Impacto del mindfulness en el estrés en trabajadores de una universidad de Lima sur / Impact of mindfulness on stress in workers of a university in southern Lima

RESUMEN Objetivo: Evaluar el impacto de un programa de mindfulness en el estrés fisiológico, distrés emocional, estrés percibido y estrés laboral en un grupo de trabajadores. Materiales y métodos: Participaron 28 trabajadores universitarios (empleados y docentes), quienes habían registrado niveles altos de estrés laboral en una evaluación institucional previa. El programa consistió en seis sesiones de entrenamiento en mindfulness una vez por semana y con dos horas por sesión (12 horas en total), con las técnicas de la atención plena en la respiración, en el cuerpo, pensamiento, emociones y descanso. Se utilizaron mediciones de Biofeedback para evaluar cinco indicadores de estrés fisiológico (temperatura, respiración, pulso, volumen sanguíneo en la piel y presión arterial) y tres pruebas para medir estrés: Inventario de Distrés Emocional Percibido (a = .85), Inventario de Estrés Percibido a = .86), Escala de Estrés Laboral (a = .90), como medidas de pretest y postest. Resultados: Volumen sanguíneo en la piel (d = 0.8), pulso sanguíneo (d = 0.8) y frecuencia de la respiración abdominal (d = 0.9), distrés emocional (d = 0.9), el estrés percibido (d = 0.7) y el estrés laboral (d = 0.6). Conclusión: El mindfulness tuvo un impacto significativo en la reducción del estrés en trabajadores universitarios.

ABSTRACT Objetive: To assess the impacto of a mindfulness program on physiological stress. emotional distress, perceived stress, and work stress in a group of workers. Material and methods: 28 universiy workers (employees and teachers) participated, who had registered high levels of work stress in a previous institutional evaluation. The program consisted of six training sessions in mindfulness once a week and with two hours per sessions (12 hours in total) with the techniques of mindfulness in breathing, in the body (body scan), thinking, emotions and break. Biofeedback measurements were used to evaluate five physiological stress indicators and three tests to measures. Results: blood volumen in the skin (d = 0.8), blood pulse (d = 0.8) and frequency of abdominal breathing (d = 0.9), emotional distess (d = 0.9), perceived stress (d = 0.7) and work stress (d = 0.6). Conclusión: mindfulness had a significant impact on stress reduction in university workers.

The quantitative structure-insecticidal activity relationships from plant derived compounds against chikungunya and zika Aedes aegypti (Diptera:Culicidae) vector.

The insecticidal activity of a series of 62 plant derived molecules against the chikungunya, dengue and zika vector, the Aedes aegypti (Diptera:Culicidae) mosquito, is subjected to a Quantitative Structure-Activity Relationships (QSAR) analysis. The Replacement Method (RM) variable subset selection technique based on Multivariable Linear Regression (MLR) proves to be successful for exploring 4885 molecular descriptors calculated with Dragon 6. The predictive capability of the obtained models is confirmed through an external test set of compounds, Leave-One-Out (LOO) cross-validation and Y-Randomization. The present study constitutes a first necessary computational step for designing less toxic insecticides.

Phytochemical profile, antioxidant and antimicrobial activity of extracts obtained from erva-mate (Ilex paraguariensis) fruit using compressed propane and supercritical CO2.

Traditionally, Ilex paraguariensis leaves are consumed in tea form or as typical drinks like mate and terere, while the fruits are discarded processing and has no commercial value. The aim of this work to evaluate phytochemical properties, total phenolic compounds, antioxidant and antimicrobial activity of extracts of Ilex paraguariensis fruits obtained from supercritical CO2 and compressed propane extraction. The extraction with compressed propane yielded 2.72 wt%, whereas with supercritical CO2 1.51 wt% was obtained. The compound extracted in larger amount by the two extraction solvents was caffeine, 163.28 and 54.17 mg/g by supercritical CO2 and pressurized propane, respectively. The antioxidant activity was more pronounced for the supercritical CO2 extract, with no difference found in terms of minimum inhibitory concentration for Staphylococcus aureus for the two extracts and better results observed for Escherichia coli when using supercritical CO2.

Activity and safety of sunitinib in poor risk metastatic renal cell carcinoma patients

Purpose To assess the activity, safety and treatment patterns of sunitinib in patients with poor-risk metastatic renal cell carcinoma (mRCC). Materials and Methods We retrospectively reviewed the charts of poor risk patients treated with sunitinib from October 2006 to July 2013 who met the eligibility criteria. The primary endpoint was overall survival (OS). Tumor radiological response was measured according to RECIST 1.1 and adverse events (AEs) were assessed through standard criteria. Results Median OS was 8.16 months (95% CI, 5.73-10.59). Of the 53 patients included in this analysis, 9 (17.0%) achieved partial response, 12 (22.6%) had stable disease. Median treatment duration was 3.30 months (95% CI: 1.96-4.63) and 26.4% of patients discontinued treatment due to toxicity. Grade 3 or higher AEs occurred in 39.6% of patients, the most common being fatigue (15.1%), neutropenia (9.5%), nausea, vomiting and diarrhea (7.5% each). Discussion Sunitinib may benefit some unselected poor-risk patients, although the rates of AEs and drug discontinuation suggest a need for careful patient monitoring. .

Activity and safety of sunitinib in poor risk metastatic renal cell carcinoma patients.

PURPOSE: To assess the activity, safety and treatment patterns of sunitinib in patients with poor-risk metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS: We retrospectively reviewed the charts of poor risk patients treated with sunitinib from October 2006 to July 2013 who met the eligibility criteria. The primary endpoint was overall survival (OS). Tumor radiological response was measured according to RECIST 1.1 and adverse events (AEs) were assessed through standard criteria. RESULTS: Median OS was 8.16 months (95% CI, 5.73-10.59). Of the 53 patients included in this analysis, 9 (17.0%) achieved partial response, 12 (22.6%) had stable disease. Median treatment duration was 3.30 months (95% CI: 1.96-4.63) and 26.4% of patients discontinued treatment due to toxicity. Grade 3 or higher AEs occurred in 39.6% of patients, the most common being fatigue (15.1%), neutropenia (9.5%), nausea, vomiting and diarrhea (7.5% each). DISCUSSION: Sunitinib may benefit some unselected poor-risk patients, although the rates of AEs and drug discontinuation suggest a need for careful patient monitoring.

Toxicidade pulmonar e hepática aos vapores do metil metacrilato: um estudo experimental em ratos / Pulmonary and liver toxicity of methyl methacrylate vapors: an experimental study in rats

Methyl methacrylate (MMA) is widely used in medicine and in dentistry in dental braces and prostheses. The most important occupational exposure route of MMA is inhalation. These study aims at evaluating the MMA toxicity to the rat lung and liver related to the time of exposure. Male and female albino Wistar rats were exposed to MMA by inhalation. One group (n=36) was exposed continuously, and the other (n=36) was exposed during 8-hours/day, without water and food intake during the exposure period as to prevent the risk of water and food contamination by MMA. A control group (n=8) received water and food without MMA exposure. Rats were sacrificed 5, 8 and 10 days after exposure. Significant morphological alterations observed were pulmonary emphysema and hepatic esteatosis early detected after 5 days of MMA exposure in 26.4 percent (n=19) and 25 percent (n=18) of the animals, respectively. Pulmonary emphysema was observed in 77.7 percent (n=28) of the rats under continuous exposure, in 66.6 percent (n=24) of the 8-hours/day-exposure group, and in only one animal from the control group. Hepatic esteatosis was observed in 94.5 percent (n=34) of the continuous exposure group, and in 72.2 percent (n=26) of the rats exposured per 8-hours/day, and statistically significant differences were observed among the groups. The literature describes many pulmonary changes related to the exposure to MMA, emphysema being the main one, what is in accordance with our data. Hepatic damage has only been seen when the MMA is administered by intravenous injection. The results of this investigation show that toxicity of MMA appeared very early at the first days of inhalation of this agent. It indicates thata proper exhaustion system should be implemented prior to using MMA in order to prevent occupational related MMA injuries.

O metil metacrilato (MMA) é amplamente usado na medicina e odontologia. A principal via de exposição ocupacional é inalatória. Este trabalho visa avaliar a ação tóxica do MMA em pulmão e fígado de ratos em diferentes períodos de exposição. Ratos Wistar albinos, machos e fêmeas, foram expostos ao MMA por inalação. Um grupo (n= 36) foi exposto continuamente e outro (n=36) exposto durante oito horas diárias, sem água e ração durante a exposição, para excluir a possibilidade de contaminação da água e ração pelo MMA. Um grupo controle (n=8) recebeu água e ração e não foi exposto ao MMA. Os animais foram sacrificados com 5, 8 e 10 dias de exposição. As alterações morfológicas significativas foram enfisema pulmonar e esteatose hepática, detectados precocemente com 5 dias de exposição ao MMA, em 26,4 por cento (n=19) e 25 por cento (n=18) dos animais, respectivamente. Enfisema pulmonar foi observado em 77,7 por cento (n=28) dos animais com exposição contínua, em 66,6 por cento (n=24) dos expostos 8 horas/ dia e em 1 animal do grupo controle. Esteatose hepática foi observada em 94,5 por cento (n=34) dos animais com exposição contínua e em 72,2 por cento (n=26) dos expostos 8 horas/dia, sendo a diferença entre os grupos estaticamente significante. A principal alteração pulmonar na literatura é o enfisema, concordando com nossos achados. Alterações hepáticas somente foram observadas na administração endovenosa do MMA. Os dados do presente trabalho mostram que o efeito tóxico do MMA se manifesta precocemente nos primeiros dias de inalação deste agente, indicando que um sistema adequado de exaustão deve ser instalado antes do uso do MMA para prevenir danos ocupacionais a ele relacionados.

Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome.

RATIONALE: The hypothesis that lung collapse is detrimental during the acute respiratory distress syndrome is still debatable. One of the difficulties is the lack of an efficient maneuver to minimize it. OBJECTIVES: To test if a bedside recruitment strategy, capable of reversing hypoxemia and collapse in > 95% of lung units, is clinically applicable in early acute respiratory distress syndrome. METHODS: Prospective assessment of a stepwise maximum-recruitment strategy using multislice computed tomography and continuous blood-gas hemodynamic monitoring. MEASUREMENTS AND MAIN RESULTS: Twenty-six patients received sequential increments in inspiratory airway pressures, in 5 cm H(2)O steps, until the detection of Pa(O(2)) + Pa(CO(2)) >or= 400 mm Hg. Whenever this primary target was not met, despite inspiratory pressures reaching 60 cm H(2)O, the maneuver was considered incomplete. If there was hemodynamic deterioration or barotrauma, the maneuver was to be interrupted. Late assessment of recruitment efficacy was performed by computed tomography (9 patients) or by online continuous monitoring in the intensive care unit (15 patients) up to 6 h. It was possible to open the lung and to keep the lung open in the majority (24/26) of patients, at the expense of transient hemodynamic effects and hypercapnia but without major clinical consequences. No barotrauma directly associated with the maneuver was detected. There was a strong and inverse relationship between arterial oxygenation and percentage of collapsed lung mass (R = - 0.91; p < 0.0001). CONCLUSIONS: It is often possible to reverse hypoxemia and fully recruit the lung in early acute respiratory distress syndrome. Due to transient side effects, the required maneuver still awaits further evaluation before routine clinical application.

Risk factors of intracranial pressure monitoring in children with fiberoptic devices: a critical review.

BACKGROUND: Intracranial pressure (ICP) monitoring has become standard in the management of severe head injuries. A variety of monitoring techniques and devices are available, each with advantages and disadvantages; however there have been few studies in the pediatric population. METHODS: To study the risk factors, efficacy, and complication rate of fiberoptic ICP monitoring we studied 98 consecutive children with severe head injuries over a 2-year period. The average patient age was 9 years and most had an initial Childrens Coma Score (CCS) of 8 or less. The monitoring devices were placed in frontal parenchyma of all children and no prophylactic antibiotics were used. All fiberoptic catheter tips were cultured upon removal. RESULTS: The average duration of ICP monitoring was 7 days; the usual range was 3-15 days, with the exception of one patient who underwent monitoring for 40 days. No complications occurred during insertion of the ICP monitors. Catheter tip cultures were positive for Staphylococcus epidermidis in 7% of the children, but none developed clinical features of CNS infection. The hospital location of placement or duration of ICP monitoring did not affect the rate of catheter tips with positive cultures. There was a 13% mechanical failure rate of the fiberoptic device. CONCLUSIONS: We conclude that fiberoptic ICP monitoring is safe and effective; however, there is a relatively low mechanical failure rate. Infection in uncommon despite prolonged use and there is little risk of complications associated with placement of this monitor.

Relationship between changes in R wave voltage and cardiac volumes. A vectorcardiographic study during hemodialysis.

The effects of acute changes in cardiac volumes determined by hemodialysis on cardiac voltages were assessed in 18 chronically uremic patients by means of a vectorcardiographic and scalar Frank leads recording, immediately before, at the 90th and 180th minute, and immediately after hemodialysis. The following parameters were simultaneously monitored: body weight, systolic and diastolic blood pressure, heart rate, hematocrit and, in eight patients, echocardiographic systolic and diastolic diameters of the left ventricle. During hemodialysis all voltages considered except R wave in X lead increased significantly. They were inversely correlated with body weight, blood pressure, and systolic and diastolic diameters and directly with hematocrit (volemia-dependent parameters). The maximal vector on the left sagittal plane and the R wave amplitude in Z lead, representing left ventricular posterolateral wall activation, showed the greatest increase. When, at the end of hemodialysis, an amount of fluids ranging from 300 to 800 ml was restored, these cardiac voltages decreased paralleling the increase of left ventricular diameters. In conclusion, these results demonstrate that cardiac voltage and volumes are inversely related.

[Echocardiographic study of left ventricular function in the mitral valve prolapse syndrome]. / Studio echocardiografico della funzione ventricolare sinistra nella sindrome da prolasso valvolare mitralico.

In the aim to clarify the magnitude and features of alterations in left ventricular function observed in patients with mitral valve prolapse syndrome (MVPS), we studied 41 patients with MVPS with M-mode echocardiography and computerized reading of recordings (with particular regard to the diastolic phase), and compared them with a control group of 15 healthy subjects matched for age and sex. Routine morphological and functional echocardiographic parameters were evaluated and, in addition, peak rates of movement of left ventricular endocardia, of wall thicknesses change and of cavity dimensions variations were obtained. Finally, a detailed analysis of various diastolic phases have been performed, according to the method proposed by Hanrath et al. There were no significant statistical differences in the morphological echocardiographic parameters (ventricular diameters, wall thicknesses) between the two groups. Patients with MVPS showed (compared to the control group) a significant increase in the peak rate of posterior wall endocardium movement during systole (1.64 +/- 0.42 vs 1.29 +/- 0.30, p less than 0.01) and a reduction of peak rate of interventricular septum thickening (1.21 +/- 0.36 vs 1.45 +/- 0.46, p less than 0.05). The comparison of all other systolic function parameters did not show statistical differences. As far as diastolic phase is concerned, no significant differences were found in the analysis of the peak velocities. However, evaluation of the diastolic phases demonstrated, in MVPS group, a significantly shorter slow filling period, both in absolute value (185.88 +/- 78.91 vs 303.15 +/- 117.58, p less than 0.001) and in percent of the whole diastole (37.42 +/- 11.88 vs 52.50 +/- 10.61, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiographic evaluation of changes in cardiac performance induced by hemodialysis.

For the purpose of assessing the cardiovascular effects of hemodialysis (HD), M-mode echocardiography was performed 24 hours before and 2 hours after this procedure in 15 patients with chronic renal failure. The results, which include computer analysis of digitized interventricular septum (IVS) and left ventricular posterior wall (LVPW), show the following statistically significant changes after HD: reduction of end-diastolic and end-systolic internal diameters of the left ventricle (LVID), increase of mean velocity of circumferential fiber shortening, of peak rate of systolic and diastolic LVID variation, of systolic and diastolic LVPW movement, and of IVS movement in systole. These results demonstrate that after HD the left ventricle not only decreases in size but also its performance improves in both contraction and relaxation. These changes did not correlate with the reduction in body weight and arterial pressure following HD; hence HD seems to act on left ventricular function by reducing mainly afterload and, possibly, by modifying some humoral parameters. In conclusion, M-mode echocardiography, especially when utilized in conjunction with the computerized analysis of the recordings, is useful and reliable in monitoring hemodynamic changes occurring during the dialytic session.

Hemodynamic evaluation by M-mode echocardiography in acute myocardial infarction.

We assessed the relationship between echocardiographic and hemodynamic parameters in 28 patients with documented acute myocardial infarction (AMI), who underwent M-mode echocardiography and Swan-Ganz catheterization during the same hospitalization. Patients with valvular heart disease were excluded from the study. On mitral valve echogram, DE interval was measured and the area enclosed by mitral valve echogram during DE interval (DE subarea ) was calculated in each echocardiogram. DE subarea /DE interval ratio was computed for each measurement set. Hemodynamic parameters were obtained in the usual fashion. Patients with pulmonary artery wedge pressure (PWP) less than 18 mm Hg showed a DE interval markedly longer than patients with PWP greater than 18 mm Hg: 81.72 +/- 15.23 vs 55.12 +/- 9.85 msec (p less than 0.001). Patients with cardiac index greater than 2.2 L min-1 m-2 had a DE subarea /DE interval ratio greater than patients with cardiac index less than 2.2 L min-1 m-2: 0.169 +/- 0.035 vs 0.094 +/- 0.017 dm2 sec-1 (p less than 0.001). Echocardiographic and hemodynamic data were then correlated in the whole study group, and it was found that DE interval was significantly (p less than 0.001) and inversely correlated to PWP; stroke index more than cardiac index was correlated (p less than 0.005) both to DE subarea /DE interval ratio and to DE interval itself; DE interval was not affected by heart rate. We were able to categorize the patients into four subsets on the basis of echocardiographic measurements. Our findings suggest the possibility of providing, through M-mode echocardiography, a noninvasive and accurate evaluation of PWP and stroke index.

Relation between marked changes in left ventricular outflow tract gradient and disease progression in hypertrophic cardiomyopathy.

Spontaneous and persistent changes in left ventricular (LV) outflow gradient have been observed occasionally in patients with hypertrophic cardiomyopathy (HC). However, the significance and frequency of such hemodynamic alterations have not been established. In this study, the serial preoperative hemodynamic status of 409 patients with HC was analyzed. Basal LV outflow tract obstruction either spontaneously appeared (or increased) or disappeared (or decreased) in 19 nonoperated patients (about 5%). Changes in hemodynamic state were shown by serial cardiac catheterization in 17 patients and by catheterization and M-mode echocardiography in 2 patients. In most patients (12 of 19), subaortic obstruction under basal conditions appeared or increased; 8 became more symptomatic and in 4 the condition remained stable. Reduction or loss of LV outflow gradient occurred in 7 patients; in 5 of these the condition deteriorated clinically and in 2 it did not change. Hence, in 13 of the 19 patients (70%), spontaneous changes in the magnitude of the basal LV outflow gradient were associated with symptomatic progression. The mechanism of the decrease or disappearance of subaortic obstruction in those patients who deteriorated clinically appeared to be related in 4 patients to impaired global and/or segmental LV function. Chronic atrial fibrillation probably contributed to the worsening clinical condition in 2 of these patients as well as in 2 others. In conclusion, substantial changes in the magnitude of basal subaortic obstruction may occur in a small proportion of patients with HC as part of the natural history of their disease, and such hemodynamic alterations are usually associated with clinical deterioration. It is exceedingly rare for the hemodynamic state of a patient with HC to change from totally nonobstructive to obstructive or vice versa, because such patients usually retain the capacity to generate gradients with provocative maneuvers.

Echocardiographic analysis of ventricular septal dynamics in hypertrophic cardiomyopathy and other diseases.

It has been suggested that the adynamic or hypokinetic appearance of the ventricular septum is a unique echocardiographic feature of hypertrophic cardiomyopathy (HC). To determine how characteristic of HC the adynamic septum is, 70 patients with this disease, and 31 with other cardiac diseases that produce left ventricular (LV) hypertrophy and pressure overload (aortic valvular stenosis or systemic hypertension), and 25 subjects with normal hearts were studied by echocardiography. On M-mode echocardiography, 53 of 70 patients (75%) with HC had an abnormally low value for percent systolic thickening of the septum associated with either reduced or normal septal excursion; however, 17 patients (25%) showed normal septal dynamics. Twenty of 31 patients (64%) with other cardiac diseases that produce pressure overload showed normal septal thickening and excursion, while 11 (36%) had reduced systolic thickening associated with either diminished or normal excursion. Greatly reduced values for percent systolic thickening of the septum were present both in patients with HC (13 +/- 1%) and in patients with other cardiac diseases (21 +/- 2%). However, differences in systolic septal thickening between the 2 groups were largely a manifestation of the greater absolute diastolic septal thickness in patients with HC. When values for percent systolic thickening were normalized for diastolic septal thickness, or when systolic thickening was compared in only patients with similar diastolic septal thicknesses, differences in septal thickening between patients with HC and those patients with other cardiac diseases were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by 2-dimensional echocardiography in patients with hypertrophic cardiomyopathy.

Distribution of left ventricular (LV) hypertrophy was assessed by wide-angle, 2-dimensional (2-D) echocardiography in 153 patients with hypertrophic cardiomyopathy and compared with the scalar electrocardiogram in the same patients. The most common electrocardiographic alterations were S-T segment changes and T-wave inversion (61%), LV hypertrophy (47%), abnormal Q waves (25%), and left atrial enlargement (24%). LV hypertrophy on the electrocardiogram was significantly more common in patients with the most extensive distribution of LV hypertrophy on 2-D echocardiogram involving substantial portions of both the ventricular septum and LV free wall (type III; 51 of 69, 74%) than in those with more limited distribution of LV hypertrophy (21 of 84, 25%; p less than 0.001). Most patients with hypertrophic cardiomyopathy and normal electrocardiograms (13 of 23) had localized (type I) hypertrophy, but only 4 had the extensive type III pattern of hypertrophy. Abnormal Q waves were significantly more common in those patients without hypertrophy of the anterior, basal septum (type IV; 15 of 27, 56%) than in those with basal septal hypertrophy (23 of 126, 18%; p less than 0.001); abnormal Q waves were uncommon in extensive type III distribution of hypertrophy (13 of 69, 19%). Thus, although no single electrocardiographic abnormality is characteristic of hypertrophic cardiomyopathy, 2-D echocardiography clarifies the significance of certain electrocardiographic patterns: (1) LV hypertrophy on the electrocardiogram, although present in only about half of the study group, was a relatively sensitive (74%) marker for extensive (type III) LV hypertrophy; (2) abnormal Q waves cannot be explained by ventricular septal hypertrophy alone; and (3) a normal electrocardiogram was most commonly a manifestation of localized LV hypertrophy.