Caracterización de las convulsiones y el status epilepticus producido por el pentilentetrazol en ratas de 14 días de edad

El status epilepticus (SE) es un tipo de actividad epiléptica con alta incidencia en niños; se caracteriza por crisis epilépticas por un tiempo prolongado, con consecuencias como muerte neuronal y desarrollo de epilepsia. A nivel experimental, el pentilentetrazol (PTZ) produce convulsiones tónico-clónicas generalizadas (CTCG) en la rata en desarrollo con alta mortalidad. En este estudio se realizó una curva dosis-respuesta con la finalidad de caracterizar las convulsiones producidas por una dosis única de PTZ (45, 50, 55, 60, 65, 70 y 75 mg/kg, i.p.) en ratas Wistar de 14 días de edad (P14). No se identificaron diferencias estadísticamente significativas entre las dosis de PTZ analizadas en la proporción de ratas que presentaron CTCG, SE o murieron después de la aplicación del PTZ. Con 45 mg/kg de PTZ ninguna rata presentó CTCG, con 50 mg/kg de PTZ el 25% de las ratas mostraron CTCG, mientras que a dosis mayores el 100% de las ratas presentaron estas convulsiones. Las ratas que presentaron CTCG y que no murieron desarrollaron enseguida SE en todas las dosis estudiadas, en un porcentaje que varió de 63% (55 y 60 mg/kg de PTZ) a 25-37% (70-50 mg/kg de PTZ). Todas las ratas inyectadas con 75 mg/kg de PTZ presentaron CTCG y murieron. Los datos de este estudio sugieren que la administración de una sola dosis de PTZ en la rata P14 puede ser un modelo útil para el estudio de CTCG y SE en la rata en desarroll

Hippocampal distribution of IL-1β and IL-1RI following lithium-pilocarpine-induced status epilepticus in the developing rat

The contribution of Interleukin-1β (IL-1β) to neuronal injury induced by status epilepticus (SE) in the immature brain remains unclear. The goal of this study was to determine the hippocampal expression of IL-1β and its type 1 receptor (IL-1RI) following SE induced by the lithium-pilocarpine model in fourteen-days-old rat pups; control animals were given an equal volume of saline instead of the convulsant. IL-1β and IL-1RI mRNA hippocampal levels were assessed by qRT-PCR 6 and 24 h after SE or control conditions. IL-1β and IL-1RI expression was detected in the dorsal hippocampus by immunohistochemical procedures; Fluoro-Jade B staining was carried out in parallel sections in order to detect neuronal cell death. IL-1β mRNA expression was increased 6 h following SE, but not at 24 h; however IL-1RI mRNA expression was unaffected when comparing with the control group. IL-1β and IL-1RI immunoreactivity was not detected in control animals. IL-1β and IL-1RI were expressed in the CA1 pyramidal layer, the dentate gyrus granular layer and the hilus 6 h after SE, whereas injured cells were detected 24 h following seizures. Early expression of IL-1β and IL-1RI in the hippocampus could be associated with SE-induced neuronal cell death mechanisms in the developing rat

Factores asociados a la sobrecarga del cuidador en cuidadores primarios de personas adultas mayores con diabetes tipo 2

Resumen: Objetivo: Caracterizar el perfil del cuidador primario informal (CPI) de pacientes adultos con diabetes tipo 2 (DT2) y los posibles factores asociados al colapso del cuidador (CC). Diseño: Estudio observacional, descriptivo, transversal y analítico, Emplazamiento: Unidad Médica de Atención Ambulatoria. Participantes: CPI mexicanos de pacientes adultos con DT2. Mediciones principales: Se recopilaron datos mediante un diseño prolectivo utilizando la escala de Zarit y una encuesta estructurada sobre factores sociodemográficos. Se realizó un análisis estadístico descriptivo y modelos de regresión logística univariantes y multivariantes. Resultados: El perfil del CPI es asumido por: mujeres, personas de 36-58 años, hijas, personas con un nivel educativo de secundaria y preparatoria, casados, católicos, con ingresos  5 años al cuidado de su paciente, sin capacitación y con enfermedades crónicas. Los factores de riesgo que incrementan el riesgo del CC son: ser mujer (OR = 11,03; IC 95%: 1,49-81,95), tener el antecedente de más de 5 años de haber asumido el papel de cuidador (OR = 2,65; IC 95%: 1,07-6,55), vivir en una casa propia (OR = 3,03; IC 95%: 1,04-8,82), con 6 o más habitantes (OR = 2,41; IC 95%: 1,08-5,38). El apoyo de redes se asoció como factor protector (OR = 0,15; IC 95: 0,07-0,33). Conclusiones: Se requieren programas de prevención para evitar el CC y sus complicaciones, así como, intervenciones para mejorar la calidad de vida de los CPI y la de los pacientes cuidados, incorporando estrategias para generar y/o incrementar sus redes de apoyo familiar y social. Abstract: Objective: To characterize the profile of the informal primary caregiver (IPC) of adult patients with type 2 diabetes (T2D) and the possible factors associated with caregiver collapse (CC). Design: Observational, descriptive, cross-sectional and analytical study. Site: Ambulatory Care Medical Unit. Participants: Mexican CPIs of adult patients with T2D. Main measurements: Data were collected through a prolective design using the Zarit scale and a structured survey on sociodemographic factors. A descriptive statistical analysis and univariate and multivariate logistic regression models were performed. Results: The CPI profile is assumed by: women, people aged 36-58, daughters, people with a secondary and high school educational level, married, Catholic, with income  5 years to the care of their patient, without training and with chronic diseases. The risk factors that increase the risk of CC are: being a woman (OR = 11.03; 95% CI: 1.49-81.95), having a history of more than 5 years of having assumed the role of caregiver (OR = 2, 65; 95% CI: 1.07-6.55), living in one's own house (OR = 3.03; 95% CI: 1.04-8.82), with 6 or more inhabitants (OR = 2.41; 95% CI: 1.08-5.38). The support of other family members and/or friends was associated as a protective factor (OR = 0.15; 95% CI: 0.07-0.33). Conclusions: Prevention programs are required to avoid CC and complications, as well as interventions to improve the quality of life of the CPI and patients in care, incorporating strategies to generate and/or increase their family and social support networks

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research