RESUMO
The physicochemical, nutritional and sensory properties of flours, doughs and tortillas made with traditional nixtamalization (TN) and ecological nixtamalization (EN) and enriched (9%) with the traditional maguey mushroom (Pleurotus agaves) were analysed. EN resulted in flours and tortillas having a greater content of bioactive compounds than that of TN flours, which represents a production process of maize tortillas containing high amounts of antioxidants. The addition of mushrooms to EN flours improved their sensory properties, whereas the addition of mushrooms to TN flours decreased them. The amount of P. agaves added to tortillas was equivalent to 3% enrichment with ß-glucans. The edible mushroom P. agaves, highly appreciated in many Mexican regions, improved the nutritional and sensory quality of blue maize tortillas when added to flours prepared by EN. A new product was developed using local traditional foods of complementary nutritional value.
Assuntos
Pão/análise , Farinha/análise , Alimentos Fortificados/análise , Pleurotus , Zea mays , Manipulação de Alimentos/métodos , Humanos , México , Valor NutritivoRESUMO
El FIHOA fue desarrollado para evaluar la capacidad funcional de pacientes con OA de manos. Objetivo: Validar FIHOA en pacientes con AR. Métodos: Estudio analítico, observacional prospectivo de corte transversal. Se incluyeron pacientes consecutivos con diagnóstico de AR (ACR/EULAR 2010). Se consignaron datos demográficos y características de la enfermedad. Todos los pacientes completaron los siguientes cuestionarios autoadministrados: FIHOA, HAQ-A, HAQ-UP-A y Quick DASH. En un subgrupo de pacientes, una terapista ocupacional valoró la capacidad funcional de la mano por medio del test de SODA-A. Se evaluó la reproducibilidad de FIHOA. Análisis estadístico: Estadística descriptiva. Confiabilidad con test de Cronbach. Validez de constructo con correlación de Spearman. Reproducibilidad test re-test. Modelo de regresión lineal. Resultados: Se incluyeron 100 pacientes. La prueba alfa de Cronbach fue de 0,94. No se evidenciaron preguntas redundantes. El FIHOA mostró excelente correlación con HAQ-A (r=0,89); HAQ-UP-A (r=0,89); Quick DASH (r=0,90) y SODA-A (r=-0,80); y buena correlación con DAS28-ERS (r=0,65), y con otros parámetros de la enfermedad. La reproducibilidad fue 0,73. La regresión lineal múltiple mostró como principal determinante del FIHOA a la presencia de rigidez matinal seguida por el uso de corticoides y el EVA general de pacientes. Conclusión: El FIHOA resultó ser confiable, válido y reproducible en pacientes con AR
FIHOA was developed to evaluate the functional capacity of patients with OA hands. Objetive: To validate FIHOA in patients with RA. Methods: Analytical, observational, prospective cross-sectional study. Consecutive patients with diagnosis of RA (ACR/EULAR 2010) were included. Demographic and RA characteristics were recorded. Patients completed the following self-administered questionnaires: FIHOA, HAQ-A, HAQ-UP-A and Quick DASH. For a patient subgroup, an occupational therapist performed an objective evaluation of the functional capacity of the hands using the SODA-A. Reproducibility was assessed. Statistical analysis: Descriptive statistics. Reliability with the Cronbach test. Construct validity with Spearman correlation. Reproducibility with test-retest reliability. Linear regression model. Results: One hundred patients were included. Cronbach's alpha test was 0.94. There were no redundant questions. FIHOA showed an excellent correlation with HAQ-A (r=0.89); HAQUP-A (r=0.89); Quick DASH (r=0.90) and SODA-A (r=-0.80); and a good correlation with DAS28- ERS (r=0.65) and with other disease parameters. Questionnaire reproducibility was 0.73. A multiple linear regression showed morning stiffness as the main determinant of FIHOA, followed by glucocorticoid use and patient global assessment. Conclusion: FIHOA was found to be reliable, valid and reproducible in patients with RA
Assuntos
Osteoartrite , Artrite Reumatoide , MãosRESUMO
The use of hydroxychloroquine (HCQ) in Primary Sjögren's Syndrome (pSS) has been assessed in different studies over the last years, with conflicting results regarding its efficacy in sicca syndrome and extraglandular manifestations (EGM). The goal of this study was to compare the incidence rate of EGM in pSS patients with and without HCQ therapy.We performed a multicenter retrospective study, including patients with pSS (European classification criteria) with at least 1 year of follow-up. Subjects with concomitant fibromyalgia, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis were excluded. Demographics and pSS characteristics were recorded. The EGM were defined by EULAR-SS disease activity index (ESSDAI). Patients were divided into two groups according to their use or not of HCQ therapy. We evaluated the use of HCQ and its relationship to EGM. HCQ therapy was defined as the continuous use of the drug for at least 3 months. A descriptive analysis of demographics and pSS characteristics was performed. We compared the incidence of EGM between groups defined by HCQ therapy using chi2 test or Fisher's exact test. A total of 221 patients were included (97.3% women), mean age, 55.7 years (SD 14). Mean age at diagnosis, 48.8 years (SD 15); median disease duration, 60 months (IQR 35-84). One hundred and seventy patients (77%) received HCQ. About half of the patients had at least one EGM during the course of the disease, 20% of them developed an EGM before the onset of the sicca syndrome and 26% simultaneously with dryness symptom. Overall, EGM were less frequent in those on HCQ therapy (36.5% vs 63.5%, p < 0.001). Considering each EGM individually, the following manifestations were more frequent in the non-treated group: arthritis (p < 0.001), fatigue (p < 0.001), purpura (p = 0.01), Raynaud phenomenon (p = 0.003), and hypergammaglobulinemia (p = 0.006). Immunosuppressive treatment was indicated on 28 patients (12.7%), 13 of which were receiving also HCQ. The first reason for those treatments was the presence of arthritis in 12/28 patients (42.8%), and the drug used in all the cases was methotrexate. Only three patients required immunosuppressive therapy with cyclophosphamide, due to the presence of glomerulonephritis, vasculitis, and interstitial lung disease. None of the patients received biologic therapy. The lower incidence of EGM was observed in patients on HCQ therapy supports its efficacy in pSS. However, further large scale prospective studies are needed to confirm these findings.
Assuntos
Antirreumáticos/uso terapêutico , Hidroxicloroquina/uso terapêutico , Síndrome de Sjogren/complicações , Síndrome de Sjogren/tratamento farmacológico , Adulto , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Hipergamaglobulinemia/epidemiologia , Hipergamaglobulinemia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Púrpura/epidemiologia , Púrpura/etiologia , Doença de Raynaud/epidemiologia , Doença de Raynaud/etiologia , Estudos RetrospectivosRESUMO
La rigidez matinal (RM) es un síntoma complejo en los pacientes con AR. Existen diferentes formas de valorar la RM. Sin embargo, la mejor manera de evaluarla es aún controversial. Objetivos: Comparar la severidad y la duración de la RM, evaluada por el médico y por cuestionarios autorreportados, con la actividad de la enfermedad y la capacidad funcional en pacientes con AR. Métodos: Estudio observacional de corte transversal. Se incluyeron pacientes con diagnóstico de AR. Se consignaron datos demográficos, características de la AR y medidas clinimétricas. Los pacientes fueron asignados aleatoriamente a uno de dos grupos: el primer grupo fue interrogado sobre la duración de la RM en minutos; el segundo grupo fue evaluado mediante un cuestionario autorreportado que cuantificaba la severidad de la RM (EVA numérica y no numérica) y la duración (en minutos y en escala de Likert). Resultados: Participaron 111 pacientes (86% mujeres). La edad media fue de 52 años y la mediana de duración de la enfermedad fue 8 años. El 51% presentaba RM. La correlación de la RM en minutos medida por el médico fue buena con HAQ-A y aceptable con DAS28 y CDAI; mientras que la severidad medida por EVA correlacionó mejor con los índices de actividad de la AR que con discapacidad. Cuando la intensidad de la RM fue evaluada por EVA se observó que un valor >5,5 cm se asoció con actividad severa de la enfermedad (Sensibilidad: 44%; Especificidad: 100%). Conclusión: La duración de la rigidez matinal, evaluada en minutos por el médico, estaría relacionada tanto con la actividad de la enfermedad como con la discapacidad. La intensidad de la rigidez matinal se asoció más fuertemente con la actividad inflamatoria en los pacientes con AR
Assuntos
Artrite Reumatoide , ArtropatiasRESUMO
RAPID3 es un cuestionario autorreportado desarrollado originalmente para valorar pacientes con AR. Recientemente fue empleado en pacientes con OA de rodillas y/o caderas con buenos resultados. Objetivo: Determinar si existe correlación entre el RAPID3 y otros cuestionarios en pacientes con OA de manos (AUSCAN), cadera y/o rodilla (WOMAC) y comparar el tiempo para su realización y cálculo. Material y métodos: Estudio analítico observacional de corte transversal. Se incluyeron pacientes consecutivos ≥50 años con diagnóstico de OA de rodillas, caderas y/o manos que completaron el RAPID3; además el AUSCAN y/o WOMAC según la localización de la OA. Se midió el tiempo para completar y calcular los cuestionarios. Resultados: Se incluyeron 104 pacientes. Al comparar RAPID3 con WOMAC y AUSCAN se observó una correlación de 0,66 y 0,62 respectivamente (p<0,01). Al evaluar RAPID3 con la subescala de función del WOMAC, la correlación fue de 0,75 (p<0,01) y con WOMAC Ab de 0,68 (p<0,001). El tiempo para completar y calcular el RAPID3 fue menor que para los otros cuestionarios. Conclusión: Se observó buena correlación entre RAPID3, WOMAC y AUSCAN, requiriendo un menor tiempo para su realización y cálculo. Por lo tanto, podría ser una herramienta útil para evaluar pacientes con OA de rodilla, caderas y/o manos
Assuntos
Mãos , Quadril , Artropatias , Joelho , OsteoartriteRESUMO
Introducción: El uso de antiinflamatorios no esteroideos (AINES) conlleva una mayor probabilidad de enfermedad gastrointestinal y cardiovascular en pacientes con factores de riesgo. Por tal motivo, se desarrollaron diversas recomendaciones con el fin de prevenir dichas complicaciones. Objetivo: Evaluar la frecuencia del consumo de AINES al momento de consultar por primera vez a un Servicio de Reumatología de demanda espontánea; y analizar tanto la conducta del médico así como el correcto cumplimiento de las recomendaciones para la toma de estos fármacos al finalizar la consulta. Material y métodos: Estudio observacional de corte transversal. Resultados: Se incluyeron 304 pacientes, 59,5% consumían AINES. La mayoría de estos pacientes presentaban riesgo gastrointestinal moderado/alto, sólo 28,3% recibían adecuada protección. De aquellos pacientes que recibían AINES, se consideró que requerían dicho tratamiento el 50%. Al finalizar la consulta, se tomó una conducta correcta en el 89% de los casos en relación al riesgo gastrointestinal. Conclusión: Más de la mitad de los pacientes consumían AINES. Se observó un buen cumplimiento de las recomendaciones por los médicos tratantes al finalizar la primera consulta. Sin embargo, es importante mencionar que el uso indiscriminado de AINES tanto por parte de los pacientes como por parte de los médicos sigue siendo alto.
Introduction: The use of Non-Steroidal Anti-Inflammatory DrugsNSAID (NSAIDS) leads to a higher probability of gastrointestinaland cardiovascular disease in patients with risk factors. Therefore,a number of recommendations were developed to prevent thesecomplications. The aim of this study was to evaluate the intake frequencyof NSAID by patients who attend to a rheumatology departmentfor the first time; and to analyze the attending physicians´ prescriptionas well as the correct implementation of the recommendationsfor the use of these drugs once this first visit was ended.Methods: We perform a cross-sectional observational study.Results: Three hundred and four patients were included, 59.5%were taking NSAIDs. Most of these patients had moderate/high gastrointestinalrisk and only 28.3% received adequate protection. Ofpatients receiving NSAIDs, it was considered that only 50% requiredsuch treatment. At the end of the first visit, the attending physiciansmade the correct implementation of the recommendations in 89%of cases in regard to gastrointestinal risk.Conclusion: More than half of the patients were taking NSAIDS.A good compliance with the recommendations by the attendingphysicians at the end of the first visit was observed. However, it isnoteworthy that the indiscriminate use of NSAIDs, both by patientsand by physicians, remains high.
Assuntos
Humanos , Anti-Inflamatórios não Esteroides , Doenças Cardiovasculares , GastroenteropatiasRESUMO
The purpose of the present study was to explore the usefulness of the Mexican sequential organ failure assessment (MEXSOFA) score for assessing the risk of mortality for critically ill patients in the ICU. A total of 232 consecutive patients admitted to an ICU were included in the study. The MEXSOFA was calculated using the original SOFA scoring system with two modifications: the PaO2/FiO2 ratio was replaced with the SpO2/FiO2 ratio, and the evaluation of neurologic dysfunction was excluded. The ICU mortality rate was 20.2%. Patients with an initial MEXSOFA score of 9 points or less calculated during the first 24 h after admission to the ICU had a mortality rate of 14.8%, while those with an initial MEXSOFA score of 10 points or more had a mortality rate of 40%. The MEXSOFA score at 48 h was also associated with mortality: patients with a score of 9 points or less had a mortality rate of 14.1%, while those with a score of 10 points or more had a mortality rate of 50%. In a multivariate analysis, only the MEXSOFA score at 48 h was an independent predictor for in-ICU death with an OR = 1.35 (95%CI = 1.14-1.59, P < 0.001). The SOFA and MEXSOFA scores calculated 24 h after admission to the ICU demonstrated a good level of discrimination for predicting the in-ICU mortality risk in critically ill patients. The MEXSOFA score at 48 h was an independent predictor of death; with each 1-point increase, the odds of death increased by 35%.
Assuntos
Insuficiência de Múltiplos Órgãos/classificação , Escores de Disfunção Orgânica , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Prospectivos , Curva ROC , Índice de Gravidade de DoençaRESUMO
The purpose of the present study was to explore the usefulness of the Mexican sequential organ failure assessment (MEXSOFA) score for assessing the risk of mortality for critically ill patients in the ICU. A total of 232 consecutive patients admitted to an ICU were included in the study. The MEXSOFA was calculated using the original SOFA scoring system with two modifications: the PaO2/FiO2 ratio was replaced with the SpO2/FiO2 ratio, and the evaluation of neurologic dysfunction was excluded. The ICU mortality rate was 20.2%. Patients with an initial MEXSOFA score of 9 points or less calculated during the first 24 h after admission to the ICU had a mortality rate of 14.8%, while those with an initial MEXSOFA score of 10 points or more had a mortality rate of 40%. The MEXSOFA score at 48 h was also associated with mortality: patients with a score of 9 points or less had a mortality rate of 14.1%, while those with a score of 10 points or more had a mortality rate of 50%. In a multivariate analysis, only the MEXSOFA score at 48 h was an independent predictor for in-ICU death with an OR = 1.35 (95%CI = 1.14-1.59, P < 0.001). The SOFA and MEXSOFA scores calculated 24 h after admission to the ICU demonstrated a good level of discrimination for predicting the in-ICU mortality risk in critically ill patients. The MEXSOFA score at 48 h was an independent predictor of death; with each 1-point increase, the odds of death increased by 35%.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/classificação , Escores de Disfunção Orgânica , Estado Terminal , Unidades de Terapia Intensiva , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Prospectivos , Curva ROC , Índice de Gravidade de DoençaRESUMO
This study examined the frequency of occurrence of non-tuberculous mycobacteria (NTM) in potable water samples from a main trauma hospital in Mexico City. Sixty-nine potable water samples were collected, 23 from each source: cistern, kitchen tap and bathroom showers. Of the 69 samples, 36 harboured NTM species. Twenty-nine of the 36 isolates were Mycobacterium mucogenicum, two Mycobacterium rhodesiae, one Mycobacterium peregrinum, one Mycobacterium fortuitum and three were Mycobacterium spp. Hospital potable water harbouring NTM represents a potential source for nosocomial infections, therefore we suggest that hospital potable water microbiological guidelines should include testing for NTM species.
Assuntos
Água Potável/microbiologia , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Hospitais , Humanos , México , Infecções por Mycobacterium não Tuberculosas/prevenção & controleRESUMO
OBJECTIVE: To describe adverse reactions to medicine (ARM) and analyse the factors associated with their presenting in patients attending a general hospital's emergency service. DESIGN: Case-control epidemiological study. SETTING: Emergency service of the San Cecilio University Hospital in Granada. PATIENTS: 654 patients over 15, men and women, who attended the emergency service between October and December 1997. 354 of them had an ARM (cases) and 300 did not (controls). MEASUREMENTS AND RESULTS: 60% of the cases were women, with an average age of 53 +/- 20. 68% of the ARM were type-A (expected). The most affected organs and systems were: digestive tract (41.8%) and skin (31.6%). Drug groups most associated with presentation of ARM were hypnosedatives and salicylates used as analgesics--antithermic drugs (28.2%), and beta-lactams and macrolides (22.6%). Most ARM were classified as probable (52%) and moderate (62%). Family practitioners were the main prescribers (49%) of medicines. 13% of patients were admitted to hospital because of a serious ARM and two people died (0.5%). According to the odds ratio, treatment with cytostatics, psychiatric drugs, NSAIDs, amoxycillin, digoxin, ACEIs and calcium antagonists, being a woman, self-medication, being under 65 and history of ARM were all associated with the presence of an ARM in our patients (cases). CONCLUSIONS: The type of medicine, being a woman, history of ARM, self-medication, and presenting digestive and dermatological symptoms were factors strongly linked to an ARM in patients attending the emergency service.