Valoración de la capacidad funcional y factores asociados en adultos mayores que residen en la parroquia El Valle, Cuenca 2013

Antecedentes: Existe una reducida cantidad de datos sobre la valoración de la capacidad funcional de los adultos mayores y no se podría decir que existen datos certeros de acuerdo a la funcionalidad y el grado de dependencia con la que esta se relaciona, a nivel mundial se ha visto que en determinados estudios se llega a coincidir en que alrededor de 1 de cada 3 adultos mayores llegan a tener cierto grado de dependencia. Objetivo:Determinar la prevalencia del grado de capacidad funcional de los adultos mayores y factores asociados en la parroquia El Valle del cantón Cuenca 2013. Metodología: Investigación de prevalencia de corte transversal, en una muestra de 350 adultos mayores de la Parroquia del Valle; la información fuelevantada mediante la escala de Katz que valora el grado de dependencia funcional para la realización de actividades cotidianas valorando la independencia o dependencia de estas. Para analizar los datos se utilizaron: frecuencias, porcentajes, promedio, desvío estándar y para asociación la razón de prevalencia con intervalo de confiabilidad de 95%. Resultados: Se estudiaron 350 adultos mayores, la dependencia fue del 39,7%; la media de edad se ubicó en 74,46 años y una desviación estándar de 7,61 años en el 60,9% de los casos de sexo femenino; casados con el 60,3%; con ocupaciones sin actividad física 32% y con enfermedades crónicas en el 86,3% de los casos siendo la de mayor prevalencia las osteoarticulares con el 49,4%; los factores de riesgo que se asociaron a dependencia física fueron: edad de 85 años y más RP 2,38 (IC 95% 1,92-2,94); el ser viudo/a RP 1,84 (IC 95% 1,44-2,35); adultos mayores con ocupaciones que no involucra actividad física RP 1,45 (IC 95% 1,06-1,99); diabetes mellitus RP 1,49 (IC 95% 1,15-1,93) y las enfermedades osteomusculares RP 1,76 (IC 95% 1,34-2,32). Conclusiones: La prevalencia de dependencia física en actividades de la vida diaria tales como lavado, vestido, uso de retrete, movilización, continencia y alimentación; es elevada y se asocia a factores biológicos y sociales.Background: There's a small amount of data on the functional capacity valuation of elders and it cannot be said that there is accurate data according to functionality and the degree of dependence to which it relates, it has been shown worldwide that in certain studies there's a match in which 1 in 3 elders have some degree of dependence. Aim: to determinate the prevalence of functional capacity level in elders and associated factors in El Valle parish of Cuenca city. Methodology: Through transversal prevalence research, in a sample of 350 elders in El Valle parish, the information was gathered utilizing the Katz scale, which assesses the degree of functional dependence for daily activities valuing the level of independence or dependence of the afore mentioned. To analyze the data the following were used: frequency, percentage, average, standard deviation and for the association, the mean prevalence with reliability interval of 95%. Results: 350 elders were studied, the dependence was 39.7%, the average age stood at 74.46 years and a standard deviation of 7.61 years in 60.9% of cases of female sex, married were 60.3%, occupations with no physical activity 32% and with chronic diseases in 86.3% of cases, being the most prevalent the osteoarticular diseases with 49.4%, the risk factors associated with physical dependence were: age 85 years and over PR 2.38 (CI 95% 1.92 to 2.94), to be widower PR 1.84 (CI 95% 1.44 to 2.35), older adults with occupations that do not involve physical activity PR 1.45 (CI 95% 1.06 to 1.99), diabetes mellitus PR 1.49 (CI 95% 1.15 to 1.93) and 1.76 PR musculoskeletal diseases (CI 95% 1.34 to 2.32). Conclusions: The prevalence of physical dependence in activities of daily living such aswashing, dressing, toilet use, mobilization, continence and feeding; is high and is associated with biological and social factors.MédicoCuenc

Solutions to Avoid False Positives for Rituximab in Pre-Transplant Crossmatches

Rituximab (anti-CD20) is commonly used as immunotherapy against B cells, in the context of pre-transplant crossmatches, where the presence of rituximab in the tested sera with donor cells can alter their results both by flow cytometry (FCXM) as complement-dependent cytotoxicity (CDCXM) giving rise to false positives. In the present study, we tested the use of an anti-rituximab monoclonal antibody (10C5, Abnova) as a method to avoid false positives in FCXM and CDCXM. We used the serum from ten patients who received therapy with rituximab, and the cells were incubated with sera treated or untreated with the 10C5 clone. In previous studies, attempts have been made to control these false positives through the use of pronase, although in these cases the alteration of Human Leukocyte Antigen (HLA) molecules has been found to be a limitation. As an alternative, we performed an assay to exclude false positives by a pre-incubation with anti-rituximab antibody (10C5) in 1:5 proportion avoiding the misinterpretation of crossmatches, particularly in patients with specific donor antibodies (DSA) without affecting the HLA molecules

Predicting anti-TNF treatment response in rheumatoid arthritis: An artificial intelligence-driven model using cytokine profile and routine clinical practice parameters

Introduction: Rheumatoid arthritis (RA) is a heterogeneous disease in which therapeutic strategies used have evolved dramatically. Despite significant progress in treatment strategies such as the development of anti-TNF drugs, it is still not possible to differentiate those patients who will respond from who will not. This can lead to effective-treatment delays and unnecessary costs. The aim of this study was to utilize a profile of the patient's characteristics, clinical parameters, immune status (cytokine profile) and artificial intelligence to assess the feasibility of developing a tool that could allow us to predict which patients will respond to treatment with anti-TNF drugs. Methods: This study included 38 patients with RA from the RA-Paz cohort. Clinical activity was measured at baseline and after 6 months of treatment. The cytokines measured before the start of anti-TNF treatment were IL-1, IL-12, IL-10, IL-2, IL-4, IFNg, TNFa, and IL-6. Statistical analyses were performed using the Wilcoxon-Rank-Sum Test and the Benjamini-Hochberg method. The predictive model viability was explored using the 5-fold cross-validation scheme in order to train the logistic regression models. Results: Statistically significant differences were found in parameters such as IL-6, IL-2, CRP and DAS-ESR. The predictive model performed to an acceptable level in correctly classifying patients (ROC-AUC 0.804167 to 0.891667), suggesting that it would be possible to develop a clinical classification tool. Conclusions: Using a combination of parameters such as IL-6, IL-2, CRP and DAS-ESR, it was possible to develop a predictive model that can acceptably discriminate between remitters and non-remitters. However, this model needs to be replicated in a larger cohort to confirm these findings

Hematologically important mutations: X-linked chronic granulomatous disease (fourth update)

International audienceChronic granulomatous disease (CGD) is an immunodeficiency disorder affecting about 1 in 250,000 individuals. CGD patients suffer from severe bacterial and fungal infections. The disease is caused by a lack of superoxide production by the leukocyte enzyme NADPH oxidase. Superoxide and subsequently formed other reactive oxygen species (ROS) are instrumental in killing phagocytosed micro-organisms in neutrophils, eosinophils, monocytes and macrophages. The leukocyte NADPH oxidase is composed of five subunits, of which the enzymatic component is gp91phox, also called Nox2. This protein is encoded by the CYBB gene on the X chromosome. Mutations in this gene are found in about 70% of all CGD patients in Europe and in about 20% in countries with a high ratio of parental consanguinity. This article lists all mutations identified in CYBB and should therefore help in genetic counseling of X-CGD patients' families. Moreover, apparently benign polymorphisms in CYBB are also given, which should facilitate the recognition of disease-causing mutations. In addition, we also include some mutations in G6PD, the gene on the X chromosome that encodes glucose-6-phosphate dehydrogenase, because inactivity of this enzyme may lead to shortage of NADPH and thus to insufficient activity of NADPH oxidase. Severe G6PD deficiency can induce CGD-like symptoms

Hematologically important mutations: The autosomal forms of chronic granulomatous disease (third update)

Chronic granulomatous disease (CGD) is an immunodeficiency disorder affecting about 1 in 250,000 individuals. CGD patients suffer from severe, recurrent bacterial and fungal infections. The disease is caused by mutations in the genes encoding the components of the leukocyte NADPH oxidase. This enzyme produces superoxide, which is subsequently metabolized to hydrogen peroxide and other reactive oxygen species (ROS). These products are essential for intracellular killing of pathogens by phagocytic leukocytes (neutrophils, eosinophils, monocytes and macrophages). The leukocyte NADPH oxidase is composed of five subunits, four of which are encoded by autosomal genes. These are CYBA, encoding p22(phox), NCF1, encoding p47(phox), NCF2, encoding p67(phox) and NCF4, encoding p40(phox). This article lists all mutations identified in these genes in CGD patients. In addition, cytochrome b(558) chaperone-1 (CYBC1), recently recognized as an essential chaperone protein for the expression of the X-linked NADPH oxidase component gp91(phox) (also called Nox2), is encoded by the autosomal gene CYBC1. Mutations in this gene also lead to CGD. Finally, RAC2, a small GTPase of the Rho family, is needed for activation of the NADPH oxidase, and mutations in the RAC2 gene therefore also induce CGD-like symptoms. Mutations in these last two genes are also listed in this article