Factores asociados al autocuidado en pacientes con diabetes. Hospital Víctor Ramos Guardia. Huaraz.2017

El presente trabajo de investigación tuvo como objetivo conocer los factores que se asocian al Autocuidado en Pacientes con Diabetes en el Hospital Víctor Ramos Guardia Huaraz, la población con la que se trabajo fue de 50 pacientes hospitalizados en el servicio de medicina, que cumplan con los criterios de inclusión establecidos en el presente trabajo. En relación a la metodología el diseño fue no experimental, el tipo de investigación fue descriptivo correlacional, transversal. El instrumento que se aplicó fue un cuestionario elaborado y validado por Méndez y Montero (2011); la técnica usada fue la encuesta. Para el procesamiento de datos se empleó el programa estadístico SPSS Versión 23, con la prueba estadística ODDS Ratio, donde los resultados en relación al autocuidado en lo que respecta a alimentación el 8% (4) si come verduras, pero el 26% (13) no lo hace, respeta los horarios de alimentación el 12% (6), pero el 14% (7) no lo hace, en lo que respecta a que si consume sal en su dieta el 4% (2) si lo hace, pero el 14% (7) no lo hace, si consume azúcar en su dieta el 14%(7) el 8%(4) no consume, actividad física el 18% (9) si realiza ejercicios, el 40%(20) no, si realiza caminatas el 12% (6), el 30% (15) no. En el autocuidado de la piel el 26% (13) si lo hace, pero el 30%(15) no lo, en el cuidado de el corte las uñas, el 16% (8) si lo hace, pero el 28% (14) no.Tesi

Pathogenicity and Epitope Specificity of IgG4 Autoantibodies in Endemic Pemphigus Foliaceus

Endemic pemphigus foliaceus, also known as Fogo Selvagem (FS), is an autoimmune blistering skin disease that exhibits geographic clustering and 100% mortality without treatment. An active focus of FS is located in the rural reservation of Limao Verde (LV), Mato Grosso do Sul, Brazil. It is widely accepted that the autoantibodies that mediate FS are predominantly of the IgG4 subclass against Desmoglein 1 (Dsg1) and that healthy individuals living in LV posses a mixture of circulating IgG anti-Dsg1 autoantibodies. It has been suggested that an unknown environmental trigger present in LV may induce an anti-Dsg1 autoimmune response, which in certain genetically predisposed individuals leads to a pathogenic IgG4 response and clinical disease. The transition from preclinical to clinical disease in FS has been associated with subclass switching and epitope spreading within the extracellular domain of Dsg1. The N-terminal region of Dsg1 has been reported to be the target for pathogenic FS IgG autoantibodies. However, the fine epitope specificity for FS IgG4 autoantibodies remains unknown. The work in this dissertation refines the identification of epitopes in Dsg1 that are recognized specifically by IgG4 autoantibodies from FS patients. Two dominant conformational epitopes were identified using epitope excision and MALDI-MS/MS. One epitope was located within the EC1 domain of Dsg1 (A129-R144) and the second epitope in the EC2 domain (Q201-R213). Moreover, residues M133 and Q135 are required to achieve the proper conformation of the epitope recognized by pathogenic IgG4 autoantibodies in FS. This study also reports that IgG4 FS antibodies recognize LJM11, a protein found in the saliva of Lutzomya longipalpis. In addition, mice immunized with LJM11 generate anti-Dsg1 antibodies. Thus, insect bites may deliver salivary antigens that initiate a cross-reactive IgG4 autoimmune response in genetically susceptible individuals, which subsequently leads to development of FS. The findings of this dissertation may uncover targets such as the epitope in EC1 for the development of epitope-specific preventative and therapeutic strategies. Additionally, this work identifies an environmental, non-infectious antigen, which may trigger development of potentially pathogenic autoantibodies in autoimmune disease.Doctor of Philosoph

Factores asociados de la automedicación en pacientes adultos que asisten al centro de salud Acapulco - 2019

La automedicación nace de la iniciativa del paciente de ingerir un determinado medicamento sin ninguna prescripción médica, lo cual se ha convertido en hábito común en la actualidad. En este contexto se realiza este estudio para determinar los factores socioeconómicos y culturales que se encuentran asociados con la automedicación en los adultos que acuden al Centro de Salud Acapulco – Callao 2019. La metodología tuvo un enfoque cuantitativo, descriptivo, con diseño no experimental de corte transversal, contando con una muestra probabilística de 57 adultos que acuden al centro de salud referido. Se utilizó como técnica la encuesta y como instrumento el cuestionario. Los resultados evidenciaron que del 100% de adultos que acuden al Centro de Salud Acapulco, Callao, el 49.1% presenta un nivel medio de automedicación, el 26.3% un nivel bajo y el 24.6% un nivel alto de automedicación, los resultados inferenciales mostraron a través de la aplicación del Chi Cuadrado p<0,05, aceptándose las hipótesis de investigación. Concluyendo que los factores socioeconómicos y culturales se encuentran asociados a la automedicación en los adultos que acuden al Centro de Salud Acapulco – Callao 2019

IgG4 autoantibodies are inhibitory in the autoimmune disease bullous pemphigoid

The IgG4 subclass of antibodies exhibits unique characteristics that suggest it may function in an immunoregulatory capacity. The inhibitory function of IgG4 has been well documented in allergic disease by the demonstration of IgG4 blocking antibodies, but similar functions have not been explored in autoimmune disease. Bullous pemphigoid (BP) is a subepidermal autoimmune blistering disease characterized by autoantibodies directed against BP180 and an inflammatory infiltrate including eosinophils and neutrophils. Animal models have revealed that the NC16A region within BP180 harbors the critical epitopes necessary for autoantibody mediated disease induction. BP180 NC16A-specific IgG belong to the IgG1, IgG3, and IgG4 subclasses. The purpose of this study was to determine effector functions of different IgG subclasses of NC16A-specific autoantibodies in BP. We find that IgG4 anti-NC16A autoantibodies inhibit the binding of IgG1 and IgG3 autoantibodies to the NC16A region. Moreover, IgG4 anti-NC16A blocks IgG1 and IgG3 induced complement fixation, neutrophil infiltration, and blister formation clinically and histologically in a dose-dependent manner following passive transfer to humanized BP180-NC16A mice. These findings highlight the inhibitory role of IgG4 in autoimmune disease and have important implications for the treatment of BP as well as other antibody mediated inflammatory and autoimmune diseases

The IgM Anti-Desmoglein 1 Response Distinguishes Brazilian Pemphigus Foliaceus (Fogo Selvagem) from Other Forms of Pemphigus

Fogo selvagem (FS) and pemphigus foliaceus (PF) possess pathogenic IgG anti-desmoglein 1-(Dsg1) autoantibodies. Although PF occurs sporadically, FS is endemic in Limao Verde (LV), Brazil (3.4% prevalence). IgM anti-Dsg1 were detected in 58% FS LV patients (n=31), 19% of FS patients from Hospital-Campo Grande (n=57), 19% from Hospital-Goiania (n=42), 12% from Hospital-Sao Paulo (n=56), 10% of PF patients from United States (n=20), and 0% of PF patients from Japan (n=20). Pemphigus vulgaris (n=40, USA and Japan), bullous pemphigoid (n=40, USA), and healthy donors (n=55, USA) showed negligible percentages of positive sera. High percentages of positive IgM anti-Dsg1 were found in healthy donors from four rural Amerindian populations (42% of 243) as compared with urban donors (14% of 81; P<0.001). More than 50% of healthy donors from LV (n = 99, age 5-20 years) possess IgM anti-Dsg1 across ages, whereas IgG-anti-Dsg1 was detected in 2.9% (age 5-10 years), 7.3% (age 11-15 years), and 29% of donors above age 16. IgM anti-Dsg1 epitopes are Ca2+and carbohydrate-independent. We propose that IgM anti-Dsg1 are common in FS patients in their native environment and uncommon in other pemphigus phenotypes and in FS patients who migrate to urban hospitals. Recurrent environmental antigenic exposure may lead to IgM and IgG responses that trigger FS

Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature

The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out

Propiedades Psicométricas del Cuestionario de Madurez Psicológica – PSYMAS en adolescentes de colegios públicos de Otuzco.

El presente estudio de diseño psicométrico tuvo por objetivo el establecer las propiedades psicométricas del Cuestionario de Madurez Psicológica – PSYMAS desde el modelo de Greenberger et al. (1975, quoted in morales et a., 2012) Para ello, la muestra estuvo constituida por 317 adolescentes de colegios públicos de Otuzco, entre hombres y mujeres, y de 15 a 18 años. Se realizó el análisis factorial confirmatorio observando índices de ajuste aceptables (X2/gl = 2.107; GFI = .907; RMSEA = .059; CFI = .910. Para la confiabilidad se utilizó el método de consistencia interna con el coeficiente Omega con resultados entre .70 al .79

Possíveis interações medicamentosas potenciais em prescrições médicas com antibacterianos dispensados no Boticário Inkafarma Lince de janeiro a junho de 2021

La presente investigación tiene como objetivo: Identificar las posibles interacciones medicamentosas potenciales en prescripciones médicas con antibacterianos. Metodología: Método deductivo, enfoque cuantitativo, tipo básico, nivel descriptivo, diseño no experimental, corte transversal retrospectivo. Se analizó 278 prescripciones médicas con antibacterianos dispensados en la botica Inkafarma de Lince. Técnica, el Análisis documental Observacional y el instrumento empleado fue una ficha de recolección de datos. Resultados: la prevalencia fue (74,8%) no presenta IMT y (25,2%) si presentó ITM, según su gravedad, (12,8%) tuvo severidad moderada y mayor con (7,4%), la interacción mayoritaria fue Farmacocinética (14,2%) Farmacodinámica (12,1%), el nivel de evidencia clínica (21.6%) fue de aspecto excelente, según el grupo farmacológico antibiótico de mayor frecuencia de ITM fue Quinolona con 16,0%, de acuerdo con la incidencia de interacciones potenciales con medicamentos antibacterianos manifestó Levofloxacino + Dexametasona con 3,5%, Ciprofloxacino + Omeprazol 1,1%, Claritromicina + Esomeprazol 1,4%, Diclofenaco + Ciprofloxacino 1,1%. Conclusión: podemos afirmar que las posibles interacciones medicamentosas potenciales en las 278 prescripciones medicas con antibacterianos, fue del 25,2 %, por otro lado, el 74,8% no presentó alguna interacció