Diseño y validación de un simulador híbrido de paracentesis

Medical education by simulation is an effective method for learning; It improves competence acquisition, repetitive practice and eliminates risks for the patient. Existing paracentesis simulators have a high cost and low level of realism, so a low cost simulator was designed and developed. A representative video of a suitable clinical scenario was demonstrated, demonstrating the complete paracentesis technique. 20 medical specialists observed the video and performed the procedure in the simulator, later applied a questionnaire on the realism of the simulator, the utility of the video, and the importance of the procedure in medical education. The results show that 85% of the participants consider the simulator favored the learning experience. 90% considered the clinical appearance to be adequate. 100% believe that the acquisition of paracentesis ability is relevant in undergraduate students.     

Hospital admissions for infectious diseases: 1999-2003 incidence in one health district in the autonomous community of Valencia, Spain

BACKGROUND:. Infectious diseases are still currently one of the leading causes of death and illness. Their dynamic nature justifies the epidemiological study thereof. This study is aimed at analyzing the incidence of infectious diseases most often conditioning hospital admissions. METHODS: A study was conducted of those individuals admitted to hospital during the 1999-2003 period whose main diagnosis at admission to hospital had been encoded according to the International Disease Classification (ICD 9-CM) as an infectious disease in the Minimum Basic Data Set. A total of 2010 active infectious disease codes were selected and were grouped into 25 groups as per the ICD 9-CM. The target population was that of one district in the Autonomous Community of Valencia. RESULTS: A total of 9.7% of the admissions during the period under study (8,585 records) were due to an infectious disease. Those affected averaged 38 years of age, median age of 37, standard deviation 31 and the range of 1-102 years. The admissions of males (54.5%) prevailed over females (48.5%). The incidence rate of admissions due to infectious diseases was 728 cases / 100,000 inhabitants / year. The highest rate of admissions was among young children and the elderly. The groups of diseases showing the largest number of admissions were, in descending order, infectious digestive, respiratory and genitourinary diseases. CONCLUSION: The hospital admissions due to infections diseases totaled one tenth of the admissions, and 7/1000 inhabitants/year required hospitalization for an infectious disorder. The highest incidence rates were found for intestinal diseases, digestive, respiratory and genitourinary tract diseases among the childhood-aged population, but also, although in smaller percentages, among individuals over 65 years of age.     

Histoplasmosis: a study of 158 cases in Venezuela, 2000-2005

Histoplasmosis, a granulomatous disease caused by Histoplasma capsulatum, is endemic in Venezuela. We conducted the current study to appraise retrospectively the demographic data, clinical features, diagnostic methods, and treatment of patients with histoplasmosis from January 2000 to December 2005.We reviewed the medical records of outpatient cases with a diagnosis of histoplasmosis and considered clinical samples processed at our laboratory. We collected demographic, epidemiologic, and clinical data from each case as available, including results of any mycologic examinations performed. Treatment and outcome data were available for some patients.We assessed 158 cases of histoplasmosis: 103 (65.2%) patients came from the Caracas metropolitan area; 53 were associated with acquired immunodeficiency syndrome (AIDS), 14 with tuberculosis, and 8 with paracoccidioidomycosis. Six pediatric patients were malnourished. Epidemiologic data suggested histoplasmosis in most cases. Patients received treatment with itraconazole and/or amphotericin B.Our results may reflect changes in the epidemiology occurring in Venezuela, perhaps due to environmental changes and the presence of AIDS. Several mycologic exams are necessary to ensure a proper diagnosis. More reliable data and statistics on this infection are necessary to monitor outbreaks closely and to establish if there is an epidemic pattern.     

Obesity and cardio-metabolic risk factors in Ecuadorian university students. First report, 2014–2015

Objective

Overweight and obesity are risk factors for developing cardiovascular disease. The objective of this study was to determine the prevalence of obesity and risk factors associated with metabolic syndrome and cardiovascular disease in university students.

Viral and immune factors associated with successful treatment withdrawal in HBeAg-negative chronic hepatitis B patients

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Combinations of simple baseline variables accurately predict sustained virological response in patients with recurrent hepatitis C after liver transplantation

Background

The efficacy of antiviral therapy in patients with hepatitis C recurrence after liver transplantation (LT) is far from optimal and a careful selection of candidates with the best chances to achieve sustained virological response (SVR) is relevant. Moreover, investigating the effects of sustained viral clearance on clinical outcomes is particularly significant. We aimed to identify and combine the best baseline predictors of SVR and to assess the clinical outcomes of antiviral therapy after LT.

Methods

We studied 144 hepatitis C virus (HCV)-infected LT recipients who underwent antiviral therapy following transplantation. Baseline predictors of SVR including donor and recipient interleukin IL28B (IL28B) rs12979860 genotype were evaluated, and the long-term effects of antiviral therapy on clinical outcomes were assessed.

Results

The presence of an IL28B CC genotype with either low viral load (VL), young donor age, or cyclosporine A (CsA)-based immunosuppression identified individuals with 69–80 % probabilities of SVR. In contrast, only 20 % of recipients with a CT/TT IL28B genotype and either high VL, old donor age, or non-CsA immunosuppression achieved an SVR (p = 0.004). Regarding clinical outcomes, the 5-year cumulative probability of graft loss was 2 % for the SVR patients and 48 % for non-responders (p < 0.001).

Conclusions

The use of simple combinations of baseline variables including IL28B polymorphisms identifies HCV-infected LT recipients with different probabilities of response to antiviral treatment. SVR is associated with improved clinical outcomes.     

Change in serum measurements of cartilage oligomeric matrix protein and association with the development and worsening of radiographic hip osteoarthritis

OBJECTIVE: To determine the association between changes in serum levels of cartilage oligomeric matrix protein (COMP) and serum N-telopeptide crosslinks (NTX) over a 6-year interval with the development and progression of radiographically apparent hip osteoarthritis (RHOA) in a community sample of elderly women over 8.3 years of follow-up. METHODS: Pelvic radiographs were obtained a mean of 8.3 years apart in Caucasian women > or =65 years of age enrolled in the Study of Osteoporotic Fractures. From a cohort of 5928 subjects, we randomly sampled study subjects ( approximately 170 per group) to perform two nested case-control studies, one of RHOA incidence and the other of RHOA progression. Baseline and year 6 serum COMP and serum NTX levels were measured by enzyme linked immunosorbent assay in duplicate and percentage change in serum levels was calculated. Odds ratios (ORs) and 95% confidence intervals (CIs) for 1 standard deviation (SD) change in the serum COMP and NTX level differences were calculated using logistic regression analysis and used to predict the development or progression of RHOA, adjusting for potential covariates. RESULTS: The percentage change in the level of serum COMP from baseline to year 6 was found to be a risk factor for the development of incident RHOA [adjusted OR of 1.58 per 1 SD increase (95% CI: 1.19-2.09)], and reduction of progression of RHOA [adjusted OR of 0.74 per 1 SD increase (95% CI: 0.58-0.96)]. Quartile analysis of serum COMP changes revealed that the three highest quartiles of change in serum COMP were associated with (1) a five-fold greater risk of developing incident RHOA [adjusted OR=5.42 (95% CI: 2.80-10.60)], and (2) a 50% decreased risk of developing progression of RHOA [adjusted OR=0.48 (95% CI: 0.30-0.80)]. No significant association was found between changes in serum NTX levels from baseline to year 6 with either incident RHOA or the progression of existing RHOA. CONCLUSION: Measurement of serum COMP at two distinct timepoints may be a method of identifying patients at risk for developing incident RHOA and those with baseline RHOA that will not rapidly progress.     

Estradiol valerate and alcohol intake: dose-response assessments

Background

An injection of estradiol valerate (EV) provides estradiol for a prolonged period. Recent research indicates that a single 2.0 mg injection of EV modifies a female rat's appetite for alcoholic beverages. This research extends the initial research by assessing 8 doses of EV (from.001 to 2.0 mg/female rat), as well assessing the effects of 2.0 mg EV in females with ovariectomies.

Results

With the administration of EV, there was a dose-related loss of bodyweight reaching the maximum loss, when it occurred, at about 4 days after injections. Subsequently, rats returned to gaining weight regularly. Of the doses tested, only the 2.0 mg dose produced a consistent increase in intake of ethanol during the time previous research indicated that the rats would show enhanced intakes. There was, however, a dose-related trend for smaller doses to enhance intakes. Rats with ovariectomies showed a similar pattern of effects, to intact rats, with the 2 mg dose. After extensive histories of intake of alcohol, both placebo and EV-treated females had estradiol levels below the average measured in females without a history of alcohol-intake.

Conclusion

The data support the conclusion that pharmacological doses of estradiol can produce enduring changes that are manifest as an enhanced appetite for alcoholic beverages. The effect can occur among females without ovaries.