Intervención educativa sobre insuficiencia renal crónica en pacientes con diabetes mellitus tipo 2

Introduction: diabetes mellitus causes severe consequences that compromise the correct functioning of the body; among them, diabetic nephropathy is of great importance, which is the main cause of chronic renal failure.Objective: to assess the effectiveness of an educational intervention on chronic renal failure in patients with type 2 diabetes mellitus at Alex Urquiola Marrero Polyclinic, Holguín municipality druing the period January - July 2018.Methods: a quasi-experimental study of educational intervention was carried out; whose target group was comprised of 55 patients diagnosed with type-2 diabetes mellitus at Alex Urquiola Marrero polyclinic Doctor’s office No-2, while the sample included 46 patients chosen by a non-probability sampling. A survey was applied before and after the intervention.Results: predominantly male patients; 45,66 % older than 60 years; 15,22 % of them were trained on the subject; 84,78 % of patients did not suffer from chronic renal failure; 10,87 % had adequate knowledge before the intervention, 93,48 % developed knowledge; 17,40 % understood the risk of developing chronic renal failure before the application of the educational strategy, after the implementation of the intervention strategy 97,83 % developed knowledge about the perception of risk.Conclusions: the educational intervention on chronic renal failure in diabetic patients suffering from type-2 diabetes mellitus increased knowledge about the risk they present to develop a diabetic nephropathy that acts as a basis for the development of chronic renal failure.Introducción: La Diabetes Mellitus es una enfermedad crónica no transmisible caracterizada por una alteración de los niveles de glucosa en sangre y que presenta diferentes complicaciones crónicas. La Nefropatía diabética es la principal causa de Insuficiencia Renal Crónica a nivel mundial.Objetivo: Evaluar la efectividad de una intervención educativa sobre Insuficiencia Renal Crónica en pacientes con Diabetes Mellitus tipo II del Consultorio #2 del Policlínico “Alex Urquiola Marrero” del Municipio Holguín en el período de enero-julio del 2018.Diseño metodológico: Se realizó un estudio cuasi-experimental de intervención educativa, cuyo universo estuvo conformado por los 55 pacientes diagnosticados con Diabetes Mellitus tipo II del Consultorio #2 del policlínico "Alex Urquiola Marrero", mientras que la muestra estuvo conformada por 46 pacientes seleccionados a través de un muestreo no probabilístico.Resultados: Predominó el sexo masculino; 45,66 % de los pacientes eran mayores de 60 años; 15,22 % de los pacientes recibieron alguna capacitación acerca del tema; 84,78 % de los pacientes no presentaban Insuficiencia Renal Crónica; 10,87 % de los pacientes presentaban conocimientos adecuados antes de la intervención, luego el 93,48 % lo presentaban; 17,40 %, comprendían el riesgo que presentaban de desarrollar Insuficiencia Renal Crónica antes de la aplicación de la estrategia educativa, luego el 97,83 % lo hacían.Conclusiones: La intervención educativa sobre Insuficiencia Renal Crónica en pacientes con Diabetes Mellitus tipo II aumentó los conocimientos sobre el riesgo que presentan los mismos para desarrollar una nefropatía diabética que actúe como base para el desarrollo de una Insuficiencia Renal Crónica

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Caracterización clínico-epidemiológica del carcinoma colorrectal

Introduction: colon and rectal cancer is among the leading causes of cancer death worldwide in recent years.Objective: to characterize clinically and epidemiologically colorectal cancer.Method: the bibliographic review was carried out by searching the Medline, Pubmed, Clinical Key, Scielo regional and Scielo Cuba databases, as well as books such as Themes of Internal Medicine, Volume II and the Topics of Surgery, Volume II, both from the Medical Sciences Publishing House. Descriptors were used: colon cancer, rectal cancer, and cancer mortality. A total of 90 papers were reviewed, of which 20 were chosen as bibliographic references.Development: colorectal cancer is a preventable neoplasm and responds satisfactorily to treatment when detected at an early age, so its prognosis depends largely on the degree of progression of the tumor, normally affects the population aged 60 to 80 years, in the that the risk factor that affects the most is aging and currently surgical treatment has proven to be the only one with a chance of cure.Conclusions: colorectal cancer currently occupies one of the first places in morbidity rates worldwide. The clinical manifestations will depend on its location, the right takes the forms: tumor, inflammatory, anemic and dyspeptic, and the left: obstructive, hemorrhagic, inflammatory and tumor and in the final periods mucosanguinolent stools, asthenia, anorexia and loss of blood are added in the final periods. weight, which often lead to cachexia.Introducción: el cáncer de colon y recto se encuentra entre las principales causas de muerte por cáncer a nivel global en los últimos años.Objetivo: caracterizar clínica y epidemiológicamente el cáncer colorrectal.Método: la revisión bibliográfica se realizó mediante una búsqueda en las bases de datos Medline, Pubmed, Clinical Key, Scielo regional y Scielo Cuba, así como libros como el Temas de Medicina Interna, Tomo II y el Temas de Cirugía Tomo II, ambos de la Editorial Ciencias Médicas. Se utilizaron los descriptores: cáncer de colon, cáncer de recto y mortalidad por cáncer. Fueron revisados un total 90 trabajos de los cuales se escogieron 20 como referencias bibliográficas.Desarrollo: el cáncer colorrectal constituye una neoplasia prevenible y responde satisfactoriamente al tratamiento cuando se detecta a temprana edad, por lo que su pronóstico depende en gran medida del grado de progresión del tumor, afecta normalmente a la población de 60 a 80 años, en el que el factor de riesgo que más incide es el envejecimiento y en la actualidad el tratamiento quirúrgico ha demostrado ser el único con posibilidades de curación.Conclusiones: el cáncer colorrectal ocupa actualmente uno de los primeros lugares en las tasas de morbilidad a nivel mundial. Las manifestaciones clínicas dependerán de su localización, el derecho adopta las formas: tumoral, inflamatoria, anémica y dispéptica, y el izquierdo: obstructiva, hemorrágica, inflamatoria y tumoral y en los períodos finales se añaden deposiciones mucosanguinolentas, astenia, anorexia y pérdida de peso, que con frecuencia llevan al enfermo a la caquexia

GastrOnSoft: software educativo sobre diagnóstico y tratamiento de neoplasias del tubo digestivo en Cirugía General

Introduction: cancers of the digestive tract constitute an important medical burden worldwide due to their high prevalence and mortality. Educational technologies are inherent elements of development in all spheres of life and among them; educational software stands out for the great benefits it brings to the teaching-learning process.Objective: to develop educational software to favor the teaching of oncological diseases of the digestive tract or system in the subject of General Surgery.Methods: a technological development research was carried out, which complies with a study in the fourth-academic year of the Medicine major at Mariana Grajales Coello School of Medical Sciences, corresponding to the subjects Neoplasias of the digestive tract of the General Surgery course. The target group comprised all fourth year-academic students, and the sample included those who participated in the research.Results: educational software was developed as a resource for the learning of the subject of neoplasias of the digestive tract for fourth-academic year students of Medicine major. It is structured by modules: introduction, syllabus, glossary, media library, complements, exercises, games and help, with an attractive and motivating design. Results were obtained regarding the fundamental teaching-learning processes.Conclusions: the software developed constitutes the fundamental basis for the computerization of the basic teaching-learning processes of Neoplasia of the digestive tract of the General Surgery subject. The development of the software gives a solution to a great extent to the planned problem; its application was assessed as effective.Introducción: los cánceres del aparato digestivo constituyen una importante carga médica mundial debido a su alta prevalencia y la mortalidad. Las tecnologías educativas constituyen elementos inherentes al desarrollo en todas las esferas de la vida y dentro de ellos se destacan los softwares educativos por los grandes beneficios que aportan en el proceso enseñanza aprendizaje.Objetivo: desarrollar un software educativo para favorecer la enseñanza de enfermedades oncológicas del tracto o tubo digestivo en la asignatura de Cirugía General.Métodos: se realizó una investigación de desarrollo tecnológico que obedece a un estudio en el cuarto año de la carrera Medicina de la Facultad de Ciencias Médicas “Mariana Grajales Coello” correspondiente los temas Neoplasias del tubo digestivo de la asignatura Cirugía General. El universo se integra por todos los estudiantes de cuarto año, y la muestra aquellos que participaron en la investigación.Resultados: se desarrolló un software educativo como recurso para el aprendizaje de la temática de neoplasias del tubo digestivo para estudiantes de cuarto año de la carrera de Medicina. Está estructurado por módulos: inicio, temario, glosario, mediateca, complementos, ejercicios, juegos y ayuda, con un diseño atractivo y motivador. Se obtuvieron resultados en cuanto a los procesos fundamentales de enseñanza-aprendizaje.Conclusiones: el software desarrollado, constituye la base fundamental para la informatización de los procesos fundamentales de enseñanza-aprendizaje de Neoplasias del tubo digestivo de la asignatura Cirugía General. La elaboración del software dio solución en gran medida al problema propuesto, siendo valorada de efectiva su aplicación

N-Acylaminophenothiazines: neuroprotective agents displaying multifunctional activities for a potential treatment of Alzheimer’s disease

We have previously reported the multifunctional profile of N-(3-chloro-10H-phenothiazin-10-yl)-3- (dimethylamino)propanamide (1) as an effective neuroprotectant and selective butyrylcholinesterase inhibitor. In this paper, we have developed a series of N-acylaminophenothiazines obtained from our compound library or newly synthesised. At micro- and sub-micromolar concentrations, these compounds selectively inhibited butyrylcholinesterase (BuChE), protected neurons against damage caused by both exogenous and mitochondrial free radicals, showed low toxicity, and could penetrate into the CNS. In addition, N-(3-chloro-10H-phenothiazin-10-yl)-2-(pyrrolidin-1-yl)acetamide (11) modulated the cytosolic calcium concentration and protected human neuroblastoma cells against several toxics, such as calcium overload induced by an L-type Ca2þ-channel agonist, tau-hyperphosphorylation induced by okadaic acid and Ab peptideThe authors gratefully acknowledge the financial support of Spanish Ministry of Science and Innovation MICINN (projects SAF2006-01249, SAF2009-13015-C02-01, and SAF2009-12150), Community of Madrid (Programa de Actividades de IþD entre Grupos de Investigación en Biociencias, project S-SAL/0275/2006), and the Institute of Health Carlos III (Red RENEVAS, RETICS-RD06/ 0026). The fellowships to G.C.G.-M. and M.P.A. from CSIC and MICINN respectively, are also acknowledged. A.G.G. also would like to thank the continued support of Fundación Teófilo Hernando, Universidad Autónoma de Madrid, Spain.Peer reviewe

Monismo y dualismo: Apuntes de jurisprudencia sobre el control constitucional de los tratados en Colombia

Entre las principales teorías del derecho internacional encontramos el dualismo y el monismo. La primera, entiende el derecho interno (nacional) y el derecho internacional como dos sistemas jurídicos que coexisten de manera separada, por lo que no se relacionan entre sí. Por otro lado, el monismo parte de la idea que los sistemas se cruzan. Al hacer parte de un mismo sistema, hay dos variantes de esta teoría. El monismo moderado con primacía del derecho internacional considera que este es superior que el derecho nacional. Por otro lado, el monismo moderado interno plantea lo opuesto. Cuales quiera que sea la teoría monista adoptada, busca que el "inferior" se adecue a sus principios. A partir del estudio del fenómeno de control constitucional en Colombia se evidencia la aplicación de las distintas teorías. En ese sentido, la obligatoriedad y eficacia del derecho internacional es cuestionada al ser contrastado con el derecho interno, particularmente con la Constitución de 1991. En Colombia, los tratados son incorporados mediante las leyes. Gracias al artículo 241 de la Constitución, la Corte Constitucional está facultada para analizar las leyes aprobatorias de tratado y contrastarlos con la Constitución. Aunque hoy en día el control constitucional es posterior a la ley aprobatoria y previo a que el ejecutivo ratifique un tratado, en los orígenes de esta figura surgió la polémica de los tratados con inconstitucionalidad sobreviniente. En ese sentido, los compromisos internacionales adoptados por Colombia antes del 91 pueden ser contrarios a la Constitución. Tal situación pone en entre dicho el principio de pacta sunt servanda. Sin embargo, como se estudiará a continuación, han sido diversos escenarios en los cuales se estudió la constitucionalidad de los tratados internacionales variando entre el dualismo y el monismo moderado. Con eso presente, en este documento, encontrarán nueve sentencias hito de control constitucional de los tratados. En cada una de ellas se analizará cómo llego la norma a ser estudiada por la Corte, los argumentos para su inconstitucionalidad, las consideraciones de la Corte, la teoría que aplicó y un breve comentario sobre la decisión y sus implicaciones

Constituciones latinoamericanas 2022. Reporte de cláusulas de control constitucional difuso y concentrado

El reporte 2022 realizado por los estudiantes del curso “constitución, convencionalidad y derecho internacional” del pregrado en Derecho de la Facultad de Jurisprudencia de la Universidad del Rosario, presenta el estudio de las formas de control constitucional, a través de las cláusulas constitucionales de veintiséis (26) países de América Latina, especialmente en lo que respecta a su cláusula de supremacía constitucional; seguido de un ejemplo analizado de una cláusula en su correspondiente constitución que desarrolle la noción de “control difuso y abstracto” y “control concreto y concentrado”

The age again in the eye of the COVID-19 storm: evidence-based decision making.

One hundred fifty million contagions, more than 3 million deaths and little more than 1 year of COVID-19 have changed our lives and our health management systems forever. Ageing is known to be one of the significant determinants for COVID-19 severity. Two main reasons underlie this: immunosenescence and age correlation with main COVID-19 comorbidities such as hypertension or dyslipidaemia. This study has two aims. The first is to obtain cut-off points for laboratory parameters that can help us in clinical decision-making. The second one is to analyse the effect of pandemic lockdown on epidemiological, clinical, and laboratory parameters concerning the severity of the COVID-19. For these purposes, 257 of SARSCoV2 inpatients during pandemic confinement were included in this study. Moreover, 584 case records from a previously analysed series, were compared with the present study data. Concerning the characteristics of lockdown series, mild cases accounted for 14.4, 54.1% were moderate and 31.5%, severe. There were 32.5% of home contagions, 26.3% community transmissions, 22.5% nursing home contagions, and 8.8% corresponding to frontline worker contagions regarding epidemiological features. Age > 60 and male sex are hereby confirmed as severity determinants. Equally, higher severity was significantly associated with higher IL6, CRP, ferritin, LDH, and leukocyte counts, and a lower percentage of lymphocyte, CD4 and CD8 count. Comparing this cohort with a previous 584-cases series, mild cases were less than those analysed in the first moment of the pandemic and dyslipidaemia became more frequent than before. IL-6, CRP and LDH values above 69 pg/mL, 97 mg/L and 328 U/L respectively, as well as a CD4 T-cell count below 535 cells/μL, were the best cut-offs predicting severity since these parameters offered reliable areas under the curve. Age and sex together with selected laboratory parameters on admission can help us predict COVID-19 severity and, therefore, make clinical and resource management decisions. Demographic features associated with lockdown might affect the homogeneity of the data and the robustness of the results

Children living with HIV in Europe: do migrants have worse treatment outcomes?

International audienceTo assess the effect of migrant status on treatment outcomes among children living with HIV in Europe