Diferencias de género en la titulación de fármacos de pacientes con insuficiencia cardiaca y fracción de eyección reducida del ensayo ETIFIC / Gender differences in drug titration among heart failure patients with reduced ejection fraction in the ETIFIC trial

Introducción y objetivos El tratamiento óptimo disminuye la mortalidad y hospitalizaciones por insuficiencia cardiaca (IC) en pacientes con IC y fracción de eyección reducida. En los ensayos clínicos las mujeres estuvieron infrarrepresentadas y no fueron evaluadas específicamente. Este estudio buscó comparar la seguridad y efectividad de titulación (ajuste de dosis) de fármacos en mujeres y varones. Métodos Estudio post hoc de género del ensayo aleatorizado multicéntrico ETIFIC. Se incluyeron pacientes hospitalizados con IC de novo y fracción de eyección reducida. Proceso estructurado de titulación en unidades de IC. Objetivo principal: la dosis relativa media de bloqueadores beta (% de la dosis objetivo) alcanzada por mujeres frente a varones. Objetivos secundarios: dosis relativas medias de otros fármacos de IC, eventos adversos y resultados clínicos a 6 meses. Resultados Se incluyeron 320 pacientes, 83 (25,93%) mujeres y 237 (74,06%) varones. (76 frente a 213 analizados). Media±desviación estándar de dosis relativa de bloqueadores beta mujeres frente a varones: 62,08±30,72% frente a 64,4±32,77%; diferencia −2,32%; IC95%, −10,58-5,94; p=0,580, antagonistas del receptor de mineralocorticoides 79,85±27,72% comparado con 67,29±31,43%; p=0,003, sin diferencias significativas en dosificación de otros fármacos. El análisis multivariante no encontró diferencias significativas. Mortalidad cardiovascular 1 (1,20%) frente a 3 (1,26%), p=1 y 0 hospitalizaciones por IC (0,00%) frente a 10 (4,22%), p=0,125. Conclusiones En un análisis post hoc del ensayo ETIFIC de titulación en IC no encontramos diferencias de género significativas en dosificación, mortalidad cardiovascular y hospitalizaciones por IC (AU)

Introduction and objectives Optimal medical therapy decreases mortality and heart failure (HF) hospitalizations in HF patients with reduced left ventricular ejection fraction. Women have been underrepresented in clinical trials and not specifically evaluated. This study aimed to compare the safety and effectiveness of drug titration in women vs men. Methods This post hoc gender study of the ETIFIC multicenter randomized trial included hospitalized patients with new-onset HF with reduced ejection fraction and New York Heart Association II-III and no contraindications to beta-blockers. A structured 4-month titration process was implemented in HF clinics. The primary endpoint was the mean relative dose (% of target dose) of beta-blockers achieved by women vs men. Secondary endpoints included the mean relative doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists, adverse events, and other clinical outcomes at 6 months. Results A total of 320 patients were included, 83 (25.93%) women and 237 (74.06%) men (76 vs 213 analyzed). The mean±standard deviation of the relative doses achieved by women vs men were as follows: beta-blockers 62.08%±30.72% vs 64.4%±32.77%, with a difference of−2.32% (95%CI,−10.58-5.94), P = .580; and mineralocorticoid receptor antagonists 79.85%±27.72% vs 67.29%±31.43%, P =.003. No other differences in drug dosage were found. Multivariate analysis showed nonsignificant differences. CV mortality was 1 (1.20%) vs 3 (1.26%), P=1, and HF hospitalizations 0 (0.00%) vs 10 (4.22%), P=.125. Conclusions In a post hoc analysis from the HF-titration ETIFIC trial, we found nonsignificant gender differences in drug dosage, cardiovascular mortality, and HF hospitalizations (AU)

Propuesta tutorial de desarrollo de competencias: los cuidados intensivos en la enseñanza mediada por tics / Competencies development tutorial proposal: intensive care in Information and Communication Technologies mediated teaching / Proposta tutorial de desenvolvimento de competências: os cuidados intensivos no ensino mediado por tics

Se torna insuficiente contar solamente con la clase presencial de una asignatura que implica estar familiarizada con un amplio conocimiento de técnicas y procedimientos, en la valoración y planificación de los cuidados para pacientes en situación crítica. La Enfermería que va a desempeñarse en la unidad de cuidados intensivos (UCI), necesita de prácticas que requieren del trabajo con casos clínicos, narrativas audiovisuales, debates interactivos y prácticas simuladas. Se estructuró la experiencia de una propuesta tutorial de desarrollo de competencias profesionales en el espacio de la asignatura de Cuidados Intensivos a Pacientes Adultos, desde la visión de la enseñanza mediada por las tecnologías de la información y comunicación (TIC). La propuesta incluyó la utilización de herramientas de trabajo colaborativo, redes sociales, simulación, mapas conceptuales, murales y narrativas audiovisuales así como las actividades de consulta, lección y glosario para el fortalecimiento de competencias profesionales basadas en la reflexión sobre la acción en el ejercicio de cuidados intensivos. El objetivo de este artículo es: describir la propuesta tutorial para la enseñanza mediada por las TIC en una asignatura teórico-práctica del quinto año de Licenciatura en Enfermería y visibilizar las actividades realizadas con fundamentación teórica en el desarrollo de la propuesta. Realizamos un recorrido por la evidencia existente y la experiencia docente de las actividades realizadas para el desarrollo de competencias profesionales, en el marco de la propuesta, desde el enfoque de educación basada en competencias, en interactividad con los y las estudiantes de la Universidad Nacional de Quilmes.

Classroom teaching is not enough at addressing subjects which imply being familiarized with diverse knowledge on the techniques and procedures related to the assessment and care planning of patients in critical situation. Nursing at the intensive care units requires a practice which addresses, for example, clinical cases, audio-visual narratives, interactive debates, and simulated drills. From an Information and Communication Technologies (ICT) mediation, a professional competencies development tutorial was proposed for the subject of Adult Patient Intensive Care. The proposal included the use of collaborative work tools, social networks, simulations, concept maps, audio-visual murals and narratives, and the development of activities linked to consultations, lessons, and glossaries, all oriented to the strengthening of the professional competencies needed to the intensive care units practice. The objective of this article is to describe this proposal of ICT mediated teaching for a theory and practice subject of the 5th year of a Nursing Baccalaureate program. Within the proposal's framework, evidence was gathered from the related interactions with professors and students of the National University of Quilmes.

Torna-se insuficiente contar apenas com a aula presencial de uma disciplina que implica estar familiarizada com um grande conhecimento de técnicas e procedimentos, na avaliação e planificação dos cuidados para pacientes em situação crítica. A Enfermagem que vai se desempenhar na unidade de cuidados intensivos (UCI), necessita de práticas que requerem do trabalho com casos clínicos, narrativas audiovisuais, debates interativos e práticas simuladas. Estruturou-se a experiência de uma proposta tutorial de desenvolvimento de competências profissionais no espaço da disciplina de Cuidados Intensivos a Pacientes Adultos, desde a visão do ensino mediado pelas tecnologias da informação e comunicação (TIC). A proposta incluiu a utilização de ferramentas de trabalho colaborativo, redes sociais, simulação, mapas conceituais, cartazes e narrativas audiovisuais, assim como as atividades de consulta, lição e glossário para o fornecimento de competências profissionais baseadas na reflexão sobre a ação no exercício de cuidados intensivos. O objetivo deste artigo é: Descobrir a proposta tutorial para o ensino mediado pelas TIC em uma disciplina teórico-prática do quinto ano de Licenciatura em Enfermagem e visibilizar as atividades realizadas com fundamentação teórica no desenvolvimento da proposta. Realizamos um percurso pela evidencia existente e a experiência docente das atividades realizadas para o desenvolvimento de competências profissionais, no marco da proposta, desde o enfoque de educação baseada em competências, em interatividade com os e as estudantes da Universidade Nacional de Quilmes.

Explaining coexistence of nitrogen fixing and non-fixing rhizobia in legume-rhizobia mutualism using mathematical modeling.

In the mutualism established between legumes and soil bacteria known as rhizobia, bacteria from soil infect plants roots and reproduce inside root nodules where they fix atmospheric N2 for plant nutrition, receiving carbohydrates in exchange. Host-plant sanctions against non N2 fixing, cheating bacterial symbionts have been proposed to act in the legume-Rhizobium symbiosis, to preserve the mutualistic relationship. Sanctions include decreased rhizobial survival in nodules occupied by cheating rhizobia. Previously, a simple population model experimentally based showed that the coexistence of fixing and cheating rhizobia strains commonly found in field conditions is possible, and that the inclusion of sanctions leads to the extinction of cheating strains in soil. Here, we extend the previous model to include other factors that could complicate the sanction scenario, like horizontal transmission of symbiotic plasmids, turning non-nodulating strains into nodulating rhizobia, and competition between fixing and cheating strains for nodulation. In agreement with previous results, we show that plant populations persist even in the presence of cheating rhizobia without incorporating any sanction against the cheater populations in the model, under the realistic assumption that plants can at least get some amount of fixed N2 from the effectively mutualistic rhizobia occupying some nodules. Inclusion of plant sanctions leads to the unrealistic extinction of cheater strains in soil. Our results agree with increasing experimental evidence and theoretical work showing that mutualisms can persist in presence of cheating partners.

Isoflavones and their effects on the onset of puberty in male Wistar rats.

This study was performed to determine how two of the most important isoflavones, genistein and daidzein, affect the gonadal axis in male prepuberal rats. One hundred and seventy-five prepuberal male Wistar rats were allocated into seven groups: one control group and six experimental groups that were orally administered a high or low dose of genistein, daidzein or a mixture of both. Testosterone determination was assayed by EIA. The testes and body weights were measured, and the histology of the epididymis with the sperm content and epididymal sperm count were evaluated. In the control group, we observed an increase in the serum testosterone levels (>2.5 ng ml(-1) ) at the third week (52 days), which corresponded to the onset of puberty in these rats. The same increase in serum testosterone levels was observed at the fourth week in rats that received low doses of isoflavones; therefore, we concluded that the onset of puberty was delayed. At high doses, there was no significant increase in testosterone levels, which could be related to the fact that these male rats did not reach puberty. These findings were supported by the results obtained from the analysis of the epididymal content as well as the testes/body weight ratio.

Mastocitosis sistémica: caso clínico / Systemic mastocytosis: report of one case

We report a 38 years old female who, since her childhood, had a history of precisely limited, fixed maculo papular dark brown cutaneous lesions in the trunk and extremities. These lesions become erythematous or urticarial after rubbing, medication intake or scratching. She also had frequent episodes of tachycardia, flushing, headache, abdominal pain, arthralgia, diarrhea and vomiting. She was hospitalized in three occasions due to high frequency tachycardia, hypotension, generalized urticarial erythema and clouding of consciousness. Three of these episodes occurred after the ingestion of antinflammatory drugs or acetylsalicylic acid. Mastocyte infiltration was confirmed in skin and bone marrow biopsies and in bone scintiscan. The use of H1, H2 blockers and mastocyte stabilizers gave partial relief to the patient

[Biliary ileus: enterolithotomy only or radical surgery?]. / Ileo biliar: sólo enterolitotomía o cirugía definitiva?

Eleven patients, 8 women and 3 men, mean age 69.9 years (range 54-81) were operated with a gallstone ileus during a seven years period. Echography and barium study of small bowel were made in 8 and 2 patients, and gave a diagnostic rate of 37% and 100%, respectively. A preoperative diagnosis was made in 72.2% of cases, simple enterolithotomy was made in 8 cases and in three cases a definitive treatment of biliary pathology was added. There was no mortality and a major complication was observed in 1 patient without biliary surgery (evisceration and recurrence of biliary ileus); no major complications were seen in patients with primary biliary surgery. With a careful, selection, surgery can be made without mortality nor morbidity.

Amiloidosis traqueobronquial / Tracheobronchial amyloidosis

Se presenta el caso de un hombre de 44 años con neumonias consecutivas del lóbulo medio, cuyo estudio endoscópico y biópsico reveló amiloidosis traqueobronquial generalizada. El bronquiolo lobar medio estaba casi completamente ocluído por una lesión gelatinosa y proliferativa la cual fue extirpada a través del broncoscopio. El estudio histológico fue positivo para amiloide. Las pruebas de laboratorio que apoyaron una causa de amiloidosis secundaria resultaron negativas. Un año después, la broncoscopia de control no mostró progresión de la enfermedad y el lumen del bronquiolo lobar medio estaba permeable peroestenosado. Finalmente, se revisa sumariamente la clasificación de amiloidosis de Thompson, los criterios para el diagnóstico histoquímico y el tratamiento de la amiloidosis pulmonar