carotid atherosclerosis were investigated in 11,502 participants aged 25 to 64 years. RESULTS: Across CARMELA cities, metabolic syndrome was most prevalent in Mexico City (27%) and Barquisimeto (26%), followed by Santiago (21%), Bogota (20%), Lima (18%), Buenos Aires (17%), and Quito (14%). In nondiabetic participants, prevalence was slightly lower but followed a comparable ranking. Overall, 59%, 59%, and 73% of women with high triglycerides, hypertension, or glucose abnormalities, respectively, and 64%, 48% and 71% of men with abdominal obesity, hypertension, or glucose abnormalities, respectively, had the full metabolic syndrome. Prevalence of metabolic syndrome increased with age, markedly so in women. Mean common carotid artery intima-media thickness (CCAIMT) and prevalence of carotid plaque increased steeply with increasing numbers of metabolic syndrome components; mean CCAIMT was higher and plaque more prevalent in participants with metabolic syndrome than without. CONCLUSION: The prevalence of metabolic syndrome and its components by NCEP ATP III criteria was substantial across cities, ranging from 14% to 27%. CARMELA findings, including evidence of the association of metabolic syndrome and carotid atherosclerosis, should inform appropriate clinical and public health interventions.

CARMELA: assessment of cardiovascular risk in seven Latin American cities.

OBJECTIVE: This cross-sectional, population-based observational study using stratified multistage sampling assessed the prevalence of cardiovascular risk factors and carotid plaques and measured carotid intima-media thickness in individuals living in major cities in 7 Latin American countries. PATIENTS AND METHODS: The study comprised individuals (n=11,550) aged 25 to 64 years, living in Barquisimeto, Bogota, Buenos Aires, Lima, Mexico City, Quito, and Santiago. Data on anthropometric parameters, blood pressure, fasting glucose, total and high-density lipoprotein cholesterol, triglycerides, carotid intima-media thickness, carotid plaque, and smoking status were collected through household interviews and clinical, biochemical, and sonographic measurements. RESULTS: The overall prevalence rates (ranges across cities) were as follows: hypertension (> or = 140/90 mm Hg or pharmacologic treatment), 18% (9%-29%); hypercholesterolemia (total cholesterol > or = 240 mg/dL), 14% (6%-20%); diabetes (glycemia > or = 126 mg/dL or self-reported diabetes), 7% (4%-9%); metabolic syndrome, 20% (14%-27%); obesity (body mass index > or = 30 kg/m2), 23% (18%-27%); smoking, 30% (22%-45%); and plaque, 8% (5%-14%). The mean intima-media thickness was 0.65 mm (0.60-0.74 mm). CONCLUSION: The prevalence of hypertension mirrored the world average in 3 cities but was lower in the rest. Hypercholesterolemia was highly prevalent even in countries of different socioeconomic levels. The prevalence of diabetes was similar to that in the developed countries. Tobacco use in women living in Santiago and Buenos Aires was among the world's highest. Intima-media thickness and carotid plaque prevalences varied widely.

Valdecoxib is as efficacious as diclofenac in the treatment of acute low back pain.

OBJECTIVE: To compare the efficacy of valdecoxib 40 mg q.d. (with a second dose on day 1) with diclofenac 75 mg b.i.d. in the treatment of acute low back pain. METHODS: This was a multicenter, randomized, double-blind study. Patients with acute low back pain, class 1a or 2a (Quebec Task Force), with a visual analog scale score >/=50 mm (on a 100-mm scale) and moderate to severe pain on a categorical scale, were randomized to valdecoxib 40 mg q.d. (with a second dose on day 1) or diclofenac 75 mg b.i.d. for 7 days (170 patients per group). The primary efficacy end point was change in pain intensity (visual analog scale, mm) from baseline to day 3 for the per-protocol population. RESULTS: Least squares mean reductions in pain intensity from baseline to day 3 were similar for valdecoxib (-42.02 mm) and diclofenac (-41.43 mm). Valdecoxib was comparable to diclofenac as the lower limit of the 95% confidence interval of the estimated difference (0.59 mm; 95% confidence interval, -3.40 to 4.59 mm) was within the prespecified noninferiority margin of -10 mm. The overall incidence of adverse events was similar for valdecoxib (28%) and diclofenac (26%). No statistically different moderate or severe upper gastrointestinal adverse events were reported, although they were numerically greater for diclofenac (8) than for valdecoxib (3). DISCUSSION: Valdecoxib 40 mg q.d. (with a second dose on day 1) provides effective relief for acute low back pain, and was at least as efficacious as diclofenac 75 mg b.i.d., with a nonsignificant but numerically lower incidence of gastrointestinal adverse events.

Carotid artery intima media thickness, plaque and Framingham cardiovascular score in Asia, Africa/Middle East and Latin America: the PARC-AALA study.

OBJECTIVE: The PARC-AALA (Paroi artérielle et Risque Cardiovasculaire in Asia Africa/ Middle East and Latin America) study was designed to evaluate the correlation between intima-media thickness of the common carotid artery (CCAIMT), carotid plaque and absolute cardiovascular risk in a multi-ethnic population. METHODS: An international, cross-sectional, study including 79 centres from 21 countries in Asia, Africa, the Middle East and Latin America. Two thousand three hundred and twenty-eight subjects, meeting all inclusion criteria, were stratified by risk factors groups (no modifiable factor or at least both uncontrolled hypertension and hypercholesterolemia). CCAIMT, presence of plaque and cardiovascular risk factors were assessed for each individual. RESULTS: Some intergeographical characteristics in demographics, and risk factors were found accompanying early atherosclerosis marker differences. In Asia where the subjects were at lower risk, the mean CCAIMT was 4% lower than in Africa/Middle East and Latin America. On multiple linear regression analysis CCAIMT and carotid plaque were independently associated with increased Framingham cardiovascular score (FCS) without heterogeneity across geographic regions. CCAIMT and carotid plaque explained roughly 20% of the FCS in both genders. CONCLUSION: The PARC-AALA study confirms the correlation between CCAIMT and FCS in three different populations. Intima-media thickness (IMT) and plaque evaluation may represent a complementary predictive tool for detection of cardiovascular disease in individuals.

Sertralina en TOC: estudio abierto, multicentrico no comparativo / Sertraline in Obsessive Compulsive disorder an open, multicentric, non-comparative study

Con el objetivo de evaluarla eficacia y seguridad de dosis fijas de sertralina en pacientes con Trastorno obsesivo- compulsivo (TOC) con y sin depresión mayor comórbida, se realizó un estudio abierto, multicéntríco, no comparativo en el que se incluyeron 52 pacientes, entre 18 y 65 años de edad, en su mayoría mujeres (65 por ciento) en seis centros en Colombia. 38 de los pacientes tuvieron diagnóstico de TOC y depresión mayor concomitante. El período de tratamiento fue de 16 a 32 semanas con una dosis variable (50 o 200 mg diarios), de acuerdo a respuesta clínica en la octava o decimosexta semana. Los pacientes respondieron en similar proporción al tratamiento con sertralina independientemente de la comorbilidad con depresión mayor. Con la dosis fija de 50 mg/día, la escala Y-BOCS se redujo en promedio un 44 por ciento en la 8a semana, y 63 por ciento en la semana 16 de tratamiento (p<0.0001). La escala de ICGyHAM-D siguieron la misma tendencia (p< 0.001). Ocho de los pacientes fueron cambiados a 200 mg. Fueron reportados eventos adversos leves y moderados por 21 pacientes: cefalea (15 por ciento) y náuseas (12 por ciento). Se concluyó que la dosis fija de 50 mg/dta de sertralina fue efectiva en la mayoría de pacientes (85 por ciento). La sertralina fue bien tolerada y la seguridad fue similar a la reportada en otros estudios

Indice de masa corporal. Adecuación energética e ingreso monetario familiar en estudiantes de enfermería de Quito

Se realiza un estudio transversal en 48 estudiantes femeninas de enfermería en las que se evalúa el índice de masa corpoal, la recomendación y adecuación energética individual según las normas FAO/OMS/UNU, y el ingreso familiar monetario. el promedio de índice de masa corporal es de 23.18, el 5.1 por ciento presenta déficit energético crónico y 23.1 por ciento obesidad de primer grado. El promedio de adecuación energética es 102,75 por ciento. El 35 por ciento de las alumnas se encuentra en el intervalo normal, el 37.5 por ciento por encima de la norma y el 27,5 por ciento por debajo de la norma de la adecuación energética. El 90.2 por ciento de las familias de las estudiantes no tienen acceso a la canasta familiar básica y el 46.3 por ciento no acceden a la canasta familiar de pobreza, establecidas por el Instituto Nacional de Estadísticas y Censos del Ecuador (INEC)...