Intervenciones hacia la Prueba de Antígeno Prostático: Una revisión rápida de literatura / Interventions for Prostate-Specific Antigen Testing: A Rapid Literature Review

Objetivo: Identificar la mejor evidencia disponible relacionada a las intervenciones dirigidas hacia la aceptación de la prueba de antígeno prostático. Metodología: Revisión rápida de literatura, siguiendo los pasos establecidos por Tapia-Benavente, los cuales son: 1.- pregunta de investigación, para lo cual se utilizó la estructura PICO acotada a la definición del problema, intervención y resultado; 2.- búsqueda de bibliografía en bases de datos reconocidas; 3.- selección de estudios y extracción de datos; 4.- evaluación del riesgo de sesgo, para lo cual se utilizó la guía de comprobación de ensayos clínicos del grupo CONSORT; y 5.- la elaboración de la síntesis además de la conclusión de la evidencia encontrada. Resultados: La búsqueda rápida de literatura arrojó un total de 51 publicaciones de tres bases de datos, PubMed (27), EBSCO (13) y SCOPUS (11); de los cuales 11 cumplían con los criterios de inclusión. El 100% de los estudios indican un cambio significativo entre el grupo experimental y control (p < .05). Las estrategias más utilizadas incluyen la visita domiciliaria, conferencias, debates en grupo, lluvia de ideas, dinámicas de pregunta y respuesta con diapositivas, así como presentación de folletos educativos, mismos que se ejecutan en un periodo de un día, hasta seis meses. Conclusiones: Se hace evidente el vacío de conocimiento referente al desarrollo e implementación de estrategias para abordar la conducta de prevención relacionada al Cancer de Próstata hacia varones de pueblos originarios, así como la falta de modelos de intervención de enfermería enfocadas en este padecimiento. (AU)

Objective: To identify the best available evidence related to interventions for the acceptance of the prostate-specific antigen test. Methodology: Rapid literature review following the steps established by Tapia-Benavente, which are: 1.- research question, for which the PICO structure limited to the definition of the problem, intervention, and result was used; 2.- bibliography search in recognized databases; 3.- study selection and data extraction; 4.- bias risk assessment, for which the CONSORT group clinical trial verification guidelines were used; and 5.- preparation of a summary and conclusion of the evidence found. Results: The rapid literature search yielded a total of 51 publications from three databases, PubMed (27), EBSCO (13), and SCOPUS (11); 11 of which met the inclusion criteria. One hundred percent of the studies indicated a significant difference between the experimental and control groups (p < .05). The most frequently used strategies included home visits, conferences, group discussions, brainstorming, question-and-answer dynamics with slides, as well as the use of educational brochures, and were carried out in a period of one day and up to six months. Conclusions: There is an evident knowledge gap in the development and implementation of strategies for Prostate Cancer prevention behavior directed to indigenous men, as well as a lack of nursing intervention models focused on this disease. (AU)

Real-world effectiveness and safety of sensor-augmented insulin pump therapy in adults with type 1 diabetes: Long-term follow-up.

OBJECTIVE: To evaluate the effectiveness and safety of sensor-augmented insulin pump therapy (SAP) in addition to a comprehensive diabetes program on glycated hemoglobin (HbA1c), severe hypoglycemia, ketoacidosis, and the hospital admission rate in patients with type 1 diabetes under real-world settings during a 2-year follow-up. METHODS: This was a retrospective real-life study comparing diabetes control before and after SAP therapy initiation. Patients ≥18 years old with type 1 diabetes were included. They were followed for 2 years with clinical assessments at months 3, 6, 12, 18, and 24. Effectiveness was estimated by difference in medians of HbA1c from baseline and at each follow-up visit. Safety was assessed by comparing the annual rates of severe hypoglycemia, hyperglycemic crisis, and hospital admission related to diabetes. RESULTS: 162 patients were included, median age 32 years, women 73%). The main indication for SAP was poor metabolic control (51.2%). At 2 years HbA1c decreased from 8.4% to 7.5% (-0.9%, 95% CI: 0.5-1.2; p<0.0001), HbA1c ≤7% improved from 14.2% to 25.3% (11.1%, 95% CI: 19.7-2.5; p=0.006), and severe hypoglycemia decreased from 22.2% to 14.1% (-8.1%, 95% CI: -16.5 to 0.3; p=0.03). CONCLUSIONS: SAP therapy improved glycemic control after the third month of use and for up to 2 years of follow-up, with lower rates of hospital admission and severe hypoglycemia. More studies are needed to assess the add-on impact of education programs and technologies for diabetes care.

Real-world effectiveness and safety of sensor-augmented insulin pump therapy in adults with type 1 diabetes: Long-term follow-up.

OBJECTIVE: To evaluate the effectiveness and safety of sensor-augmented insulin pump therapy (SAP) in addition to a comprehensive diabetes program on glycated hemoglobin (HbA1c), severe hypoglycemia, ketoacidosis, and the hospital admission rate in patients with type 1 diabetes under real-world settings during a 2-year follow-up. METHODS: This was a retrospective real-life study comparing diabetes control before and after SAP therapy initiation. Patients ≥18 years old with type 1 diabetes were included. They were followed for 2 years with clinical assessments at months 3, 6, 12, 18, and 24. Effectiveness was estimated by difference in medians of HbA1c from baseline and at each follow-up visit. Safety was assessed by comparing the annual rates of severe hypoglycemia, hyperglycemic crisis, and hospital admission related to diabetes. RESULTS: 162 patients were included, median age 32 years, women 73%). The main indication for SAP was poor metabolic control (51.2%). At 2 years HbA1c decreased from 8.4% to 7.5% (-0.9%, 95% CI: 0.5-1.2; p<0.0001), HbA1c ≤7% improved from 14.2% to 25.3% (11.1%, 95% CI: 19.7-2.5; p=0.006), and severe hypoglycemia decreased from 22.2% to 14.1% (-8.1%, 95% CI: -16.5 to 0.3; p=0.03). CONCLUSIONS: SAP therapy improved glycemic control after the third month of use and for up to 2 years of follow-up, with lower rates of hospital admission and severe hypoglycemia. More studies are needed to assess the add-on impact of education programs and technologies for diabetes care.

Riedel's Thyroiditis: Report of Two Cases and Literature Review.

Riedel's thyroiditis is a rare entity consisting of a fibrotic process of the thyroid which can generate gland destruction, infiltration of cervical structures and even airway obstruction. It has been associated with systemic fibrotic disorders, autoimmune diseases, and more recently with spectrum of diseases related to excess of Immunoglobulin G type 4 (IgG4). Two cases of Riedel's thyroiditis by IgG4, confirmed by immunohistochemistry and was managed surgically with favorable results during the follow-up time, are presented. These case descriptions highlight the diagnostic challenge of this disease, describe the response with surgical management, and make a brief update on the subject.

Enfermedad Cerebro Vascular Isquémica. Comportamiento preventivo. Policlínico No. 1. Manzanillo / Ischemic Cerebrovascular Disease. A preventive treatment. Polyclinic I. Manzanillo

Se realizó un estudio del comportamiento de la Enfermedad Cerebro Vascular Isquémica en 23 pacientes, pertenecientes a 10 Consultorios del Médico de la Familia del Policlínico Integral Docente No 1 de Manzanillo, en el período comprendido entre febrero 2010 y diciembre 2013, se analizaron variables del comportamiento intrahospitalario y extrahospitalario. Más de la mitad estuvo comprendido entre 50 y 69 años de edad con predominio en el sexo femenino, 14 pacientes de estos debutaron en su forma aterotrombótica. La evaluación neurológica manifestó su mayor representatividad entre 13 y 15 puntos para la escala de Glasgow en la evaluación inicial. El antecedente patológico personal de hipertensiónarterial alcanzó su mayor representación en la forma aterotrombótica, y la cardiopatía isquémica para la forma cardioembólica(AU)

It was carried out a study of the behavior of the Ischemic Cerebrovascular disease in 23 patients belonging to 10 Family medical offices of the Teaching Integrated Polyclinic I in Manzanillo, during the period of February 2010 to December 2013. There were analyzed the variables of the intrahospital and extrahospital behavior. More than a half were in the group of 50-69 years old, prevailing the female sex, 14 patients presented the atherothrombotic form. The neurologic assessment had its greatest representativity about 13-15 scores for the Glasgow scale in the initial evaluation. The personal pathological antecedent of hypertension reached its greatest representation in the atherothrombotic form and the ischemic cardiopathy for the cardioembolic form(EU)

Resultados del tratamiento microquirúrgico de la hernia discal lumbar / Results of the microsurgical treatment of lumbar discal hernia

Se realizó un estudio prospectivo de intervención a 168 pacientes con el diagnóstico de hernia discal lumbar. A todos se les practicaron estudios radiológicos simples pre y postoperatorios: Tomografía Axial Computarizada o Resonancia Magnética Nuclear. Se evaluaron elementos del cuadro clínico en el pre y postoperatorios. Se realizó la investigación con el objetivo de describir la aplicación de la técnica microquirúrgica, que permitió la aplicación de la discectomía simple por foraminotomía en la mayoría de los pacientes, con verdadera herniación discal y en el nivel l5-S1(AU)

It was performed a prospective intervention study to 168 patients with the diagnosis of lumbar discal hernia. There were carried out simple pre and post operative radiological studies: Computerized Axial Tomography or Nuclear Magnetic Resonance. There were evaluated some elements of the pre and post operative clinical setting. It was performed the research with the objective to describe the application of the microsurgical technique, what allowed the application of simple discectomy with foraminotomy in most of the patients with real discal hernia in the level 15-SI(AU)

Enfermedad Cerebro Vascular Isquémica. Comportamiento preventivo. Policlínico No. 1. Manzanillo / Ischemic Cerebrovascular Disease. A preventive treatment. Polyclinic I. Manzanillo

Se realizó un estudio del comportamiento de la Enfermedad Cerebro Vascular Isquémica en 23 pacientes, pertenecientes a 10 Consultorios del Médico de la Familia del Policlínico Integral Docente No 1de Manzanillo, en el período comprendido entre febrero 2010 y diciembre 2013, se analizaron variables del comportamiento intrahospitalario y extrahospitalario. Más de la mitad estuvo comprendido entre 50 y 69 años de edad con predominio en el sexo femenino, 14 pacientes de estos debutaron en su forma aterotrombótica. La evaluación neurológica manifestó su mayor representatividad entre 13 y 15 punto para la escala de Glasgow en la evaluación inicial. El antecedente patológico personalde hipertensiónarterial alcanzó su mayor representación en la forma aterotrombótica, y la cardiopatía isquémica para la forma cardioembólica(AU)

It was carried out a study of the behavior of the Ischemic Cerebrovascular disease in 23 patients belonging to 10 Family medical offices of the Teaching Integrated Polyclinic I in Manzanillo, during the period of February 2010 to December 2013. There were analyzed the variables of the intrahospital and extrahospital behavior. More than a half were in the group of 50-69 years old, prevailing the female sex, 14 patients presented the atherothrombotic form. The neurologic assessment had its greatest representativity about 13-15 scores for the Glasgow scale in the initial evaluation. The personal pathological antecedent of hypertension reached its greatest representation in the atherothrombotic form and the ischemic cardiopathy for the cardioembolic form(EU)

Leishmania panamensis infection and antimonial drugs modulate expression of macrophage drug transporters and metabolizing enzymes: impact on intracellular parasite survival.

OBJECTIVES: Treatment failure is multifactorial. Despite the importance of host cell drug transporters and metabolizing enzymes in the accumulation, distribution and metabolism of drugs targeting intracellular pathogens, their impact on the efficacy of antileishmanials is unknown. We examined the contribution of pharmacologically relevant determinants in human macrophages in the antimony-mediated killing of intracellular Leishmania panamensis and its relationship with the outcome of treatment with meglumine antimoniate. METHODS: Patients with cutaneous leishmaniasis who failed (n = 8) or responded (n =8) to treatment were recruited. Gene expression profiling of pharmacological determinants in primary macrophages was evaluated by quantitative RT-PCR and correlated to the drug-mediated intracellular parasite killing. Functional validation was conducted through short hairpin RNA gene knockdown. RESULTS: Survival of L. panamensis after exposure to antimonials was significantly higher in macrophages from patients who failed treatment. Sixteen macrophage drug-response genes were modulated by infection and exposure to meglumine antimoniate. Correlation analyses of gene expression and intracellular parasite survival revealed the involvement of host cell metallothionein-2A and ABCB6 in the survival of Leishmania during exposure to antimonials. ABCB6 was functionally validated as a transporter of antimonial compounds localized in both the cell and phagolysosomal membranes of macrophages, revealing a novel mechanism of host cell-mediated regulation of intracellular drug exposure and parasite survival within phagocytes. CONCLUSIONS: These results provide insight into host cell mechanisms regulating the intracellular exposure of Leishmania to antimonials and variations among individuals that impact parasite survival. Understanding of host cell determinants of intracellular pharmacokinetics/pharmacodynamics opens new avenues to improved drug efficacy for intracellular pathogens.

Regulatory T cells in the pathogenesis and healing of chronic human dermal leishmaniasis caused by Leishmania (Viannia) species.

BACKGROUND: The inflammatory response is prominent in the pathogenesis of dermal leishmaniasis. We hypothesized that regulatory T cells (Tregs) may be diminished in chronic dermal leishmaniasis (CDL) and contribute to healing during treatment. METHODOLOGY/PRINCIPAL FINDINGS: The frequency and functional capacity of Tregs were evaluated at diagnosis and following treatment of CDL patients having lesions of ≥6 months duration and asymptomatically infected residents of endemic foci. The frequency of CD4(+)CD25(hi) cells expressing Foxp3 or GITR or lacking expression of CD127 in peripheral blood was determined by flow cytometry. The capacity of CD4(+)CD25(+) cells to inhibit Leishmania-specific responses was determined by co-culture with effector CD4(+)CD25(-) cells. The expression of FOXP3, IFNG, IL10 and IDO was determined in lesion and leishmanin skin test site biopsies by qRT-PCR. Although CDL patients presented higher frequency of CD4(+)CD25(hi)Foxp3(+) cells in peripheral blood and higher expression of FOXP3 at leishmanin skin test sites, their CD4(+)CD25(+) cells were significantly less capable of suppressing antigen specific-IFN-γ secretion by effector cells compared with asymptomatically infected individuals. At the end of treatment, both the frequency of CD4(+)CD25(hi)CD127(-) cells and their capacity to inhibit proliferation and IFN-γ secretion increased and coincided with healing of cutaneous lesions. IDO was downregulated during healing of lesions and its expression was positively correlated with IFNG but not FOXP3. CONCLUSIONS/SIGNIFICANCE: The disparity between CD25(hi)Foxp3(+) CD4 T cell frequency in peripheral blood, Foxp3 expression at the site of cutaneous responses to leishmanin, and suppressive capacity provides evidence of impaired Treg function in the pathogenesis of CDL. Moreover, the concurrence of increased Leishmania-specific suppressive capacity with induction of a CD25(hi)CD127(-) subset of CD4 T cells during healing supports the participation of Tregs in the resolution of chronic dermal lesions. Treg subsets may therefore be relevant in designing immunotherapeutic strategies for recalcitrant dermal leishmaniasis caused by Leishmania (Viannia) species.

Fusión espinal. Estudio de una serie de 14 pacientes. Hospital Militar 37, Ghana, 2008- 2010 / Spinal fusion. Study of a series of 14 patients. Military Hospital 37. Ghana. 2008-2010

Se realizó un estudio original de una serie de 14 pacientes operados de inestabilidad vertebral, a los cuales se les practicó fusión espinal en el periodo octubre 2008-octubre 2010. Durante el periodo octubre-2008 a octubre-2010 se realizó un estudio prospectivo de intervención a 14 pacientes con el diagnóstico de columna vertebral inestable. A todos se les practicó estudios radiológicos simples pre y postoperatorios, Tomografía Axial Computarizada o Resonancia Magnética Nuclear. Evaluamos elementos del cuadro clínico pre y postoperatorios. El sexo masculino fue el más afectado y alcanzó la mayor representación 78.5 por ciento y el grupo etáreo de mayor representación 21-30 años (50 por ciento). Siendo la inestabilidad cervical la de mayor número de casos fusionados. El abordaje posterior, se practicó en 12 de los pacientes operados (85.7 por ciento). Las causas más frecuentes de inestabilidad las constituyeron las traumáticas. A los pacientes operados se les practicó descompresión de los elementos nerviosos. Se usaron técnicas como: la fijación transpedicular, fusión de las masas laterales, corpectomía y fijación con láminas y tornillos. Los peores resultados se mostraron en la fusión espinal cervical. La mayor incidencia se presentó entre los 21 y 30 años de edad. La etiología traumática las más frecuente, mostrando la columna cervical los peores resultados quirúrgicos(AU)

It was performed an original study of a series of 14 patients surgically treated for vertebral instability and the spinal fusion was practiced to them during the period october 2008- October 2010. During the period october 2008 to October-2010 a prospective study of intervention was performed to 14 patients with the diagnosis of instability in the spinal cord. Pre and post operatives simple radiological studies were practiced to all of them, Axial Computerized Tomography or Magnetic Nuclear Resonance. We evaluated the elements of the pre and post operative clinical manifestations. Male sex was the most affected with 78, 5 percent and the group of age of higher incidence was 21-30 years (50 percent). The cervical instability belonged to the greatest number of fusion cases The posterior management was practiced in 12 of the operated patients (85,7 percent). The most frequent causes of instability were made by traumas. Decompression of the nervous elements was practiced on the operated patients. Techniques like: The trans-pedicle fixing, fusion of the lateral crowds, laminectomy and fixing with plates and screws were used. They showed the worst results in the spinal cervical fusion.The higher incidence was presented in the group of age from 21-30. Male sex was the most affected, traumatic ethiology was the most frequent, showing the cervical cord disorders the worst results(EU)