RESUMO
RESUMEN La atención en salud a personas de la diversidad sexual (LGBT+), se ve afectada negativamente por la heternormatividad que ha regido históricamente nuestra sociedad. Se destaca la marginalización de este grupo de la población en el sistema de salud, debido a distintas discriminaciones y vulneraciones de derechos, que se convierten en barreras de salud. El objetivo de esta investigación es conocer la experiencia en atención en salud que reciben personas adultas LGBT+ del Gran Concepción. Para esto, se realizaron entrevistas semiestructuradas, enmarcadas en una investigación de tipo cualitativa, por medio del uso de Teoría Fundamentada. Cuatro categorías principales emergieron desde la codificación de las 6 entrevistas realizadas, correspondientes a "Heteronormatividad", "Desinformación de profesionales de la salud", "Desinformación sobre deberes y derechos de los y las pacientes" y "Reconocimiento de la diversidad". Se concluye que la formación de profesionales de la salud es de gran relevancia, en conjunto a la participación social de la comunidad LGBT+. Ambos aspectos actúan como estrategias para superar las desigualdades y la marginalización de la población LGBT+ en salud.
ABSTRACT Health care for people who identify themselves as part of the LGBT+ community is negatively affected by heteronormativity, which has historically ruled our society. The marginalization of this group of society in our health care system stands out. Its causes are different discriminations and violations of LGBT+ people's rights, which become health barriers. The objective of this research was to know the health care experience of LGBT+ adults from Concepción. Semi-structured interviews were carried out, in the context of a qualitative research, through the use of Grounded Theory. Four main categories emerged from the coding of the 6 interviews, corresponding to "Heteronormativity", "Disinformation from health care professionals", "Disinformation about patients' rights and duties" and "Diversity acknowledgement". It is concluded that health care professionals' training is of the upmost importance, as much as social participation of the LGBT+ community. Both together act as strategies to overcome LGBT+ population inequalities and marginalization, in the context of health care.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Atitude do Pessoal de Saúde , Atenção à Saúde , Minorias Sexuais e de Gênero/psicologia , Preconceito , Chile , Entrevistas como Assunto , Comunicação , Direitos do Paciente , Pesquisa Qualitativa , Discriminação Social , Diversidade de Gênero , Acessibilidade aos Serviços de SaúdeRESUMO
La infección por el virus SARS-CoV-2 (COVID-19) ha planteado importantes de-safíos para pacientes con enfermedades reumatológicas autoinmunes en tratamiento con agentes biológicos. Actualmente no hay evidencia contundente sobre cómo esta terapia afecta el riesgo de adquirir esta infección o su evolución. Sin embargo, hay datos sobre el riesgo de infecciones virales con agentes biológicos en pacientes con enfermedades reumatológicas y específicamente cuál ha sido la experiencia de pacientes inmunosuprimidos con otros coronavirus. Además, ya se han publicado algunos estudios observacionales que han examinado la incidencia y severidad de COVID-19 en pacientes usuarios de biológicos. Por último, el cre-ciente conocimiento sobre la fisiopatología de la infección por SARS-CoV-2 está paradójicamente apoyando el papel beneficioso de algunos agentes biológicos como los inhibidores de IL-6 (Tocilizumab) e IL-1 (Anakinra) en COVID-19 grave. Se revisará la evidencia disponible para el manejo de pacientes reumatológicos con terapias biológicas en tiempos de pandemia.
The infection caused by SARS-CoV-2 (COVID-19) has posed significant challenges for patients with autoimmune rheumatic diseases being treated with biological agents. There is currently no conclusive evidence on how this therapy affects the risk of acquiring this infection or its outcomes. However, there are data on the risk of viral infections with biological agents in patients with rheumatologic diseas-es, and specifically what has been the experience of immunosuppressed patients with other coronaviruses. In addition, some observational studies have already been published that have examined the incidence and severity of COVID-19 in pa-tients using biologics. Finally, the growing knowledge about the pathophysiology of SARS-CoV-2 infection is paradoxically supporting the beneficial role of some biological agents such as IL-6 (Tocilizumab) and IL-1 (Anakinra) inhibitors in severe COVID-19. The available evidence for the management of rheumatology patients with biological therapies in times of pandemic will be reviewed.
Assuntos
Humanos , Pneumonia Viral , Terapia Biológica/efeitos adversos , Doenças Reumáticas/complicações , Doenças Reumáticas/terapia , Infecções por Coronavirus/terapia , Pandemias , BetacoronavirusRESUMO
RESUMEN La ausencia de una perspectiva de género incorporada en la enseñanza médica genera múltiples desigualdades en la atención de salud, en particular a las mujeres y a las personas LGBT+. Para contrarrestar esto, se han realizado múltiples intervenciones en distintas facultades de salud, desde la aproximación de la salud de la mujer, la medicina de género y la medicina basada en sexo y género. No obstante, pese a que se valoran positivamente las intervenciones realizadas, la mayoría tiende a no perdurar en el tiempo debido a obstáculos comunes entre distintas instituciones de enseñanza en salud. Así, se concluye que la incorporación de una conciencia de género en la formación inicial de profesionales médicos es de suma urgencia.
ABSTRACT The lack of a gender perspective within medical education generates various types of inequalities on people's health care, particularly of women and LGBT+ people. As a response to this, there have been many interventions at faculties of health, from the approaches of women's health, gender medicine and medicine based on sex and gender. However, even though these interventions are regarded as positive, most of them don't last through time, due to common obstacles between different institutions of medical education. Thus, the incorporation of gender awareness in initial training of medical professionals is of the utmost importance.
Assuntos
Humanos , Masculino , Feminino , Educação Médica , Minorias Sexuais e de Gênero , Perspectiva de Gênero , Saúde da Mulher , Pessoal de Saúde , Discriminação SocialRESUMO
Mexican Mestizos (admixed) have been poorly studied for short tandem repeats (STRs) included for new human identification (HID) kits, such as the GlobalFiler PCR Amplification kit. Therefore, this kit was analyzed in 784 unrelated volunteers from the city of Tijuana (n = 381) and Sonora state (n = 403) in the northwest region of Mexico. Allele frequencies, forensic parameters, Hardy-Weinberg equilibrium, and linkage equilibrium were estimated or evaluated for 21 autosomal STRs, respectively. For this HID kit, the combined power of discrimination (PD) was > 0.99999999999999 (RMP range = 1.23 to 3.0 × 10-25), and the combined power of exclusion (PE) were 0.999999993 and 0.999999997 in Tijuana city and Sonora state, respectively. Interpopulation analyses based on STRs of the GlobalFiler kit was performed, including four Mexican Native American, one Mexican Mestizo, and four ethnic American populations (USA), previously studied. The low-but significant-differentiation observed among Mexican Mestizos (FST = 0.0969%; p = 0.02584) justifies the creation of STR databases for HID purposes in this country. In brief, results allow the confident use of the GlobalFiler kit for HID purposes in Mestizo population from the Northwest region Mexico.
Assuntos
Genética Populacional , Repetições de Microssatélites , Impressões Digitais de DNA , Frequência do Gene , Humanos , México , Reação em Cadeia da PolimeraseRESUMO
AIM: To determine the bacterial microbiota in root canals associated with persistent apical periodontitis and their relationship with the clinical characteristics of patients using next-generation sequencing (NGS). METHODOLOGY: Bacterial samples from root canals associated with teeth having persistent apical periodontitis were taken from 24 patients undergoing root canal retreatment. Bacterial DNA was extracted, and V3-V4 variable regions of the 16S rRNA gene were amplified. The amplification was deep sequenced by Illumina technology to establish the metagenetic relationships among the bacterial species identified. The composition and diversity of microbial communities in the root canal and their relationships with clinical features were analysed. Parametric and nonparametric tests were used to analyse differences between patient characteristics and microbial data. RESULTS: A total of 86 different operational taxonomic units (OTUs) were identified and Good's nonparametric coverage estimator method indicated that 99.9 ± 0.00001% diversity was recovered per sample. The largest number of bacteria belonged to the phylum Proteobacteria. According to the medical history from the American Society of Anesthesiologists (ASA) Classification System, ASA II-III had higher richness estimates and distinct phylogenetic relationships compared to ASA I individuals (P < 0.05). Periapical index (PAI) score 5 was associated with increased microbiota diversity in comparison to PAI score 4, and this index was reduced in symptomatic patients. CONCLUSIONS: Based on the findings of this study, it is possible to suggest a close relationship between several clinical features and greater microbiota diversity with persistent endodontic infections. This work provides a better understanding on how microbial communities interact with their host and vice versa.
Assuntos
Bactérias/classificação , Bactérias/genética , Bactérias/patogenicidade , Cavidade Pulpar/microbiologia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Metagenômica/métodos , Microbiota/genética , Periodontite Periapical/microbiologia , Adulto , Biodiversidade , Chile , DNA Bacteriano/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico 16S/genética , Tratamento do Canal RadicularAssuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Gástricas/cirurgia , Gastroscopia/instrumentação , Obstrução da Saída Gástrica/cirurgia , Stents Metálicos Autoexpansíveis , Neoplasias Gástricas/complicações , Adenocarcinoma/cirurgia , Adenocarcinoma/complicações , Stents , Reprodutibilidade dos Testes , Gastroscopia/métodos , Resultado do Tratamento , Obstrução da Saída Gástrica/etiologia , Medicina Baseada em EvidênciasRESUMO
Acute infectious diarrhea is still a major public health problem, both in developing and developed countries, causing morbidity, mortality and high costs. Acute diarrhea particularly affects people in extrema age ranges, travelers and immunosuppressed individuals. Traditional microbiological study, based on cultures, direct microscope analysis, and antigen tests show poor performance, due to low sensitivity and specificity, slowness and the diversity of bacteria, viruses and parasites that complicate getting the results. New molecular techniques based on multiple polymerase chain reaction (PCR) kits allow for the identification, in few hours and simultaneously, of many agents, such as bacteria, viruses and parasites, with high sensitivity and specificity; which will probably transform etiological diagnosis of acute diarrhea
La diarrea aguda infecciosa continúa siendo un problema de salud pública tanto en países en vías de desarrollo como en países desarrollados, causando morbi-mortalidad y grandes gastos económicos. Las diarreas agudas son especialmente importantes en personas con edades extremas, viajeros e inmunodeprimidos. El estudio microbiológico tradicional basado en cultivos, análisis microscópico directo y pruebas de antígenos tiene un rendimiento pobre, dado por su baja sensibilidad y especificidad, lentitud y la gran diversidad de bacterias, virus y parásitos que dificultan la obtención de resultados. Las nuevas técnicas de diagnóstico molecular basadas en kits de reacción de polimerasa en cadena (PCR) múltiple permiten identificar en pocas horas y en forma simultánea una gran cantidad de agentes, tanto bacterias, virus, como parásitos, con alta sensibilidad y especificidad, lo que probablemente transformará el diagnóstico etiológico de las diarreas agudas.
Assuntos
Humanos , Disenteria/diagnóstico , Disenteria/etiologia , Reação em Cadeia da Polimerase , Técnicas de Diagnóstico Molecular , Disenteria/microbiologia , Gastroenteropatias/complicações , Gastroenteropatias/diagnósticoRESUMO
El cáncer de mama es la primera causa de muerte por cáncer en mujeres chilenas. Mientras la mayoría de las personas logra curarse de esta enfermedad, un 5% de los casos se presenta inicialmente con enfermedad avanzada y hasta un 20-30% de pacientes con enfermedad localizada pueden sufrir recurrencias sistémicas. La mayoría de las neoplasias mamarias son dependientes del estímulo estrogénico, de allí que la deprivación de estrógenos es la principal estrategia terapéutica. Recientemente, el uso de terapias molecularmente dirigidas en combinación con la terapia endocrina ha logrado mejorar los resultados de sobrevida del cáncer de mama avanzado, con menos efectos colaterales que aquellos producidos por la quimioterapia convencional. El conocimiento de los mecanismos de acción de estas nuevas terapias, sus toxicidades, vías de resistencia y selección de pacientes para lograr los mejores beneficios terapéuticos son aspectos relevantes en el manejo de la enfermedad. Presentamos una revisión del estado actual del manejo del cáncer de mama metastásico hormonodependiente con enfásis en el uso de terapias endocrinas combinadas con terapias moleculares.
Breast cancer is the leading cause of cancer death in Chilean women. While most patientes are cured, five percent of cases present with advanced disease initially and up to 20-30% of patients with localized disease may suffer systemic recurrences. The majority of breast neoplasms are dependent on the estrogenic stimulus, hence the deprivation of estrogen is the main therapeutic strategy. Recently, the use of molecular targeted therapies in combination with endocrine therapy has been successful in improving the survival outcomes of advanced breast cancer, with fewer side effects than those produced by conventional chemotherapy. Knowledge of the mechanisms of action of these new therapies, their toxicities, resistance pathways and patient selection to achieve the best therapeutic benefits are relevant aspects in the management of the disease. We present a review of the current state of management of hormone-dependent metastatic breast cancer with emphasis on the use of endocrine therapies combined with molecular therapies.