RUNA - Repositorio de Saúde
Not a member yet
11570 research outputs found
Sort by
Effectiveness of steroids versus placebo in preventing upper airway obstruction after extubation in critically ill children: rationale and design of a multicentric, double-blind, randomized study
Get PDFBACKGROUND: Post-extubation upper airway obstruction (UAO) is a frequent complication causing stridor and respiratory distress, which occasionally require reintubation, thereby increasing morbidity and mortality rates. Contradictory results have been obtained in studies assessing the effectiveness of steroids in preventing post-extubation UAO, and the available evidence is limited. We designed a multicentric randomized, placebo-controlled study to explore the effectiveness of dexamethasone in preventing post-extubation UAO in children. METHODS: A multicentric, prospective, double-blind, randomized, placebo-controlled, phase IV clinical trial has been designed. The sample will include pediatric patients who are between 1 month and 16 years of age and who have been intubated for more than 48 h. Patients who have airway disorders or who have received steroids within the previous seven days will be excluded. Patients will be randomly assigned to receive either placebo or a therapy with dexamethasone 0.25 mg/kg every 6 h to be started 6 to 12 h prior to extubation (to a total of four doses). Randomization will be performed at a 1:1 ratio. Follow-up of patients will be carried out for 48 h after extubation. The main objective of this study is to access the reduction in the incidence of moderate to severe UAO symptoms following extubation. Secondary objectives include assessing the decrease in the incidence of reintubation, evaluating the use of additional therapies for UAO, and monitoring potential side effects of dexamethasone. DISCUSSION: The results of this study will contribute to the existing evidence on prophylaxis for post-extubation airway obstruction. TRIAL REGISTRATION: EudraCT identifier: 2009-016596-30. Registered on May 11, 2010
COVID-19 and inflammatory bowel disease: questions arising from patient care and follow-up during the initial phase of the pandemic (February-April 2020)
No full textCOVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was described in China in late 2019. There are currently more than three million diagnosed cases, constituting a pandemic which has caused a worldwide crisis. The devastating effects of this infection are due to its highly contagious nature and although mild forms predominate, in absolute values, the rates for severe forms and mortality are very high. The information on the characteristics of the infection in inflammatory bowel disease is of special interest, as these patients have higher attendance at health centres, which may increase their risk of infection. Furthermore, the treatments used to control the inflammatory activity may modify the disease course of COVID-19. The Spanish Working Group on Crohn's Disease and Ulcerative Colitis and the Spanish Nurses Working Group on Inflammatory Bowel Disease have prepared this document as a practical response to some common questions about the treatment of these patients
Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study
Get PDFDietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler's milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population
Leukocyte Associated Immunoglobulin Like Receptor 1 Regulation and Function on Monocytes and Dendritic Cells During Inflammation
Get PDFInhibitory receptors are crucial immune regulators and are essential to prevent exacerbated responses, thus contributing to immune homeostasis. Leukocyte associated immunoglobulin like receptor 1 (LAIR-1) is an immune inhibitory receptor which has collagen and collagen domain containing proteins as ligands. LAIR-1 is broadly expressed on immune cells and has a large availability of ligands in both circulation and tissues, implicating a need for tight regulation of this interaction. In the current study, we sought to examine the regulation and function of LAIR-1 on monocyte, dendritic cell (DC) and macrophage subtypes, using different in vitro models. We found that LAIR-1 is highly expressed on intermediate monocytes as well as on plasmacytoid DCs. LAIR-1 is also expressed on skin immune cells, mainly on tissue CD14(+) cells, macrophages and CD1c(+) DCs. In vitro, monocyte and type-2 conventional DC stimulation leads to LAIR-1 upregulation, which may reflect the importance of LAIR-1 as negative regulator under inflammatory conditions. Indeed, we demonstrate that LAIR-1 ligation on monocytes inhibits toll like receptor (TLR)4 and Interferon (IFN)-alpha- induced signals. Furthermore, LAIR-1 is downregulated on GM-CSF and IFN-gamma monocyte-derived macrophages and monocyte-derived DCs. In addition, LAIR-1 triggering during monocyte derived-DC differentiation results in significant phenotypic changes, as well as a different response to TLR4 and IFN-alpha stimulation. This indicates a role for LAIR-1 in skewing DC function, which impacts the cytokine expression profile of these cells. In conclusion, we demonstrate that LAIR-1 is consistently upregulated on monocytes and DC during the inflammatory phase of the immune response and tends to restore its expression during the resolution phase. Under inflammatory conditions, LAIR-1 has an inhibitory function, pointing toward to a potential intervention opportunity targeting LAIR-1 in inflammatory conditions
Traducción y adaptación transcultural al español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria
Get PDFAIM: To describe the translation and cross-cultural adaptation process of the Hopkins Symptom Checklist-25 (HSCL-25) scale into Spanish, Catalan and Galician. DESIGN: Translation, cross-cultural adaption and comprehensibility analysis through cognitive debriefing. LOCATION: Research Units of Primary Care in Barcelona and Vigo. PARTICIPANTS: Family doctors and Primary Care patients. MAIN MEASUREMENTS: Following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): 1) Direct translation. 2) Pilot study based on Delphi methodology with family doctors. 3) Back-translation. 4) Equivalence analysis. 5) Comprehension analysis of versions obtained in Spanish, Catalan and Galician through cognitive debriefing in a sample of patients. 6) Transcultural harmonization. RESULTS: 73 family doctors participated in the Delphi study. The consensus was established in the first round for the Spanish and Catalan translations, and in the second round for the Galician. The back-translations were similar in all 3languages. All versions were equivalent between them and compared to the original English version. In the cognitive interview, 10 patients participated for each language, without modifying the writing of the items. CONCLUSIONS: The translations of the HSCL-25 scale in Spanish, Catalan and Galician are semantically and conceptually equivalent to the original version. Translations are understandable and well accepted by patients
New Cancer Diagnosis After Bleeding in Anticoagulated Patients With Atrial Fibrillation
Get PDFBackground Bleeding is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulant therapy, and may be the first manifestation of underlying cancer. We sought to investigate to what extent bleeding represents the unmasking of an occult cancer in patients with AF treated with oral anticoagulants. Methods and Results Using data from CardioCHUVI-AF (Retrospective Observational Registry of Patients With Atrial Fibrillation From Vigo's Health Area), 8753 patients with AF aged >/=75 years with a diagnosis of AF between 2014 and 2017 were analyzed. Of them, 2171 (24.8%) experienced any clinically relevant bleeding, and 479 (5.5%) were diagnosed with cancer during a follow-up of 3 years. Among 2171 patients who experienced bleeding, 198 (9.1%) were subsequently diagnosed with cancer. Patients with bleeding have a 3-fold higher hazard of being subsequently diagnosed with new cancer compared with those without bleeding (4.7 versus 1.4 per 100 patient-years; adjusted hazard ratio [HR], 3.2 [95% CI, 2.6-3.9]). Gastrointestinal bleeding was associated with a 13-fold higher hazard of new gastrointestinal cancer diagnosis (HR, 13.4; 95% CI, 9.1-19.8); genitourinary bleeding was associated with an 18-fold higher hazard of new genitourinary cancer diagnosis (HR, 18.1; 95% CI, 12.5-26.2); and bronchopulmonary bleeding was associated with a 15-fold higher hazard of new bronchopulmonary cancer diagnosis (HR, 15.8; 95% CI, 6.0-41.3). For other bleeding (nongastrointestinal, nongenitourinary, nonbronchopulmonary), the HR for cancer was 2.3 (95% CI, 1.5-3.6). Conclusions In patients with AF treated with oral anticoagulant therapy, any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis. These bleeding events should prompt investigation for cancers at those sites
Mania as Debut of Cushing's Syndrome
Get PDFThis is a case of a patient affected by Cushing syndrome that was admitted at the hospital due to hormonal problems. He had presented psychiatric symptoms that were mistakenly considered not directly connected to the pathology causing the clinical condition, but a mere psychological reaction to it
Variabilidad intramétodo en medidas del flujo del acceso vascular con termodilución: ¿Un enemigo en los programas de seguimiento?
Get PDFObjetivo: Analizar el impacto de la variabilidad intramétodo de la Termodilución (TD) en las medidas prospectivas de flujo de acceso (QA) y su relación con los parámetros de seguimiento de primera generación.
Método: Estudio prospectivo. Se realizaron 2 mediciones consecutivas de QA (M1 y M2) y un seguimiento (M3) en 6 meses. Se recogieron datos demográficos y parámetros de seguimiento de primera generación.
Resultado: Se analizaron 112 fistulas arteriovenosas(FAV). La mediana de la variabilidad generada entre M1 y M2 no difiere del porcentaje de variación de QA a los 6 meses (p=0,123). En el 16,8% (14) de los pacientes el QA ha disminuido más del 25% y en un 28,9% (24) aumentó más del 25%. Se evidenció una ligera tendencia a aumentar el porcentaje de descenso de QA a medida que el flujo de las fístulas es mayor (r=-0,229; p=0,006). Por otra parte, un descenso de QA superior al 25% no se asoció a menor dosis de diálisis (p=0,183), ni ha aumento significativo de la presión venosa dinámica (p=0,823) ni al aumento de incidencias durante la punción (p=0,823).
Conclusiones: La presencia de pacientes con aumento de flujo superior a la variabilidad intramétodo y la no asociación entre un descenso superior al 25% y cambios en otros parámetros de seguimiento, hace sospechar la presencia de errores de medición de QA. Frente a ello es conveniente el uso combinado con métodos de primera generación, tanto para establecer el QA basal como para interpretar los descensos en el seguimiento
Asociación entre el humo ambiental de tabaco y el estado de salud en la población infantil
No full textOBJECTIVE: This study aimed to estimate the association between second-hand smoke (SHS) exposure in children and asthma, wheezing and perceived health. METHOD: A cross-sectional study based on a telephone survey was performed on a representative sample of 2411 children under 12 years old in Spain. Exposure to SHS in private and public settings, and the prevalence of asthma, wheezing and perceived poor health were described. The association between health indicators and SHS exposure was analyzed using multivariate Poisson regression models with robust variance according to age and educational level. RESULTS: The prevalence of SHS exposure in children was 29.2% in private settings and 42.5% in public settings. There was no association between SHS exposure and asthma, wheezing and perceived poor health in children </=5 years. In children aged 6-11 years with parents with primary/secondary education, presenting asthma (adjusted prevalence ratio [aPR]: 2.1; 95% confidence interval [95%CI]: 1.2-3.8) and worse perceived health (aPR: 1.6; 95%CI: 1.1-2.1) were positively associated with SHS exposure in private settings. In children with parents with university studies, a negative association between SHS exposure and asthma (aPR: .3; 95%CI: 0.1-0.7) and wheezing (aPR: 0.3; 95%CI: 0.1-0.8) was observed. CONCLUSIONS: There are differences in the association between SHS exposure and asthma, wheezing and poor perceived health according to educational level. Interventions with an equity perspective aimed at reducing SHS exposure in childhood should be implemented
The La Gota de Leche Institution of Santiago de Compostela (1904-1980)
Get PDFEn este artículo se aborda la creación y puesta en funcionamiento de la Institución de «La Gota de Leche» de Santiago de Compostela, a partir de diversas fuentes primarias archivísticas y de prensa. Aunque el inicio de su actividad fue tardía en comparación con otras ciudades similares, sus beneficios pronto se dejaron ver, a través del descenso de las cifras de mortalidad infantil. Estructurado en un consultorio de niños de pecho que seleccionaba los que pasaban a La Gota de Leche, consulta prenatal, asistencia a partos a domicilio y centro de vacunación, constituyendo, en conjunto, el Instituto Municipal de Puericultura. La labor asistencial sirvió de base para el nuevo modelo de atención de 1941, con la promulgación de la Ley de Seguridad Social que provocó la desaparición de estas instituciones. Abordamos el perfil de los empleados de la insti-tución y las polémicas y críticas en torno a la labor desarrollada en las Gotas de Leche.Palabras clave: La Gota de Leche, Santiago de Compostela, Instituto Municipal de Puericultu-ra, Consultorio de niños de pecho, lactancia, mortalidad infantil.This article deals with the creation and putting into operation of the “La Gota de Leche” institution in Santiago de Compostela, based on various archival and press primary sources. Although the start of its activity was late compared to other similar cities, its benefits were soon seen, through the decline in infant mortality figures. Structured in a pediatric office that selected children who went to the “La Gota de Leche”, prenatal consultation, home delivery assistance and vaccination center, forming, together, the Municipal Institute of Childcare. The assistance work served as the basis for the new care model of 1941, with the promulgation of the Social Security Law that caused the disappearance of these institutions. We approach the profile of the employees of the institution and the controversies and criticisms about the work developed in the Drops of Milk.Key words: La Gota de Leche, Santiago de Compostela, Municipal Institute of Childcare, Breastfeeding Office, breastfeeding, infant mortality.Este artigo trata da creación e posta en marcha da institución “La Gota de Leche” en Santiago de Compostela, baseada en diversas fontes primarias de arquivos e prensa. Aínda que o inicio da súa actividade foi tardío en comparación con outras cidades similares, pronto se viron os seus benefi-cios, por mor do descenso das cifras de mortalidade infantil. Estruturado nunha consulta pediátrica que seleccionou aos nenos que foron á “La Gota de Leche”, consulta prenatal, asistencia a domici-lio e centro de vacinación, formando xuntos o Instituto Municipal de Puericultura. O traballo de asistencia serviu de base para o novo modelo asistencial de 1941, coa promulgación da Lei da Se-guridade Social que provocou a desaparición destas institucións. Abordamos o perfil dos emprega-dos da institución e as polémicas e críticas sobre o traballo desenvolvido nas “Gota de Leche”.Palabras clave: La Gota de Leche, Santiago de Compostela, Instituto Municipal de Coidados Infantís, Oficina de lactancia materna, lactación materna, mortalidade infanti