Motivos que intervienen en la implementación de las Terapias Alternativas y Complementarias a la práctica de cuidados enfermeros : Estudio descriptivo de corte transversal a realizarse con enfermeros profesionales de instituciones de salud públicas y privadas durante el primer semestre del año 2020

Enfermería implementa un proceso sistematizado y dinámico de cuidados a personas, ya desde los inicios de la profesión Florence Nightingale, de acuerdo con la perspectiva de su época, claramente naturalista, entendía que la enfermedad es la respuesta de la naturaleza frente a una agresión externa. Posteriormente Virginia Henderson introduce en el concepto el aspecto global de la persona y su relación con el entorno. Madeleine Leininger conceptualiza y funda la Enfermería Transcultural, a la cual definió como el área de estudio y trabajo centrado en el cuidado basado en la cultura, creencia de salud o enfermedad, valores o prácticas de las personas, para ayudarlas a mantener o recuperar su salud, hacer frente a sus discapacidades o a su muerte. En definitiva, se constata, la relación de la persona con su entorno y que en este proceso los factores intra, inter y extrapersonales son definitivamente importantes y determinantes. 1 Es así que, la disciplina enfermera se sustenta en paradigmas holísticos que dan origen a las Terapias Alternativas y Complementarias. Estas terapias suelen denominarse en muchos países del mundo como medicina tradicional (MT). La misma, es una parte importante y con frecuencia subestimada de los servicios de salud. El interés y aplicación de este tipo de medicina está en aumento en la mayoría de los países donde ya se encuentra reglamentada y está creciendo rápidamente en los demás países del mundo. Se extiende más allá de los productos y usuarios, abarcando también las prácticas y a los profesionales. (OMS, 2013). En Argentina, un número creciente de personas decide complementar los tratamientos indicados por la medicina ortodoxa con terapias alternativas. Esto no es una rareza local; va en consonancia con lo que pasa en el mundo. Cuando la gente busca solución a sus problemas de salud recurre a medicinas integradoras y menos invasivas, que son repudiadas desde algunos ámbitos médicos y académicos. Lo muestra, por ejemplo, una encuesta que realizó el Centro Argentino de Etnografía Americana en 2009; los resultados indican que alrededor del 90% de las personas consultadas que padecía cáncer combinaba la medicina convencional y alguna de las alternativas. El objetivo de las mismas apunta a reducir la medicalización, definida como, el proceso de convertir situaciones que han sido siempre normales en cuadros patológicos y pretender resolver, mediante la medicina, situaciones que no son médicas, sino sociales, profesionales o de las relaciones interpersonales. Actualmente enfermería, como disciplina y como todas las ciencias en general, incluidas las llamadas ciencias de la salud, está continuamente, planteándose y replanteándose tanto sus marcos teóricos como metodológicos. Por esta razón las autoras del presente proyecto de investigación contemplaron esta situación disciplinar, además de considerar la demanda existente a nivel mundial como en Argentina de implementar, en forma eficaz y libre de riesgos, Terapias Alternativas y Complementarias, para comenzar a investigar sobre las mismas. Así surge la necesidad de dar a conocer los motivos que intervienen en la implementación de las terapias alternativas y complementarias en la práctica de los cuidados, según opinión de los enfermeros en el servicio de internación de hospitales públicos y privados durante el primer semestre del 2020. Por otro lado, se decide investigar sobre las mismas para brindar información con respaldo científico y posibilitar la reflexión sobre estas Terapias Alternativas y Complementarias a las instituciones de salud y equipo interdisciplinario, principalmente al personal de enfermería. Algunas de estas terapias complementarias, utilizadas conjuntamente con el tratamiento oncológico y bajo supervisión y control médico y/o de personal capacitado, pueden tener efectos beneficiosos para aliviar síntomas, paliar efectos secundarios de los tratamientos medicamentosos (especialmente los relacionados al dolor crónico) y mejorar la calidad de vida de los pacientes. En nuestro ámbito sanitario se desconoce la repercusión económica global que tienen las terapias alternativas y complementarias, entre otros aspectos, porque no hay estudios acerca de las mismas, tampoco existe ningún tipo de registro fiable que nos aporte el número de enfermeros que lo aplican en las instituciones sanitarias. El PROYECTO se encuentra organizado en dos capítulos: Capítulo I: plantea y define el problema de estudio, su justificación; se desarrolla el marco teórico y se incluyen definición conceptual de la variable, objetivo general y específicos que persiguen la investigación. Capítulo II: se desarrolla la metodología que se utilizará, la cual incluye, el tipo de estudio, la operacionalización de la variable, el universo, el tipo de fuente utilizada, la técnica o instrumento para la recolección de datos y los planes -de procesamiento presentación y análisis de los datos- cronograma de actividades, presupuesto y referencias bibliográficas (según normas APA). Además, se incluye un apartado apara anexos, donde se incorporan las notas de autorización destinadas a las autoridades de las instituciones, consentimiento informado, el instrumento y por último la tabla matriz.Fil: Herrera Rodriguez, María Luz. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Enfermería; Argentina.Fil: Quiros Alvarez, Diana Maribel. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Enfermería; Argentina.Fil: Silva, Nancy Beatriz. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Enfermería; Argentina.Fil: Tello, Maria Josè. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Escuela de Enfermería; Argentina

Concordance of p16INK4a and E6*I mRNA among HPV-DNA-Positive Oropharyngeal, Laryngeal, and Oral Cavity Carcinomas from the ICO International Study

Simple Summary The utility of a diagnostic algorithm for the detection of HPV-driven oral cavity (OCC), oropharyngeal (OPC), and laryngeal (LC) carcinomas using HPV-DNA testing followed by p16(INK4a) immunohistochemistry, taking E6*I mRNA detection as the reference standard, was assessed in HPV-DNA-positive formalin-fixed paraffin-embedded samples from 29 countries. The concordance of p16(INK4a) and E6*I mRNA among 78, 257, and 51 HPV-DNA-positive OCC, OPC, and LC, respectively, was moderate to substantial in OCC and OPC but only fair in LC. A different p16(INK4a) expression pattern was observed in those cases HPV-DNA-positive for types other than HPV16, as compared to HPV16-positive cases. We concluded that the diagnostic algorithm of HPV-DNA testing followed by p16(INK4a) immunohistochemistry might be helpful in the diagnosis of HPV-driven OCC and OPC, but not LC. Our study provides new insights into the use HPV-DNA, p16(INK4a), and HPV-E6*I mRNA for diagnosing an HPV-driven head and neck carcinoma. Background: Tests or test algorithms for diagnosing HPV-driven oral cavity and laryngeal head and neck carcinomas (HNC) have not been yet validated, and the differences among oral cavity and laryngeal sites have not been comprehensively evaluated. We aimed to assess the utility of a diagnostic algorithm for the detection of HPV-driven oral cavity (OCC), oropharyngeal (OPC) and laryngeal (LC) carcinomas using HPV-DNA testing followed by p16(INK4a) immunohistochemistry, taking E6*I mRNA detection as the reference standard. Methods: Formalin-fixed paraffin-embedded OCC, OPC, and LC carcinomas were collected from pathology archives in 29 countries. All samples were subjected to histopathological evaluation, DNA quality control, and HPV-DNA detection. All HPV-DNA-positive samples (including 78 OCC, 257 OPC, and 51 LC out of 3680 HNC with valid HPV-DNA results) were also tested for p16(INK4a) immunohistochemistry and E6*I mRNA. Three different cutoffs of nuclear and cytoplasmic staining were evaluated for p16(INK4a): (a) >25%, (b) >50%, and (c) >= 70%. The concordance of p16(INK4a) and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was assessed. Results: A total of 78 OCC, 257 OPC, and 51 LC were HPV-DNA-positive and further tested for p16(INK4a) and E6*I mRNA. The percentage of concordance between p16(INK4a) (cutoff >= 70%) and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was 79.5% (95% CI 69.9-89.1%), 82.1% (95% CI 77.2-87.0%), and 56.9% (95% CI 42.3-71.4%), respectively. A p16(INK4a) cutoff of >50% improved the concordance although the improvement was not statistically significant. For most anatomical locations and p16(INK4a) cutoffs, the percentage of discordant cases was higher for HPV16- than HPV-non16-positive cases. Conclusions: The diagnostic algorithm of HPV-DNA testing followed by p16(INK4a) immunohistochemistry might be helpful in the diagnosis of HPV-driven OCC and OPC, but not LC. A different p16(INK4a) expression pattern was observed in those cases HPV-DNA-positive for types other than HPV16, as compared to HPV16-positive cases. Our study provides new insights into the use HPV-DNA, p16(INK4a), and HPV-E6*I mRNA for diagnosing an HPV-driven HNC, including the optimal HPV test or p16(INK4a) cutoffs to be used. More studies are warranted to clarify the role of p16(INK4a) and HPV status in both OPC and non-OPC HNC

Risk thresholds for alcohol consumption : combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

Background Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. Methods We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12.5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5.6 years [5th-95th percentile 1.04-13.5]) from 71 011 participants from 37 studies. Findings In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5.4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1.14, 95% CI, 1.10-1.17), coronary disease excluding myocardial infarction (1.06, 1.00-1.11), heart failure (1.09, 1.03-1.15), fatal hypertensive disease (1.24, 1.15-1.33); and fatal aortic aneurysm (1.15, 1.03-1.28). By contrast, increased alcohol consumption was loglinearly associated with a lower risk of myocardial infarction (HR 0.94, 0.91-0.97). In comparison to those who reported drinking >0-100-200-350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively. Interpretation In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Iniciación a la investigación científica: una experiencia de enseñanza desarrollada en una universidad argentina

A partir del advenimiento de la sociedad del conocimiento, la ciencia y la tecnología se han constituido en pilares fundamentales de evolución económica y social. Para responder a esta demanda de la sociedad, la universidad debe asumir como una de sus tareas específicas el desarrollo de habilidades para la investigación científica, tomada como herramienta de procesos de enseñanza–aprendizaje y de producción intelectual. En este trabajo se presenta una experiencia llevada a cabo en una universidad argentina: una asignatura de estructura modular destinada a alumnos de grado que se inician en actividades de investigación en diversos campos disciplinares. Se describen las propuestas pedagógicas de los cuatro módulos que componen la asignatura y las conclusiones surgidas tras seis años de implementación.Since the advent of the knowledge soci-ety, science and technology have become fundamental pillars of economic and social evolution. In order to respond to this demand, the development of specific skills for scientific research should be undertaken by the university as a tool of teaching–learning pro-cesses and intellectual production. This work presents an experience carried out in an Argentine university: a four–module course destined to undergraduates who are initiating a research career in different disciplinary fields. The pedagogical proposal of each module is described as well as the conclusions derived after six years of implementation.Fil: Prósperi, Roxana. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; ArgentinaFil: Quiros, Maria Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; ArgentinaFil: Grimaldi, Elsa Irene. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Investigaciones en Catálisis y Petroquímica ; ArgentinaFil: de Bianchetti, Liliana. Universidad Nacional del Litoral; ArgentinaFil: Charpin, Graciela. Universidad Nacional del Litoral. Facultad de Humanidades y Ciencias; ArgentinaFil: Mattioli, Estela Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral. Facultad de Ingeniería y Ciencias Hídricas; ArgentinaFil: Cantora, Ana. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas; Argentin