Cardiorenal Syndrome: An Unsolved Clinical Problem

The clinical relevance of the bidirectional cross-talk between heart and kidney is increasingly recognized. However, the optimal approach to the management of kidney dysfunction in heart failure remains unclear. The purpose of this article is to outline the most plausible pathophysiologic theories that attempt to explain the renal impairment in acute and chronic heart failure, and to review the current treatment strategies for these situations

Protocolo de actuación para pacientes psiquiátricos en el servicio de urgencias del hospital Royo Villanova

La pandemia de covid-19 ha impactado gravemente en la salud mental, viéndose incrementados las urgencias psiquiátricas de forma alarmante. En el hospital Royo Villanova de Zaragoza fueron atendidos durante el año 2021, 1.057 pacientes con patologías psiquiátricas. Los pacientes psiquiátricos que acuden a los servicios de urgencias necesitan ser tratados acorde a sus necesidades y a su enfermedad. Para conseguir esto, se debe dotar al personal sanitario con herramientas y habilidades que les capaciten a realizar una asistencia sanitaria de calidad, evitando riesgos o lesiones para el paciente, el personal del servicio o desperfectos del material. <br /

Plan de cuidados estandarizado dirigido a pacientes colostomizados

Introducción: una ostomía es una intervención quirúrgica que sirve para comunicar un órgano con la piel abdominal. Las colostomías unen el colon con el exterior, mediante esta abertura, denominada estoma, se expulsan las heces fuera del cuerpo. En 2018, en España, había alrededor de 70.000 ostomizados y cada año esta cifra se incrementa en 16.000 pacientes. Las colostomías son las ostomías más frecuentes, suponen el 55% del total de las realizadas. Las causas que motivan la realización de una colostomía son: el cáncer colorrectal, las enfermedades intestinales inflamatorias y la diverticulitis. Las colostomías suponen un gran impacto en la vida de los pacientes tanto a nivel físico, como psíquico y social. La labor de la enfermería es fundamental para restablecer la autonomía, ofrecer prestaciones asistenciales y de rehabilitación a las personas ostomizadas.Objetivo: elaborar un plan de cuidados estandarizado dirigido a pacientes intervenidos, nuevos portadores de colostomías permanentes.Metodología: se ha realizado una búsqueda bibliográfica para la actualización del tema del estudio en diferentes bases de datos, libros y páginas web. Con la información se ha realizado un plan de cuidados de enfermería al paciente colostomizado, siguiendo la metodología enfermera de Virginia Henderson y la taxonomía NANDA, NIC / NOC.Conclusión: la elaboración de este plan de cuidados otorga a los profesionales de salud una herramienta que les permite aplicar unos cuidados seguros y de calidad a las personas colostomizadas, centrados en la atención integral del paciente, a través de unas actividades de enfermería dirigidas la educación nutricional, al control de la eliminación, el cuidado de la piel periestomal, junto con los cuidados psíquicos y sociales, que refuercen el correcto autocuidado.Palabras clave: "colostomía", "plan de cuidados", "ámbito psicológico", "ostomizados", "autonomía", "enfermería".<br /

Fatores associados à presença de ideação suicida entre universitários

RESUMO Objetivo: analisar os fatores associados à ideação suicida em uma amostra representativa de estudantes universitários. Método: estudo transversal analítico, realizado com 637 estudantes de uma Universidade Federal de Mato Grosso. Investigadas variáveis de presença de ideação suicida, demográficas e socioeconômica, uso de álcool por meio do Alcohol, Smoking and Substance Involvement Screening Test, e sintomas depressivos (Inventário de Depressão Maior). A análise bivariada foi realizada com o teste do Qui-quadrado, e a análise múltipla pelo modelo de regressão Poisson. Resultados: constatou-se que 9,9% dos estudantes tinham ideias suicidas nos últimos 30 dias, e na análise bivariada as variáveis classe econômica, orientação sexual, prática religiosa, tentativas de suicídio na família e entre amigos, consumo de álcool e sintomas depressivos apresentaram associação com ideação suicida. Na análise múltipla permaneceu como fatores associados orientação sexual, tentativas de suicídio na família e presença de sintomas depressivos. Conclusão: tais achados constituem um diagnóstico situacional que possibilita a formulação de políticas acadêmicas e de ações de prevenção para o enfrentamento dessa situação no campus universitário.RESUMEN Objetivo: analizar los factores asociados a la ideación suicida en una muestra representativa de estudiantes universitarios. Método: estudio transversal analítico, realizado con 637 estudiantes en una Universidad Federal de Mato Grosso. Fueron investigadas las variables: presencia de ideación suicida; demográficas y socioeconómicas; uso de alcohol por medio del Alcohol, Smoking and Substance Involvement Screening Test; y síntomas depresivos (Inventario de Depresión Mayor). El análisis bivariado fue realizado con el test de Chi-cuadrado y el análisis múltiple con el modelo de regresión de Poisson. Resultados: se constató que 9,9% de los estudiantes tuvieron ideas suicidas en los últimos 30 días, y en el análisis bivariado las variables: clase económica; orientación sexual; práctica religiosa; intentos de suicidio en la familia y entre amigos; consumo de alcohol; y síntomas depresivos, presentaron asociación con ideación suicida. En el análisis múltiple permanecieron como factores asociados la orientación sexual, los intentos de suicidio en la familia y la presencia de síntomas depresivos. Conclusión: estos hallazgos constituyen un diagnóstico situacional que posibilita la formulación de políticas académicas y de acciones de prevención para enfrentar esa situación en el campus universitario.ABSTRACT Objective: to analyze the factors associated with suicidal ideation in a representative sample of university students. Methods: cross-sectional study, carried out with 637 students of the Federal University of Mato Grosso. The presence of suicidal ideation, demographic and socioeconomic variables, use of alcohol through the Alcohol, Smoking and Substance Involvement Screening Test, and depressive symptoms (Major Depression Inventory) were investigated. Bivariate analysis was performed with the Chi-square test and multivariate analysis using the Poisson regression model. Results: it was found that 9.9% of the students had suicidal thoughts in the previous 30 days and, in the bivariate analysis, the variables economic class, sexual orientation, religious practice, suicide attempts in the family and among friends, alcohol consumption and depressive symptoms were associated with suicidal ideation. In the multivariate analysis sexual orientation, suicide attempts in the family and the presence of depressive symptoms remained as associated factors. Conclusion: these findings constitute a situational diagnosis that enables the formulation of academic policies and preventive actions to confront this situation on the university campus

Betanin loaded nanocarriers based on quinoa seed 11S globulin. Impact on the protein structure and antioxidant activity

The objective of the present contribution was to design and characterize betanin (Bt) loaded in a nanovehicle of 11S quinoa seed protein. 11S was isolated from quinoa seed floor. Protein purification was performed by Size-Exclusion Chromatography. MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization-Time-Of- Flight) analysis confirmed the identity of 11S. Nanocarriers (11S-Bt) were generated at pH 8 at different ionic strength. Globulin intrinsic fluorescence spectra showed a quenching effect exerted by Bt, demonstrating in turn protein-bioactive interaction. Stern-Volmer and Scatchard models application confirmed static quenching and allow obtaining parameters that described 11S and betanincomplexation process. Bt-11S globulin interactions seem to be more probably of physical type. Protein solubility was increased after complexation with Bt. 11S betanin-loaded nanocarrier showed additive effect in terms of both, antiradical or reducing power capacity in comparison to Bt as evaluated by two methods, 2,2 -azino-bis-(3-ethylbenzothiazoline-6-sulfonate) (ABTS), and by ferric reducing antioxidant power (FRAP). Interestingly 11S globulin quaternary structure was modified by the bioactive, experimenting hexamer dissociation. This nanocolloid could have the potentiality to exert the Bt controlled delivery for pharmaceutical and nutraceutical products. Bt could also be protected from light and oxygen in such systems.Fil: Martínez, María Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Velázquez Duarte, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Burrieza, Hernán Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Biodiversidad y Biología Experimental y Aplicada. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Biodiversidad y Biología Experimental y Aplicada; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Biodiversidad y Biología Experimental; ArgentinaFil: Martínez, Karina Dafne. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias. Instituto de Tecnología de Alimentos y Procesos Químicos. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Tecnología de Alimentos y Procesos Químicos; ArgentinaFil: Domínguez Rubio, Ana Paula. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: dos Santos Ferreira, Cristina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Orgánica; ArgentinaFil: del Pilar Buera, María. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Industrias. Instituto de Tecnología de Alimentos y Procesos Químicos. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Tecnología de Alimentos y Procesos Químicos; ArgentinaFil: Perez, Oscar Edgardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; Argentina. Universidad Nacional de Lanús; Argentin

Adipokines, hormones related to body composition, and insulin resistance in HIV fat redistribution syndrome

BACKGROUND: Lipodystrophies are characterized by adipose tissue redistribution, insulin resistance (IR) and metabolic complications. Adipokines and hormones related to body composition may play an important role linking these alterations. Our aim was to evaluate adipocyte-derived hormones (adiponectin, leptin, resistin, TNF-α, PAI-1) and ghrelin plasma levels and their relationship with IR in HIV-infected patients according to the presence of lipodystrophy and fat redistribution. METHODS: Anthropometric and metabolic parameters, HOMA-IR, body composition by DXA and CT, and adipokines were evaluated in 217 HIV-infected patients on cART and 74 controls. Fat mass ratio defined lipodystrophy (L-FMR) was defined as the ratio of the percentage of the trunk fat mass to the percentage of the lower limb fat mass by DXA. Patient's fat redistribution was classified into 4 different groups according the presence or absence of either clinical lipoatrophy or abdominal prominence: no lipodystrophy, isolated central fat accumulation (ICFA), isolated lipoatrophy and mixed forms (MXF). The associations between adipokines levels and anthropometric, metabolic and body composition were estimated by Spearman correlation. RESULTS: Leptin levels were lower in patients with FMR-L and isolated lipoatrophy, and higher in those with ICFA and MXF. Positive correlations were found between leptin and body fat (total, trunk, leg, arm fat evaluated by DXA, and total, visceral (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio evaluated by CT) regardless of FMR-L, and with HOMA-IR only in patients with FMR-L. Adiponectin correlated negatively with VAT, and its mean levels were lower in patients with ICFA and higher in those with no lipodystrophy. Resistin was not correlated with adipose tissue but positively correlated with HOMA-IR in FMR-L patients. PAI-1 levels were higher in MXF-patients and their levels were positively correlated with VAT in those with FMR-L. Ghrelin was higher in HIV-infected patients than controls despite BMI-matching. CONCLUSION: The overall body fat reduction in HIV lipoatrophy was associated with low leptin plasma levels, and visceral fat accumulation was mainly associated with decreased plasma levels of adiponectin

Carotid intima media thickness is associated with body fat abnormalities in HIV-infected patients.

BACKGROUND: HIV-infected patients may be at increased risk of cardiovascular (CV) events, and lipodystrophy is generally associated with proatherogenic metabolic disturbances. Carotid intima-media thickness (cIMT) has been used as a surrogate marker for atherosclerosis and it has been shown to be an independent risk factor for CV disease. Our objective was to evaluate cIMT in HIV-infected patients on combined anti-retroviral therapy (cART) with and without lipodystrophy defined by fat mass ratio (L-FMR), and to determine the association of lipodystrophy and visceral obesity [(visceral (VAT), subcutaneous adipose tissue (SAT) volume and VAT/SAT ratio, objectively evaluated by CT scan] with cIMT. METHODS: Cross-sectional study of 199 HIV-infected patients. Body composition by DXA and abdominal CT, lipids, blood pressure, inflammatory markers, and cIMT by ultrasonography were performed. L-FMR was defined as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared using the chi-square or Fisher's exact test. Spearman correlation coefficients were estimated to study the association between cIMT and clinical and metabolic characteristics. Means of cIMT, adjusted for age, were calculated, using generalized linear models. RESULTS: L-FMR was present in 41.2% of patients and cIMT was higher in these patients [0.81 (0.24) vs. 0.76 (0.25); p=0.037)]. Lipodystrophic patients had higher VAT and VAT/SAT ratio and lower SAT. cIMT was associated with lipodystrophy evaluated by FMR, trunk fat, total abdominal fat, VAT and VAT/SAT ratio. No association was observed between cIMT and leg fat mass. Using generalized linear models, cIMT means were adjusted for age and no significant differences remained after this adjustment. The adjusted mean of cIMT was 0.787 (95%CI: 0.751-0.823) in patients without lipodystrophy, and 0.775 (95%CI: 0.732-0.817) in those with lipodystrophy (p=0.671). CONCLUSIONS: HIV-infected patients on cART with lipodystrophy defined by FMR, had a significantly higher cIMT. Carotid IMT was also associated with classical cardiovascular risk factors. In these patients, visceral adipose tissue had a significant impact on cIMT, although age was the strongest associated factor

A convenient synthesis of new 6-substituted purinylcarbanucleosides on cyclopenta[b]thiophene

The 12th International Electronic Conference on Synthetic Organic Chemistry session Bioorganic Chemistry and Natural ProductsThe first members of a new family of heterocarbobicyclic nucleoside analogues have been synthesized from the cis/trans mixture of (4-amino-5,6-dihydro-4H-cyclopenta[b]thiophen-6-yl)methanols cis/trans-7. The separation of cis and trans intermediates during preparation of the 6-chloropurine derivatives allowed separate preparation of the purine heterocarbanucleosides cis-10 and trans-11, from which cis-(12-14) and trans-(16-18) were obtained by replacement of the 6-chloro substituent with amino, hydroxy and cyclopropylamino groups. Additionally, the 6-phenyl-purinyl analogues cis-15 and trans-19 were prepared from cis-10 and trans-11 using Suzuki-Miyaura methodologyThe authors thank the Xunta de Galicia for financial support under project PGIDIT02BTF20305P

Lipodystrophy defined by Fat Mass Ratio in HIV-infected patients is associated with a high prevalence of glucose disturbances and insulin resistance

INTRODUCTION: Combined antiretroviral therapy (cART) in the treatment of HIV-1 infection has been associated with complications, including lipodystrophy, hyperlipidaemia, insulin resistance (IR) and diabetes. AIMS: To compare the prevalence of glucose homeostasis disturbances and IR in HIV patients on cART according to the presence of lipodystrophy (defined clinically and by Fat Mass Ratio) and different patterns of fat distribution and to establish their associations. DESIGN: Cross-sectional cohort study. METHODS: We evaluated body composition and IR and insulin sensitivity indexes in 345 HIV-infected adults. RESULTS: Patients with clinical lipodystrophy (CL) had higher plasma glucose levels than patients without CL, without significant differences in plasma insulin levels, A1c, HOMA-IR, HOMA-B, QUICKI, or MATSUDA index. Patients with lipodystrophy defined by FMR had higher plasma glucose and insulin levels, A1c, HOMA-IR, QUICKI and MATSUDA than patients without lipodystrophy, without differences in HOMA-B. Higher insulin resistance (HOMA-IR ≥ 4) was present in patients with FMR-defined lipodystrophy. Patients with FMR-defined lipodystrophy had a higher prevalence of IFG, IGT and DM than patients without lipodystrophy. Significant associations between HOMA-IR and total, central and central/peripheral fat evaluated by CT at abdominal level were found and no association between HOMA-IR and peripheral fat. Association between HOMA-IR and total and trunk fat but no association with leg and arm fat (evaluated by DXA) was found. CONCLUSIONS: IR and glucose disturbances were significantly increased in patients with FMR-defined lipodystrophy. FMR lipodystrophy definition seems to be a more sensitive determinant of insulin resistance and glucose disturbances than clinical definition

Impact of Lipodystrophy on the prevalence and components of metabolic syndrome in HIV-infected patients

BACKGROUND: In HIV-infected patients, combination antiretroviral therapy (cART) is associated with clinical lipodystrophy (CL) and metabolic abnormalities (MA). This study aimed to evaluate the prevalence of the metabolic syndrome (MS) and its components, and to determine whether patients with or without CL had a different prevalence of MA. METHODS: We evaluated 345 HIV-infected patients on cART using two different MS definitions (NCEP-ATPIII-2005 and IDF-2005) and the Framingham risk score. RESULTS: CL was present in 58.7% of the patients. The prevalence of the MS was 52.2% (ATPIII) and 43.2% (IDF), and it was not significantly different between patients with (W) or without (WT) CL, regardless of the definition used (ATPIII WCL 52.9% vs WT CL 51.1%; p = 0.738; IDF WCL 41.3% vs WTCL 46.0%; p = 0.379). Moderate concordance was observed between the 2 definitions (kappa = 0.484; p < 0.001) and after gender stratification there was good concordance in women (kappa = 0.759; p < 0.001). Patients with CL had lower waist circumference and HDL-C and higher triglycerides levels. In women, CL was significantly associated with MS, hypertriglyceridemia and low HDL cholesterol independently of age, cART and BMI. Patients with CL had a significantly higher risk of coronary heart disease at 10 years, measured by the Framingham risk score, than patients without CL. Those with CL and with MS had higher frequencies of moderate and high risk categories than those without MS. CONCLUSIONS: The prevalence of the MS was high in these HIV-infected patients with an age average of 40 years and this finding could explain why HIV patients have an increased risk for cardiovascular disease (CVD)