RESUMO

The use of mask and face shield has been established as one of the main preventive measures for the control of COVID 19 spread. In Mexico, as well as in other regions of the world, 3D printing has been employed for the design and production of masks and face shields as personal protective equipment (PPE). These models have been fabricated mainly by the makers, industries, and university communities; therefore, it is necessary to analyze the feasibility of the 3D printed PPE to understand its advantages and limitations. In this work, some characteristics of masks and face shields fabricated by additive manufacturing were studied to explore their viability as protection against flow fluids similar to human sneeze. In the present paper, the PPE was designed, and 3D printed utilizing three types of polylactic acid (PLA) as base material. The morphology and the surface elemental analyses of sectioned samples were analyzed by scanning electron microscopy (SEM) and energy dispersion x-ray spectroscopy (EDS). Showing spacing between printed layers, porous areas, and dispersed copper particles. On the other hand, a computational fluid dynamics (CFD) simulation was carried out, the results demonstrated the importance of using PPE for protection of a possible exposure to a "contaminated" aerosol and human sneeze. Based on the abovementioned results, it is possible to consider the commercial PLA as suitable material for the manufacturing of PPE due to its capability to be disinfected employing isopropanol, ethanol, or commercial disinfectants.

RESUMO

Resumen Los trastornos respiratorios del sueño (ronquido primario y síndrome de apnea-hipopnea obstructiva del sueño) han sido tratados mediante múltiples modalidades a lo largo de la historia. Sin embargo, la cirugía de la vía aérea superior siempre ha estado presente, dando cabida a la aparición de múltiples técnicas para este fin. El estudio adecuado de los sitios anatómicos de estrechez o colapso de la vía aérea superior y sus contribuyentes (bajo el concepto de topodiagnóstico) y el mejor entendimiento de los mecanismos de acción de los diferentes procedimientos descritos, ha permitido el nacimiento de una nueva disciplina, dedicada al manejo quirúrgico planificado de este grupo de patologías: la cirugía del sueño.

Abstract Sleep-related breathing disorders (primary snoring and obstructive sleep apnea-hypopnea syndrome) have been treated with multiple modalities throughout history. However, upper airway surgery has always been present, giving appearance of multiple techniques for this purpose. The adequate study of the anatomical sites of upper airway narrowness or collapse and its contributors (under the concept of topodiagnosis) and a better understanding of the different procedures, has allowed the birth of a new discipline, dedicated to a planned surgical management for this group of pathologies: sleep surgery.

RESUMO

RESUMEN Introducción: Las enfermedades cardiovasculares representan la primera causa de muerte en el mundo. La estimación del Riesgo Cardiovascular (RCV) podría disminuir la carga de la enfermedad y mejorar la calidad de vida de los pacientes. Objetivo: Estimar el RCV en pacientes sin sospecha de cifras tensionales elevadas en una Clínica de Medicina Familiar en la Ciudad de México. Métodos: Estudio transversal descriptivo, participaron 101 pacientes de sexo masculino y femenino, de 40 a 69 años, sin diagnóstico previo de Hipertensión Arterial (HTA), pero que presentaron cifras tensionales altas al momento del estudio. Para diagnosticar HTA se utilizaron los criterios de la Asociación Americana del Corazón-2017. El RCV se evaluó con el ASCVD-Risk Estimator Plus. Resultados: En la muestra la HTA estuvo presente en el 55.4 %, 44.6 % manifestaron presión arterial elevada. Respecto al RCV, 54.4 % presentaron bajo riesgo, 11.8 % riesgo límite, 25.7 % intermedio y 7.9 % alto. Los factores de RCV con mayor prevalencia fueron diabetes mellitus tipo 2 (DM2), sobrepeso, obesidad y elevación de cifras tensionales. Discusión: Un porcentaje importante de participantes presentó RCV en sus diferentes categorías. Se requiere ser más estrictos en los parámetros utilizados para definir la HTA; pues sin intervenciones oportunas las enfermedades cardiovasculares continuarán incrementándose. Conclusión: Cerca de la mitad de los casos presentaron un RCV de límite a alto. Existió alta prevalencia de factores de riesgo individuales como DM2, HTA y dislipidemia. Se deben fortalecer búsquedas intencionadas de pacientes con características similares a las de este estudio para prevenir el desarrollo de enfermedades cardiovasculares.

ABSTRACT Introduction: Cardiovascular diseases are the main cause of death in the world. The estimation of the Cardiovascular Risk (CVR) could both reduce the burden of the illness and improve the quality of life of the patients. Objective: To estimate the CVR in adult patients without a suspicion of having high pressure readings in a Clinic of Family Medicine in Mexico City. Methods: This is a descriptive and transversal study with a sample of 101 male and female patients in the range of 40 to 69 years old, who did not have a previous hypertension diagnosis but who, at the moment of this study, showed high tension readings. The American Heart Association 2017 criteria were used. The cardiovascular risk was assessed using the ASCVD-Risk Estimator Plus. Results: Arterial hypertension readings were found in 55.4 % of the sample. 54.4 % of the sample met the criteria for low risk, 11.8 % for limit risk, 25.7 % for medium risk, and 7.9 % for high risk. The most prevalent factors associated with cardiovascular risk were type 2 diabetes mellitus, overweight, obesity, and hypertension. Discussion: An important percentage of the sample showed cardiovascular risk to some degree, suggesting that perhaps using stricter parameters to define hypertension could prompt more timely interventions. Conclusion: Considering both the high percentage of participants who demonstrated having a cardiovascular risk of concern and the high prevalence of risk factors such as Type 2 Diabetes Mellitus, hypertension, and overweight, timely monitoring interventions should be promoted in order to prevent the development of cardiovascular diseases.

RESUMO Introdução: As doenças cardiovasculares representam a principal causa de morte a nível mundial. A estimativa do risco cardiovascular (RCV) poderia diminuir o peso da doença e melhorar a qualidade de vida dos pacientes. Objetivo: Estimar o RCV em pacientes sem suspeita de tensão arterial elevada em uma Clínica de Medicina Familiar na Cidade do México. Métodos: Um estudo descritivo transversal envolvendo 101 pacientes do sexo masculino e feminino com idades entre os 40 - 69 anos, sem diagnóstico prévio de hipertensão (HTA), mas com tensão arterial elevada no momento do estudo. Os critérios da American Heart Association-2017 foram utilizados para diagnosticar o HTA. O RCV foi avaliado utilizando o ASCVD-Risk Estimator Plus. Resultados: Na amostra, a HTA esteve presente em 55,4 %, 44,6 % reportou tensão arterial elevada. Em relação à RCV, 54,4 % apresentavam baixo risco, 11,8 % risco limite, 25,7 % risco intermédio e 7,9 % alto risco. Os fatores de RCV mais prevalentes foram a diabetes melito tipo 2 (DM2), excesso de peso, obesidade e tensão arterial elevada. Discussão: Uma percentagem significativa de participantes tinha RCV em diferentes categorias. Há necessidade de ser mais rigoroso nos parâmetros utilizados para definir a HTA; sem intervenções atempadas, as doenças cardiovasculares continuarão aumentando. Conclusão: Quase metade dos casos tinham um limite de RCV elevado. Havia uma elevada prevalência de fatores de risco individuais tais como DM2, hipertensão e dislipidemia. A procura intencional de pacientes com características semelhantes às deste estudo deve ser reforçada para prevenir o desenvolvimento de doenças cardiovasculares.

RESUMO

INTRODUCCIÓN: La planificación de cirugías para el manejo del síndrome de apneahipopnea obstructiva del sueño (SAHOS) ha incrementado su precisión desde la introducción de la endoscopía del sueño inducido por fármacos (DISE). OBJETIVO: Evaluar la técnica de faringoplastía de reposición con suturas barbadas (BRP) para el colapso velofaríngeo y/o de paredes laterales orofaríngeas evaluado mediante DISE en pacientes con SAHOS. MATERIAL Y MÉTODO: Ochenta y ocho pacientes fueron evaluados para cirugía mediante antropometría, escala de somnolencia de Epworth (ESS) y poligrafía respiratoria. Veinte y seis de 88 pacientes fueron seleccionados. De los 26, 14 accedieron al tratamiento quirúrgico, el que se seleccionó en base a la DISE. En todos los casos, se realizó BRP. RESULTADOS: A los 3 meses de la cirugía hubo mejoría en 10/14 pacientes (criterios de Sher, disminución del índice de apnea-hipoapnea a <20 o 50% del basal). La ESS bajó en promedio de 12 a 5 puntos (p <0,05). No se reportaron incidentes en el posoperatorio y no han ocurrido eventos adversos. CONCLUSIÓN: La técnica de BRP es una técnica sencilla y útil para la expansión anterior y lateral del paladar blando y orofaringe, con una tasa de éxito similar en esta cohorte a la reportada internacionalmente.

INTRODUCTION: Surgical planning for the management of obstructive sleep apneahypopnea syndrome (OSAHS) has changed since the introduction of drug induced sleep endoscopy (DISE). AIM: To evaluate the technique of barbed sutures reposition pharyngoplasty (BRP) for velopharyngeal collapse and/or oropharyngeal lateral walls after DISE evaluation in OSAHS patients. MATERIAL AND METHOD: 88 patients were evaluated for surgery by anthropometry, Epworth sleepiness scale (ESS) and respiratory polygraphy. 26 of 88 patients were selected. Of the 26, 14 agreed to surgical treatment, which was selected on DISE findings. In all cases, BRP was performed. RESULTS: Three months after surgery there was improvement in 10/14 patients (Sher criteria, apnea-hypopnea index reduction at <20 or 50% of baseline). The ESS improved on average 12 to 5 (p <0.05). No incidents were reported in the post-operative period and no adverse events were reported. CONCLUSION: The BRP technique is a simple and useful technique for the anterior and lateral expansion of the soft palate and oropharynx, with a similar success rate in this cohort to that internationally reported.

Assuntos

RESUMO

BACKGROUND: The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias. METHODS: This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017. Overall survival (OS) and recurrence-free survival (RFS) were analysed by intention to treat. Inverse probability of surgery treatment weighting using propensity scoring was undertaken. RESULTS: A total of 255 patients underwent re-resection (190 open, 65 laparoscopic). Nineteen laparoscopic procedures were converted to open operation. Surgery before 2011 was the only factor associated with conversion. Duration of hospital stay was shorter after laparoscopic re-resection (median 4 versus 6 days; P < 0·001). Three-year OS rates for laparoscopic and open re-resection were 87 and 62 per cent respectively (P = 0·502). Independent predictors of worse OS were residual cancer found at re-resection (hazard ratio (HR) 1·91, 95 per cent c.i. 1·17 to 3·11), blood loss of at least 500 ml (HR 1·83, 1·23 to 2·74) and at least four positive nodes (HR 3·11, 1·46 to 6·65). In competing-risks analysis, the RFS incidence was higher for laparoscopic re-resection (P = 0·038), but OS did not differ between groups. Independent predictors of worse RFS were one to three positive nodes (HR 2·16, 1·29 to 3·60), at least four positive nodes (HR 4·39, 1·96 to 9·82) and residual cancer (HR 2·42, 1·46 to 4·00). CONCLUSION: Laparoscopic re-resection for selected patients with incidental gallbladder cancer is oncologically non-inferior to an open approach. Dissemination of advanced laparoscopic skills and timely referral of patients with incidental gallbladder cancer to specialized centres may allow more patients to benefit from this operation.

ANTECEDENTES: No se conoce la seguridad y la eficacia oncológica de la re-resección laparoscópica del cáncer incidental de vesícula biliar. Este estudio tiene como objetivo comparar las re-resecciones del cáncer incidental de vesícula biliar por vía laparoscópica y vía abierta, minimizando el sesgo de selección. MÉTODOS: Estudio de cohortes observacional, retrospectivo y multicéntrico de pacientes con cáncer incidental de vesícula biliar que se sometieron a una re-resección con intención curativa en 4 centros entre 2000 y 2017. Se analizó la supervivencia global (overall survival, OS) y la supervivencia libre de recidiva (recurrence free survival, RFS) según intención de tratamiento. Se calculó la probabilidad inversa de la ponderación del tratamiento quirúrgico utilizando puntuación de propensión. RESULTADOS: Se incluyeron 255 pacientes con re-resección (190 por vía abierta y 65 por vía laparoscópica). Se convirtieron 19 pacientes del grupo laparoscópico. El único factor relacionado con la conversión fue la realización de la cirugía antes de año 2011. La mediana de la estancia hospitalaria fue más corta tras la re-resección laparoscópica (4 versus 6 días; P < 0,001). La OS a tres años fue del 87% y del 62% (P = 0,502) para las re-resecciones laparoscópicas y abiertas, respectivamente). Los factores predictivos independientes relacionados con una peor OS fueron el hallazgo de cáncer residual en el momento de la re-resección (cociente de riesgos instantáneos, hazard ratio, HR 1,91; i.c. del 95% 1,17-3,11), una pérdida hemática > 500 ml (HR 1,83; i.c. del 95% 1,23-2,74) y la presencia de ≥ 4 ganglios positivos (HR 3,11; i.c. del 95% 1,46-6,65). En el análisis de riesgo competitivo, la RFS fue mayor para la resección laparoscópica (P = 0,038), pero no hubo diferencias en la OS entre ambos grupos. Los factores predictivos independientes de peor RFS fueron la detección de 1-3 ganglios positivos (HR 2,16; i.c. del 95% 1,29-3,60), ≥ 4 ganglio positivos (HR 4,39; i.c. del 95% 1,96-9,82) y el cáncer residual (HR 2,42; i.c. de 95% 1,46-4,0). CONCLUSIÓN: En pacientes seleccionados, los resultados oncológicos de la re-resección laparoscópica de un cáncer incidental de vesícula biliar no son inferiores a los que se obtienen por vía abierta. Una mayor difusión de las técnicas laparoscópicas avanzadas y una oportuna derivación de los pacientes con cáncer de vesícula biliar incidental a centros especializados podrían permitir que un mayor número de pacientes se beneficiaran de este abordaje.

Assuntos

RESUMO

RESUMEN Paciente de 32 años que acudió a consultas por epistaxis intermitente. A la exploración, se evidenció una masa proveniente del septum en fosa nasal izquierda no sospechosa, que a la biopsia demostró ser un angiofibroma. Se describe el abordaje terapéutico de un angiofibroma extranasofaríngeo septal y una revisión de la literatura.

ABSTRACT A 32-year-old patient attended our department for intermittent epistaxis. Upon examination, a non-suspicious mass coming from the septum was found in the left nostril, which at biopsy proved to be an angiofibroma. We describe the therapeutic approach of a septal extranasopharyngeal angiofibroma and a review of the literature.

Assuntos

RESUMO

It is well accepted that the presence of cytokines belonging to the Th1/Th17/Th22 axis of immuno-inflammatory response in the joint environment, such as IL-1ß, IL-17 and IL-22, respectively, are associated with pathogenesis of several synovial joint degenerative disorders. During temporomandibular joint osteoarthritis (TMJ-OA), IL-1ß and IL-17 have been implicated in the inflammation and resorption of sub-chondral bone; however, the role of Th22 response in the TMJ-OA pathophysiology has not been established. This study aimed to compare the expression of Th1/Th17/Th22-type cytokines, chemokines and chemokine receptors in synovial fluid samples obtained from TMJ-OA or disk displacement with reduction (DDWR) patients. In addition, it aimed to associate these levels with joint pain, imagenological signs of bone degeneration, RANKL production, osteoclastogenesis and osteoclast-induced bone resorption. Higher levels of IL-1ß, IL-17 and IL-22 were expressed in TMJ-OA compared with DDWR subjects, and these increased levels significantly correlated with RANKL expression, joint pain and articular bone degeneration. Higher levels of CCR5, CCR6 and CCR7, as well as their respective ligands CCL5 and CCL20, responsible for recruitment of IL-1ß, IL-17 and IL-22-producing cells, were over-expressed in TMJ-OA compared with DDWR subjects. Osteoclastogenesis and osteoclast-induced bone resorption were significantly greater in presence of synovial fluid from TMJ-OA compared with DDWR subjects. These data demonstrate that cytokines, CCLs and CCRs associated with the Th1/Th17/Th22 axis of immuno-inflammatory response are involved in TMJ-OA pathogenesis. These findings suggest that IL-22 is involved in the RANKL expression in TMJ-OA, which in turn induces differentiation of osteoclasts and subsequent resorption of sub-chondral bone.

Assuntos

RESUMO

Local chicken populations are a major source of food in the rural areas of South America. However, very little is known about their genetic composition and diversity. Here, we analyzed five populations from South America to investigate their maternal genetic origin and diversity, hoping to mitigate the lack of information on local chicken populations from this region. We also included three populations of chicken from the Iberian Peninsula and one from Easter Island, which are potential sources of the first chickens introduced in South America. The obtained sequencing data from South American chickens indicate the presence of four haplogroups (A, B, E and D) that can be further subdivided into nine sub-haplogroups. Of these, four (B1, D1a, E1a(b), E1b) were absent from local Iberian Peninsula chickens and one (D1a) was present only on Easter Island. The presence of the sub-haplogroups A1a(b) and E1a(b) in South America, previously only observed in Eastern Asia, and the significant population differentiation between Iberian Peninsula and South American populations, suggest a second maternal source of the extant genetic pool in South American chickens.

Assuntos

RESUMO

Tannins are polyphenolic compounds that cause astringent flavor and turbidity in food. Tannase is an enzyme that catalyzes the hydrolysis of tannins and is used in food industry. This study was conducted to determine the genetic variability and the tannase alleles variation in fungal strains isolated from soil and plants at five extreme areas of Coahuila, México. Two screening assays under 1 and 20 % of tannic acid were performed, with the isolations. In these assays, it was possible to identify 756 and 128 fungal strains, respectively. The major fungal variability was observed in "Cuatro Ciénegas" with 26 strains. The microorganisms were distributed in 11 groups, which correspond to Aspergillus section Nigri. AN7 and AN1 groups showed the major number of isolates from "Paila" and "Cuatro Ciénegas" locations, respectively. In the last location, the major diversity and specific richness were found. But in "Ojo Caliente," tannase allele conservations were observed.

Assuntos

RESUMO

Introducción: La evaluación del cuidado se ha convertido en un indicador de calidad para la práctica de enfermería, sin embargo, debido a la escasez de instrumentos que consideren la perspectiva de la enfermera y no solo del usuario, es necesario contar con una herramienta que evalúe la percepción de los comportamientos de cuidado que las enfermeras ofrecen en la práctica hospitalaria para mejorar los procesos de calidad y calidez. Objetivo: Validar y adecuar la versión en español del Caring Behaviors Assessment, para obtener una primera versión que pueda evaluar los comportamientos del cuidado otorgado en una población de enfermeras mexicanas de un hospital de segundo nivel de atención. Metodología: Diseño descriptivo, transversal y de proceso. Muestreo por conveniencia, la muestra estuvo integrada por 83 enfermeras mexicanas de un ambiente hospitalario. Resultados: El índice de validez de contenido fue igual a 0.96. El coeficiente en la escala general fue de a=0.96, por subescalas osciló entre 0.75 y 0.86 respectivamente. El análisis factorial mostró una varianza explicada del 72% para el primer factor. Conclusión: La primera versión del instrumento que se adecuó para valorar la percepción del cuidado otorgado por enfermería mostró una validación y consistencia interna aceptables, por tanto, se considera una herramienta útil en la evaluación de cuidados de enfermería que puede llegar a contribuir a mejorar estándares de calidad de los servicios desde el punto de vista humanístico.

Introduction: The assessment of care has become a quality indicator in the nursing practice, however, due to the few instruments which consider the perspective of nurses, not only that of the user, and in order to improve the quality of care, it is important to rely on a tool which assesses the perceived caring behaviors that nurses provide within the clinical practice. Objective: To validate and adequate the version in Spanish of the Caring Behaviors Assessment in order to establish a first draft which can be used to assess the provided caring behaviors of a population of Mexican nurses at a hospital of second level of attention. Methodology: This is a study with descriptive, transversal, and process design, which uses sampling by convenience. The sample included 83 Mexican nurses. Results: The content validity index turned out to be 0.96. The coefficient in the general scale was a = 0.96, and those of the sub-scales ranged from .75 to .86 respectively. The analysis of factors indicated a 72% of the total variance explained by the first factor. Conclusion: The first version of the adapted instrument showed acceptable validity and consistency, and therefore was considered a useful tool for the assessment of perceived provided nursing care, which can contribute to the improvement of the standards of health services from the humanistic point of view.

Introdução: A avaliação do cuidado virou um indicador de qualidade para a prática de enfermagem, porém, devido à escassez de instrumentos que considerem a perspectiva da enfermeira e não só do usuário, é necessário contar com uma ferramenta que avalie a percepção dos comportamentos de cuidado que as enfermeiras oferecem na prática hospitalar para melhorar os processos de qualidade e cordialidade. Objetivo: validar e adequar a versão em espanhol do Caring Behaviors Assessment, para obter uma primeira versão que possa avaliar os comportamentos do cuidado outorgado na população de enfermeiras mexicanas de um hospital de segundo nível de atenção. Metodologia: Desenho descritivo, transversal e de processo. Amostragem por conveniência, a amostra esteve integrada por 83 enfermeiras mexicanas de um ambiente hospitalar. Resultados: O índice de validade de conteúdo igual a 0.96. O coeficiente na escala geral foi de a = 0.96, por sub-escalas variou entre .75 e .86 respetivamente. A análise fatorial mostrou uma variância explicada do 72% para o primeiro fator. Conclusão: A primeira versão do instrumento que se adequou para valorizar a percepção do cuidado conferido por enfermagem, mostrou uma validade e consistência interna aceitáveis, portanto, considera-se uma ferramenta útil na avaliação de cuidados de enfermagem que pode chegar a contribuir a melhorar padrões de qualidade dos serviços desde o ponto de vista humanístico.

Assuntos