Neuropatía óptica isquémica anterior no arterítica

A review of anterior ischemic optic neuropathy is very difficult to diagnose and its treatment is harmful in patients' vision. There are different types of ischemic optic neuropathy: anterior (arteritic and non-arteritic) and later, but non-arteritic anterior form is the most important because of its high incidence. It is a multifactorial disease associated with a large number of risk factors. Its treatment is part of an individualized manner; it is recommended the use of antioxidants, but in recent time has tried other treatments and options with some success.Se realiza una revisión sobre neuropatía óptica isquémica anterior, entidad de difícil diagnóstico y tratamiento que resulta nefasta  en la visión de los pacientes. Existen diferentes tipos de neuropatías ópticas isquémicas: anterior (arterítica y no arterítica) y posterior, pero su forma anterior no arterítica constituye la más importante por su alta incidencia. Es una enfermedad multifactorial, asociada a una gran cantidad de factores de riesgo. Su tratamiento se enmarca de una manera individualizada, se preconiza el uso de antioxidantes, pero en los últimos tiempos se han probado otras alternativas terapéuticas con algún éxito.

EMBOLIA DE LÍQUIDO AMNIÓTICO Ó DISFUNCIÓN MITOCONDRIAL INDUCIDA POR HIPOXIA.

RESUMENGestante de 22 años de edad, primigesta,  ingresa a centro obstétrico del Hospital Belén de Trujillo por embarazo de 39 semanas en labor de parto fase activa, termina en parto eutócico, expulsivo de 2.30 horas, con producto de  3,200 g.  APGAR  8, 9;  en el puerperio inmediato presenta hemorragia por atonía uterina  el que se maneja con solución salina y Misoprostol 600 ug vía rectal. 50 minutos post parto, presenta disnea, taquicardia,  diaforesis y  ansiedad, se p0loantea el diagnóstico  de shock hipovolémico e insuficiencia respiratoria aguda es transferida a la unidad  de cuidados críticos maternos. Se inicia tratamiento de soporte con ventilación mecánica, antibióticos y vasotrópicos; se plantea disfunción orgánica múltiple por embolia de líquido amniótico versus disfunción mitocondrial,  a D/ shock séptico. La paciente permanece en coma por 10 días,  en ventilación mecánica   por 21 días, hemodiálisis precoz  por 5  días.  Evolución favorable y es dada de alta a los 30 días después del ingreso. Palabras clave: parto eutócico, disfunción orgánica, embolia de líquido amniótico, disfunción mitocondrial.  (BIREME DeCS

Environmental Challenges for the prevention of cholera in the province of Guantanamo

Se realiza un estudio para identificar aspectos ambientales relacionados con el cólera en los municipios de la provincia Guantánamo. Actualmente, se viene estudiando la compleja relación entre las condiciones ecológicas del medio y la dinámica poblacional de este, con el fin de poder conocer qué variables son las críticas en el surgimiento de un proceso infectivo o una epidemia de ahí que las acciones intencionadas sobre el medio ambiente para prevenir el cólera siempre deberán ser prioritarias en las estrategias de reordenamiento ambiental. Las variables estudiadas fueron la población no beneficiada por acueductos, indicadores de interés sobre los residuales líquidos, el número de fosas existentes, datos relacionados con el manejo de residuales sólidos, así como los resultados relacionados con el aislamiento y tipificación de gérmenes en las muestras de agua y alimentos estudiadas. Finalmente se emiten conclusiones y recomendaciones. A study was conducted to identify environmental aspects of cholera in the towns of Guantanamo. Currently, two aspects are studied such as: the complex relationship between the ecological conditions of the environment and population dynamics, in order to know which variables are critical in the emergence of an infectious process or an epidemic hence, intentional actions on environment to prevent cholera should always be a priority in environmental reorganization strategies. The variables were studied as: the population with no benefit from waterworks, indicators of interest on liquid waste, the number of existing tanks, data related to the management of solid waste and results related to the isolation and characterization of bacteria in samples of water and foods. Finally conclusions and recommendations are issued

Evaluación de un campo clínico de enfermería del área materno infantil

Introduction: Clinical practice is essential in nursing training. It includes, based on curricular objectives, consistent services, consistent teaching-learning strategies, learning environments, monitoring and evaluation methods. Clinical fields must be evaluated by academics and students. Objective: To evaluate a clinical field of the maternal and child area. Methodology. Quantitative, descriptive, longitudinal study, carried out from 2015 to 2019 in a 2nd level Hospital. Technique and instrument: Survey and questionnaire that explores: Organization, work and learning environment, theory-practice relationship, monitoring and evaluation. Population: Students who completed the educational experience. Sample: 81 students located in selected clinical field. Results: 80% and 100% adequate clinical field and time, not adequate duration 25%. 100% referred motivators to the environment, conditions and experience. Satisfactory interpersonal relationships between 90% and 100%. For + 80%, previous and required knowledge are correlational. -80% thought that the clinic provides training for the maternal and child area. + 80% consider the evaluation and supervision system adequate. Conclusion: The results reflect that the clinical field is adequate. As good practice, the academic community must identify opportunities to influence, through analysis, reflection, academic discussion and educational research to improve clinical teaching.Introducción: La práctica clínica es fundamental en la formación de enfermería. Incluye en función de objetivos curriculares, servicios acordes, estrategias de enseñanza- aprendizaje congruentes, ambientes de aprendizaje, métodos de supervisión y de evaluación. Los campos clínicos deben ser evaluados por académicos y estudiantes. Objetivo: Evaluar un campo clínico del área materno infantil. Metodología. Estudio cuantitativo, descriptivo, longitudinal, efectuado de 2015 a 2019 en un Hospital de 2do nivel. Técnica e instrumento: Encuesta y cuestionario que explora: Organización, ambiente laboral y de aprendizaje, relación teoría-práctica, seguimiento y evaluación. Población: Estudiantes que cursaron la experiencia educativa. Muestra: 81 alumnos ubicados en campo clínico seleccionado. Resultados: Campo clínico y horario adecuados 80% y 100%, no adecuada la duración 25%. 100% refirió motivadores el entorno, condiciones y experiencia. Relaciones interpersonales satisfactorias entre 90% y 100%. Para +80% son correlacionales saberes previos y los requeridos. -80% opinó que la clínica capacita para el área materno infantil. + 80% considera adecuado el sistema de evaluación y supervisión. Conclusión: Los resultados reflejan que el campo clínico es adecuado. Como buena praxis la comunidad académica debe identificar oportunidades para incidir, mediante análisis, reflexión, discusión académica e investigación educativa para mejorar la enseñanza clínica

Physician Perception of Blood Pressure Control and Treatment Behavior in High-Risk Hypertensive Patients: A Cross-Sectional Study

Objective: We examined physician perception of blood pressure control and treatment behavior in patients with previous cardiovascular disease and uncontrolled hypertension as defined by European Guidelines. Methods: A cross-sectional study was conducted in which 321 primary care physicians throughout Spain consecutively studied 1,614 patients aged ≥18 years who had been diagnosed and treated for hypertension (blood pressure ≥140/90 mmHg), and had suffered a documented cardiovascular event. The mean value of three blood pressure measurements taken using standardized procedures was used for statistical analysis. Results: Mean blood pressure was 143.4/84.9 mmHg, and only 11.6% of these cardiovascular patients were controlled according to 2007 European Guidelines for Hypertension Management target of <130/80 mmHg. In 702 (49.2%) of the 1426 uncontrolled patients, antihypertensive medication was not changed, and in 480 (68.4%) of these cases this was due to the physicianś judgment that blood pressure was adequately controlled. In 320 (66.7%) of the latter patients, blood pressure was 130-139/80-89 mmHg. Blood pressure level was the main factor associated (inversely) with no change in treatment due to physician perception of adequate control, irrespective of sociodemographic and clinical factors. Conclusions: Physicians do not change antihypertensive treatment in many uncontrolled cardiovascular patients because they considered it unnecessary, especially when the BP values are only slightly above the guideline target. It is possible that the guidelines may be correct, but there is also the possibility that the care by the physicians is appropriate since BP <130/80 mmHg is hard to achieve, and recent reviews suggest there is insufficient evidence to support such a low BP targetFunding for this study was obtained from RECORDATI ESPAÑA, S.L through an unrestricted grant. Krista Lundelin has a ‘‘Rio Hortega’’ research training contract (Expediente CM10/00327) from the Ministry of Science and Innovation (Instituto de Salud Carlos III), Spain Governmen

Ethnic Inequalities in Mortality: The Case of Arab-Americans

BACKGROUND: Although nearly 112 million residents of the United States belong to a non-white ethnic group, the literature about differences in health indicators across ethnic groups is limited almost exclusively to Hispanics. Features of the social experience of many ethnic groups including immigration, discrimination, and acculturation may plausibly influence mortality risk. We explored life expectancy and age-adjusted mortality risk of Arab-Americans (AAs), relative to non-Arab and non-Hispanic Whites in Michigan, the state with the largest per capita population of AAs in the US. METHODOLOGY/PRINCIPAL FINDINGS: Data were collected about all deaths to AAs and non-Arab and non-Hispanic Whites in Michigan between 1990 and 2007, and year 2000 census data were collected for population denominators. We calculated life expectancy, age-adjusted all-cause, cause-specific, and age-specific mortality rates stratified by ethnicity and gender among AAs and non-Arab and non-Hispanic Whites. Among AAs, life expectancies among men and women were 2.0 and 1.4 years lower than among non-Arab and non-Hispanic White men and women, respectively. AA men had higher mortality than non-Arab and non-Hispanic White men due to infectious diseases, chronic diseases, and homicide. AA women had higher mortality than non-Arab and non-Hispanic White women due to chronic diseases. CONCLUSIONS/SIGNIFICANCE: Despite better education and higher income, AAs have higher age-adjusted mortality risk than non-Arab and non-Hispanic Whites, particularly due to chronic diseases. Features specific to AA culture may explain some of these findings

The Salmonella Genomic Island 1 Is Specifically Mobilized In Trans by the IncA/C Multidrug Resistance Plasmid Family

BACKGROUND: The Salmonella genomic island 1 (SGI1) is a Salmonella enterica-derived integrative mobilizable element (IME) containing various complex multiple resistance integrons identified in several S. enterica serovars and in Proteus mirabilis. Previous studies have shown that SGI1 transfers horizontally by in trans mobilization in the presence of the IncA/C conjugative helper plasmid pR55. METHODOLOGY/PRINCIPAL FINDINGS: Here, we report the ability of different prevalent multidrug resistance (MDR) plasmids including extended-spectrum β-lactamase (ESBL) gene-carrying plasmids to mobilize the multidrug resistance genomic island SGI1. Through conjugation experiments, none of the 24 conjugative plasmids tested of the IncFI, FII, HI2, I1, L/M, N, P incompatibility groups were able to mobilize SGI1 at a detectable level (transfer frequency <10(-9)). In our collection, ESBL gene-carrying plasmids were mainly from the IncHI2 and I1 groups and thus were unable to mobilize SGI1. However, the horizontal transfer of SGI1 was shown to be specifically mediated by conjugative helper plasmids of the broad-host-range IncA/C incompatibility group. Several conjugative IncA/C MDR plasmids as well as the sequenced IncA/C reference plasmid pRA1 of 143,963 bp were shown to mobilize in trans SGI1 from a S. enterica donor to the Escherichia coli recipient strain. Depending on the IncA/C plasmid used, the conjugative transfer of SGI1 occurred at frequencies ranging from 10(-3) to 10(-6) transconjugants per donor. Of particular concern, some large IncA/C MDR plasmids carrying the extended-spectrum cephalosporinase bla(CMY-2) gene were shown to mobilize in trans SGI1. CONCLUSIONS/SIGNIFICANCE: The ability of the IncA/C MDR plasmid family to mobilize SGI1 could contribute to its spread by horizontal transfer among enteric pathogens. Moreover, the increasing prevalence of IncA/C plasmids in MDR S. enterica isolates worldwide has potential implications for the epidemic success of the antibiotic resistance genomic island SGI1 and its close derivatives

Design of Novel Relaxase Substrates Based on Rolling Circle Replicases for Bioconjugation to DNA Nanostructures

During bacterial conjugation and rolling circle replication, HUH endonucleases, respectively known as relaxases and replicases, form a covalent bond with ssDNA when they cleave their target sequence (nic site). Both protein families show structural similarity but limited amino acid identity. Moreover, the organization of the inverted repeat (IR) and the loop that shape the nic site differs in both proteins. Arguably, replicases cleave their target site more efficiently, while relaxases exert more biochemical control over the process. Here we show that engineering a relaxase target by mimicking the replicase target, results in enhanced formation of protein-DNA covalent complexes. Three widely different relaxases, which belong to MOBF, MOBQ and MOBP families, can properly cleave DNA sequences with permuted target sequences. Collaterally, the secondary structure that the permuted targets acquired within a supercoiled plasmid DNA resulted in poor conjugation frequencies underlying the importance of relaxase accessory proteins in conjugative DNA processing. Our results reveal that relaxase and replicase targets can be interchangeable in vitro. The new Rep substrates provide new bioconjugation tools for the design of sophisticated DNA-protein nanostructures.This work was financed by grants BFU2014-55534-C2-1-P from the Spanish Ministry of Economy and Competitiveness and 612146/FP7-ICT- 2013 and 282004/FP7-HEALTH.2011.2.3.1-2 from the European Union Seventh Framework Programme to FC and grant BFU2014-55534-C2-2-P from the Spanish Ministry of Economy and Competitiveness to GM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Functional assessment of older patients in the emergency department: comparison between standard instruments, medical records and physicians' perceptions

BACKGROUND: We evaluated the accuracy of physician recognition of functional status impairment in older emergency departments (ED) patients. In particular, we evaluated the accuracy of medical records (a comparison of the information in the medical record with the functional status based on proxy interviews), and the accuracy of physician knowledge (a comparison of the information obtained from the responsible physician with the functional status based on proxy interviews). METHODS: Cross-sectional study on 101 frail older patients selected at random from among those attending ED, their ED physicians, and respondents. The study was conducted at ED in four general university teaching hospitals in a city, from July through November 2003. Functional data shown on patients' medical records were compared against functional data obtained from respondents (family members), using Kendall's Tau-b statistic. In addition patients' Katz Indices (which assesses six basic activities of daily living – basic ADL) based on interviews with ED physicians were compared against those obtained from respondents, using the coefficient of concordance weighted kappa (κ). Each patient and his respondent were paired with a single physician. RESULTS: The correlation between information on dependence for basic ADL obtained from medical records and that furnished by respondents, was 0.41 (95% CI 0.27–0.55). Concordance between the respective Katz Indices obtained from physicians and respondents was 0.47 (95% CI 0.38–0.57). CONCLUSION: Older subjects' functional status is not properly assessed by emergency department physicians