Cuidados de enfermería en pacientes con dolor oncológico basado en la teoría de síntomas desagradables, servicio de oncología del Hospital Nacional Almanzor Aguinaga Asenjo - 2017

El paciente oncológico se ha convertido en un reto para el profesional de enfermería, es por ello que debe ser importante conocer teorías que sustente el cuidado enfermero. La presente investigación cualitativa tuvo como objetivo identificar, describir, analizar y comprender el cuidado de enfermería en pacientes con dolor oncológico. La muestra se determinó por saturación y redundancia, los sujetos de investigación: 10 enfermeras, 10 pacientes y 10 familiares. Los datos se recolectaron mediante la entrevista semi estructurada a profundidad. Durante toda la investigación se tuvo en cuenta, los criterios de rigor científico y éticos. Se obtuvo las siguientes categorías: 1. Reconociendo la teoría de síntomas desagradables en la intervención del cuidado de enfermería. 2. Identificando al dolor como síntoma principal de la teoría de síntomas desagradable. 3. Reconociendo los factores influyentes de la teoría de síntomas desagradables. 4. Cuidado de enfermería al paciente con dolor oncológico. La consideración final, se debe lograr ampliar los conocimientos del profesional de enfermería, ya que esta teoría sirve como guía en la intervención del cuidado, las investigadoras asumen que con el conocimiento adquirido del profesional enfermero podrá mejorar su actuación al brindar un cuidado holístico, se espera que la enfermera, utilice de manera adecuada todos los aspectos farmacológicos y no farmacológicos teniendo como único objetivo disminuir el dolor al paciente involucrando para ello a la familia, que debe ser considerada como pilar importante en su tratamiento

Analysis of a urinary biomarker panel for clinical outcomes assessment in cirrhosis

Background Biomarkers are potentially useful in assessment of outcomes in patients with cirrhosis, but information is very limited. Given the large number of biomarkers, adequate choice of which biomarker(s) to investigate first is important. Aim Analysis of potential usefulness of a panel of urinary biomarkers in outcome assessment in cirrhosis. Patients and Methods Fifty-five patients with acute decompensation of cirrhosis were studied: 39 had Acute Kidney Injury (AKI) (Prerenal 12, type-1 HRS (hepatorenal syndrome) 15 and Acute Tubular Necrosis (ATN) 12) and 16 acute decompensation without AKI. Thirty-four patients had Acute-on-chronic liver failure (ACLF). A panel of 12 urinary biomarkers was assessed, using a multiplex assay, for their relationship with ATN, ACLF and mortality. Results Biomarker with best accuracy for ATN diagnosis was NGAL (neutrophil-gelatinase associated lipocalin): 36 [26-125], 104 [58-208] and 1807 [494-3,716] μg/g creatinine in Prerenal-AKI, type-1 HRS and ATN, respectively; p<0.0001 (AUROC 0.957). Other attractive biomarkers for ATN diagnosis were IL-18, albumin, trefoil-factor-3 (TFF-3) and glutathione-S-transferase-π (GST-π) Biomarkers with less accuracy for ATN AUCROC<0.8 were β2-microglobulin, calbindin, cystatin-C, clusterin and KIM-1 (kidney injury molecule-1). For ACLF, the biomarker with the best accuracy was NGAL (ACLF vs. No-ACLF: 165 [67-676] and 32 [19-40] μg/g creatinine; respectively; p<0.0001; AUROC 0.878). Interestingly, other biomarkers with high accuracy for ACLF were osteopontin, albumin, and TFF-3. Biomarkers with best accuracy for prognosis were those associated with ACLF. Conclusions A number of biomarkers appear promising for differential diagnosis between ATN and other types of AKI. The most interesting biomarkers for ACLF and prognosis are NGAL, osteopontin, albumin, and TFF-3. These results support the role of major inflammatory reaction in the pathogenesis of ACLF

Neutrophil gelatinase-associated lipocalin is a biomarker of acute-on-chronic liver failure and prognosis in cirrhosis

BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is a syndrome that occurs in cirrhosis characterized by organ failure(s) and high mortality rate. There are no biomarkers of ACLF. The LCN2 gene and its product, neutrophil gelatinase-associated lipocalin (NGAL), are upregulated in experimental models of liver injury and cultured hepatocytes as a result of injury by toxins or proinflammatory cytokines, particularly Interleukin-6. The aim of this study was to investigate whether NGAL could be a biomarker of ACLF and whether LCN2 gene may be upregulated in the liver in ACLF. METHODS: We analyzed urine and plasma NGAL levels in 716 patients hospitalized for complications of cirrhosis, 148 with ACLF. LCN2 expression was assessed in liver biopsies from 29 additional patients with decompensated cirrhosis with and without ACLF. RESULTS: Urine NGAL was markedly increased in ACLF vs. no ACLF patients (108(35-400) vs. 29(12-73)μg/g creatinine; p<0.001) and was an independent predictive factor of ACLF; the independent association persisted after adjustment for kidney function or exclusion of variables present in ACLF definition. Urine NGAL was also an independent predictive factor of 28day transplant-free mortality together with MELD score and leukocyte count (AUROC 0.88(0.83-0.92)). Urine NGAL improved significantly the accuracy of MELD in predicting prognosis. The LCN2 gene was markedly upregulated in the liver of patients with ACLF. Gene expression correlated directly with serum bilirubin and INR (r=0.79; p<0.001 and r=0.67; p<0.001), MELD (r=0.68; p<0.001) and Interleukin-6 (r=0.65; p<0.001). CONCLUSIONS: NGAL is a biomarker of ACLF and prognosis and correlates with liver failure and systemic inflammation. There is remarkable overexpression of LCN2 gene in the liver in ACLF syndrome. LAY SUMMARY: Urine NGAL is a biomarker of acute-on-chronic liver failure (ACLF). NGAL is a protein that may be expressed in several tissues in response to injury. The protein is filtered by the kidneys due to its small size and can be measured in the urine. Ariza, Graupera and colleagues found in a series of 716 patients with cirrhosis that urine NGAL was markedly increased in patients with ACLF and correlated with prognosis. Moreover, gene coding NGAL was markedly overexpressed in the liver tissue in ACLF

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

[Montreal 1976] [Material gráfico]

Contiene fotografías pertenecientes al archivo fotográfico del diario "Región", publicadas entre 1974 y 1976, aunque la mayoría en 1976Todas las fotografías firmadas por Foto E. Gar (Oviedo), Cifra Gráfica, y EF

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

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Social Support in unwanted maternity of ecuadorian undergraduate college students : Analysis from a gender perspective.

Existe una alta prevalencia de embarazos indeseados en jóvenes universitarias ecuatorianas. Esta investigación transversal de alcance correlacional se pregunta cómo ha sido posible conciliar ambos roles, de madre y universitaria, encontrando en el apoyo social percibido, la diferencia que permitió no abandonar sus estudios. A partir de una muestra caracterizada socio-demográficamente, se analiza el apoyo social percibido por 50 madres universitarias de la sierra ecuatoriana. Se encontró que el 80% del total de madres, inició la maternidad cursando estudios como consecuencia de embarazos no deseados. El 44,9% interrumpió los estudios por esta causa y el apoyo social fue el facilitador principal para continuar el doble rol, de madre y estudiante. Asimismo emergen diferencias significativas entre las solteras y las casadas/unidas respecto a todas las variables de estudio. Se encontraron asociaciones estadísticamente significativas entre haber contraído matrimonio a causa del embarazo y continuar casada así como la percepción de apoyo por la pareja y tiempo de acompañamiento en la maternidad. Los resultados evidencian la importancia de diseñar programas, con perspectiva de género, que faciliten la conciliación y minimicen el riesgo de deserción universitaria

Apoyo social en la maternidad indeseada de estudiantes universitarias ecuatorianas: Análisis desde la perspectiva de género

There is a high prevalence of undesired pregnancies among young&nbsp;Ecuadorian university students. This correlational cross-sectional research&nbsp;inquires how it has been possible to reconcile both roles, that of a mother and of a student. The findings show that the perceived social support marks&nbsp;the difference that allowed women not to abandon their studies. Based on a sample, characterized socio-demographically, of 50 women&nbsp;who are both mothers and undergraduate college students in the central&nbsp;zone of Ecuador, the study analyzes the structural social support and the&nbsp;functional social support. It was found that 80% of mothers started motherhood during the&nbsp;course of their studies and as a product of undesired pregnancies. 44.9%&nbsp;interrupted their studies due to undesired maternity and social support was the main factor which impulse them to continue the double role of mother&nbsp;and student. Significant differences also emerged between single and&nbsp;married/united women with respect to all the variables in the study. The&nbsp;chi-square reveals a statistically significant association between getting&nbsp;married as a result of pregnancy and staying married, and also between&nbsp;the perception of support of the partner and the time of accompaniment in&nbsp;maternity. The results showed the importance of designing specific programs&nbsp;with a gender perspective that facilitate the conciliation of both roles and&nbsp;minimize the risk of dropping out of university.Existe una alta prevalencia de embarazos indeseados en jóvenes&nbsp;universitarias ecuatorianas. Esta investigación transversal de alcance&nbsp;correlacional se pregunta cómo ha sido posible conciliar ambos roles, de madre y universitaria, encontrando en el apoyo social percibido, la&nbsp;diferencia que permitió no abandonar sus estudios.A partir de una muestra caracterizada socio-demográficamente, se&nbsp;analiza el apoyo social percibido por 50 madres universitarias de la sierra&nbsp;ecuatoriana. Se encontró que el 80% del total de madres, inició la maternidad&nbsp;cursando estudios como consecuencia de embarazos no deseados. El 44,9%&nbsp;interrumpió los estudios por esta causa y el apoyo social fue el facilitador&nbsp;principal para continuar el doble rol, de madre y estudiante. Asimismo&nbsp;emergen diferencias significativas entre las solteras y las casadas/unidas&nbsp;respecto a todas las variables de estudio. Se encontraron asociaciones&nbsp;estadísticamente significativas entre haber contraído matrimonio a causa&nbsp;del embarazo y continuar casada así como la percepción de apoyo por la pareja y tiempo de acompañamiento en la maternidad. Los resultados&nbsp;evidencian la importancia de diseñar programas, con perspectiva de&nbsp;género, que faciliten la conciliación y minimicen el riesgo de deserción&nbsp;universitaria