Practical Application of a Battery of Brief Tools to Evaluate Geriatric Medical Inpatients for the Three Ds.

OBJECTIVE: The investigators aimed to identify the clinical characteristics of patients with or without delirium and preexisting depression, dementia, both, or neither by using validated tools easily administered in clinical practice. METHODS: In this cross-sectional prospective observational study conducted in Medellín, Colombia, 200 geriatric inpatients were evaluated with the Delirium Diagnostic Tool-Provisional (DDT-Pro), Informant Questionnaire on Cognitive Decline in the Elderly, Hachinski Ischemic Scale, Cornell Scale for Depression in Dementia, and Charlson Comorbidity Index-short form. Delirium motor subtype, mortality, and length of hospital stay were assessed. RESULTS: The study included 134 patients without delirium (67%), 14 with delirium only (7%), 16 with delirium and dementia (8%), 13 with delirium and depression (7%), and 23 with delirium, dementia, and depression (the three Ds) (12%). Prevalence rates of dementia (59%) and depression (55%) among 66 patients with delirium were higher than prevalence rates among patients without delirium (13% and 28%, respectively), suggesting that both conditions are risk factors. Main medical diagnoses, mortality, and dementia type did not differ among groups. Motor subtypes were similar among delirium groups. Patients in the delirium groups, except those in the delirium and depression group, were older than patients without delirium. Medical burden was highest among the patients with delirium and dementia and those with all three conditions. Delirium and dementia were more severe when comorbid with each other. Depression was most severe among patients with delirium and depression. Patients with all three conditions had a longer length of hospital stay than those without delirium. CONCLUSIONS: Using brief tools to detect dementia and depression in conjunction with the DDT-Pro to assess delirium diagnosis and severity is feasible and enables a more in-depth evaluation of elderly hospitalized patients. Because previous longitudinal research suggests that these comorbid conditions influence prognosis following a delirium episode, better identification of the three Ds offers proactive interventional opportunities. Depression is an underrecognized risk factor for delirium.

Qualitative perspectives of isolation experiences due to COVID-19 from a group of bioethicists in training performing interdisciplinary healthcare activities. Medellin, Colombia. September 2020.

Introduction: In Colombia, there is still little information on how health care personnel have lived and coped with isolation due to COVID-19. Objectives: To explore the experiences related to the isolation of health professionals performing interdisciplinary care activities from March to September 2020, in Medellín, Colombia. Methods: Qualitative, exploratory, with a group of bioethicists in training. Data collected through the focus group, after obtaining the consent and approval of the Institutional Ethics Committee. Open and axial coding was performed. Texts are presented in prose, information was triangulated, and results were validated with the participants. Results: Work increased and staff decreased, with high staff turnover, redistribution and reassignment of loads and roles, facilitating physical and emotional overload. Study participants considered that teleworking facilitated their work, although more work was done. They lived in double isolation, had losses, and took work and family overloads. For fear of infecting and being infected, they separated from their loved ones, "this is an absolutely lonely disease, if people does not die from COVID, sadness and loneliness kills them." It affected "the recovery process, specifically, of psychiatric patients was prolonged, worsening their condition." They live in the present, and prioritize what is most important, because "being healthy and having those you love is the best wealth". Conclusion: Isolation increased workload, with reassignment of roles, affecting health care. For fear of becoming infected and infecting, study participants lived a double isolation, with anguish and uncertainty, which is why now they prioritize the most important health and love.

Introducción: En Colombia, todavía hay pocas informaciones sobre cómo los profesionales sanitarios han vivido y afrontado el aislamiento por la COVID-19. Objetivos: Explorar las experiencias relacionadas al aislamiento de profesionales sanitarios con actividad asistencial interdisciplinar, entre marzo y septiembre de 2020, en Medellín, Colombia. Métodos: Se condujo una investigación cualitativa y exploratoria con un grupo de bioeticistas en formación. Datos recolectados a través de un grupo focal, después de obtener el consentimiento y la aprobación del Comité de Ética Institucional. Se realizó codificación abierta y axial. Los textos se presentan en prosa, se hizo triangulación de la información, y se validaron los resultados con los participantes. Resultados: El trabajo aumentó y el personal disminuyó, con alta rotación de personal, reasignación y redistribución de cargas y roles, facilitando la sobrecarga física y emocional. Los participantes consideraron que el teletrabajo facilitó su trabajo, aunque se ha hecho más trabajo. Además, hubo un doble aislamiento, pérdidas y sobrecargas de trabajo y familiares. Por miedo a infectar e infectarse, se separaron de sus seres queridos, "esta es una enfermedad absolutamente solitaria, si uno no muere de la COVID, lo matan la tristeza y la soledad." La pandemia también afectó el proceso de recuperación, específicamente de los pacientes psiquiátricos, que se alargó, empeorando su condición. Los profesionales viven el presente y priorizan lo más importante: "tener salud y a los que amas es la mejor riqueza". Conclusión: El aislamiento aumentó la carga de trabajo, con reasignación de roles, afectando la atención sanitaria. Por miedo a infectarse e infectar, los participantes del estudio vivieron un doble aislamiento, con angustia e incertidumbre, y ahora priorizan la salud y el amor.

Using hypnoanalysis and guided imagery to identify and manage emotional aspects of multiple sclerosis.

BACKGROUND: To date, no studies have used hypnosis to examine and manage the potential emotional causes of multiple sclerosis (MS) in the scientific field; therefore, we decided to compare the effectiveness of hypnoanalysis and guided imagery for determining and manage these emotional causes. METHODS: Fifteen participants with severe MS were included and assigned into 2 groups: hypnoanalysis and guided imagery. In the hypnoanalysis group, the participants underwent 10 hypnotic sessions to understand events related to the cause of the disease, which were restructured (the events were modified by adding the psychological resources that each involved person needed); in addition, other techniques were used to investigate the causes and solutions according to the participants' unconscious. The guided imagery group received 10 group sessions of body relaxation and guided imagery, which were recorded for practice at home. Outcome measures, namely, disability (the Expanded Disability Status Scale, EDSS), quality of life (QoL, measured with the SF-36) and number of relapses, were evaluated 4 months previous the intervention, at baseline, post-intervention, and 3 months later. RESULTS: Hypnoanalysis revealed that stressful events and psychoemotional maladaptive patterns acted as causal, detonating, or aggravating factors of disease, and psychoemotional changes were the most frequent and varied solutions. No changes were observed in disability between the two groups. The guided imagery group showed an improvement in 2 subscales of QoL when compared with the hypnoanalysis group (which disappeared at the follow-up); this difference is probably due to the increased number of sessions and probably due to psychoemotional maladaptive patterns being more frequently mentioned than difficult circumstances in life and/or unsolved past events. However, the techniques used in hypnoanalysis were effective in understanding the potential emotional causes of MS, which showed high intra- and inter-participant consistency. CONCLUSIONS: The daily use of guided imagery overcame the restructuring of negative past events to improve QoL in patients with MS. TRIAL REGISTRATION: ACTRN12618002024224 (retrospectively registered).

Más allá de las moléculas Lo que los clínicos desconocen: acortando brechas / Filling the gap: Beyond molecules What clinicians ignore

Para acortar la brecha entre lo molecular y la clínica, el personal de atención médica debe tener un conocimiento básico de los mecanismos moleculares que gobiernan la identidad celular, mediante la activación selectiva de genes. La expresión diferencial de genes permite a las células sintetizar las proteínas requeridas para cumplir con sus funciones biológicas, y ello posibilita a las células responder a estímulos internos y externos. Para esto se debe tener primero acceso a los genes que codifican las proteínas, determinando el fenotipo celular. Modificaciones en la estructura de la cromatina permiten a la maquinaria transcripcional tener acceso a secuencias de ADN. El ADN es transcripto en ARNm, que sufre diversas modificaciones antes de salir del núcleo para ser traducido en una proteína en el citoplasma. Cualquier desregulación en alguno de los procesos asociados se presenta como una patología. A inicios del siglo XXI se reportó la secuenciación del genoma humano, y sorprendentemente uno de los principales hallazgos fue que solo un 2% de la secuencia codifica para proteínas, lo cual dejó un interrogante sobre cómo funcionan y se regulan los procesos genéticos que llevan a la identidad celular. Desde entonces las investigaciones han permitido utilizar los principios que rigen estos procesos para ampliar el conocimiento de los mecanismos asociados a enfermedades. Gracias a estos avances, se ha buscado determinar aplicaciones clínicas dirigidas a los procesos involucrados en la expresión génica diferencial, lograr una mejor comprensión sobre los procesos patológicos de la enfermedad y desarrollar herramientas diagnósticas.

To narrow the gap between the bench and the clinic, healthcare personnel should have a basic understanding of molecular mechanisms ruling cell identity, since it establishes the key differences between health and disease states. Differential gene expression allows for protein synthesis required for the cell's biological function. In this process genes are selected from the entire genome to meet the cell's biological functioning and respond to internal and external stimuli. To this end, first the chromatin must be remodeled for the transcriptional machinery to gain access to DNA sequences coding for particular genes. DNA can then be transcribed into mRNA, followed by different processes leading to mature mRNA leaving the nucleus for protein synthesis in the cytoplasm. Any dysregulation in these processes results in disease. In the beginning of this millennium the human genome project sequenced the whole genome. Surprisingly, one of the main findings was only 2% of the genome represented protein coding sequences, which raised the question about the remainder of the genome and cell identity. Based on principles derived from the human genome project many investigations have shed light on mechanisms associated with disease. Thanks to advancements in differential gene expression, researchers are seeking for a better understanding in pathological processes associated with disease and the development of diagnostic tools.

Identificación de parásitos intestinales en agua de pozos profundos de cuatro municipios. Estado Aragua, Venezuela. 2011-2012 / Identification of intestinal parasites in water from deep wells located in four municipalities of the state of Aragua, Venezuela, 2011-2012

Introducción: el agua subterránea es un recurso natural que se encuentra entre grietas y espacios debajo del suelo, acumulándose en capas de tierra, arena y rocas compuestas por materiales permeables que permiten su movilización, siendo explotada mediante el bombeo en pozos; ésta se contamina con microorganismos patógenos por filtración subterránea de aguas servidas y otros tipos de contaminantes. Objetivos: identificar parásitos intestinales en agua de consumo humano proveniente de pozos profundos en los municipios Girardot (GIR), Francisco Linares Alcántara (FLA), José Ángel Lamas (JAL) y Libertador (LIB) del estado Aragua-Venezuela. Métodos: se tomaron muestras de agua provenientes de 56 pozos profundos distribuidos en los cuatro municipios, se les aplicó la técnica de concentración por floculación para la recuperación de huevos de helmintos y quistes de protozoarios y la tinción de Kinyoun para el diagnóstico de coccidios y microsporidios intestinales. Resultados: en la recuperación de huevos de helmintos, quistes protozoarios y microspordios intestinales se encontró una prevalencia general de 37,5 por ciento, siendo FLA el de mayor valor (70 por ciento). Se observó la presencia de protozoarios en 90 por ciento de las muestras positivas, las especies más frecuentes correspondieron a Blastocystis sp. y Endolimax nana, solo en FLA se observaron huevos de helmintos. No se evidenció la presencia de coccidios en las muestras analizadas, con respecto a microsporidios se encontró en una muestra de LIB. Conclusión: estos resultados indican la necesidad de tratar el agua para su posterior consumo, dado que representa un importante medio de transmisión para los parásitos intestinales(AU)

Introduction: groundwater is a natural resource found in underground cracks and gaps, where it accumulates in layers of soil, sand and rock made up of permeable materials allowing its motion. The wells from which groundwater is pumped up may become contaminated by pathogenic microorganisms due to subsoil filtration of wastewater and other contaminants. Objectives: identify intestinal parasites in human consumption water from deep wells located in the municipalities of Girardot (GIR), Francisco Linares Alcántara (FLA), José Ángel Lamas (JAL) and Libertador (LIB), in the state of Aragua, Venezuela. Methods: water samples were collected from 56 deep wells located in the four municipalities. The flocculation concentration method was applied to recover helminth eggs and protozoan cysts. Kinyoun staining was used to diagnose intestinal coccidia and microsporidians. Results: recovery of helminth eggs, protozoan cysts and intestinal microsporidians revealed an overall prevalence of 37.5 percent, with the greatest values in FLA (70 percent). Protozoa were found in 90 percent of the positive samples, the most common species being Blastocystis sp. and Endolimax nana. Helminth eggs were found only in FLA. No evidence was observed of the presence of coccidia in the samples analyzed. Microsporidians were found in a sample from LIB. Conclusion: results point to the need to treat the water before human consumption, being as it is an important medium for the transmission of intestinal parasites(AU)

Estudio seroepidemiológico de la enfermedad de Chagas en la comunidad Copey-El Guayabillo, Estado Carabobo, Venezuela / Seroepidemiological study of Chagas disease in the community of Copey-El Guayabillo, State of Carabobo, Venezuela

Introducción: la enfermedad de Chagas, causada por Trypanosoma cruzi y transmitida por insectos de la familia Reduviidae, es considerada un problema de salud pública dada su magnitud y trascendencia; es una de las enfermedades transmisibles de más amplia distribución en el continente americano. Dentro de los factores que intervienen en el ciclo de transmisión se encuentran la calidad de las viviendas, el material de las paredes y los techos, la presencia de otros reservorios del parásito, la endofilia o exofilia del vector, y la presencia de árboles y otros hábitats. Objetivo: determinar la seroprevalencia de esta enfermedad en la comunidad de Copey-El Guayabillo, del estado Carabobo. Métodos: se estudiaron 115 pacientes, distribuidos en 36 viviendas, a los que se les aplicó una encuesta epidemiológica, 3 pruebas serológicas (ELISA [enzyme-linked immunosorbent assay] y hemoaglutinación indirecta, e inmunofluorescencia indirecta). Resultados: se obtuvo una prevalencia general de 6,09 por ciento en personas mayores a 40 años, con predominancia en el sexo masculino (71 por ciento ) y la ocupación de agricultor (57,14 por ciento ). El tipo de vivienda más frecuente de los pacientes seropositivos correspondió con el rancho de zinc (71,43 por ciento ). El 85,71 por ciento presentó anexos (gallinero, depósito de leña y cochinera). Adicionalmente, no se encontraron rastros fecales, huevos, exuvias, ni ejemplares vivos o muertos (ninfas o adultos) de vectores en el interior de las viviendas encuestadas. De la misma forma, se analizaron 18 animales mediante xenodiagnóstico, con resultados negativos. Conclusión: estos resultados indican que no existía una transmisión activa de la enfermedad en la comunidad para el momento del desarrollo de esta investigación(AU)

Introduction: Chagas disease, caused by Trypanosoma cruzi and transmitted by insects of the family Reduviidae, is considered to be a public health problem due to its magnitude and impact. It is one of the communicable diseases most broadly distributed in the American continent. The factors involved in its transmission cycle include the poor quality of housing, the material of which walls and roofs are built, the presence of other reservoirs of the parasite, the endophilia and exophilia of the vector, and the presence of trees and other habitats. Objective: determine the seroprevalence of the disease in the community of Copey-El Guayabillo, State of Carabobo. Methods: a study was conducted of 115 patients from 36 households, who were given an epidemiological survey, 3 serological tests (ELISA [enzyme-linked immunosorbent assay], indirect hemagglutination and indirect immunofluorescence). Results: overall prevalence was 6.09 percent for people over 40, with a predominance of the male sex (71 percent) and the occupation of agricultural worker (57.14 percent). Most seropositive patients (71.43 percent) lived in huts with laminated metal covers. 85.71 percent of the houses had annexed structures (henhouses, woodsheds and pigpens). No fecal traces, eggs, exuviae, or living or dead specimens (nymphs or adults) of the vector were found inside the houses surveyed. Eighteen animals were tested by xenodiagnosis with negative results. Conclusion: these results indicate that there was no active transmission of the disease in the community at the time of the research(AU)

Estudio seroepidemiológico de la enfermedad de Chagas en la comunidad Copey-El Guayabillo, Estado Carabobo, Venezuela / Seroepidemiological study of Chagas disease in the community of Copey-El Guayabillo, State of Carabobo, Venezuela

Introducción: la enfermedad de Chagas, causada por Trypanosoma cruzi y transmitida por insectos de la familia Reduviidae, es considerada un problema de salud pública dada su magnitud y trascendencia; es una de las enfermedades transmisibles de más amplia distribución en el continente americano. Dentro de los factores que intervienen en el ciclo de transmisión se encuentran la calidad de las viviendas, el material de las paredes y los techos, la presencia de otros reservorios del parásito, la endofilia o exofilia del vector, y la presencia de árboles y otros hábitats. Objetivo: determinar la seroprevalencia de esta enfermedad en la comunidad de Copey-El Guayabillo, del estado Carabobo. Métodos: se estudiaron 115 pacientes, distribuidos en 36 viviendas, a los que se les aplicó una encuesta epidemiológica, 3 pruebas serológicas (ELISA [enzyme-linked immunosorbent assay] y hemoaglutinación indirecta, e inmunofluorescencia indirecta). Resultados: se obtuvo una prevalencia general de 6,09 % en personas mayores a 40 años, con predominancia en el sexo masculino (71 %) y la ocupación de agricultor (57,14 %). El tipo de vivienda más frecuente de los pacientes seropositivos correspondió con el rancho de zinc (71,43 %). El 85,71 % presentó anexos (gallinero, depósito de leña y cochinera). Adicionalmente, no se encontraron rastros fecales, huevos, exuvias, ni ejemplares vivos o muertos (ninfas o adultos) de vectores en el interior de las viviendas encuestadas. De la misma forma, se analizaron 18 animales mediante xenodiagnóstico, con resultados negativos. Conclusión: estos resultados indican que no existía una transmisión activa de la enfermedad en la comunidad para el momento del desarrollo de esta investigación.

Introduction: Chagas disease, caused by Trypanosoma cruzi and transmitted by insects of the family Reduviidae, is considered to be a public health problem due to its magnitude and impact. It is one of the communicable diseases most broadly distributed in the American continent. The factors involved in its transmission cycle include the poor quality of housing, the material of which walls and roofs are built, the presence of other reservoirs of the parasite, the endophilia and exophilia of the vector, and the presence of trees and other habitats. Objective: determine the seroprevalence of the disease in the community of Copey-El Guayabillo, State of Carabobo. Methods: a study was conducted of 115 patients from 36 households, who were given an epidemiological survey, 3 serological tests (ELISA [enzyme-linked immunosorbent assay], indirect hemagglutination and indirect immunofluorescence). Results: overall prevalence was 6.09% for people over 40, with a predominance of the male sex (71 %) and the occupation of agricultural worker (57.14 %). Most seropositive patients (71.43 %) lived in huts with laminated metal covers. 85.71 % of the houses had annexed structures (henhouses, woodsheds and pigpens). No fecal traces, eggs, exuviae, or living or dead specimens (nymphs or adults) of the vector were found inside the houses surveyed. Eighteen animals were tested by xenodiagnosis with negative results. Conclusion: these results indicate that there was no active transmission of the disease in the community at the time of the research.