Disfuncion familiar como factor asociado a no adherencia terapéutica en pacientes con esquizofrenia

Objetivo: Demostrar si la disfunción familiar es factor asociado a no adherencia terapéutica en pacientes con esquizofrenia en el Hospital Victor Lazarte Echegaray. Material y Métodos: Se llevó a cabo un estudio de tipo analítico, observacional, prospectivo, seccional transversal. La población de estudio estuvo constituida por 178 pacientes adultos con esquizofrenia; las cuales fueron divididas en 2 grupos: con o sin adherencia terapéutica ; se calculó el odds ratio y la prueba chi cuadrado. Resultados: No se apreciaron diferencias significativas entre los grupos de estudio en relación a las variables edad, genero ni procedencia. La frecuencia de disfunción familiar en pacientes con esquizofrenia con no adherencia terapéutica fue 34%. La frecuencia de disfunción familiar en pacientes con esquizofrenia con adherencia terapéutica fue 16%. La Disfunción familiar es factor asociado a no adherencia terapéutica en pacientes con esquizofrenia con un odds ratio de 2.79 el cual fue significativo (p<0.05). Conclusiones: La disfunción familiar es factor asociado a no adherencia terapéutica en pacientes con esquizofrenia en el Hospital Victor Lazarte Echegaray.Objective: To demonstrate if family dysfunction is a factor associated with noncompliance in patients with schizophrenia at the Victor Lazarte Echegaray Hospital. Material and Methods: An analytical, observational, retrospective, cross sectional study was carried out. The study population consisted of 178 adult patients with schizophrenia; Which were divided into 2 groups: with therapeutic or therapeutic noncompliance; The odds ratio and chi-square test were calculated. Results: There were no significant differences between the study groups in relation to the variables age, gender or origin. The frequency of familial dysfunction in patients with schizophrenia with noncompliance was 34%. The frequency of familial dysfunction in patients with schizophrenia with therapeutic compliance was 16%. Family dysfunction is a factor associated with noncompliance in patients with schizophrenia with an odds ratio of 2.79 which was significant (p <0.05). Conclusions: Family dysfunction is a factor associated with noncompliance in patients with schizophrenia at the Victor Lazarte Echegaray Hospital.Tesi

Development of a Panel of Genome-Wide Ancestry Informative Markers to Study Admixture Throughout the Americas

Most individuals throughout the Americas are admixed descendants of Native American, European, and African ancestors. Complex historical factors have resulted in varying proportions of ancestral contributions between individuals within and among ethnic groups. We developed a panel of 446 ancestry informative markers (AIMs) optimized to estimate ancestral proportions in individuals and populations throughout Latin America. We used genome-wide data from 953 individuals from diverse African, European, and Native American populations to select AIMs optimized for each of the three main continental populations that form the basis of modern Latin American populations. We selected markers on the basis of locus-specific branch length to be informative, well distributed throughout the genome, capable of being genotyped on widely available commercial platforms, and applicable throughout the Americas by minimizing within-continent heterogeneity. We then validated the panel in samples from four admixed populations by comparing ancestry estimates based on the AIMs panel to estimates based on genome-wide association study (GWAS) data. The panel provided balanced discriminatory power among the three ancestral populations and accurate estimates of individual ancestry proportions (R2>0.9 for ancestral components with significant between-subject variance). Finally, we genotyped samples from 18 populations from Latin America using the AIMs panel and estimated variability in ancestry within and between these populations. This panel and its reference genotype information will be useful resources to explore population history of admixture in Latin America and to correct for the potential effects of population stratification in admixed samples in the region

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

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Objective: To demonstrate if family dysfunction is a factor associated with noncompliance in patients with schizophrenia at the Victor Lazarte Echegaray Hospital. Material and Methods: An analytical, observational, retrospective, cross sectional study was carried out. The study population consisted of 178 adult patients with schizophrenia; Which were divided into 2 groups: with therapeutic or therapeutic noncompliance; The odds ratio and chi-square test were calculated. Results: There were no significant differences between the study groups in relation to the variables age, gender or origin. The frequency of familial dysfunction in patients with schizophrenia with noncompliance was 34%. The frequency of familial dysfunction in patients with schizophrenia with therapeutic compliance was 16%. Family dysfunction is a factor associated with noncompliance in patients with schizophrenia with an odds ratio of 2.79 which was significant (p <0.05). Conclusions: Family dysfunction is a factor associated with noncompliance in patients with schizophrenia at the Victor Lazarte Echegaray Hospital.Objetivo: Demostrar si la disfunción familiar es factor asociado a no adherencia terapéutica en pacientes con esquizofrenia en el Hospital Victor Lazarte Echegaray. Material y Métodos: Se llevó a cabo un estudio de tipo analítico, observacional, prospectivo, seccional transversal. La población de estudio estuvo constituida por 178 pacientes adultos con esquizofrenia; las cuales fueron divididas en 2 grupos: con o sin adherencia terapéutica ; se calculó el odds ratio y la prueba chi cuadrado. Resultados: No se apreciaron diferencias significativas entre los grupos de estudio en relación a las variables edad, genero ni procedencia. La frecuencia de disfunción familiar en pacientes con esquizofrenia con no adherencia terapéutica fue 34%. La frecuencia de disfunción familiar en pacientes con esquizofrenia con adherencia terapéutica fue 16%. La Disfunción familiar es factor asociado a no adherencia terapéutica en pacientes con esquizofrenia con un odds ratio de 2.79 el cual fue significativo (p<0.05). Conclusiones: La disfunción familiar es factor asociado a no adherencia terapéutica en pacientes con esquizofrenia en el Hospital Victor Lazarte Echegaray

Seminario Integrador 4 - ME178 - 202102

Curso de la especialidad de la carrera de medicina, de carácter teórico del ciclo 11, en el que los estudiantes al realizar la revisión y análisis de casos clínicos de todas las especialidades médicas elaboran diagnósticos, planes de trabajo y terapéutico pertinentes. El curso de seminario integrador 4 busca desarrollar las competencias específicas de práctica clínica- promoción, prevención y tratamiento (nivel 3) y profesionalismo - sentido ético legal y responsabilidad profesional - aprendizaje autónomo y desarrollo profesional (nivel 3). El curso de seminario integrador 4 les permitirá a los estudiantes tomar decisiones ante los diferentes retos diagnósticos del paciente y de la comunidad como miembro de un equipo interprofesional en su futura vida profesional

Seminario Integrador 3 - ME174 - 202102

Curso de la especialidad de la carrera de medicina, de carácter teórico del ciclo 10, en el que los estudiantes al realizar la revisión y análisis de casos, elaboran diagnósticos, planes de trabajo y terapéuticos pertinentes. El curso de seminario integrador busca desarrollar las competencias generales de: pensamiento crítico (nivel 3) y las competencias específicas de práctica clínica-promoción, prevención y tratamiento (nivel 2) y profesionalismo- aprendizaje autonómo y desarrollo profesional (nivel 3). El curso de seminario integrador 3, les permitirá a los estudiantes tomar decisiones ante los diferentes retos diagnósticos del paciente pediátrico y gineco-obstétricos en la mujer como miembro de un equipo interprofesional en su futura vida profesional.

Seminario Integrador 3 - ME174 - 202101

Curso de la especialidad de la carrera de medicina, de carácter teórico del ciclo 10, en el que los estudiantes al realizar la revisión y análisis de casos, elaboran diagnósticos, planes de trabajo y terapéuticos pertinentes. El curso de seminario integrador busca desarrollar las competencias generales de: pensamiento crítico (nivel 3) y las competencias específicas de práctica clínica-promoción, prevención y tratamiento (nivel 2) y profesionalismo- aprendizaje autonómo y desarrollo profesional (nivel 3). El curso de seminario integrador 3, les permitirá a los estudiantes tomar decisiones ante los diferentes retos 1diagnósticos del paciente pediátrico y gineco-obstétricos en la mujer como miembro de un equipo interprofesional en su futura vida profesional