Estrategias de afrontamiento en mujeres diagnosticadas con cáncer de mama en fase de iniciación.

Describir las estrategias de afrontamiento que presentan las mujeres diagnosticadas con cáncer de mama en la fase de iniciación de la fundación “Amo mi calva” 2019.La presente investigación está enfocada en describir las estrategias de afrontamiento utilizadas en una muestra de 30 mujeres diagnosticadas con cáncer de mama en fase de iniciación pertenecientes a la fundación “Amo mi calva” en la ciudad de Medellín, seleccionadas mediante una encuesta sociodemográfica que permitiera arrojar datos como la edad, sexo, fase del diagnóstico y tipo de cáncer; además, se utilizó como herramienta la escala de Estrategias de Coping Modificada (EEC-M), la cual evalúa estrategias de afrontamiento correspondientes a los factores solución de problemas, búsqueda de apoyo social, espera, religión, evitación emocional, búsqueda de apoyo profesional, reacción agresiva, evitación cognitiva, reevaluación positiva, expresión de la dificultad de afrontamiento, negación y por último autonomía. Según el análisis de los resultados, se pudo identificar que la muestra utiliza varias estrategias de afrontamiento de tipo adaptativo enfocadas a la emoción, la estrategia de afrontamiento que predominó fue la que corresponde al factor apoyo en la religión, obteniendo un puntaje alto del 90% de la muestra y la menos utilizada corresponde al factor expresión de la dificultad de afrontamiento, esta puntuó bajo en un 70% de las participantes, cabe resaltar que las participantes no usan una sola estrategia de afrontamiento, por el contrario, acuden a utilizar varias estrategias para afrontar su situación

Conocimiento y actitud de las madres de pacientes de sala de neonatología hacia la donación de leche materna en el Hospital Bertha Calderón en el segundo semestre del 2021

Los bancos de leche se expandieron con el objetivo de proporcionarle alimento seguro a los bebés prematuros, con bajo peso al nacer o distintas patologías que comprometen su bienestar. El presente trabajo tuvo como objetivo analizar el conocimiento y actitud de las madres de pacientes ingresados en sala de neonatología del Hospital Bertha Calderón sobre la donación de leche materna en el Banco de leche humana de este establecimiento, en el segundo semestre del 2021. El estudio de acuerdo a su naturaleza es de carácter positivista y que sigue la ruta cuantitativa: no experimental, de corte transversal, prospectivo y de alcance descriptivo. En cuanto a la recolección de datos se hizo uso de instrumentos tales como la encuesta, la cual fue realizada a un total de 100 madres, para el procesamiento de la información se usó del programa MS-Excel en donde se plasmó cada una de las variables, logrando así identificar la deficiencia de conocimiento de las madres de los pacientes ingresados en la sala de neonatología sobre la donación de leche materna y el Banco de leche esta falta de conocimiento es compensada por la buena actitud que demostraron hacia la donación de leche y ser parte de la donación. En referencia a los resultados y conclusiones, se tiene que modificar la forma de educación a las pacientes para que sean más comprensibles para poder mejorar el nivel de conocimiento e incrementar el número de donadoras en el banco de leche ya que el 63% de las madres encuestadas presentó conocimientos deficientes en lo que respecta a lactancia materna, donación de leche y banco de lech

Fear of COVID-19, risk perception and preventive behavior in health workers: a cross-sectional analysis in middle-income Latin American countries

The aim of this study was to examine the association between fear of COVID-19 and risk perception with preventive behavior in health professionals from four Latin American countries. An analytical cross-sectional study was conducted. Health professionals with on-site care in Colombia, Ecuador, Guatemala, and Peru were surveyed. Information was collected through an online self-report questionnaire. The main variables were preventive behavior as the dependent variable and fear of COVID-19 and risk perception as independent variables. Linear regression was used, and unstandardized beta coefficient and value of ps were calculated. Four hundred and thirty-five health professionals were included, the majority were aged 42 years or older (45.29, 95%CI: 40.65–50.01) and female (67.82, 95%CI: 63.27–72.05). It was shown that the greater the fear of COVID-19, the greater the preventive behavior of COVID-19 infection (B  = 2.21, p  = 0.002 for total behavior; B = 1.12, p = 0.037 for additional protection at work; B = 1.11, p

Population structure among Mycobacterium tuberculosis Isolates from pulmonary tuberculosis patients in Colombia

Background: Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. Principal Findings: A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1). Conclusions: This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellı ´n and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this sublineage

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Fístula aorto-atrial derecha: una presentación inusual

Resumen: Las fístulas aorto-atriales son anomalías anatómicas poco comunes, de etiología multifactorial; la causa más frecuente en la población adulta son las infecciones endocárdicas. Puede manifestarse como falla cardíaca, pasando por hipertensión pulmonar, hasta ser asintomática y precipitarse por algún evento estresante. El método diagnóstico de elección es la ecocardiografía, que según su localización pudiera ser mejor la modalidad, transtorácica o transesofágica. Se han descrito reparaciones endovasculares y quirúrgicas de las fístulas; esta última técnica es la más utilizada porque, como se indicó, la etiología más frecuente son los procesos infecciosos endomiocárdicos. Abstract: Aorta-to-atrium fistulas are rare anatomical anomalies, of a multifactorial aetiology. The most common cause in the adult population is due to endocardial infections. They can present as cardiac failure, ranging from pulmonary hypertension to being asymptomatic, and being precipitated by any stressful event. The diagnostic method of choice is echocardiography, and depending on its location, the transthoracic or trans-oesophageal mode would be better. Endovascular and surgical repairs of the fistulas have been described. This latter technique is the most used because, as previously mentioned, the most common origin is an endomyocardial infection. Palabras clave: Ecocardiografía, Endocarditis, Fístula, Keywords: Echocardiography, Endocarditis, Fistul